Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 1 of 22

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JUN , 82003

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CENTRAL I BY

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UNITED STATES DISTRICT COURT Scan Only_

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CENTRAL DISTRICT OF CALIFORNIA

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II KATIE A" et al.,

CASE NO. CV02-5662 AHM (SHx)

12

Plaintiffs,

13

v.

ORDER RE CLASS CERTIFICATION

14 DIANA BONTA, et al.,

15

Defendants,

16

17

18

I.

iJlTN '19 2003

19

INTRODUCTION

20

This lawsuit challenges the alleged failure of the State of California and the

21 County of Los Angeles to provide appropriate mental health services to foster

22 children in California with "behavioral, emotional or psychiatric impairments ...

23 who need individualized mental health services .... " First Amended Complaint

24 ("FAC"). ~ 37. Thc Plaintiffs are five troubled children who are in the custody of

25 the Los Angeles County Department of Children and Family Services ("DCFS").

26 The Defendants are Los Angeles County; DCFS; Acting Director ofDCFS

27 Marjorie Kelly; Director of California Department of Health Services ("DHS")

28 Diana Bonta; and Director of the California Department of Social Services

.... - Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 2 of 22

1 ("DSS") Rita Saenz. Plaintiffs have reached a tentative settlement agreement

2 with the Los Angeles County Defendants on behalf of a subclass of children who

3 are in the custody of DCFS, or have been referred to or are subject to referral to

4 DCFS. Whether the Los Angeles subclass may be certified and whether that

5 settlement should be approved are not at issue here. What is at issue is whether,

6 in their suit against Defendants Bonta and Saenz (hereinafter "State Defendants"),

7 Plaintiffs may, under Fed. R. Civ. P. 23(b)(2), represent a class composed of:

8

children in foster care in California, or at imminent risk of foster care

placement, who have a behavioral, emotional or psychiatric

9

Impairment and who need individualized mental llealth services,

including but not limited to professionally acceptable assessments,

10

behavioral supp-ort and case management services, family support,

crisis support, therapeutic foster care and other necessary servIces in

11

the home or in a home-like setting, to treat or ameliorate their

disabilities or impairments.

12
FAC ~ 37.1 For the following reasons, the Court certifies a differently-defined

13

class but holds that one of the named Plaintiffs, Gary E., may not represent the

14

class, because his interests are not typical of the class as a whole.

15

II.

16

FACTS2

17

Unless otherwise noted, the First Amended Complaint alleges the

18
following. 3 More than 90,000 children are in foster care in California. FAC ~ 3.

19

According to a 2001 report of the Little Hoover Commission, more than 50,000

20

of those children may need, but do not receive, adequate mental health services.

21

Id. ~ 45. Plaintiffs allege that for foster children with "behavioral, emotional or

22

23 1 Plaintiffs later proposed a modified definition of the requested class. See
24 ection III(1), below. 25
2 This statement of facts does not include many of Plaintiffs' specific 26 llegations against the Los Angeles County Defendants.
27
3 In reviewing a motion for class certification, the Court generally is bound 28 0 take the substantive allegations of the complaint as true. Blackie v. Barrack, 524
. 2d 891, 901 n. 17 (9th Cir. 1975).

2

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 3 of 22

psychiatric impainnents," id. ~ 37, adequate mental health services include,

1 among other things, wraparound services, therapeutic foster care services and/or

2 case management services.

3

Wraparound services are

4

specific individualized community-based services and supports

cfesigned for children who have serious mental or emotional disorders

5

and provided in the child's own home or an alternative family setting.

... Although the key' to wraparound is provision of services and

6

supports tailored to the individual needs of each child typical

wraparound services include crisis intervention, mobile therapy,

7

therapeutic staff support, behavioral specialist consultation, cognitive

retraming, family based rehabilitation services, specialized

8

evalua~ions, fa~ly therapy, parent e~ucation.and training, and other

outpatient psychiatric ana psychological servIces.

9

id. ~ 59.

10

Therapeutic foster care consists of

II

intensive and highly coordinated mental health and support services

12

provided to a foster parent or care giver, in which the foster

parent/care giver becomes an integral part of the child's treatment

13

team.... For children in the foster care system or who are at risk of

out-of-home placement and whose needs are too great for a

14

conventional foster home ... therapeutic foster care is an important

alternative to placement in an institutional or congregate care setting.

15

id.~61.

16

Case management services assist Medicaid beneficiaries in obtaining
17

needed medical, social, educational and other services. FAC ~ 62. Plaintiffs
18

claim that case management is "essential to coordinate the provision of

19

[wraparound] services and to coordinate health care services with services
20

available from other programs, such as child welfare and education." Id. ~ 59.

21

Plaintiffs allege, and State Defendants agree, that virtually all foster
22

children in California receive, or are eligible to receive, their health care services
23

through Medi-Cal, California's Medicaid program. Id. ~ 3; Answer ~ 3. This

24

means, according to Plaintiffs, that virtually all foster children in California who

25

have "behavioral, emotional or psychiatric impainnents," FAC ~ 37, are entitled
26

to case management, wraparound and/or therapeutic foster care services where
27

appropriate.
28

Plaintiffs allege, however, that foster children with such impainnents do

3

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 4 of 22

1 not have access to Medicaid case management on a consistent, statewide basis. 2 Id. ~ 63. They also allege that California does not provide wraparound or

3 therapeutic foster care as a Medi-Cal service, nor does California provide

4 components of these services to Medi-Cal-eligible children on a consistent

5 statewide basis. Id. ~~ 60-61. These failures, Plaintiffs allege, violate the Early

6 and Periodic Screening, Diagnostic and Treatment ("EPSDT") requirements of

7 the Medicaid Act (42 U.S.C. § 1396 et seq.); Substantive Due Process under the

8 United States and California Constitutions (U.S. Const. amend. XIV; CA Const.

9 art. I § 7(a)); the Americans with Disabilities Act (42 U.S.C. § 12132,28 C.F.R. §

10 35.l30); the Rehabilitation Act (29 U.S.C. § 701 et seq.); and California

11 Government Code § 11135 and its associated regulations. Id. ~~ 76-92.

12

Plaintiffs seek a judgment declaring that Defendants' alleged failure to

13 comply with the foregoing constitutional, statutory and regulatory provisions is

14 unconstitutional. They also seek a permanent injunction against further

15 violations. FAC, pages 26-27. They do not seek monetary damages, either

16 compensatory or punitive.

17 1. The Plaintiffs

18

All five fictitiously-named Plaintiffs are children who are or were residing

19 in Los Angeles in the custody ofDCFS.4 Plaintiff Katie A. is a fourteen-year-old

20 girl who currently resides in Los Angeles County. She was removed from her

21 home at age four on account of neglect; her mother was homeless and her father 22 incarcerated. FAC ~ 10. By age five, Katie's assessments indicated that she was

23 a trauma victim, that she has difficulty with peer relations and needs intensive 24 individualized treatment, with supportive services for her caretaker. Id. ~ 11-12.

25 However, Plaintiffs allege that DCFS has consistently placed Katie in congregate

26

27

4 Each of the named plaintiffs is prosecuting this action through a court-

28 pproved guardian ad litem.

4

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 5 of 22

care facilities with other behaviorally and emotionally disturbed children, where

2 she has received limited attention. Id. ~ 12. In her ten years in DCFS custody,

3 Katie has been in thirty-seven out-of-home placements, including four different

4 group homes, nineteen stays at eight different psychiatric hospitals and seven 5 stays at the MacLaren Children's Center ("MacLaren"V Id. ~ 14.

6

Plaintiff Mary B. is a sixteen-year-old legally blind girl who resides in Los

7 Angeles County and who has been in foster care for three years. She was

8 removed from her home at age thirteen after being physically and emotionally

9 abused and left unsupervised by her mother. She was subsequently diagnosed

10 with a sexually transmitted disease and revealed that she had been sexually 11 abused by her maternal uncle and stepfather. !d. ~ 15. During her three years in

12 DCFS custody, Mary has had twenty-eight placements, including "repeated"

13 psychiatric hospitalizations. Id. ~ 16, 18. Plaintiffs allege that she has never

14 received a comprehensive psychiatric assessment since her entry into DCFS

IS custody. Id. ~ 16. Although a Department of Mental Health screening committee

16 suggested that a specialized foster home with wraparound services could meet

17 Mary's needs, DCFS placed her in a large residential facility. Id. ~ 18. She

18 currently resides in a high-level, restrictive group home. !d.

19

Plaintiff Janet C. is eleven years old and has been in foster care in Los

20 Angeles County for more than two years. Id. ~ 19. She was removed from her

21 parents' custody following reports of physical abuse in the home. Id. During her

22 time in foster care, she has had twenty-five placements, including five with family

23 members, twelve hospital stays at seven different hospitals and three stays at

24 MacLaren. Id. ~ 23. Plaintiffs allege that DCFS has failed to provide Janet with

25 the consistent, intensive mental health services and other support that she needs.

26 Id. ~ 21. As a result, she "continues to deteriorate." Id.

27

28

5 MacLaren was closed down sometime after this lawsuit was filed.

5

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 6 of 22

1

Plaintiff Henry D. is a nine year-old legally blind boy who currently resides

2 in a group home in Los Angeles County. !d. ~~ 24,27. He was first removed

3 from his home at the age of four following reports of physical and sexual abuse

4 by his mother's boyfriend. Plaintiffs allege that despite documentation of

5 Henry's serious behavioral and emotional problems, DCFS did not provide him

6 with a mental health evaluation or appropriate mental health services. Id. ~ 24.

7 Henry was later returned to his mother's custody, but she subsequently returned

8 him to foster care on account of further abuse by her boyfriend. Id. ~ 25. He has

9 been diagnosed with Major Depression and Post Traumatic Stress Disorder and

10 was not provided with intensive individual therapy until about six months after

11 that diagnosis. Id. Plaintiffs allege that DCFS's current case plan for Henry is

12 deficient in that it fails to identify his individual needs and any specific services

13 to be provided to him. Id. In the fourteen months following his second removal

14 from his home, Henry had twelve placements, including six hospital stays at three

15 different hospitals and one stay at MacLaren. Id. ~ 27.

16

Plaintiff Gary E. is a fourteen year old boy who returned home after six

17 months in foster placements. Id. ~ 28. During his six months in foster care, a

18 therapist documented Gary's significant emotional and behavioral problems

19 which have impeded his educational progress. !d. ~ 29. However, Plaintiffs

20 allege that Gary did not receive appropriate mental health and behavioral support

21 services. Id. He was returned to his mother's home, without any supportive

22 services, because DCFS determined that there was no facility capable of meeting

23 Gary's educational, physical and emotional needs. Id. ~ 30. Plaintiffs allege that

24 without appropriate supportive services, Gary faces the imminent risk of another

25 entry into the foster care system. Id. ~ 31.

26

Though Gary E. formerly resided in Los Angeles County, he is now

27 residing with his father in Boise, Idaho. In December 2002, the juvenile

28 dependency court authorized a visit by Gary with his father. Although Gary was

6

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 7 of 22

to return to California in early January, he did not return because delinquency

2 charges were filed against him requiring him to stay in Idaho. 3113/03 Joint

3 Statement of Plaintiffs' Counsel and County Defendants on Progress of Named

4 Plaintiffs at 2. As a result of those charges, Gary is currently on probation, one

5 condition of which is that he not leave Idaho without a court order. Gary's father

6 has applied for legal custody of Gary and DCFS services for Gary have been

7 suspended pending determination of whether he will return to Los Angeles. Id.

S 2. The State Defendants

9

Defendant DHS is the single state agency responsible for administering or

10 supervising the administration of Medi-Cal. Answer ~ 32 (citing 42 U.S.C. §

11 1396a(a)(5). Defendant CDSS is the single state agency responsible for

12 supervising the administration of child welfare services in California. Answer ~

13 36. See also Calif. Welf. & lnst. Code §10600. To that end, CDSS is empowered

14 to promulgate regulations and standards, id. § 10554, and investigate, examine

15 and make reports on public officers responsible for the administration of public

16 social services funds administered by CDSS. Id. § 10602. Additionally,

17 Defendant Saenz, CDSS' s Director, is responsible for administering laws relating

18 to child welfare services (except health care services and medical assistance), id.

19 § 10553(b), and has the authority to take action against counties that fail to

20 comply with state statutes and regulations addressing child welfare services. Id. §

21 10605.

22

III.

23

Class Certification Requirements

24

Federal Rule of Civil Procedure 23 establishes the standards for certifying

25 a class action. Under Rule 23(a), class certification is appropriate where: (1) the

26 proposed class is so numerous that joinder is impracticable, (2) there are

27 questions oflaw or fact common to the class, (3) the claims or defenses of the

28 representative parties are typical of the claims or defenses of the class, and (4) the

7

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 8 of 22

representative parties will fairly and adequately protect the interests of the class.

2 Fed. R. Civ. P. 23(a). Plaintiffs also must satisfy one of the Rule 23(b)

3 requirements. In this case, they seek to proceed under Rule 23(b)(2).

4 Certification under Rule 23(b)(2) is appropriate where the opposing party "has

5 acted or refused to act on grounds generally applicable to the class, thereby

6 making appropriate final injunctive relief or corresponding declaratory relief with

7 respect to the class as a whole." Fed. R. Civ. P. 23(b)(2).

8

The party seeking class certification bears the burden of establishing that

9 he or she meets the requirements of Rule 23. Zinser v. Accufix Research Institute,

10 Inc., 253 FJd 1180, 1186 (9th Cir. 2001). The Court must conduct a "rigorous

11 analysis" to determine that the prerequisites are met, General Tel. Co. a/the

12 Southwest v. Falcon, 457 U.s. 147,161 (1982), but a plaintiff seeking class

13 certification need not make a prima facie showing that he will prevail on the

14 merits of his substantive claims. Murray v. Local 2620, 192 F.R.D. 629,631

15 (N.D. Cal. 2000). Rather, in reviewing a motion for class certification, the Court

16 generally is bound to take the substantive allegations of the complaint as true.

17 Blackie v. Barrack, 524 F. 2d 891, 90 I n. 17 (9th Cir. 1975). The Court will look

18 beyond the pleadings only when necessary to decide whether the Rule 23

19 requirements have been satisfied. Bates v. United Parcel Service, 204 F.R.D.

20 440,443-44 (N.D. CaL 2001). If the moving party has met his burden under Rule

21 23, the Court has broad discretion to certify the class. Zinser, 253 FJd at 1186.

22

In certifying a class, the court should keep in mind the dual purposes of

23 Rule 23: (1) to promote judicial economy through the efficient resolution of

24 multiple claims in a single action; and (2) to provide persons with smaller claims,

25 who would otherwise be economically precluded from doing so, the opportunity

26 to assert their rights. 7A Wright, Miller & Kane, Federal Practice & Procedure 2d

27 ("Wright") § 1754; Schwarzer, Tashima & Wagstaffe, Cal.Prac. Guide:

28 Fed.Civ.Pro. Before Trial § 10:250 (The Rutter Group 2003).

8

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Before assessing each of the explicit requirements of Rule 23, the Court

2 must evaluate the State Defendants' threshold contention that the class Plaintiffs

3 seek to represent is not adequately defined.

4

1. The Proposed Class Can Be Defined Adequately

5

"An essential prerequisite of an action under Rule 23 is that there must be a

6 'class.'" Wright § 1760. However, the contours of the class need no~ be so clear

7 that every potential member may be identified at the time of class certification.

8 0 'Connor v. Boeing North American, Inc., 184 F.R.D. 311, 319 (C.D. Cal. 1998)

9 (citing Wright § 1760). Rather, "a class will be found to exist if the description of

10 the class is definite enough so that it is administratively feasible for the court to

11 ascertain whether an individual is a member." Id. (citing Aiken v. Obledo, 442

12 F.Supp. 628, 658 (E.D.CaI.1977». Plaintiffs seek to certifY a Rule 23(b)(2) class;

13 a definition that identifies all potential class members with precision is not

14 necessary because they seek not money damages on behalf of individual class

15 members but institutional reform on the part ofDHS and DCFS. See

16 Fed.R.Civ.P. 23 Advisory Comm. Notes 1966 Amendment (23(b)(2) actions

17 include those "in the civil rights field where a party is charged with

18 discriminating unlawfully against a class, usually one whose members are

19 incapable of specific enumeration."). As such, the focus is primarily on what

20 Defendants are doing (and what Plaintiffs allege they ought to be doing) rather

21 than exactly who they are doing (or failing to do) it to.

22

The Court has discretion to limit or otherwise redefine the class if the Court

23 finds that the Plaintiffs' class definition does not meet a "minimum standard of

24 definiteness." 7A Wright § 1760. At the hearing on this motion, the Court

25 expressed its view that two aspects of the class definition plaintiffs originally

26 proposed - see page 2, supra - were unduly vague or overbroad. First, the phrase

27 "at imminent risk of foster care placement" without more, did not and could not

28 meaningfully identifY those children not in foster care who may be entitled to, but

9

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 10 of 22

1 are not then receiving, the enumerated mental health services. Second, the terms

2 "behavioral [and] emotional ... impairment" are overbroad. As State Defendants

3 pointed out, those terms are so elastic and imprecise that they could be construed

4 to encompass virtually all children in California, at least at some points in almost

5 every child's development. At the Court's request, both sides then submitted

6 proposed written revisions to the original class definition. Based on those

7 supplemental proposals and on the arguments of the parties at the hearing, the

8 Court now holds that the following class definition is adequate for purposes of a

9 Rule 23(b)(2) class action.

10

"The class consists of children in California who,

11

(a) are in foster care or are at imminent risk of foster care

placement; and

12

(b) have a mental illness or condition that has been documented or, had

13

an assessment already been conducted, would have been

documented; and

14

(c) who need individualized mental health services, including but not

15

limited to professionally a~ceptable .assessments, ~~havioral support

and case management servIces, famIly support, cnSlS support,

16

therapeutic foster care and other necessary services in tEe home or in

a home-like setting, to treat or ameliorate their illness or condition.

17

18

For the purposes ofthis case, 'imminent risk of foster care placement'

19 means that within the last 180 days a child has been participating in voluntary

20 family maintenance services or voluntary family reunification placements6 and/or

21 has been the subject of either a telephone call to the Child Protective Services

22 hotline or some other documented communication made to a local Child

23

24

6 Plaintiffs represented that these services are provided to children formerly in

oster care who are returned for a trial period to live with their families to determine

25 hether those children can function at home. These children are "at risk," because

26 hey will be returned to foster care ifthings go badly. Accord Coleman v. Wilson, 912

.Supp. 1282, 1293 (E.D. Cal. 1995) (certifying a Rule 23(b)(1) and 23(b)(2) class

27 onsisting of "all inmates with serious mental disorders who are now or who will in

28 he future be confined within the California Department of Corrections" except for

hree correctional facilities) (emphasis added).

10

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 11 of 22

1 Protective Services agency regarding suspicions of abuse, neglect or

2 abandonment.

3

In the foregoing definition of the certifiable class, the phrase "mental

4 illness or condition," tracks the language of 42 U.S.C. § I396d(r)(1 )(A)(ii) and 42

5 U.S.C. § 1396d(r)(5), which govern the provision of EPSDT services. The

6 language added at the end of the definition also provides a meaningful standard

7 for the phase "imminent risk of foster care placement."

8

State Defendants nevertheless argue that the services enumerated in

9 requirement (c) are unduly vague and ambiguous. Whatever uncertainty may be

10 inherent in those terms will not defeat Rule 23(b)(2) class certification. In this

II case, Plaintiffs are arguing that the law entitles children in foster care (or at

12 imminent risk offoster care placement) to certain mental health assessments and,

13 if necessary, mental health services, which the State currently is not providing.

14 To prevail, Plaintiffs will have to show why failure to make those services

15 available violates the law. Plaintiffs are entitled to define a Rule 23(b)(2) class

16 by this kind of reference to the injury they allege. In Daniels v. City a/New York,

17 198 F.R.D. 409 (S.D.N.Y. 2001), the plaintiffs asked the court to certify a class

18 consisting of all persons who had been or would be subjected by officers of the

19 Street Crimes Unit of the New York City Police Department to "illegal stopping

20 and/or frisking ... in the absence of the reasonable articulable suspicion ... [in

21 violation of the Fourth Amendment] ... in a manner that discriminates on the

22 basis of race and/or national origin in violation of the Equal Protection Clause of

23 the Fourteenth Amendment." !d. at 412. The defendants argued that the class

24 was not sufficiently well-defined, because determination of class membership for

25 each putative plaintiff would require an individualized assessment of the very

26 thing the plaintiffs were trying to prove on behalf of the class as a whole - that

27 the police had violated that individual's Fourth and Fourteenth Amendment

28 rights. Rejecting that contention, the Court held that the class met the specificity

requirement, noting that "general class descriptions based on the harm allegedly
II

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 12 of 22

1 suffered by plaintiffs [are] acceptable in class actions seeking only declaratory

2 and injunctive relief under Rule 23(b)(2)." Id. at 416 (citation omitted). See also
3 Forbush v. J.c. Penney Co., Inc., 994 F.2d 1101, 1105 (5th Cir. 1993) (class

4 definition in Rule 23(b)(2) class action met specificity requirement despite that

5 class was defined by reference to the wrongdoing Plaintiffs alleged). If and to the

6 extent that after discovery has been conducted it proves advisable to break down

7 this class into sub-classes, the Court has the authority to do so. Marisol A. v.

8 Giuliani, 126 FJd 1372, 1378 (2d. Cir. 1997).

9

2. Rule 23 Requirements

10

a. Numerosity

11

To satisfy the Rule 23(a) requirements for certification, the proposed class

12 must be so numerous that joinder of all members is impracticable. Fed. R. Civ. P.

13 23(a)(1). Although decisions vary as to the number of members sufficient to

14 make joinder impracticable, in general, courts have held that joinder is practicable

15 where there are fewer than 25 parties, and impracticable where there are more

16 than 35. 7A Wright § 1762; Patrick v. Marshall, 460 F.Supp. 23, 26 (N.D. Cal.

17 1978). It is not necessary that the exact size of the class be known if "general

18 knowledge and common sense indicate that it is large." Perez-Funez v. District

19 Director, I.N.S., 611 F.Supp. 990, 995 (C.D. Cal. 1984) (quoting Orantes-

20 Hernandez v. Smith, 541 F.Supp. 351, 370 (C.D. Ca1.1982)). Additional factors

21 in assessing whether joinder is impractical are geographic diversity of class

22 members, whether individual claimants can institute separate suits, and whether

23 the class representatives seek injunctive or declaratory relief. Jordan v. County of

24 Los Angeles, 669 F.2d 1311, 1319 (9th Cir.), vacated on other grounds, 459 U.S.

25 810 (1982).

26

The numerosity requirement is easily satisfied here. The class consists of

27 children in foster care, or at imminent risk of being placed in foster care, who are

28 Medi-Cal eligible and who need mental health services. Plaintiffs allege - and

the
12

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 13 of 22

State Defendants agree - that there are more than 90,000 children in foster care in

2 California and that virtually all of those children are Medi-Cal eligible. FAC ~ 3;

3 Answer ~ 3. The State Defendants also do not quarrel with Plaintiffs'

4 representation that a 2001 report of the Little Hoover Commission found that

5 there were "[m]ore than 50,000 children in the foster care system who may need

6 mental health services [but] do not get them." FAC ~ 45. Those 50,000 children

7 are located throughout California and allegedly lack essential mental health

8 services. Joinder is impracticable, because those numerous class members are

9 minors without the financial or psychological means to institute individual

10 actions against the State.

11

b. Commonality

12

Rule 23(a)(2) requires that common questions oflaw or fact exist among

13 class members. The Ninth Circuit has construed this requirement "permissively,"

14 and, in fact, considers the requirements for finding commonality under Rule

15 23(a)(2) to be "minima!." Hanlon v. Chrysler Corp., 150 FJd 1011, 1019-1020

16 (9th Cir. 1998). Indeed, "[a]ll questions offact and law need not be common to

17 satisfy the rule. The existence of shared legal issues with divergent factual

18 predicates is sufficient." Id. at 1019. Thus, in a civil-rights suit, "commonality is

19 satisfied where the lawsuit challenges a system-wide practice or policy that

20 affects all of the putative class members." Armstrong v. Davis, 275 FJd 849, 868

21 (9th Cir. 2001). And suits alleging that a government program does not comply

22 with the mandates offederal statutes or regulations "generally satisfy the

23 commonality requirement," because "the government's uniform policies and

24 alleged legal violations similarly affect all of the members of the putative class."

25 5 Moore's Federal Practice § 23.23[5][g] (Matthew Bender 3d ed.).

26

In Baby Neal v. Casey, 43 FJd 48 (3d Cir. 1994), the plaintiffs sought to

27 certify a class consisting of abused or neglected children in the custody of

28 Philadelphia's Department of Human Services. They alleged that systemic

deficiencies prevented that Department from providing various child welfare
13

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 14 of 22

1 services legally mandated by the United States Constitution and by federal and

2 state law. Baby Neal, 43 FJd at 52. The Third Circuit held that the class

3 satisfied the commonality requirement. The court observed that "[Rule 23(b)(2)]

4 classes have been certified in a legion of civil rights cases where commonality

5 findings were based primarily on the fact that defendant's conduct is central to the

6 claims of all class members irrespective of their individual circumstances and the

7 disparate effects of the conduct." ld. at 57. The Court held that alleged violations

8 by the Department of statutory and Constitutional standards amounted to a

9 "common course of conduct" toward all children in its custody sufficient to

10 satisfy the commonality requirement, without need for individualized

11 determinations of the propriety of injunctive relief. ld. Moreover, the court noted

12 that commonality does not require that all members of the class suffer the same

13 injury. That they were all subject to the injury or faced the immediate threat of

14 injury sufficed for Rule 23(b)(2). Id.

15

In Marisol A. by Forbes v. Giuliani, 126 FJd 372 (2d Cir. 1997), eleven

16 children brought an action challenging alleged systemic failures of the New York

17 City child welfare system in violation of the federal and New York state

18 Constitutions and various federal and state laws. Id. at 375. Each named plaintiff

19 challenged a different aspect of the child welfare system, including alleged

20 inadequate training and supervision of foster parents, failures to properly

21 investigate reports of suspected neglect and abuse, delays in removing children

22 from abusive homes, and the inability to secure appropriate placements for

23 adoption. Id. at 376. The named plaintiffs sought to certify a class consisting of

24 "[a]ll children who are or will be in the custody of the New York City

25 Administration for Children's Services ('ACS'), and those children who, while

26 not in the custody of ACS, are or will be at risk of neglect or abuse and whose

27 status is or should be known to ACS." Id. The district court identified as a

28 common question of law whether each child had a legal entitlement to the

specified services and it identified as a common question of fact whether
14

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defendants had systematically failed to provide the services. Id. at 377. The

2 Second Circuit held that the district court did not abuse its discretion in finding

3 that the plaintiffs' alleged injuries "derive from a unitary course of conduct by a

4 single system," id. , and therefore satisfy the commonality requirement.

5

According to Plaintiffs, EPSDT requires screening services - to identify

6 defects, conditions and illness - as well as treatment services, to correct or

7 ameliorate those conditions. Id. (citing 42 U.S.C. § 1396d(r)(1), 42 C.F.R. §

8 441.56(b), 42 U.S.C. § 1396d(r)(5». Plaintiffs maintain that for foster children

9 with mental health problems, such mandatory treatment services include

10 "professionally adequate assessments and case management and, depending on

11 the needs of the child, may include behavioral support services, individualized

12 wraparound services, therapeutic foster care and psychiatric or clinical services

13 provided in a home-like setting." FAC ~ 58. Plaintiffs go on to allege that foster

14 children with such impainnents do not have access to Medicaid case management

IS on a consistent, statewide basis. !d. ~ 63. They also allege that California does

16 not provide wraparound or therapeutic foster care as a Medi-Cal service, nor does

17 California provide components of these services to Medi-Cal-eligible children on

18 a consistent statewide basis. Id. ~~ 60-61.

19

Plaintiffs allege that DHS is violating the EPSDT requirements and the

20 other constitutional and statutory provisions described at page 4, supra, by not

21 ensuring that these services are provided to foster children with "behavioral,

22 emotional or psychiatric impainnents." (In the class this Court has certified they

23 are children with a "mental illness or condition.") CDSS promulgates regulations

24 and standards, id. § 10554, is responsible for administering laws relating to child

25 welfare services, id. § 10553(b), and has the authority to take action against

26 counties that fail to comply with state statutes and regulations addressing child

27 welfare services. !d. § 10605.

28

The class satisfies the commonality requirement, because DHS and CDSS's

alleged failure to provide adequate mental health services to foster children in
15

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 16 of 22

California is "a system-wide practice or policy that affects all of the putative class

2 members," Armstrong, 275 FJd at 868. As in Baby Neal, the alleged conduct of

3 the Defendant governmental agencies is a "common course of conduct" affecting

4 all members of the proposed class. Baby Neal, 43 F.3d at 57. Whether these

5 mental health services must be but are not provided to foster children are the

6 common issues offact and law in Plaintiffs' case against Defendants DHS and

7 CDSS.

8

Defendants rely heavily on the Tenth Circuit's holding in J.B. v. Valdez,

9 186 FJd 1280 (10th Cir. 1999), to support their argument that the commonality

10 requirement is not satisfied. In J.B. the plaintiffs sought declaratory and

11 injunctive relief alleging that systemic failures in the state welfare system had

12 resulted in a lack of available therapeutic services to mentally or developmentally

13 disabled children in New Mexico. Id. at 1282, 1289. The majority held that the

14 district court did not abuse its discretion when it declined to certify a class

15 consisting of all children in or at risk of being in state custody with mental or

16 developmental disabilities that require treatment. The court rejected the plaintiffs'

17 theory of commonality, finding that the children came into state custody in a

18 variety of ways and that they did not share a common statutory or constitutional

19 claim. It stated, "[w]e refuse to read an allegation of systematic [sic] failures as a

20 moniker for meeting the class action requirements." Id. at 1189. This is

21 inconsistent with Ninth Circuit (Armstrong), Second Circuit (Marisol A.) and

22 Third Circuit (Baby Neal) precedent and would defeat the strong policy

23 arguments favoring availability of class action remedies to those subjected to

24 "system-wide practice[s] or polic[ies]," Armstrong, 275 FJd at 868. See also

25 Walters v. Reno, 145 FJd 1032, 1047 (9th Cir. 1998) ("It is sufficient if class

26 members complain of a pattern or practice that is generally applicable to the class

27 as a whole.") What matters is whether the proposed systemic changes will affect

28 an individual class member, not how he or she came to be a class member in the

first place.
16

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 17 of 22

1

The proposed class satisfies the commonality requirement.

2

c. Typicality

3

The typicality requirement "is designed to assure that the named

4 representative's interests are aligned with those of the class." Jordan, 669 F.2d at

5 1321. Where such an alignment exists, a representative who vigorously pursues

6 his or her own interests will necessarily advance the interests of the class. Id.

7 The Ninth Circuit interprets the Rule 23(a) typicality requirement permissively.

8 Hanlon. 150 F.3d at 1020. A named plaintiff must be a member of the class he

9 seeks to represent and must "possess the same interest and suffer the same injury"

10 as class members. Falcon, 457 U.S. at 156. The named plaintiffs' claims need

11 not be identical to the claims of the class; rather, the claims are typical if they are

12 "reasonably co-extensive with those of absent class members." Hanlon, 150 FJd

13 at 1020. It is sufficient for the plaintiffs' claims to "arise from the same remedial

14 and legal theories." Arnold v. United Artists Theatre Circuit. Inc., 158 F.R.D.

15 439,449 (N.D. Cal. 1994).

16

The State Defendants' principal argument against typicality is that because

17 all representative Plaintiffs are or were in the custody only of Los Angeles

18 County, they are not representative of other class members in the custody of other

19 California counties. Opp. at 18. Defendants' argument fails. They have

20 demonstrated no reason to find that a named plaintiff living in Los Angeles

21 County has a different interest in causing DHS and CDSS to ensure she receives

22 the mental health services she needs and to which she is entitled than does a class

23 member residing in a different county. Similarly, the injury a representative

24 plaintiff suffers because Medi-Cal does not routinely provide, say, wraparound

2S services, arises from the same remedial or legal theory as the injury a class

26 member in a different county suffers from that same Medi-Callimitation. In

27 short, because the named Plaintiffs are challenging state practices and policies

28 allegedly being followed in all California counties, it is irrelevant in what county

17

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 18 of 22

1 they reside.

2

The State Defendants are correct, however, that Plaintiff Gary E.'s interests

3 are not typical of the class. Since the First Amended Complaint was filed, Gary

4 E. traveled to Idaho to visit his father, who resides there. Since then, Gary's

5 father has applied for legal custody of Gary and Gary may not leave Idaho absent

6 a court order. For this reason, DCFS services for Gary have been suspended

7 pending determination of whether he will return to Los Angeles. 3/l3/03 Joint

8 Statement of Plaintiffs' Counsel and County Defendants on Progress of Named

9 Plaintiffs at 2. Although Plaintiffs may be correct in their unsupported assertion

10 that (at least for reporting or record keeping purposes) Gary E. remains in the

11 custody of DCFS (presumably until Gary's father receives legal custody), Reply

12 at 8 n. 5, Gary's interest in California-provided benefits is not typical of the

13 interest of other class members in those same benefits.

14

The State Defendants' other argument against typicality is that the named

15 Plaintiffs' interests are now moot, because they have reached a settlement with

16 the Los Angeles County Defendants. Opp. at 12. This argument also fails,

17 because, as described above, the Complaint asserts that the law imposes particular

18 obligations on DHS and CDSS. The State Defendants have provided no support

19 for their argument that if the County Defendants fulfil their obligations to the

20 named plaintiffs the State Defendants would no longer continue to have

21 independent responsibilities to them or to the class as a whole.

22

For these reasons, the Court holds that Plaintiffs Katie A., Mary B., Janet

23 C. and Henry D. satisfy the typicality requirement, but that Gary E. does not.

24

d. Adequacy of Representation

25

Before certifying a class under Rule 23, the Court must find that "the

26 representative parties will fairly and adequately protect the interests of the class."

27 Fed. R. Civ. P. 23(a)(4). This depends on two questions: (1) whether the named

28 Plaintiffs and their counsel have any conflicts of interest with other class

members
18

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 19 of 22

1 and (2) whether the named plaintiffs and their counsel will prosecute the action

2 vigorously on behalf of the class. Hanlon, 150 F. 3d at 1020.

3

Defendants do not argue that the named Plaintiffs or their counsel have

4 conflicts of interest with other class members and there is no reason to suspect

5 there are such conflicts. The State Defendants do appear to challenge Plaintiffs'

6 counsel's ability to pursue this action vigorously by challenging Plaintiffs'

7 counsel's decision not to join the 57 other California counties in this action.

8 Defendants argue that because the provision of public social services is a county

9 function and responsibility, class members will not obtain the relief they seek

10 without naming all California counties in this suit. Opp. at 19 (citing Welf. &

11 Inst. Code § 10800). The State Defendants also maintain that children in

12 different counties will receive and be eligible for different child welfare services.

13 Opp. at 19. However, California law subjects the administration by all counties

14 of federal or state-funded foster care services to CDSS and DHS regulations.

15 Welf. & Inst. Code §§ 10054, 10800. Plaintiffs' counsel's decision to sue the

16 state agencies that promulgate and enforce the regulations that are binding on all

17 counties by no means suggests that Plaintiffs' counsel will not vigorously

18 represent the class. This is especially true, given that in the context of these kinds

19 of claims an injunction against the State Defendants will bind all California

20 counties. E.g. Blanco v. Anderson, 39 F.3d 969,971-72 (9th Cir. 1994).

21

Finally, discovery disputes notwithstanding, the Court finds that the Legal

22 Director of the ACLU of Southern California (Rosenbaum Dec!. ~ 5), the Legal

23 Director of the Judge David L. Bazelon Center for Mental Health Law (Birnum

24 Decl. ~ I), the chair of the Los Angeles Pro Bono Committee of the Heller

25 Ehrman White & McAuliffe firm (Peterson Dec!. ~ 2), the Center for Law in the

26 Public Interest (Diamond Decl. ~ I) and the Western Center on Law and Poverty

27 (Newman Decl. ~ 3), are highly capable of representing the class.

28

19

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 20 of 22

1

e. Rule 23(b)(2) Requirements

2

Besides the four requirements of Rule 23(a), Plaintiffs must also satisfy the

3 requirements of one of the subdivisions of Rule 23(b). This action satisfies the

4 requirements of Rule 23(b)(2).

5

Certification under Rule 23(b)(2) is appropriate where the opposing party

6 "has acted or refused to act on grounds generally applicable to the class, thereby

7 making appropriate final injunctive relief or corresponding declaratory relief with

8 respect to the class as a whole." Fed. R. Civ. P. 23(b)(2). As the Advisory

9 Committee Notes explain, Rule 23(b)(2) was adopted to permit the prosecution of

10 civil rights actions. See Fed. R. Civ. P. 23 Adv. Comm. Notes 1966 Amend.;

II Walters, 145 F.3d at 1047. This lawsuit seeks declaratory and injunctive relief

12 against allegedly illegal statewide practices concerning provision of mental health

13 services to children in foster care. Since this action "complain[s] of a pattern or

14 practice that is generally applicable to the class as a whole," id., it clearly satisfies

15 the Rule 23(b)(2) standard.

16

IV.

17

DISCOVERY ON "CLASS RELATED ISSUES" IS NOT NEEDED

18

BEFORE THE COURT CERTIFIES THIS CLASS

19

Rule 23(c)(1) contemplates that the Court will determine whether to certify

20 the class "as soon as practicable after the commencement of an action." The

21 Local Rules require that a motion for class certification be filed within 90 days

22 after service of a Complaint purporting to commence a class action. L.R.23-3.

23 Nevertheless, the State Defendants argue that class certification is "premature" at

24 this time, because, they have not yet had the opportunity to conduct discovery "on

25 a host of class-related issues." Opp. at 24. Without specifying what "class-related

26 issues" Defendants are referring to, Defendants appear to suggest they need

27 discovery to ascertain more clearly what Plaintiffs' claims are. Howcver, as the

28 Court has explained above in its analysis of the individual Rule 23 requirements,

20

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 21 of 22

the First Amended Complaint contains allegations sufficient to understand 2 Plaintiffs' claims for class certification purposes. Moreover, Defendants have not

3 pointed out any particular factual uncertainties which, if resolved, would bear on

4 whether class certification would be appropriate. Accordingly, Defendants'

5 request that the Court defer ruling on class certification pending unspecified

6 discovery is denied.

7

V.

8

NOTICE IS NOT REQUIRED

9

Rule 23(c)(2) requires that notice be provided to class members in Rule

10 23(b)(3) class actions. Fed. R. Civ. P. 23(c)(2). There is no such corresponding 11 requirement for Rule 23(b)(2) class actions. Eisen v. Carlisle &Jacquelin, 417 12 U.S 156, 177 n. 14 (1974); EEOC v. General Telephone Co., 599 F.2d 322, 334

13 (9th Cir. 1979) ("When an action is certified under Rule 23(b)(2) ... absent class

14 members are not required to receive notice or to have the opportunity to opt-out of

15 the suit."). Accordingly, no notice is required in this Rule 23(b)(2) action.

16

VI.

17

CONCLUSION

18

For the foregoing reasons, Plaintiffs' motion to certify a class is

19 GRANTED.7 The following class is certified:

20

"Children in California who

21

(a) are in foster care or are at imminent risk of foster care

placement; and

22

(b) have a mental illness or condition that has been

23

documented or, had an assessment already been

conducted, would have been documented; and

24

(c) who need individualized mental health services,

25

including but not limited to professionally acceptable

assessments, behavioral sup'port and case management

26

services, family support, crisis suppprt, ~herapeutic

foster care and other necessary services m the home or

27

in a home-like setting, to treat or ameliorate their illness

28

7 Docket No. 50.
21

Case 2:02-cv-05662-AHM-SH Document 92 Filed 06/18/2003 Page 22 of 22

or condition.

2

For the purposes of this case, 'imminent risk of foster care

3

placement' means that within the last 180 days a child has been

4

participating in voluntary family maintenance services or voluntary

5

family reunification placements and/or has been the subject of either a

6

telephone call to the Child Protective Services hotline or some other

7

documented communication made to a local Child Protective Services

8

agency regarding suspicions of abuse, neglect or abandonment."

9

However, Plaintiff Gary E. may not serve as a class representative, because

10 his recent relocation to Idaho prevents him from satisfying the Rule 23(a)(3)

11 typicality requirement.

12

13 IT IS SO ORDERED.

14
15 DATE: ~ \9. ~ro)
16

17

18

19

20

21

22

23

24

25

26

27

28

22

 </s> • Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 1 of 7 Page ID #:88

1 MARK D. ROSENBAUM (59940) BEN WIZNER (215724)
2 AMERICAN CIVIL LIBERTIES UNION

NOTE CHANGES MADE BY THE COU~ T.
FILED CLERK. U.S. DISTRICT COURT I

OF SOUTHERN CALIFORNIA

3 1616 Beverly Boulevard

RIG INA Los Angeles, California 90026-575,2

4 Telephone: (213) 977-95°th

I

5 Facsimile: (213) 250-3919U

4riority

MAY 2a2003
r'
BCYENTRAL DIS I'l PrAfJ~LIDFEOPAUN'TYA

LIN MIN KONG 083512}

6 LAURA DIAMOND (85062)

KATRINA MCINTOSH (210859)

7 CENTER FOR LAW IN tHE

PUBLIC INTEREST

8

3250 Santa

OMcoeannicaP,arCkaBliflovrdn'il aSt9e.0430050-3219

~e~d
= C~o:~d -
JS-S/JS-6 JS-2IJS-3
Scan Qui.>'
RONALIT'C. PETERSON (54312) CARLYLE W. HALL III (84842)

9 Telephone: (310) 314-1947 FacsImile: (310) 314-1957
10
Attorneys for Plaintiffs

HELLER EHRMAN WHITE & McAULIFFE LLP
601 S. Figueroa Street) 40th Floor Los Angeles, California 90017-5758

11

Telephone: (213) 689-0200

[Additional counsel appear on signature page] Facsimile: (213) 614-1868

12

13 i-

UNITED STATES DISTRICT COURT

e) -.'
14 ~', -'J_ CENTRAL DISTRICT OF CALIFORNIA/WESTERN DIVISION

J Case No.: CV-02-05662 AHM (SHx)

Plaintiffs, UNLIMITED JURISDICTION

,

v.

L

18 "

DIANA BONTA, et a1.,

19

20

Defendants.

[CLASS ACTION]
r,sllA~] ORDER FOR A~PROVAL OF CLASS
SETTLEMENT, PROVISIONAL CERTIFICATION OF SETTLEMENT

21

CLASS, APPROVAL OF FORM AND

MANNER OF NOTICE TO CLASS,

22

AND SCHEDULING OF FAIRNESS

23

HEARING

24

Honorable A. Howard Matz

25

MS' "'--E'-'-:NT=ER::;:-;ED~O:;t;iN~C\

Date: Time:

None Set None Set

26

MAY 2 I 2003

Dept.:

14

Trial Date: None Set

27
28 II---clS~\"==:::::::==+~,:"";;;;-,,,------,

First Amended Complaint Filed: December 20, 2002

IPROPOSEDI ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV-02-05662 AHM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 2 of 7 Page ID #:89

1

The Court, having read and considered the proposed Settlement of the claims in

2 this lawsuit between plaintiffs and defendants Los Angeles County, Los Angeles C'o~nty

3 Department of Children and Family Senrices, and David Sanders, Director of the Los

4 Angeles County Department of Children and Family Services and successor-in-interest

5 to Anita Bock ("County Defendants"), the Stipulated Order, and the Joint Application

6 between plaintiffs and County Defendants for an Order Setting Fairness Hearing on the

7 Settlement of the Claims in this Lawsuit between These Parties and Directing Notice to

8 the Affected Subclass,

9

IT IS HEREBY ORDERED:

10

1. The Court gives its preliminary approval to the proposed Settlement of this

11 lawsuit between plaintiffs and CounA.!ndants and the related Stipulated Order. A

10 12 fairness hearing shall be held on ~

,2003, in Courtroom No. 14

13 of this Court, at '3 ~ 1112 p.r\1_ to hear the objections of class members, if any are made, to

14 the approval of the Settlement and entry of the Stipulated Order.

15

2. For the sole purpose of giving notice of the proposed Settlement and the

16 Stipulated Order, this case shall be conditionally certified as to all claims in the First

17 Amended Complaint against the County Defendants on behalf of a subclass of children

18 and young adults who: (a) are in the custody of Los Angeles County Department of

19 Children and Family Services ("DCFS") or have been referred to or are subject to

20 referral to DCFS; (b) have a behavioral, emotional, or psychiatric impairment; and (c)

21 need individualized mental health services, including but not limited to professionally

22 acceptable assessments, behavioral support and case management services, family

23 support, crisis support, therapeutic foster care, and other medically necessary services in

24 the home or in a home-like setting, to treat or ameliorate their disabilities or

25 impairments. lfthe proposed settlement is not finally approved, then this lawsuit will

26 proceed as if there had been no settlement or conditional certification of a class.

27

3. At the expense of the County Defendants, the following steps shall be taken

28 to give notice to members of this conditional settlement subclass that the Settlement will
2
IPROPOSEDI ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV-02-05662 AHM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 3 of 7 Page ID #:90

1 be approved and the Stipulated Order will be entered unless these class members object

, 1
2 to the Settlement and Stipulated Order and the Court accepts their objections, I,.'J.

3

At least thirty (30) days'prior to the fairness hearing on the proposed Settlement

. I
, ,
4 and Stipulated Order, the County Defendants:

5

A. Shall enclose a printed notice substantially in the form set forth in Exhibit

6 "A" in a mailing to all persons in the categories listed below for whom the County has

7 addresses in its SNAP database. The SNAP database is the County's collection of

8 names and addresses for all cases in which the County Department of Children and

9 Family Services ("DCFS") is currently offering services. This includes cases that are

10 currently open in juvenile dependency court and those in which families are receiving

11 services from DCFS informally. The categories of persons in the SNAP database who

12 will be sent the notices include:

13

(l) children, aged 10 and over;

14

(2) caretakers, including foster parents and relative caretakers, who are

15 currently taking care of dependent children;

16

(3) biological parents of children who are receiving services from DCFS

17 whose parental rights have not been terminated;

18

B. Shall mail the printed notice to Miriam Krinsky, Executive Director of

19 Children's Law Center("CLC"), Los Angeles; Ms. Krinsky has agreed to distribute

20 copies of the notice to all of the attorneys who work at CLC. I

21

C. Shall mail the printed notice to all of the attorneys on the Juvenile

22 Dependency Court's panel of attorneys who represent children and parents in

23 dependency actions pursuant to Calif. Welf. & Inst. § 317.

24

25

2611---------------

I

27

Children are represented by counsel in dependency proceedings. Most children are represented

by an attorney at one of the three law finns that comprise CLC. Some children are represented by

28 "panel" attorneys, described in Section C, infra.

3
/pROPOSEDI ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV·02·0S662 ARM (SRx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 4 of 7 Page ID #:91

1

D. Shall mail the printed notice to all attorneys on the Juvenile Dependency

2 Courts panel attorneys who represent children in civil actions and are appointed

" , , 'J

3 pursuant to Calif. Welf. & Inst. § 317(e).

"

4

E. Shall mail this printed notice to the following stakeholder groups and/or

5 interested advocate's groups: Alliance for Children's Rights; Public Counsel; Mental

6 Health Advocacy Services; Court Appointed Special Advocates (CASA) of Los

7 Angeles; Bet Tzedek Legal Services; Legal Aid Foundation of Los Angeles;

8 Neighborhood Legal Services of Los Angeles County; Western Law Center for

9 Disability Rights; California Foster Parent Association; California Youth Connection,

10 California Alliance of Child and Family. Services; Association of Community Human

11 Services Agencies; Mental Health Association of Los Angeles.

12

F. Shall post the notice in a prominent location in all DCFS offices;

13

G. Shall mail the notice to the following Mental Health Treatment Facilities -

14 Starview Adolescent Center and other licensed Community Treatment Facilities

15 ("CTFs") in Los Angeles County; all licensed Institutes for Mental Disease ("IMDs")

16 that serve children or youth, age 18 or younger; and Metropolitan State Hospital and

17 request that it be posted in a prominent location;

18

H. Shall post the notice on the website for Los Angeles County, DCFS.

19

I. Shall mail the notice to all foster family agencies ("FF A") and group homes

20 with which the County currently contracts to provide placement services to children and

21 request that the notice be posted in a prominent location in these facilities;

22

J. Shall set up a toll-free number, at least thirty (30) days prior to the fairness

23 hearing, by which persons can contact plaintiffs' counsel to communicate questions or

24 concerns about the settlement agreement.

25

4. At least thirty (30) days prior to the fairness hearing on the proposed

26 Settlement and Stipulated Order, plaintiffs' counsel shall post the notice and the

27 Settlement on the following website: htttp:llwww.hewm.comlfostercaresettlement.

28
4
IPROPOSEDI ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV-02-05662 AHM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 5 of 7 Page ID #:92

1

5. The Court finds that the notice set forth in the preceding paragraph$

2 are reasonably calculated to provide adequate notice to members of the subclass of the

3 proposed Settlement and Stipulated Order, and that the Due Process requirements of the

4 United States Constitution will be met with respect to those class members.

5

6. At least seven (7) days before the Fairness Hearing, the County

6 Defendants shall serve and file a declaration reporting to the Court and counsel for the

7 other parties as their compliance with the notice provisions set forth above.
--::-18H----'7

9 DATED: ~% cl \) , 2003
10

1'1'-

12

13 14

15

16

17

18

19
20

21
22

23

24
25

26

27
28
5
[PROPOSED) ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV·02·05662 AHM (SRx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 6 of 7 Page ID #:93

1

PROOF OF SERVICE BY MAIL

I- .,

2

, I.;

3

I, Debora K. Biggers, declare as f o l l o w s : , .

4

I am employed with the law firm of Heller Ehrman White & McAuliffe LLP, '..

5 whose address is 601 South Figueroa Street, 40th Floor, Los Angeles, California 90017.

6 I am readily familiar with the business practices of this office for collection and

7 processing of correspondence for express mailing with the United States Postal Service;

8 I am over the age of eighteen years and not a party to this action.

9

On May 9,2003, I served the following:

10

[PROPOSED] ORDER FOR APPROVAL OF CLASS

SETTLEMENT, PROVISIONAL CERTIFICATION OF

11

SETTLEMENT CLASSl,!PPROVAL FO FORM AND MANNER OF

NOTICE TO CLASS, Arm SCHEDULING OF FAIRNESS

12

HEARING

13 on the below parties in this action by placing true copies thereof in sealed envelopes,

14 addressed as shown, for collection and mailing pursuant to the ordinary business

15 practice ofthis office which is that correspondence for express mailing is collected and

16 deposited with the United States Postal Service on the same day in the ordinary course

17 of business:

18

SEE ATTACHED SERVICE LIST

19

I declare under the penalty of perjury under the laws of the United States of

20 America that the foregoing is true and correct and that I am employed in the office of a

21 member of the bar of this Court at whose direction the service was made.

22

Executed at Los Angeles, California, on May 9,2003.

23

24

25

26

27

28
6
IPROPOSEDI ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVISIONAL CERT. OF SETTLEMENT CLASS, APPROVAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV-02-0S662 AHM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 82

• Filed 05/20/03 Page 7 of 7 Page ID #:94

1

SERVICE LIST

, ,

2

3 BILL LOCKYER 4 Attorney General of the State of California
JOHN H. SANDERS 5 Lead Supervising Deputy Attorney General 6 SANDRA L. GOLDSMITH
CRISTINA FELIX-CARRASCO 7 Deputy Attorneys General 8 300 S. Spring Street, 9th Floor, North Tower
Los Angeles, California 90013 2501 9 Telephone: (213) 897-2456 10 Facsimile: (213) 897-2805

Attorneys for Defendants '. DIANA BONTA, Director:o'f California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

11 LLOYD W. PELLMAN 12 County Counsel
ADA GARDINER 13 Assistant County Counsel 14 DAWYN R. HARRISON
Senior Deputy County Counsel 15 JERRY M. CUSTIS 16 Deputy County Counsel
CATHERINE J. PRATT 17 Deputy County Counsel 18 Office of County Counsel
Children's Services Division 19 201 Centre Plaza Drive, Suite 1 20 Monterey Park, California 91754-2143
Telephone: (323) 526-6106 21 Facsimile: (323) 881-3791
22

Attorneys for Defendants, LOS
ANGELES COUNTY, LOS ANGELES COUNTY
DEPARTMENT OF
CHILDREN AND FAMILY SERVICES, AND DAVID
SANDERS, DIRECTOR

23

24

25

26

27

28
7
(PROPOSED) ORDER FOR PRELIMINARY APP. OF CLASS SETTLEMENT, PROVlSIONAL CERT. OF SETTLEMENT CLASS, APPROYAL OF FORM AND MANNER OF NOTICE TO CLASS, AND SCHEDULING OF FAIRNESS HEARING
CASE NO. CV-02-05662 AHM (SH,)

 </s> • Case 2:02-cv-05662-AHM-SH Document 128

• Filed 07/16/03 Page 1 of 5 Page ID #:145

1 MARK D. ROSENBAUM (59940) BEN WIZNER (215724)

2 AMERICAN CIVIL LIaERTIES UNION OF SOUTHERN CALIFORNIA
3 1616 Beverly Boulevard Los Angeles, California 90026-5752
IGI NAL 4 Telephone: (213) 977-9500
5 FacSImile: (213) 250-39190R LIN MIN KONG (l83512)

F1mt
, cLeAr(, U,S, DISTRICT COURT
..ul6:m3 I lr.'E~NT.R_ALJDI\W(Ili~L~llIr)nIICAlIFDOERPNlJIl,"\

6 LAURA DIAMOND (185062) KATRINA MCINTOSH (210859)
7 CENTER FOR LAW IN tHE PUBLIC INTEREST
8 3250 Ocean Park Blvd.\ Ste. 300 Santa Monica, Californ1a 90405-3219
9 Telephone: (310) 314-1947 FacSImile: (310) 314-1957

NOTE CHANGES MADE BY THE COURT.
RONALD C. PETERSON (54312) CARLYLE W. HALL III (f84842) HELLER EHRMAN WHitE &
McAULIFFE LLP 601 S. Figueroa Street, 40th Floor

10 Attorneys for Plaintiffs

Los Angeles, California 90017-5758 Telephone: (213) 689-0200

11 ,..., .' ,

Facsmule: (213) 614-1868 Priority _'--'

12 :~ counsel appear on signature page]

Send Enter

""~ _ ......

Closed _I-

13 (I 14 .'

~

UNITED STATES DISTRICT COURT

JS·5IJS-6 - r-
JS-2IJS·3 _I-
Scan OnlY_I-

CENTRAL DISTRICT OF CALIFORNINWESTERN DIVISION

15 ;

16 KATIE A;, et aL,

17

18

v.

19 DIANA BONTA, et al.,
20

21

Plaintiffs, Defendants.

Case No.: CV-02-05662 AHM (SHx) UNLIMITED JURISDICTION [CLASS ACTION) fP1t6P88Jil&l STIPULATED ORDER RE FINAL APPROVAL OF CLASS SETTLEMENT
Honorable A, Howard Matz

22

Date:

None Set

Time:

None Set

23

Dept.:

14

Trial Date: None Set

24 First Amended Complaint Filed:

25

December 20, 2002

26

ENTER ONICMS

27

28

IPROPOSEDI STIPULATED ORDER RE FINAL APPROVAL OF CLAS~ SETTLEMENT

.7

\;Mt- ~U. \;v-02·05662 ARM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 128

• Filed 07/16/03 Page 2 of 5 Page ID #:146

1

Based upon the Settlement Agreement between the plaintiffs and defendants Los

2 Angeles County, Los Angeles County Department of Children and Family Services, and

3 Marjorie Kelly, Interim Director of the Los Angeles County Department of Children and

4 Family Services and successor-in-interest to Anita Bock, and upon the evidence and

5 argument presented at the fairness hearing,

6

IT IS HEREBY ORDERED, ADJUDGED AND DECREED AS FOLLOWS:

7

1. This Court has jurisdiction over the claims against defendants Los Angeles

8 County, Los Angeles County Department of Children and Family Services, and Marjorie

9 Kelly, Interim Director of the Los Angcles County Department of Children and Family

10 Services and successor-in-interest to Anita Bock, (hereinafter collectively referred to as

11 "County Defendants") pursuant to 28 U.S.C. §§ 1331, 1343 and 1367. Venue is proper

12 in this Court pursuant to 28 U.S.C. § 1391(b). The County Defendants need not answer

13 or otherwise respond to the Complaint filed by plaintiffs. This order shall have no effect

14 on any of plaintiffs' claims against defendants Diana Bonta, Director of the California

15 Department of Health Services; and Rita Saenz, Director of the California Department

16 of Social Services.

17

2. This case shall be certified as a class action for purposes of all causes of

18 action in Plaintiffs' Complaint against the County Defendants on behalf of a class of

19 children and young adults who: (a) are in the custody ofLos Angeles County

20 Department of Children and Family Services ("DCFS"), or have been referred to or are

21 subject to referral to DCFS; (b) have a behavioral, emotional, or psychiatric impairnlent;

22 and (c) need individualized mental health services, including but not limited to

23 professionally acceptable assessments, behavioral support and case management

24 services, family support, crisis support, therapeutic foster care, and other medically

25 necessary services in the home or in a home-like setting, to treat or ameliorate their

26 disabilities or impairments. Members of the class include children and young adults

27 living with their parents or relatives or in any of a variety of placements, such as

28 MacLaren's Children Center, group homes or foster homes.

2
(PROPOSEDI STIPULATED ORDER RE FINAL APPROVAL OF CLASS SETTLEMENT CASE NO. CV-02-05662 ARM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 128

• Filed 07/16/03 Page 3 of 5 Page ID #:147

1

3. The Settlement Agreement is fair, reasonable and adequate for members of

2 the class.

3

4. The Court shall retain jurisdiction to enforce the accompanying Settlement

4 Agreement between the parties until the case has been dismissed pursuant to the terms

5 theof .s.ttl~\):~;~t. ~" ~ ~m ~ i~
~ ~~~'~-i:~lMsM'~ ~~Mf~

DATED:

~ \& ,2003

"

86

THE HONORAB E A. HOWARD 1\TZ

9

UNITED STATE DISTRICT JUDGE

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3
IPROPOSEDI STIPULATED ORDER RE FINAL APPROVAL OF CLASS SETTLEMENT CASE NO. CV-02-0S662 AHM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 128

• Filed 07/16/03 Page 4 of 5 Page ID #:148

1
PROOF OF SERVICE BY MAIL
2

3

I, Debora K. Biggers, declare as follows:

4

I am employed with the law firm of Heller Ehrman White & McAuliffe LLP,

5 whose address is 601 South Figueroa Street, 40th Floor, Los Angeles, California 90017.

6 I am readily familiar with the business practices of this office for collection and

7 processing of correspondence for express mailing with the United States Postal Service;

8 I am over the age of eighteen years and not a party to this action.

9

On May 9, 2003, I served the following:

10

STIPULATED ORDER RE FINAL APPROVAL OF CLASS

SETTLEMENT

11

on the below parties in this action by placing true copies thereof in sealed envelopes,

12
addressed as shown, for collection and mailing pursuant to the ordinary business

13
practice of this office which is that correspondence for express mailing is collected and

14
deposited with the United States Postal Service on the same day in the ordinary course

15
of business:

16
SEE ATTACHED SERVICE LIST

17
I declare under the penalty of perjury under the laws of the United States of

18 America that the foregoing is true and correct and that I am employed in the office of a

19
member of the bar of this Court at whose direction the service was made.

20 Executed at Los Angeles, California, on May 9, 2003.

21 22

~:~~'--------------

23

24
25

26

27

28

4
IPROPOSEDI STIPULATED ORDER RE FINAL APPROVAL OF CLASS SETTLEMENT CASE NO. CV·02·05662 ARM (SHx)

• Case 2:02-cv-05662-AHM-SH Document 128

• Filed 07/16/03 Page 5 of 5 Page ID #:149

1

SERVICE LIST

2

3 BILL LOCKYER 4 Attorney General of the State of California
JOHN H. SANDERS 5 Lead Supervising Deputy Attorney General
SANDRA L. GOLDSMITH 6 CRISTINA FELIX-CARRASCO 7 Deputy Attorneys General 8 300 S. Spring Street, 9th Floor, North Tower
Los Angeles, California 90013 2501 9 Telephone: (213) 897-2456 10 Facsimile: (213) 897-2805

Attorneys for Defendants DIANA BONTA, Director of California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

11 LLOYD W. PELLMAN 12 County Counsel
ADA GARDINER 13 Assistant County Counsel
14 DAWYN R. HARRISON Senior Deputy County Counsel
15 JERRY M. CUSTIS 16 Deputy County Counsel
CATHERINE J. PRATT 17 Deputy County Counsel 18 Office of County Counsel
Children's Services Division 19 201 Centre Plaza Drive, Suite 1 20 Monterey Park, California 91754-2143
Telephone: (323) 526-6106 21 Facsimile: (323) 881-3791
22

Attorneys for Defendants, LOS
ANGELES COUNTY, LOS ANGELES COUNTY
DEPARTMENT OF
CHILDREN AND FAMILY SERVICES, AND DAVID
SANDERS, DIRECTOR

23
LA 244202 vI
24 5/9/031106 AM (95514.0001)
25

26

27

28

5
IPROPOSEDI STIPULATED ORDER RE FINAL APPROVAL OF CLASS SETTLEMENT CASE NO. CV-02-05662 ARM (SHx)

 </s> • ~,
Case 2:02-cv-05662-AHM-SH Document 149

•' Filed 02/23/04 Page 1 of 5 Page ID #:167

LLOYD W. PELLMAN, County Counsel

2 CJAAMTEHSERMl.NOEWJ.EPNRSA, TATc,tiSngenAiosrsDisteapnuttyCoCuonutyntyCoCuonusnesle(l82(,'r5",.,).)9...,L.,9..)\,.l0oI\..loll\l.,L-l-=I:':;,:---;~~y_--1

Children's Services Division 3 201 Centre Plaza Drive, Suite 1

CLERK U.S.FDILISETDRIC':T.:..:I:C' OURT

4 Monterey Park, CA 91754-2143 TeletJhone: (323) 526-6242

" j'~1
FEB 23 ai04

5 Facsimile: (323) 881-3791

6 ,.~ttoni.,eys for Los Angeles County

CBYENTRAL

"I"TJ"ln UlICALIFORNIA· ft r g",ftV OEPUTY

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UNITED STATES DISTRICT COURT

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12

Plaintiffs,

CASE NO. CV-02-05662 AHM (SHx)

STIPULA TION BETWEEN

13 v.

PLAINTIFFS AND COUNTY

DEFENDANTS REGARDING

14 Diana Bonta et ai.,

DEFINITION.9!2li.1~
MEMBERS;~~lORDER

15

Defendants.

16

Room: 14

17

The Hon. A. Howard Matz, District Court Judge

18

19

The Plaintiffs and the County of Los Angeles, through their respective

20 counsel, stipulate and agree that the following definition of the plaintiff class shall

21 be used for the purposes of the settlement agreement approved by this Court on

22 July 16, 2003:

23

The class members include children and young adults who:

24

(a) are in the custody ofLos Angeles County Department of Children and

25 Family Services ("DCFS") in foster care or who are at imminent risk of foster care

26 placement by DCFS; and

OCKETED ON CM

27

(b) are eligible for services under the Early and Periodic Sc ~ ~J:('-D

Fe') ~ 3 2004

.t44 . 28

Diagnosis

and

Treatment

("EPSDT")

program

of

the

Medicaid

Act, as defined in
......... -'-'.'.--~

....

-1-

\-y

• Case 2:02-cv-05662-AHM-SH Document 149

Filed 02/23/04 Page 2 of 5 Page ID ;#. :168r.

42 U.S.C. § 1396 et seq.; and

,

2

(c) have a mental illness or condition that is documented or, had an ;,::

,,;",

~'~L

3 assessment been completed, cOllld have been documented; and

C"I

4

(d) need individualized mental health services, including but not limited to

5 professionally acceptable assessments, behavioral support and case management

6 services, family support, crisis support, therapeutic foster care, and other medically

7 necessary services in the home or in a home-like setting, to treat or ameliorate their
,
8 illness or condition.

9

Insofar as the above definition is functionally the same as that definition

10 contained in the written settlement agreement and in order to clarify any ambiguity
I
11 that may exist as to the meaning of the definition in the existing written settlement

12 agreement, the above definition,shall replace the definition of the class included in

13 the written settlement agreement previously lodged with this Court and comports

14 with the definition agreed to by counsel for Plaintiffs and the County at the fairness

15 hearing conducted on July 16,2003.
16

17

IT IS SO STIPULATED AND AGREED.

18
19 Dated: February~, 2004
20 21 22 23 24 25

LLOYD W. PELLMAN

County Counsel

JAMES M. OWENS

Acting Assistant County Counsel

CATHERINE J. PRATT

Senior Deputy County Counsel

BY~ CA

EJ.PRATT

Attorneys for County Defendants

26

27

28

-2-

" FEE('13 '04 11:50 FR •
# G Case 2:02-cv-05662-AHM-SH Document 149 Filed 02/23/04 Page 3 of 5 Page ID #:169

Dated: February i::;, 2004
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20
21 22
23 24 25 26 27
28

L:,'':I
tU
and Poverty"· Attorneys for the Plaintiffs
·3·
** TOTAL PAGE. [id ,.:. "

• .-,
Case 2:02-cv-05662-AHM-SH Document 149

Filed 02/23/04 Page 4 of 5 Page ID #:170

DECLARATION OF SERVICE
~,"_~I
eLi

STATE OF CALIFORNIA, County of Los Angeles:

"<-

(''';'1

NANCY TSAI states: I am and at all times herein mentioned have been a (....\

citizen of the United States and a resident of the County of Los Angeles, over the

age of eighteen years and not a party to nor interested in the within action' that my

business address is 20 I Centre Plaza Drive, Suite 1, City of Monterey Park, County

of Los Angeles; State of California; that I am readily familiar with the business

practice ofthe LOS Angeles County Counsel for collection and processing of

correspondence for maIling with the United States Postal Service; and that the

correspondence would be deposited within the United States Postal Service that

same day in the ordinary course of business.

That on the 18th day of February, 2004, I served the attached STIPULATION BETWEEN PLAINTIFFS AND
COUNTY DEFENDANTS REGARDING DEFINITION OF CLASS MEMBERS; [PROPOSED] ORDER

upon Interested Party(ies) by depositing copies thereof, enclosed in a sealed envelope and placed for collection and mailing on that date followinE ordinary business practtces in the United States Postal Service, addressed as :follows:

See Attached Service List

(BY MAIL) I am "readily familiar" with this office's practice of collection and processmg correspondence by mailing. Under thatpractice it would be deposited witll U.s. postal service on that same day witfl postage fully prepaid at Los Angeles, California, in the ordinary course of business. I am aware that on motIOn of the party served, service IS presumed invalid if postal cancellation date or jJostage meter date is more than one day after date of deposit for mailing in afIidavlt. (FEDERAL) I declare that I am employed in the offices of a member of this court at whose direction the service was made I declare under penalty of perjurY that the foregoing is true and correct. Executed this 18th day of February, 2004, at Monterey Park, California.

~YTSAI

CHSV.118533.1

• Case 2:02-cv-05662-AHM-SH Document 149

Filed 02/23/04 Page 5 of 5 Page ID #:171

Katie A. et al. v. Diana Bonta et al.

CV-02-05662 AHM (SHx) '"(__I U.! ;2'

SERVICE LIST

Mark D. Rosenbaum, Esq. Ben Wizner, Esq. American Civil Liberties Union
of Southern California 1616 Beverly Boulevard Los Angeles, California 90026-5752 (Attorneys for Plaintiffs)

Melinda Bird, Esq. Marilyn Holle Esq. Protection & Advocacy, Inc. 3580 Wilshire Boulevard Suite 902 Los Angeles, California 90010 (Attorneys for Plaintiffs)

Robert Garci~ Esq. Erica Flores, bSq. Center for Law in the Public Interest 3250 Ocean Park Boulevard Suite 300 Santa Monica, California 90405 (Attorneys for Plaintiffs)

Robert D. Newman, Esq. Kimberly Lewis, Esq. Western Center on Law and Poverty 3701 Wilshire Boulevard Suite 208 Los Angeles, California 90010-2809 (Attorneys for Plaintiffs)

Ronald C. Peterson, Esq. Carlyle W. Hall III, Esg. Heller Ehrman White 8i
McAuliffe LLP 601 South Figueroa Street" 40th Floor Los Angeles, California 9v017-5758 (Attorneys for Plaintiffs)

Ira Burnim, Esq. Bazelon Center for Mental Health Law 1101 Fifteenth Street, NW Suite 1212 Washington DC 20006 (Attorneys for Plaintiffs)

Patrick Gardner, Esq. Katina Ancar, Esq. National Center for Youth Law 405 - 14th Street, 15th Floor Oakland, California 94612-270 I (Attorney for Plaintiffs)

Sandra L. Goldsmith Deputy Attorney General 300 South Spring Street, Room 1702 Los Angeles, California 90013

Miriam A. Krinksy, Esq. Children's Law Center of Los Angeles 20 I Centre Plaza Driv~ Suite 10 Monterey Park, CA 91/54-2178

CHSY.l!8533.!

 </s> Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 1 of 30 Page ID #:340

., ,.
i,' . -

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19

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(,)
_J

ROBERT D. NEWMAN, SBN 86534 KIMBERLY LEWIS, SBN 144879 2 WESTERN CENTER ON LAW & POVERTY 3701 Wilshire Boulevard, Suite 208 3 Los Angeles, CA 90010 (213) 487-7211 Fax: 213-487-0242 4

CLERK.

u.s.

FILED DISTRICT

COURT..1

1.1.1

MAY, 2311

5 RONALD C. PETERSON, SBN 54312

ALISSA B. KOLE~1..~BN 223256

6 HEliLER EHRMA1'l1'l, LLP

r:-
9-

3'3.3 so~hh Hope Street, Suite 3900 £'08 An e\es, California 90071-3043

~n) 6 9-0200 Fax: 213-614-1868

It ;':::'";,j

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.t~"-,t:..~Cn'~.):-
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16 ~1tof')l~Yts for Plaintiffs

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If" .

[Ac:ldltlOpal counsel appear on next page)

!.... )

,

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Closed JS-5IJS-6 JS-2/JS-3 _ Scan Only_

12

UNITED STATES DISTRICT COURT

13

CENTRAL DISTRICT OF CALIFORNIA

14 KA TIE A. by and through her next friend Michael Ludin; MARY B. by and
15 throu~h her next friend Robert Jacobs; JANET C. by and through her next
16 friend Dolores Johnson; HENRY D. by and through his next friend Gillian
17 Brown: AND GARY E. by and through his next friend Michael Ludin;
18 individually and on behalf of others similarly situated,
19
Plaintiffs, 20 v.
21 DIANA BONTA, Director of California Department of Health Services; LOS
22 ANGELES COUNTY; LOS ANGELES COUNTY DEP ""'"1"'"
23 OF CHILDREN AND FAMILY SERVICES; ANITA BLOCK, Director
24 of the Los Angeles County Department of Children ana Family Services; RITA
25 SAENZ, Director of the California Department of Social Services, and
26 DOES 1 through 100, Inclusive

Case No. CV-02-05662 AHM (Shx)
~~ Rt1Eit'GWATDIDNGENDUM TO
PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Date: Judge:

April 24, 2006 A. Howard Matz Courtroom: 14
-,

27

Defendants.

28

IPROPOSEDI ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 2 of 30 Page ID #:341
1 ATTORNEYS FOR PLAINTIFFS: . 2. MARK D. ROSENBAUM SBN 59940
AMERICAN CIVIL LIBERTIES UNION 3 OF SOUTHERN CALIFORNIA
1616 Beverly Boulevard 4 Los Angeles, California 90026
(213) 977-9500 Fax: 213-250-3919 5 6 MELINDA BIRD, SBN 102236
MARIL YN HOLLE, SBN 61530 7 PROTECTION AND ADVOCACY, INC.
3580 Wilshire Boulevard, Suite 902 8 Los Angeles CA 90010
(213) 427-8747 Fax: 213-427-8767
9
10 IRA BURNIM (pro hac vice) BAZELON CENTER FOR MENTAL
11 HEALTH LAW 1101 Fifteenth Street, NW, Suite 1212
12 Washington, DC 20006 (202) 467-5730 Fax: 202-223-0409
13
14 JOHN O'TOOLE, SBN 62327 PATRICK GARDNER, SBN 208119
15 LEE CIA WELCH, SBN 208714 NATI~tilAL CENTER FOR YOUTH LAW
16 405 14 Street, 15th Floor Oakland CA 94612
17 (510)835-8098 Fax: 510-835-8099
18 19 20
21
22 23 24 25 26
27
28
(PROPOSEDI ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 3 of 30 Page ID #:342

1

State

De-fendants'

Motion

for

Clarification

and/or

Correction

of

the

Order (~

2 Granting Plaintiffs' Motion for Preliminary Injunction came on for hearing on ;,xpril

:;~

3 24, 2006. Plaintiffs were represented by Robert D. Newman and Melinda Bird::;

4 State Defendants were represented by Sandra L. Goldsmith and Erin S. Kubota.

5

The Court denies State Defendants" Motion for Clarification and/or

6 Correction ("Clarification Motion"). The Court nonetheless issues this Addendum

7 to the March 14,2006 Order Granting Plaintiffs' Motion for Preliminary Injunction

8 ("Order").

9

10

(1) "Are the services required under the Order restricted to those services

II eligible for Medicaid Federal Financial Participation (FFP)? (42 U.S.C. § 1396b; 42

12 C.F.R. § 430.0 & §430.1, et seq.)" [Clarification Motion at 6: 17-19]

13

Response: Yes. This Court only ruled upon the merits of Plaintiffs' Medicaid

14 claims. Order at 20 n. 17. The Court concluded that "wraparound services and

15 therapeutic foster care fall within the EPSDT [Early and Periodic Screening,

16 Diagnosis and Treatment] obligations ofMedicaid-participating states" and that

17 "this conclusion is buttressed by the fact that in other states wraparound services and

18 therapeutic foster care programs have been funded by Medicaid." Id. at 15:3-6.

19 Given that wraparound services and therapeutic foster care ("TFC") are mandated

20 by the EPSDT obligations of the Medicaid Act, these services are by definition

21 eligible for Medicaid FFP. See also 42 C.F.R. § 431.250(b)(2)(federal financial

22 participation is available for "services provided within the scope of the federal

23 Medicaid program and made under a court order").

24

25

(2) "Does the screening referred to at page 20, lines '5-9, of the Order consist

26 of the screening services defined in 42 U.S.C. § 1396d(r)(J), which are referred to in

27 42 U.S.C. § 1396d(r)(5)? [Clarification Motion at 6:20-22]

28

Response: It is necessary to look at the statutory scheme in its entirety for

1
ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

- - - - - - - ----

• Case 2:02-cv-05662-AHM-SH Document 454

Filed 05/12/06 Page 4 of 30

Page ID #:343

1 the authority for the screening referred to at page 20, lines 5-9, of the Order, andnot
Cl
2 merely the screening services required by 42 U.S.C. § 1396d(r)(I)(A); 42 U.S.G:! §

3 1396d(r)(l )(B), for example, also provides further guidance.

4

5

(3) "Does the Order require screening and provision of 'wraparound services'

6 and 'therapeutic foster care' for Medi-Cal-eligible members only of the statewide

7 class?" [Clarification Motion at 6:23-25]

8

Response: The Order requires screening and provision of wraparound

9 services and TFC only for Medi-Cal eligible members of the statewide class.

10

II

(4) "Is the statewide class restricted to EPSDT-eligible children?"

12 [Clarification Motion at 6:26]

13

Response: No. The Court has previously certified the following class in this

14 case:

15

"[C]hildren in California who (a) are in foster care or are at imminent

16

risk of foster care placement; and (b) who have a mental illness or

17

condition that has been documented or, had an assessment already been

18

conducted, would have been documented; and (c) who need

19

individualized mental health services, including but not limited to

20

professionally acceptable assessments, behavioral support and case

21

management services, family support, crisis support, therapeutic foster

22

care and other necessary services in the home or in a home-like setting,

23

to treat or ameliorate their illness or condition."

24 Order at 2: 13-17. Plaintiffs' motion for preliminary injunction did not ask the

25 Court to modifY the above definition of the statewide class, nor did the Order

26 make any such modifications in the class definition. Plaintiffs' First

27 Amended Complaint also alleges claims under the Americans with

28 Disabilities Act, the Rehabilitation Act, and substantive due processes

2
ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

--

-------

• Case 2:02-cv-05662-AHM-SH Document 454

Filed 05/12/06 Page 5 of 30 Page ID #:344

1 wherein Plaintiffs seek wraparound services and TFC for class members who D
2 are not EPSDT-eligible children and youth. The Court has not ruled on the ~!;!

3 merits of those claims.. See, e.g., Order at 4 n. 5 ("the Court need not deal

4 directly with the claims asserted under the Americans with Disabilities Act

5 and Rehabilitation Act").

6

7

(5) "What services does the Order require that State Defendants are not

8 already providing?" [Clarification Motion at 6:27-7:1]

9

Response: Wraparound services and TFC. Order at 20:15.

10

II

(6) "At page 20, lines 16-17, the Order states, 'Such forms of treatment

12 [wraparound services and therapeutic foster care, as defined in Appendices A and B]

13 shall be provided to class members on a consistent, statewide basis through the

14 Medi-Cal program or other means' What 'other means' is the Order referring to?"

15 [Clarification Motion at 7:2-6]

16

Response: "Other means" refers to other statewide programs besides the

17 Medi-Cal program. The Court has given State Defendants the flexibility to choose

18 whether they want a different statewide program besides the Medi-Cal program to 19 provide wraparound services and TFC to class members for whom these services are

20 medically necessary.

21

22

(7) "The Order states, at page 21, lines 1-3, '(The plan need not necessarily

23 include all of the aspects of wraparound services and therapeutic foster care

24 specified in Appendices A and B.), What 'plan' is the Order referring to here, and

25 what aspects of 'wraparound services and therapeutic foster care specified in

26 Appendices A and B' must be included in the plan and what aspects need not be

27 included in the plan?" [Clarification Motion at 7:7-12]

28

Response: State Defendants' first question concerns the "plan." The "plan" is

3 ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 6 of 30 Page ID #:345

the one that "counsel for the State Defendants and for Plaintiffs shall meet and ,-, ;.~
2 confer and develop...for implementing this preliminary injunction." Order at:2'1 :4-
1:~::
3 5.

4

State Defendants' second questions concerns the different "aspects" of

5 wraparound services and TFC specified in Appendices A and B. True copies

6 of Appendices A and B are attached to this Addendum. The Order should not

7 be construed to mean that every component and/or subcomponent of

8 wraparound services and TFC, as described in Appendices A and B, must be

9 funded, monitored, reported on, etc. To give one example, the Court is not

10 ordering that State Defendants fund a subcomponent of wraparound services

11 and TFC for a class member that would be duplicative of another

12 subcomponent of wraparound services and TFC that is already receiving

13 funding.

14

15

(8) "What is meant at page 21, lines 7-8, of the Order by 'the eligibility

16 criteria for wraparound services and therapeutic foster care" [Clarification Motion at

17 7:13-14]

18

Response: The Court is asking the parties to set forth in the plan the

19 conditions under which class members will be entitled to receive these two

20 mental health services. See, e,g., Emily Q. v. Bonta, 208 F.Supp.2d 1078,

21 1085 (CD.Cal. 2001 )(setting forth the Medi-Cal eligibility criteria for

22 children and youth under the age 21 to receive a different mental health

23 service, Therapeutic Behavioral Services).

24

25

(9) "At lines 10-12 on page 21, the Order states, 'In negotiating the plan,

26 counsel shall diligently and in good faith take into account and apply this Court's

27 previous rulings and observations in this case and in Emily Q.' What 'previous

28 rulings and observations in this case and in Emily Q.' does the order refer to? State

4
ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 7 of 30 Page ID #:346

1 Defendants' counsel herein does not, and has never, represented the State Defendant

c,~

2

in Emily Q. Moreover, the California Department of Social Services in not a

llJ
":.,,,

2:

3 defendant in Emily Q." [Clarification Motion at 7: 15-22]

4

Response: State Defendants are able to review the prior rulings and

5 orders, plus the transcripts of various hearings, in this case and Emily Q. in

6 order that5..tate Defl dants ca~obtai'1lf1nilp'~wer to this particular question._, ~

;.~~.

~,~s v~~.~ V\s ~-;:~~i'--.'\.

7 .~ ~i\4~~ 'tj'. f

~. ~, .

8

9 the parties Miey,ld try tJJ narrow their differences w~ver possibl;;,(b) the'"

10

'.

identity the areas in dispute; ~s) the fHH'ties 5hotllyr~ a

11 means to resolve the disputed iSS~" €t1)~rsons with~d:ision

12 making authority should participate in tMtt;e negotiations.

13

14

(10) "Where the Order directs the State Defendants to 'screen' or to 'provide'

15 services, is this limited to requiring State Defendants to provide financial coverage

16 for the services? If not, what does the Order require of the State Defendants?"

17 [Clarification Motion at 7:23-26]

18

Response: The Order is not limited to requiring State Defendants merely to

19 provide "financial coverage" for the screening of class members and for the

20 provision of wraparound services and TFC to class members when medically

21 necessary. The Order contains the broad injunction that State Defendants "shall

22 provide wraparound services and therapeutic foster care...to class members on a

23 consistent, statewide basis...." Order at 20: 15-17. The Order further directs that

24 "[a]mong other things," the implementation plan "must identity the responsibilities

25 of the different State agencies, the need for additional providers, the eligibility

26 criteria for wraparound services and therapeutic foster care [and] methods and

27 procedures to inform class members of the availability of these services." Order at

28 21:5-9.

5
ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 8 of 30 Page ID #:347

1

(11) "What state agencies are included in 'the different State agencies referred

Ci

2 to at lines 6-7 on page 21" [Clarification Motion at 7:27-28]

~~;

3

Response: The three state agencies with principal responsibilities for :i'

4 the mental health needs of foster children in California are California

5 Department of Health Services, California Department of Social Services and

. 6 California Department of Mental Health. However, the ultimate responsibility

7 lies with the State itself.

8

9

(12) "The Order states at page 4, lines 8-lO, 'Even though the Government

10 has agreed to provide aid to these children and has an interest in doing so, the

11 adversary process risks swallowing up and interfering with both sides' mutual

12 objectives.' Defendants are uncertain if this statement references a formal

13 agreement or some other requirement. It is also unclear whether the reference to

14 'Government' is meant to indicate Defendants or some other form offederal, state

15 or local government and what 'specific aid' the Court is referring to." [Clarification

16 Motion at 8: 1-8]

17

Response: This question does not require an answer. The Order was trying to

18 reflect the prior statements by State Defendants about how they were acting in good

19 faith and with the utmost integrity in providing class members with all the mental

20 health services that they are entitled to receive.

21
22 Dated: Mayl~, 2006
23
24

A. HOW MATZ UNlTED STATES DISTRICT JUDGE

25 Submitted by: 26

27 Robert D. Newman 28 Attorney for Plaintiffs

6
ADDENDUM TO ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 9 of 30 Page ID #:348

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 10 of 30 Page ID #:349

Components of Wraparound Services

Wraparound services are defined in Welfare and Institutions Code §18251(d) as

"community-based intervention services that emphasize the strengths of the child and

family and includes the delivery of coordinated, highly individualized unconditional

services to address needs and achieve positive outcomes in their lives." Proyiders of

wraparound care services: (a) engage in a unique assessment and treatment planning

process that is characterized by the formation of a child, family, and multi-agency team

(b) marshal community and natural supports through intensive case management and (c)

make available an array of therapeutic interventions, which may include behavioral

support services, crisis planning and intervention, parent coaching and education, mobile

therapy, and medication monitoring.

The components of wraparound care services, by definition, are individualized,

and thus unique to each child and family. However, wraparound care services often

include the following:

1

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 11 of 30 Page ID #:350

Component
Engagement of the Child and Family: A wraparound coordinatOr organizes an initial meeting with the child and famUy. During this meeting the coordinator engages the child and famUy, explains wraparound care services, and encourages the participation of additional family members and other natural supports.
The engagement of the child and family continues throughout the provision of wra~around care services.

Rendering Providers of

Federal Statutory ..

Formal Supports Include

Authorization :,';

the Followinl!!

(all citations to 42 U.S.C.)

Any other staff operating Case-management servi<;e~, §

within hislher scope of

1396d(a) (19)

,:,

practice

Screening services, §

Staff with BAJBS in MH 1396d(r) (1) (B)

related field or with 2 years

experience in Mental

Such other necessary health

Health

care, diagnostic services,

treatment, and other

Staff without BAJBS in measures to correct or MH related field or with 2 ameliorate defects and

years experience in Mental physical and mental illnesses

Health

and conditions discovered

during screens, § 1396d(r) (5)
csw

Anticipatory guidance, §

MFT

1396d (r) (1) (B) (v)

MD/DO PhD/PsyD

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

NP/CNS

RN

Immediate Crisis Stabilization: One goal of a wraparound service

Student professionals with co-signature Any other staff operating within hislher scope of

Screening services, § 1396d(r)(l) (B)

! Rendering Providers: - CNS - Clinical Nurse Specialist - DO· Doctors of Osteopathy - CSW - Clinical Social Worker - MD - Medical Doctor - MFT - Marriage &Family Therapist - NP - Nurse Practitioner - PhD - Doctor of Philosophy, clinical psychologist - PsyD - Doctor of Psychology, clinical psychologist - PT - Psychiatric Technician

2

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 12 of 30 Page ID #:351

provider is to ensure safety. Crisis practice

stabilization describes actions

taken to address immediate

Staff with BA!BS in MH

concerns about safety and

related field or with 2 years

security.

experience in Mental

Health

Before the first full team meeting,

the wraparound coordinator and Staff without BA!BS in

other team,members might need MH related field or with 2

to address safety issues related to . years experience in Mental

medical needs, severe psychiatric Health

symptoms, behaviors of a child

that might place others in

CSW

jeopardy, or issues related to a

child living in an unsafe

MFT

environment

MD/DO

In addition to the immediate relief

of existing safetY concerns, the PhD/PsyD

wraparound coordinator attempts

to predict potential areas of crisis NP/CNS

and to clearly identify ways to

resolve the crisis, should one

RN

occur.

Student professionals with

co-signature

Case-management servid.~~, §

1396d (a) (19)

"':,~.,
~,~:r::

( (
Such other necessary health

care, diagnostic services,

treatment, and other

measures to correct or

ameliorate defects and

physical and mental illnesses

and conditions discovered

during screens, § 1396d(r) (5)

Outpatient hospital services, § 1396d(a) (2) (A)
, Rural health clinic services, § 1396d(a)(2) (B)
Federally-qualified health center services, § 1396d(a) (2) (C)
Physician services, § 1396d(a) (5) (A)

Medical care or any other type of remedial care furnished by licep.sed practitioners, § 1396d(a)(6)

Home health care services, § , 1396d(a) (7)

Clinic services, § 1396d (a) (9)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Certified pediatric nurse practitioner or certifled family nurse practitioner

3

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 13 of 30 Page ID #:352

services, § 1396d(a)(21)

,

c~
11)

Personal care services, § 1396d(a) (24)

~?::
:?::
<t:

i, I

I~" 'j

Anticipatory guidance, §

1396d(r) (1) (B) (v)

Transportation, § 1396d(a) (27)

Strengths aM Needs Assessment: The wraparound coordinator is responsible for gathering information that identifies the unique skills, talents, interests, and resources of the child and family. This information is used to build a strength-based and individualized service plan.

Any other staff operating Case-management services, §

within his/her scope of

1396d(a) (19)

practice

Screening services, §

Staff with BAJBS in MH 1396d(r) (1) (B)

related field or with 2 years

experience in Mental

Such other necessary health

Health

care, diagnostic services,

treatment, and other

Staff without BAJBS in measures to correct or

MH related field or with 2 ameliorate defects and

years experience in Mental physical and mental illnesses

Health

and conditions discovered

during screens, § 1396d(r) (5)

CSW

Other diagnostic, screening,

MFT

preventive, and rehabilitative

services, § 1396d(a)(13)

MD/DO

Physician services, §

PhD/PsyD

1396d(a) (5) (A)

NP/CNS
RN
Student professionals with co-signature

Medical care or any other type of remedial care furnished by licensed practitioners, § 1396d(a)(6)
Anticipatory guidance, § 1396d(r) (1) (B) (v)

WraparouM Team Formation: Any other staff operating Case-management services, § 4

Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 14 of 30 Page ID #:353

The child, the parent or guardian, within his/her scope of and the wraparound coordinator practice are almost always members of the

1396d(a) (19) C)
UI
Other diagnostic, screening;

wraparound team.

Staff with BAIBS in MH preventive, and rehabilitative I .
related field or with 2 years services, § 1396d(a) (13) I;;::

In addition, friends, extended

experience in Mental

family, neighbors, members of the Health

Such other necessary health

family's faith community,

care, diagnostic services,

teachers, social workers, therapists Staff without BAIBS in treatment, and other

and co-workers might be among MH related field or with 2 measures to correct or

those invited to join.

years experience in Mental ameliorate defects and

Health

physical and mental illnesses

The wraparound coordinator

and conditions discovered

contacts potential team members CSW

during screens, § 1396d(r) (5)

to explain the specific reasons

they are needed on the team and MFT

Physician services, §

coordinates the schedu les of team

1396d(a) (5) (A)

members.

MD!DO

Medical care or any other

Once the team is formed, the

PhD/PsyD

type of remedial care

wraparound coordinator mayor

furnished by licensed

may not serve as the wraparound NP/CNS

practitioners, § 1396d(a) (6)

facilitator. Any member of the

team can serve as the facilitator. RN

Anticipatory guidance, §

1396d (r) (1) (B) (v)

Student profeSSionals with

co-signature

Transportation, §

1396d(a)(27)

Wraparound Service Plan

Any other staff operating Case-management services, §

Development: With the help of a within his/her scope of

1396d(a) (19)

facilitator, the wraparound team practice

works together to develop and

Physician services, §

adopt a wraparound service plan. Staff with BAIBS in MH 1396d (a) (5) (A)

The service plan describes the related field or with 2 years

needs, long-range vision and

experience in Mental

Such other necessary health

short-term objectives for the child Health

care, diagnostic services,

and family, and the services that

treatment, and other

will best fit their needs.

Staff without BA/BS in measures to correct or

MH related field or with 2 ameliorate defects and

During the wraparound team

years experience in Mental physical and mental illnesses

meetings, the wraparound

Health

and conditions discovered

facilitator will coordinate the

during screens, § 1396d (r) (5)

5

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 15 of 30 Page ID #:354

assignment of tasks to team

CSW

members. Deadlines for task

completion are recorded.

MIT

Any team member may accept assignments to secure services and supports, sometimes from formal networks of mental health supports, other times from other child.serving systems, and often from community and other informal sources.

MD(DO PhD/PsyD NP/CNS
RN
Student professionals with co-signature

,
Medical care or any other ti::
type of remedial care :~:: :..~.,
furnished by licensed .~:: , I
practitioners, § 1396d(a)(6)
Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)
Anticipatory guidance, § 1396d(r) (1) (B) (v)
Transportation, § 1396d(a) (27)

Wraparound Service Pian Implementation: Once the wraparound service plan is established, those team members with specific aSSignments carry out their assigned responsibilities within the agreed timeframes. The services will be highly individualized, and wUI consist of both natural and formal supports.
The types of services provided will vary from child to child, and from team to team. However, the formal services that are provided may include (but are not limited to): diagnostic intellectual evaluations, comprehensive neurological evaluations, therapeutic behavioral support services, individual and family crisis planning and intervention services, parent coaching and .education, medication monitoring, intensive in-home, individual, group, and family therapy services, interactive

Any other staff operating within hislher scope of practice
Staff with BA/BS in MH related field or with 2 years experience in Mental Health
Staff without BA/BS in MH related field or with 2 years experience in Mental Health
CSW
MIT
MD(DO
PhD/PsyD
NP/CNS
RN
Student professionals with

Screening services, § 1396d(r) (1)(B)
Case-management services, § 1396d(a) (19)
Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r) (5)
Rural health clinic services, § 1396d(a) (2)(B)
Federally-qualified health center services, § 1396d(a) (2) (C)
Physician services, § 1396d(a) (5) (A)
Medical care or any other tYPe of remedial care

6

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 16 of 30 Page ID #:355

psychotherapy using play equipment, physical device, or other mechanisms of non-verbal communication, individual rehabilitation services, and day rehabilitation.

co-signature

Natural supports will also vary from child to child and team to team. One example of a natural support could be enrolling a child in basketbalUeague.

furnished by licensed , , 1
practitioners, § 1396d(a)(6)

2:
..',7;'"
~

Home health care services}:§

',-,'

1396d (a) (7)

\n

Clinic services, § 1396d(a) (9)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d (a) (13)

Certified pediatric nurse practitioner or certified family nurse practitioner services, § 1396d(a) (21)

Personal care services, § 1396d(a) (24)

Anticipatory guidance, § 1396d(r) (1) (B) (v)

Ongoing Crisis and Safety Planning: The wraparound facilitator leads the wraparound team through a crisis planning process.
Typically, a team meeting to develop the crisis plan is held a few days after the initial wraparound plan is developed.
,

Transportation, §

1396d (a) (27)

Any other staff operating Case-management services, §

within his/her scope of

1396d(a) (19)

practice

Such other necessary health

Staff with BA/BS in MH care, diagnostic services,

related field or with 2 years treatment, and other

experience in Mental

measures to correct or

Health

ameliorate defects and

physical and mental illnesses

Staff without BA/BS in and conditions discovered

MH related field or with 2 during screens, § 1396d(r) (5)

years experience in Mental

Health

Physician services, §

1;396d(a) (5)(A)

CSW

Medical care or any other

MIT

type of remedial care

furnished by licensed

7

• Case 2:02-cv-05662-AHM-SH Document 454

Filed 05/12/06 Page 17 of 30 Page ID #:356

MDIDO PhD/PsyD NP/CNS

practitioners, § 1396d(a) (6) r....i 11.1
Other di~gnostic, screeni~~, preventive, and rehabilitative services, § 1396d(a)(13) ::~~

RN

Tracking and Adapting the Wraparound Service Plan: The wraparound facilitator tracks assignment completion.
The facilitator also works with the team to modify the wraparound plan when appropriate.

Student professionals with co-signature Any other staff operating within his!her scope of practice
Staff with BAJBS in MH related field or with 2 years experience in Mental Health
Staff without BAJBS in MH related field or with 2 years experience in Mental Health
CSW
MFT
MDIDO

Case-management services, § 1396d(a)(19)
Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r) (5)
Physician services, § 1396d(a) (5) (A)
Medical care or any other type of remedial care furnished by licensed practitioners, § 1396d(a) (6)

PhD/PsyD NP/CNS RN

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Transition: The wraparound team ensures that children and families are appropriately transitioned from the wraparound services, either when the child leaves the children's mental

Student professionals with co-signature Any other staff operating within his!her scope of practice
Staff with BA/BS in MH related field or with 2 years

Screening services, § 1396d(r)(l) (B)
Case-management services, § 1396d(a) (19)

8

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 18 of 30 Page ID #:357

health system for the adult mental health system, or when the child and family no longer need formal supports.

experience in Mental Health
Staff without BA/BS in MH related field or with 2 years experience in Mental Health
csw
MIT

Such other necessary health

care, diagnostic services,

u
11.1

treatment, and other ~.:

measures to correct or U·:r ameliora te defects and ,':

physical and mental illnesses

and conditions discovered

during screens, § 1396d(r) (5)

Rural health clinic services, § 1396d(a) (2) (B)

MD/DO PhD/PsyD

Federally-qualified health center services, § 1396d(a)(2) (C)

NP/CNS
RN
Student professionals with co-signature

Physician services, § 1396d (a) (5) (A)
Medical care or any other type of remedial care furnished by licensed practitioners, § 1396d(a) (6)

Home health care services, § 1396d(a) (7)

Clinic services, § 1396d(a) (9)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Certified pediatric nurse practitioner or certified family nurse practitioner services, § 1396d(a) (21)

Personal care services, § 1396d(a) (24)

Anticipatory guidance, § 1396d(r) (1) (B)( v)

9

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 19 of 30 Page ID #:358

tt.

,

Transportation, §

Lli

1396d (a) (27)

:!i~ .. ';'"

-

10

Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 20 of 30 Page ID #:359
t)
III

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 21 of 30 Page ID #:360

Components of Therapeutic Foster Care
Ci
U..I
Therapeutic foster care is an intensive, individualized mental health service provided t~:'~
of
child in a family setting, utilizing specially trained and intensively supervised foster parents.

Therapeutic foster care programs: (a) place a child singly, or at most in pairs, with a foster parent

who is carefully selected, trained, and supervised and matched with the child's needs; (b) create',

through a team approach, an individualized treatment plan that builds on the child's strengths;

(c) empower the therapeutic foster parent to act as a central agent in implementing the child's

treatment plan; (d) provide intensive.oversight of the child's treatment, often through daily

contact with the foster parent; (e) make available an array of therapeutic interventions to the

child, the child's family, and the foster family (interventions may include behavioral support

, services for the child, crisis planning and intervention, coaching and education for the foster

parent and the child's family, mobile therapy for the child and child's family, and medication
monitoring); and (D enable the child to successfully transition from therapeutic foster care to

placement with the child's family or alternative family placement by continuing to provide

therapeutic interventions.

Therapeutic foster care is both a highly structured and highly individualized service. As

such, the components of the services are, by definition, unique to each child and family.

However, therapeutic foster care services often include the following:

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 22 of 30 Page ID #:361

Component
Recruitment and Matching: One task is the recruitment of families to serve as therapeutic foster parents, and then matching those families with children in need of a therapeutic foster home.
One matching technique is to recruit families with an existing relationship to the child.

Potential Provider(s) and Non-Recipient
Particioants Includel Any other staff operating within hisJher scope of practice
Staff with BAIBS in MH related field or with 2 years experience in Mental Health
Staff without BAIBS in MH related field or with 2 years experience in Mental Health, including therapeutic foster parents
CSW
MIT
MD/DO

E~d!;:ral StatutQrY u

Authorization [U '';''
(all citation§ tQ 12 U.S.G)

Screening services, §

!;;..
I,,)

1396d(r) (1) (B)

',/ I

Case-management services, § 1396d(a) (19)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Such other necessary ~ealth care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r)(5)

PhD/PsyD
.
NP/CNS

Anticipatory guidance, § 1396d(r) (1) (B) (v)

RN

Therat>etttic Foster Parent Training:

Student professionals with co-signature Any other staff operating Screening services, §

. 1 Rendering Providers: - CNS - Clinical Nurse Specialist DO - Doctors of Osteopathy CSW -Clinical Social Worker MD - Medical Doctor MFT - Marriage & Family Therapist NP - Nurse Practitioner PhD - Doctor of Philosophy, clinical psychologist PsyD - Doctor of Psychology, clinical psychologist PI - Psychiatric Technician

2

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 23 of 30 Page ID #:362

Before a child enters into the home of a therapeutic foster parent, the foster parent undergoes a pre-service training, during which the foster parent is taught how to use behavior management strategies.
When a child is placed in a therapeutic foster home, the foster parents receive ongoing supervision and support, similar to that given to therapist trainees.

within his/her scope of practice
Staff with BA/BS in MH related field or with 2 years experience in Mental Health
Staff without BA/BS in MH related field or with 2 years experience in Mental Health, including therapeutic foster parents
CSW
MIT

1396d(r) (1) (B)

U

Case-management

I..::L~'z"-l:

services, § 1396d(a) (19r.ri

Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r)(5)

Physician services, § 1396d(a) (5) (A)

MD/DO PhD/PsyD NP/CNS
RN

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a} (13)
Anticipatory guidance, § 1396d(r} (1) (B) (v)

Development of Treatment PIan:
Each child has a treatment plan that is both standardized and individualized. Age-appropriate limits are set for all of the children placed in therapeutic foster care settings. The plans are focused on the individualized strengths and needs of the child.
The plan guides the foster parents to be specific in the way they reinforce progress and to be consistent in setting limits and consequences. The plan engages children by building on their strengths.

Student professionals with co-signature Any other staff operating within his/her scope of practice
Staff with BA/BS in MH
related field or with 2
years experience in Mental Health
Staff without BA/BS in MH related field or with
2 years experience in
Mental Health, including therapeutic foster parents
CSW

Screening services, § 1396d(r} (1) (B)
Case-management services, § 1396d(a} (19)
Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r)(5}

3

- - - - - - --------

• Case 2:02-cv-05662-AHM-SH Document 454

Filed 05/12/06

•Page 24 of 30

Page ID #:363

Team meetings are held, during which the overall integrity of the child's treatment plan is monitored and reevaluated, and the sequencing and timing of interventions is planned.

MFT MD/DO PhD/PsyD

NP/CNS

Other diagnostic, C1

screening, preventive, a:l1d
rehabilitative services, §2:

1396d(a) (13)

(I)

Anticipatory guidance, § 1396d(r) (1) (B) (v)

RN

Tracking and Adapting the Treatment Plan: Therapeutic foster care coordinators provide intensive case monitoring, coordinate the efforts of the foster parents and the individual therapists.
They also maintain contact with the child's biological parents, teachers, psychiatrist, caseworkers, parole/probation officers, employers, and other important members of the child's community.

Student professionals with co-signature Any other staff opera ting within hislher scope of practice
Staff with BAJBS in MH rela ted field or with 2 years experience in Mental Health
Staff without BAJBS in MH related field or with 2 years experience in Mental Health, including therapeutic foster parents
csw
MFT
MD/DO
PhD/PsyD
NP/CNS
RN

Case-management services, § 1396d(a)(19)
Physician services, § 1396d(a)(5)(A)
Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r) (5)
Medical care or any other type of.remedial care furnished by licensed practitioners, § 1396d(a) (6)
Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Student professionals with co-signature

Anticipatory guidance, § 1396d(r) (1) (B) (v)

Transportation, §

4

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 25 of 30 Page ID #:364

Plan Implementation-Individual Child Treatment: On a day-to-day basis. the therapeutic foster parent is the primary agent who implements the child's treatment plan.

Any other staff operating within his!her scope of practice
CSW

1396d(a) (27)

(...1

L~I

:~::

.'''q,''

Screening services. §

~.I",
U

1396d(r) (1) (B)

rrj

Case-management services. § 1396d(a)(19)

In addition. individual mental health treatment is provided for all children in therapeutic foster homes. Natural supportS are also provided.

Therapeutic Foster Parent
MDIDO

The types of services provided will vary PhD/PsyD

from child to child. and from team to

team. However. the formal services MFT

that are provided may include (but are

not limited to): diagnostic intellectual NP/CNS (involved as

evaluations, comprehensive

needed)

neurological evaluations, therapeutic

behavioral support services. individual RN (involved as needed)

and family crisis planning and

intervention services, parent coaching Student professionals

and education. medication monitoring, with co-signature

intensive in-home, individual. group, (involved as needed)

and family therapy services. interactive

psychotherapy using play equipment,

physical device. or other mechanisms of

non-verbal communication. individual

rehabilitation services. and day

rehabilitation.

Natural supports will also vary from child to child and team to team. One example of a natural support could be enrolling a child in basketball league.

Such other necessary health care. diagnostic services. treatment. and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens. § 1396d(r) (5)
Rural health clinic services. § 1396d(a) (2) (B)
Federally-qualified health center services, § 1396d(a) (2)(C)
Physician services. § 1396d (a)(5) (A)
Medical care or any other type of remedial care furnished by licensed practitioners, § 1396d(a) (6)
Home health care services. § 1396d(a) (7)

Clinic services, § 1396d(a) (9)

Other diagnostic. screening. preventive. and rehabilitative services. §

5

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 26 of 30 Page ID #:365

1396d(a) (13)

c)

UJ

Certified pediatric nurs~~:

practitioner or certified :';

family nurse practitioner',

services, § 1396d(a)(21)

Personal care services, § 1396d(a) (24)
,
Anticipatory guidance, § . 1396d(r) (1) (B) (v)

Plan Implementation-Family Treatment: The ultimate goal of a therapeutic foster placement depends on the child's long-term plan.
If reunification with the child's family is the goal, therapeutic foster care programs prepare the family for when the child returns home.
To this end, where appropriate, family therapy is provided, and parents are taught how to use the behavioral management techniques used by the child's therapeutic foster family.

Any other staff operating within his!her scope of practice
CSW

Transportation, § 1396d(a) (27) Screening services, § 1396d(r) (1) (B)
Case-management services, § 1396d (a) (19)

Therapeutic Foster Parent
MO/DO (involved as needed)
PhOJPsyO (involved as needed)
MIT (involved as needed)
NP/CNS (involved as needed)
RN (involved as needed)

Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r) (5)
Rural health clinic services, § 1396d(a) (2) (B)
Federally-qualified health center services, § 1396d(a) (2) (C)

Student professionals with co-signature (involved as needed)

Physician services, § 1396d (a) (5) (A)
Medical care or any other type of remedial care furnished bv licensed

6

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 27 of 30 Page ID #:366

practitioners, §

1396d(a) (6)

1.:1 LLI

:~;::

Home health care servi2~s,

§ 1396d(a) (7)

~~:

Clinic services, § 1396d (a) (9)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Certified pediatric nurse practitioner or certified family nurse practitioner services, § 1396d (a) (21)
,
Personal care services, § 1396d(a) (24)

Anticipatory guidance, § 1396d(r) (1) (B) (v)

Transition: The therapeutic foster care coordinator ensures that children and families are appropriately transitioned from therapeutic foster care, either when the child and family no longer need therapeutic foster care, or when the child leaves the children's mental health system for the adult mental health system.
Many children transitioned from therapeutic foster homes receive wraparound care services. Usually the family therapy continues after the child leaves care and the biological family is encouraged to call if there is a crisis.

Any other staff operating within his/her scope of practice
Staff with BA/BS in MH related field or with 2 years experience in Mental Health
Staff without BA/BS in MH related field or with 2 years experience in Mental Health
CSW
MD/DO (involved as

Transportation, § 1396d (a) (27) Screening services, § 1396d(r) (1) (B)
Case-management services, § 1396d(a) (19)
Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered during screens, § 1396d(r)(5)
Rural health clinic

7

• Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 28 of 30 Page ID #:367

needed)
PhD/PsyD (involved as needed)
MFT (involved as needed)
NP/CNS (involved as needed)
RN (involved as needed)
Student professionals with co-signature (involved as needed)

services, § 1396d(a)(2)(B) (_~J ILl

Federally-qualified hea@

center services, §

<f,.J

1396d(a)(2) (C)

r,r:.

Physician services, § 1396d(a) (5) (A)

Medical care or any other type of remedial care furnished by licensed practitioners, § 1396d (a) (6)

Home health care services, § 1396d (a) (7)

Clinic services, § 1396d (a) (9)

Other diagnostic, screening, preventive, and rehabilitative services, § 1396d(a) (13)

Certified pediatric nurse practitioner or certified family nurse practitioner services, § 1396d(a) (21)

Personal care services, § 1396d(a) (24)

Anticipatory guidance, § 1396d(r} (1) (B) (v)

Transportation, § 1396d (a) (27)

8

Case 2:02-cv-05662-AHM-SH Document 454

• Filed 05/12/06 Page 29 of 30 Page ID #:368

PROOF OF SERVICE (:.1

2

KATIE A. v. DIANA B~NTA

lU

CV-02-05662 AHM ( Hx)

3

4 I am employed in the County of Los Angeles, State of California. I am over the

age of 18 and not a party to the within action;. my business address is : 370 I

5 Wilshire Blvd., Ste. 208, Los Angeles, CA 9uOlO

.

6

On May 2,2006, I served the foregoing document(s) described as:

7

rPROPOSEDl ADDENDUM TO ORDER GRANTING PLAINTIFFS'

MOTION FOR PRELlMINARY INJUNCTION

8

by placing the original _x_ a true copy thereof enclosed in a sealed envelope

9 addressed as follows:

10

SEE ATTACHED SERVICE LIST

11

On the above date:

12 X (By X U.S. MAILIBY 0 EXPRESS MAIL) The sealed envelope, with postage thereon fully prep'aid) was plac~d for coflection and mailing .following

13

ordmary busmess practices. I am aware that on motion of the

party served, service is presumed invalid if the postage

14

cancellation date or postage meter date on the envelope is more

than one day after the date of deposit for mailing set torth in

15

this declaration. I am readily familiar with Western Center On

Law And Poverty's practice for collection and processing of

16

documents for mailing with the United States Postal Service

and that the documents are deposited with the United States

17

Postal Service the same day as the day of collection in the

ordinary course of business.

18

BY FACSIMILE TRANSMISSION I caused such document to be

19

transmitted to the offices of the addressee(s) via facsimile machine, prior

to 5:00 p.m. on the date specified above.

20

21

(BY FEDERAL EXPRESS OR OTHER OVERNIGHT SERVICE) I

deposited the sealed envelope in a box or other facility regularly maintained

22

by the express service carrier or delivered tIle sealed envelope

to an autliorized carrier or driver authorized by the express

23

carrier to receive documents.

24

I declare under penalty of perjury that the foregoing is true and correct.

25

Executed on May 2, 2006 at Los Angeles, California.

26

27

28

\

, • ~«~"<.~-- - - - - - - - - - - - - - - - - - - - - - -
Case 2:02-cv-05662-AHM-SH Document 454 Filed 05/12/06 Page 30 of 30

Page ID #:369

2

SERVICE LIST

Cl
lu

3 BILL LOCKYER Attorney General of the State of California
4 JOHN H. SANDERS Lead Supervising Deputy Attorney General
5 SANDRA L. GOLDSMITH Supervising Deputy Attorney General
6 RfCHARD T. WALDOW De8uty Attorneys Gen~ral
7 30 S. Spring Street, 91 Floor, North Tower Los Angeles) California 90013-2501
8 (213) 897-2'156
(213) 897-2805 -Fax
9

Attorneys for Defendants DIANA BONTA, Director of California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

10 Count)' Counsel RAYMOND G. FORTNER, JR.
11 County Counsel ANDREW W. OWENS
12 Assistant County Counsel BRANDON T. NICHOLS
13 Deputy County Counsel Hall of Administration, Room 602
14 500 West Temple Street Los Angeles, California 90012
15 (213) 974-1938
(213) 687-4745 - Fax
16

Attorneys for LOS ANGELES COUNTY

17

18

19

20

21

22

23

24

25

26

27

28

-2 -

 </s> Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 1 of 34 Page ID #:428

fiLED CLERK, U.S. DISTRICT COURT

"

I ROBERT D. NEWMAN, SBN 86534

KIMBERLY LEWIS SBN 144876

2 RICHARD A. ROTHSCHILD, SBN 67356

WESTERN CENTER ON LAW & POVERTY 3 3701 Wilshire Boulevard,< Suite 208
Los Angeles, California ~OO I0

l'C:'.EBYN~_ TRA_ L 01+J:P.l-.ruivo..rlJi-t::y;o:l[Ij·Fi:'QcPR;UNrI~,.\

4 Telephone: (213) 487-7211

Send

_

FacsImile: (213) 487-0242

Enter

5

Closed

Attorneys for Plaintiffs

JS-5IJS-6 _

6
RAYMOND G. FORTNER, JR., County Counsel

JS-2/JS-3 _ Scan Only_

7 ANDREW W. OWENS, Assistant County Counsel

BRANDON T. NICHOLS) Senior Deputy County Counsel (SBN 187188)

8 648 Kenneth Hahn Hall or Administration

500 West Temple Street

9 Los Angeles, California 90012-2713

Telephone: (213) 974-1938

10 FacsImile: (213) 687-4745

11 Attorneys for County Defendants

12
UNITED STATES DISTRICT COURT
13
CENTRAL DISTRICT OF CALIFORNIA
14

15 KATIE A., by and thro~h her next

friend, Michael Ludin; ARY B., bb and

16 thro~ her next friend, Robert Jaco s;

JAN C., by and throuff her next

17 friend Dolores Johnson; ENRY D., by

and through his next friend Gillian

18

Browni and next fnend,

MGAicRhaYelEL.,u~Illa!nidndthivrioduugahllJh.i

19 and on behalf of other simi arly situate ,

CASE NO. CV -02-05662 ARM (ShX) FINDINGS OF FACTS AND CONCLUSIONS OF LAW RE SETTLEMENT AGREEMENT BETWEEN PLAINTIFFS AND
COUNTY; ORDER THEREON

20

Plaintiffs,

21

v.

22 DIANA BONTA, Director of California D~artment of Health Services~LOS
23 A GELES COUNT~ LOS A GELES COUNTY DEPART ENT OF
24 CHILDREN AND FAMILY SERVICES; ANITA BOCK, Director of the Los
25 AnJeles County Department of Children an Famil):: Services' RITA SAENZ,
26 Director of the California Department of Social Services; and DOES I through
27 100, Inclusive,

NOV 2 I2IJ08

28

Defendants,

HOA.402196.2

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 2 of 34 Page ID #:429

The Court's changes to the [ProposedI Findings and Conclusions,~~at 1..1
2 the parties lodged on October 30, 2006 are in bold typeface. In certain ~
,:t'
3 instances the Court has issued a ruling (c,g,., "OVERRULED"), but in other ,~I
4 instances the Court's response to the objection is reflected in changes to the

5 text.

6

I. Background on Settlement Agreement'

7

1. In July 2002, Plaintiffs Katie A., et al. ("Plaintiffs") filed this lawsuit

8 against defendants Los Angeles County ("County"), Los Angeles County

9 Department of Children and Family Services ("DCFS"), and Marjorie Kelly, then

10 interim DCFS Director (collectively referred to as "County Defendants"). The

11 lawsuit also was brought against the then current Directors of the California

12 Department of Health Services and California Department of Social Services

13 (collectively referred to as "State Defendants"). The original complaint alleged

14 claims for violations of the Early and Periodic Screening, Diagnosis and Treatment

15 ("EPSDT") provisions of the Medicaid Act [42 U.S.C. § 1396 et seq.], substantive

16 due process under the Fourteenth Amendment of the U.S. Constitution, Americans 17 with Disabilities Act [42 U.S.c. § 12132 et seq.], Section 504 of the Rehabilitation

18 Act [29 U.S.C. § 701 et seq.], substantive due process under Article I, § 7(a) of the

19 California Constitution, and California Government Code § 11135 et seq.

20

2. Shortly after the filing of this lawsuit, Plaintiffs and the County

21 Defendants entered into settlement negotiations. After protracted negotiations,

22 Plaintiffs and County Defendants entered into a Settlement Agreement

23 ("Agreement"). They sought Court approval for the Agreement in May of 2003.

24

25

26

IPlaintiffs and County Defendants have not provided specific evidential)'

27 references or citations to any findings of fact and conclusions of law where the

parties are in agreement unless sucfi finding of fact offers or references new

28 evidence not all'eady before this Court. Wnere specific findings are in dispute, the

specific references or citations to support such findings or objections are provided.

H0A.402l962

·2-

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 3 of 34 Page ID #:430

i

3. On July 16, 2003, following notice and a fairness hearing, the g,ourt

1.1
2 approved the Agreement as being fair, reasonable and adequate as to a Coui._j-tywide 3 class. The Stipulated Order provides that "[t]he Court shall retain jurisdicti'~fn to

4 enforce the accompanying Settlement Agreement between the parties until the case

5 has been dismissed pursuant to the terms of the Settlement Agreement." Stipulated

6 Order at ~4; see also Agreement at ~5 (Agreement is "binding and enforceable").

7

4. The definition of the Countywide class, as refined by the Court on

8 February 23,2004, includes children and young adults who:

9

(a) are in the custody of DCFS or in foster care or are at imminent

10

risk of foster care placement by DCFS; and

II

(b) are eligible for services under the Early and Periodic Screening,

12

Diagnosis and Treatment ("EPSDT") program of the Medicaid

13

Act as defined in 42 U.S.C. § 1396 et seq.; and

14

(c) have a mental illness or condition that is documented or, had an

15

assessment been completed, could have been documented; and

16

(d) need individualized mental health services, including [listing

17

services] ... and other medically necessary services in the home

18

or in a home-like setting, to treat or ameliorate their illness or

19

condition.

20

5. The central proviSion of the Agreement is Paragraph 6, which states

21 that the "objectives of this Agreement'are that members of the class shall":

22

(a) promptly receive necessary, individualized mental health services

23

in their own home, a family setting or the most homelike setting

24

appropriate to their needs;

25

(b) receive the care and services needed to prevent removal from

26

their families or dependency or, when removal cannot be

27

avoided, to facilitate reunification, and to meet their needs for

28

safety, permanence, and stability;

HOAA021962

-3-

-----------
Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 4 of 34 Page ID #:431

•
2
3 4

(c) be afforded stability in their placements, whenever possible, sinc .J .. U multiple placements are harmful to children and are disrQptive of ,!~
family contact, mental health treatment and the provision(of other ,l'l
services; and

5

(d) receive care and services consistent with good child welfare and

6

mental health practice and the requirements of federal and state

7

law. "

8

6. Paragraph 7 of the Agreement spells out some specific obligations to

9 which the County agreed, "inter alia," to "fulfill the objectives" of Paragraph 6.

10 Among the County's specific obligations are to "ensure that the needs of members

11 of the class for mental health services are identified and that such services are

12 provided to them," to "expand Wraparound Services," and to "enhance permanency

13 planning, increase placement stability and provide more individualized, community

14 based emergency and other foster care services to foster children ..."

15

7. Pursuant to the Agreement, the parties appointed a six-member expert

16 advisory panel (" Panel"). Among other tasks, the Panel was to "determine whether

17 the County has met the objectives set forth in Paragraph 6, and implemented the

18 plans set forth in Paragraph 7." The Panel was also required to make regular writte

19 reports to the parties and Court of its findings and recommendations. At the end of

20 the two years, the Panel was required to determine "whether the County Defendants

21 have fulfilled the objectives in Paragraph 6 and have met their obligations under

22 Paragraph 7, and are likely to continue to do so for the following twelve months." I

23 it was determined that the County had not complied with the Agreement, the County

24 was obliged to confer with the Panel to "develop a plan to address all areas of

25 non-compliance and to set deadlines for obtaining such compliance."

26

II. The First Two Years of Implementin2 the A2reement

27

8. In July of2005, County Defendants stipulated to extension of the

28 Panel's operations for at least one additional year.

HOA.402196.2

-4-

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 5 of 34 Page ID #:432

•

9. In August 2005, the Panel issued a two-year report finding that,tne

._,1

2 County had not complied with the terms of the Agreement. The Panel repo®d,

3 inter alia, that class members "are not receiving necessary mental health seJlces
,/,'
4 because their needs for those services are not being assessed ...and because

5 existing services are insufficient or inadequate" and that there "has been little or no

6 expansion of home and community based mental health services for the plaintiff

7 class." The Panel also found that the County lacks reliable information on the size

8 of the Plaintiff class or the extent to which their mental health needs are being met.

9 And, the Panel stated that the County has no means for tracking outcomes for the

10 class, such as the number of class members who are currently stable or are currently

11 receiving sufficient mental health services. With respect to the County initiatives

12 under Paragraph 7 related to mental health care, the Panel found them to be "either

13 quite small in scope or at the early planning stages and as a result, affect only a smal

14 portion of class members."

15

III. County's Compliance Plan

16

10. The County subsequently developed the County Plan, which it

17 contended will "achieve full compliance with the obligations of the Agreement."

18

II. In October 2005, however, the Panel informed the County that the

19 County Plan falls short of the requirements of Paragraph 19 of the Agreement. On

20 December 6,2005, the County responded in writing. The parties held a

21 teleconference with the Panel on December 12, 2005, to discuss the County's

22 response. On January 18, 2006, the Panel reiterated its concerns about the County

23 Plan. Despite a few areas of agreement, the Panel highlighted "many areas of

24 disagreement between the Panel and the County regarding the content, scope and/or

25 detail of the County's plan." "It underestimates the number of class members

26 needing intensive home-based services, fails to commit to sufficient expansion of

27 services to meet their needs and throughout lacks the level of detail about strategies

28 needed for the Panel to judge its efficacy." It "describes aspirations, not strategies."

HOA 402196.2

-5-

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 6 of 34 Page ID #:433

<-,.'~\

2

IV. Motion to Compel Compliance with Settlement Agreement ;~:I

3

12. On February13, 2006, Plaintiffs filed a Motion to Compel com~iiance

4 with the Settlement Agreement ("Motion").

5

13. On Februaly 27,2006, the County filed an opposition to the Motion as

6 well as a proposed order.

7

14. On June 15,2006, the Court entered an Order.

8

15. On July 31,2006, each party filed a response to the Order of June 15,

9 2006 addressing the contemplated modifications to the County Plan.

10

16. On September 6, 2006, a Status Conference was held. Melinda Bird

11 and Kimberly Lewis appeared on behalf of the Plaintiffs and Brandon T. Nichols

12 appeared on behalf of the County. Paul Vincent, chair of the Panel, was also

13 present. On October 18, 2006, the Court entered a subsequent order.

14

V. Screening and Assessment of Class Members

15

17. There are almost 40,000 children in the County receiving child welfare

16 services from DCFS, of whom approximately 23,000 are in out-of-home care.

17

18. Currently, six medical hubs are operational in some capacity throughout

18 the County to screen the needs of children who have been newly detained, i.e.

19 removed from their homes and in DCFS' custody. The hubs are not currently

20 screening all children who are newly detained for mental health needs. (Supplement I

21 Declaration ("Decl.") of Dr. Charles Sophy at ~4). Some children who are already

22 in out-of-home placements are screened through Team Decision- Making2 meetings

23 within DCFS regional offices. In addition, mental health staff who have been locate

24 in units within the DCFS offices in charge of "D-rate homes" have been assigned th

25 responsibility for screening and re-certifying foster children who have been placed i

26 those homes; a D-rate home is paid an enhanced rate for serving a child with severe

27

28

2A description is provided in the Glossary.

HOAA02196 2

-6-

----------
Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 7 of 34 Page ID #:434

•

mental health needs. As of June 2006, the D-rate unit staff had reviewed 152 newly

,,_.1

1.1
2 designated D-rate cases and referred 441 new and existing cases to mental h,,1-ealth

3 services; this unit had also reviewed 392 existing D-rate cases (re-certificatfun .,;">

4 services) to assess the need for additional mental health services and to provide case

5 management. (Exhibit ("Exh.") 300, attached to Supplemental Dec!' of Dr. Charles 6 Sophy).

7

19. The County plans to screen every child who now enters foster care to

8 determine the child's need for mental health services but has not provided a clear

9 timeline for accomplishing this task.

10

20. The County initially proposed, as benchmarks for compliance with the

11 Agreement, that 80 % of the children entering foster care be screened for mental

12 health needs within 60 days of their detention from their families, and that 80% ofth

13 children who have been screened positively - i.e. identified as needing mental health

14 services - be formally assessed within 90 days of their detention from their families

15 (or no more than 30 days after the screen). Citing numerous factors it claims are 16 beyond its control, the County subsequently proposed benchmarks of screening

17 90% of children" some time shortly after detention" and formally assessing 90% of

18 children "some time after a positive screen."

19

21. The foregoing benchmarks for compliance are inadequate. In

20 principle, the objectives of the County Plan should be full compliance, which

21 would require the County Plan to: (a) screen all [100%] of the children who are

22 entering foster care within 60 days of their detention from their families, and (b)

23 assess all [100%] of the children who have been identified as needing mental health

24 services within 30 days of their screening. Unless the County can demonstrate

25 that there are reliable methods to ascertain that certain new "entrants" into

26 the foster care system are not in need of immediate screening and assessment

27 and unless the County can demonstrate that it could identify who they are,

28 100% screening and assessment will be necessary.

HOA.402196.2

-7-

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 8 of 34 Page ID #:435

VI. Mental Health Needs of Children Who Have Not Been Removed

~::I

2

from Their Homes

.U i2

3

22. The Countywide class includes children and youth who are "at ~,

:/)
4 imminent risk of foster care placement by DCFS." While the Agreement does not

5 define what is meant by "imminent risk offoster care placement," the Court has

6 supplied such a definition for the statewide class in this lawsuit. For the statewide

7 class, the Court has defined "imminent risk of foster care placement" to mean that

8 "within the last 180 days a child has been participating in voluntary family

9 maintenance services or voluntary family reunification placements and/or has been

10 the subject of either a telephone call to the Child Protective Services hotline or some

11 other documented contact with the local Child Protective Services agency regarding

12 suspicions of abuse, neglect or abandonment."

13

23. There are approximately 17,000 children who are receiving child welfar

14 services in the County but who have not been removed from their homes.

15

24. The County has not presented the Court with any data regarding the

16 incidence of mental disorders among these 17,000 children and, in the absence of

17 evidence to the contrary, it is reasonable to assume that their mental health needs are

18 comparable to the mental health needs of children already in out-of-home

19 placements.

20

25. The County Plan does not provide for the screening and assessment of

21 these class members so long as they remain in their own homes. Nor does the

22 County Plan provide for any mental health services to these children.

23

26. One of the stated objectives of the Agreement is that members of the

24 class shall "receive the care and services needed to prevent removal from their

25 families or dependency ..." The Panel has stated that the County cannot

26 accomplish this objective unless it first identifies class members who live at home

27 and assess their needs, rather than waiting until their conditions deteriorate and their

28 needs become obvious.

HOA.4021962

-8·

Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 9 of 34 Page ID #:436

27. County Defendants have offered no argument that the County PI~n

2 should not include provisions for these 17,000 children.

;ld

;~?:

3

28. The County's Plan should be amended to identify and address tli~

~""'t

4 needs of class members who have not been removed from their homes, including

5 both those with Serious Emotional Disturbance ("SED") and those with mental

6 health needs who have not been identified as SED.

7

VII. Mental Health Needs of Children Who Have Been Placed in

8

Foster Family Agencies

9

29. The Countywide class includes children and youth who have been

10 removed from their homes and placed with Foster Family Agencies ("FFAs"). 11 Placements in FFAs are common in the County, comprising approximately 40% of 12 all foster home (out-of-home) placements. According to County Defendants, 6,177

13 children had been placed in FFAs in the County as of November 2005.

14

30. In pleadings, the County had stated that the County Plan includes

15 provisions addressing class members who are placed in FFAs. However, the

16 documents which comprise the County Plan make no express reference to providing

17 mental health services to these children.

18

31. The Panel has repeatedly said that "it is concerned about the

19 inadequacy of intensive services for children in FFAs (where there is a high multiple

20 placement rate and a high rate of movement to residential care, indicating that the

21 children's needs and foster parents' needs are not met}." "There are many children

22 with trauma-linked behavior problems, which do not yet constitute serious emotiona

23 disturbance, that make children unmanageable for the inadequately trained and

24 supported relatives and FFA foster parents. These children and their caretakers

25 need much more attention" from the mental health system than they are currently

26 receiving, attention that usually amounts to only about one hour per week from a

27 mental health professional with 30-35 clients.

28

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 10 of 34 Page ID #:437

~

32. In its defense, the County has contended that "children in FF AS,.do not

._1

2 typically require intensive services," citing the study by the County's own m~tal

.::::'

3 health expert, Dr. John Lyons. In that study, Dr. Lyons found that a low ove"t1a' ll

4 percentage [10.6%] of children in FFAplacements are eligible for therapeutic foster

5 care ("TFC"). Dr. Lyons attributed this finding to the fact that many children in

6 FFA placements are newborns, infants and toddlers.

7

33. The Court, however, gives greater weight to the additional findings by

8 Dr. Lyons that the percent of children in FFA placements in the County who have

9 "actionable behavioral needs" at the time of initial placement ranged from more than

10 30% for the 6-9 years age group to more than 50% for the 16-17 years age group.

11 Similarly, the number of children who would be better served in TFC ranged from

12 10% of the 6-9 year olds to more than 35% of the 16-17 year olds.

13

34. Another credible, undisputed finding by Dr. Lyons is that "there was

14 infrequent evidence of much actual treatment" for foster children in the FFAs "other

15 than regular social work visits that appear to consist primarily of monitoring."

16

35. The County Plan, as currently written, is inadequate in its failure to

17 provide for the mental health needs of class members who are placed in FFAs.

18

VIII. Mental Health Needs of Children in Congregate Care

19

36. Congregate care is residential care for foster children provided in group

20 or institutional settings, as opposed to care for these children provided at home or in

21 their communities. Congregate care is often referred to as"group homes." Group

22 homes in California are classified into Rate Classification ("RCL") Levels of 1-14,

23 using a point system designed to reflect the level of care and services they provide.

24 The State of California's monthly foster care payments per child are $5613 for a

25 RCL 12 facility and $6371 for a RCL 14 facility.

26

37. As of the Fall of 2004, more than 100 young children below the age of

27 eight had been placed in group homes. While the County subsequently made

28

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 11 of 34 Page ID #:438

efforts to reduce the number of young children in group care, 405 children ag~s 12 .. ...,

2 and younger were still in group care at the end of August 2005.

;l;J:

.:_"

3

38. As of November 2005, there were 1,832 children in group home~ in the

:,t)

4 County. More than half of the children in group homes have been placed in RCL

5 facilities of 12 and above.

6

39. According to Dr. Lyons, more than half of the foster children who are

7 in RCL 12 and 14 facilities could be served in family settings if they received

8 intensive home-based services (e.g. wraparound).

9

40. The County Plan does not explain how the approximately 2,000

10 children in congregate care will receive the "new" intensive mental health services

11 when the County Plan only calls for 1,220 new intensive mental health services slots

12 Nor does the County Plan explain how the County intends to modify the existing

13 services to the 2,080 children/youth that it claims are already receiving intensive

14 mental health services.

15

41. The County Plan also does not clearly describe when and how foster

16 children in group care will be transitioned to family or home-based settings.

17

42. The County Plan, as currently written, is inadequate in that it does not

18 clearly describe how it provides for home and community-based intensive mental

19 health services, as alternatives to congregate care, especially for children who are

20 ages 12 and younger and those children placed in RCL facilities of 12 and above.

21

IX. Mental Health Needs of Children in D-Rate Homes

22

43. One concern of the Panel "has been the lack of sufficiently intensive

23 services to meet the needs of class members in D-rate homes which are foster

24 homes paid an enhanced rate (a "D-rate"). By definition and by County policy, thes

25 homes are only to be used for children "with severe and persistent emotional and/or

26 behavioral problems".

27

28

HOA 402)96.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 12 of 34 Page ID #:439

44. There are approximately 2,600 children living in D-rate homes. ,Vnder

,•• .1

2 the County Plan, half of the children in the D-Rate homes will receive

"ll

3 "intensive-level mental health services."

;/'1

4

45. In its County Plan, the County admits that "virtually all of the 2,000

5 children now in congregate care can be better served through a more intensive

6 mental health services model and that half of the 2,600 children in D-rate homes

7 can also be better served through a similar approach."

8

46. One concern of the Panel "has been the lack of sufficient intensive

9 services to meet the needs" of these class members in D-rate homes.

10

47. The County Plan assumes that many of the children in D-rate homes

11 have been inappropriately placed there and as a consequence only "half of the

12 children receiving the higher D-Rate foster care payment" will require

13 "intensive-level mental health services."

14

48. Only recently did Plaintiffs and the Panel receive a copy of the

15 above-mentioned declaration dated October 19,2006, of Dr. Charles Sophy.3

16

49. Based upon "his background, training, and experience," Dr. Charles

17 Sophy, DCFS' Medical Director, has now submitted a declaration in which he

18 expresses the opinion that the children in D-Rate homes "have historically been

19 subject to inconsistent, and variable quality mental health assessments" and that, "if

20 properly assessed approximately 50% of the children subject to D-rate payments

21 would be found to be better served through other means than intensive mental

22 health services." (Supplemental Dec!. of Dr. Charles Sophy at ~5)

23

The Court OVERRULES Plaintiffs' objection to this paragraph, which

24 merely paraphrases accurately what Dr. Sophy stated. The Court recognizes,

25 however, that his statement lacks evidentiary support.

26

27

lPlaintiffs did not have the opportunity to present evidence to respond to the

assertions contained in this new round of declarations from County officials, such

28 as Dr. Dr. Charles Sophy. Nor was the Panel afforded an opportunity to comment

on these declarations.

HOA.4021962

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---------
Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 13 of 34 Page ID #:440

50. The County Plan does not explain how the one-half of the childr~n ~.)
2 (1,300) in D-rate homes will receive the "new" intensive mental health servi~~s whe ,~::...
3 the County Plan only calls for 1,220 new intensive mental health serviees slQ~. No
"r,
4 does the County Plan clearly explain how the County intends to modify the existing

5 services to the 2,080 children/youth that it claims are receiving intensive mental heal h

6 servlces.

7

51. The County Plan, as currently written, is inadequate in that it does not

8 clearly describe how it will provide for the intensive mental health needs of children

9 who have been placed in D-rate homes.

l O X . Overall Mental Health Needs of Class Members

11

A. Estimates of Need

12

52. In general, the County plan has assumed that 50% of the 23,000

13 children currently in out-of-home placement (foster care) need mental health service.

14 Hence, the County Plan provides for 11,500 foster children to receive such services.

15

53. With regard to all the class members in out-of-home placement, the

16 County has conducted no assessment or study to determine what percentage of

17 them need mental health services.

18

54. The County has explained that the County's assumptions and estimates

19 of the number of class members, and the intensity of their mental health needs, were

20 developed for planning purposes. The County concedes that the actual number of

21 children with mental health needs, and the number of children with intensive versus

22 basic mental health needs, may be higher or lower than the planning-numbers 23 indicate. (Supplemental Dec!. of Dr. Charles Sophy at ~~ 5-9; and Supplemental 24 Dec!. of Gregory Leklitner at ~~ 3-6) In fact, officials with the County Department

25 of Mental Health ("DMH") have said that the incidence of mental health needs coul

26 range from as low as 35% to as high as 85%.

27

55. The Panel has reported that a recent federal study estimated that 85% 0

28 the children in California's foster care system have developmental, emotional or

HOA 402196.2

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behavioral problems and that other studies have shown that 50 to 80% of chi!s.lren in
••J
2 foster care require mental health treatment. Plaintiffs are concerned that the ~
3 County's projections of overall need for mental health services of children iQ~foster 'J;
4 care could eventually prove wrong by as much as 8,050 (85% of 23,000 is 19,550).

5

56. The Court finds that the above County assumptions and estimates of

6 need are sufficient for initial planning purposes. These projections should, however,

7 be modified soon after further evidence is adduced as to the actual mental health

8 needs of children in foster care.

9

B. Projections of Need for Basic v. Intensive Services

10

57. After subtracting the 7,130 foster children who are "already receiving

11 some form of mental health service" from the projected 11,500 foster children who

12 need services, the County has projected a need to provide new services to the 13 remaining 4,370 children in foster care: 1,220 new children will receive intensive-Ie el

14 services and 3,150 new children will receive basic-level services.

15

58. The County has reached these figures by projecting that the percentage

16 of these 4,370 additional children in foster care who will require basic services

17 versus intensive services will be the same as the percentage of the 7,130 children in

18 foster care who are currently receiving basic services (71 %) versus intensive service 19 (29%).

20

59. The County Plan therefore creates approximately 1,220 new "slots" for

21 intensive in-home mental health services and 3,150 new "slots" for basic level menta

22 health services. None of these slots are intended for the 7,130 foster children who

23 are currently receiving some form of mental health services from the County.

24

60. The County has not conducted any formal study to confirm that these

25 7,130 foster children are being adequately served at the present time. And, the

26 County has not conducted any formal study to determine what percentage of

27 children in out-of-home placements need mental health services. Instead, it has relie

28 on its own past experience with this population and published research and reviews.

HOA.4021962

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 15 of 34 Page ID #:442

Supplemental Decl. of Dr. Charles Sophy at ~~ 5-9; and Supplemental Dec!. Qf

2 Gregory Lecklitner at ~~ 3-6)

eL-i'

3

61. Only recently did Plaintiffs and the Panel receive copies of the

~r"'1

4 above-mentioned supplemental declarations of Dr. Charles Sophy and Gregory

5 Lecklitner.

6

62. According to new declarations from County officials, the County

7 anticipates that not every child in congregate care will actually require intensive

8 mental health services and that the County's assumptions and estimates of the

9 number of class members, and the intensity of their mental health needs were

10 developed for planning purposes. The County concedes that the actual number of

11 children with mental health needs, and the number of children with intensive versus

12 basis mental health needs may be higher or lower than the planning-numbers indicat .

13 (Supplemental Del. of Dr. Charles Sophy at ~~ 5-9; and Supplemental Decl. of

14 Gregory Lecklitner at ~~3-6). The Court OVERRULES the County's objection

15 to this paragraph, for the reasons stated as to paragraph 49.

16

63. The County admits that "there are a number ofthe 7,130 children/youth

17 who are currently receiving services that lack the intensity, duration, and

18 comprehensiveness that they require."

19

64. In its Plan documents, the County also admits that "virtually all of the

20 2,000 children now in congregate care can be better served through a more intensive

21 mental health services model and that half of the 2,600 children in D-rate homes can

22 also be better served through a similar approach."

23

65. In the Panel's opinion, the County Plan "underestimates the number of

24 class members needing intensive home-based services", "fails to commit to sufficien

25 expansion of services to meet their needs" and has found that 'basic' mental health

26 care is inadequate for most foster children as it lacks intensity, is oflimited duration,

27 and does not comprehensively address children's needs.

28

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1

66. The Panel has similarly found that the mental health services cunently

.-'

2 provided to children in foster care in the County are inadequate and that mos~ofthe

2'

3 11,500 children/youth that the County has projected to need mental health seryices ;,r.

4 "must have intensive services, including home-based services, to be stable and

5 functioning well."

6

67. The Panel has also found that the County's current mental health data

7 information system is unreliable and inadequate. Further, the Panel has stated that

8 the County does not, in any comprehensive way, currently track which specific

9 mental health services foster children are receiving, whether the children's needs are

10 being met, and whether the children's mental health condition is improving.

11

68. The County Plan does not adequately describe existing mental health

12 services and apparently asserts that some existing services, such as the RCL 12 and

13 14 facilities and locked Community Treatment Facilities ("CTFs"), are an adequate

14 substitute for intensive home-based services.

15

69. The idea that the mental health services provided to foster children in

16 RCL 12 and 14 facilities and CTFs are "equivalent" to the intensive services that

17 could be provided to these children in home-based settings appears to be

18 inconsistent with one of the objectives of the Agreement that class members "receiv

19 necessary, individualized mental health services in their own home, a family setting r

20 the most homelike setting appropriate to their needs." It would be the County's

21 burden to demonstrate that RCL 12 and 14 facilities and CTF's may be the most

22 home-like setting appropriate to the clinical needs of some class members.

23

70. The County's assumption that none of the foster children currently

24 receiving basic services require more intensive services currently is unsupported by

25 any data, evidence or study. The relative percentage of children receiving basic,

26 versus intensive, mental health services may be a reasonable estimation, based upon

27 actual experience with the population of children in Los Angeles County, but these

28

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 17 of 34 Page ID #:444

numbers cannot and do not represent conclusive findings of the Court. Th~y are,

"-~
2 however, permissible factors to consider for planning purposes only. ~

.t:.

3

71. The Panel concluded that the County Plan "underestimates the n"ul' mber

iFI

4 of class members needing intensive home-based service" and "fails to commit to

5 sufficient expansion of services to meet their needs." Exh. 165 (letter) at 1. The

6 Court agrees that the County Plan must be modified to consider the mental health 7 needs of children who are receiving child welfare services from the County but who

8 have not been removed from their homes. The Court finds, however, that for

9 purposes of plan development only, the County's estimates regarding the number 10 of class members in out-of -home care who require intensive home-based mental

11 health services are reasonable. The County is on notice that it will not be dismissed

12 from this lawsuit until it has developed sufficient county-wide service capacity to

13 provide intensive mental health services, for those class members who need such 14 services, in the most home-like setting appropriate to each class members' need,

15 whether this number exceeds initial County estimates or not.

16

XI. Wraparound Services

17

72. Wraparound services are defined in the Welfare and Institutions Code

18 as "community based intervention services that emphasize the strengths of the child

19 and family and [that] include[] the delivery of coordinated, highly individualized

20 unconditional services to address needs, and achieve positive outcomes in their

21 lives." Welf. & Inst. Code § 18251 (d).

22

73. In granting a preliminary injunction against the State in the case, this

23 Court found that wraparound services include a) a unique assessment and treatment

24 planning process that is characterized by the formation of a child, family, and

25 multi-agency team, b) marshaling of community and natural supports through

26 intensive case management, and c) the availability of an array of therapeutic

27 interventions, which may include behavioral support services, crisis planning

28 intervention, parent coaching and education, mobile therapy, and medication

HOA 402196 2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 18 of 34 Page ID #:445

monitoring and that they may be medically necessary for foster children with,.rnental

2 health care needs. Katie A.v. Bonta, 433 F.Supp.2d 1060, 1076-78 (C.D. Ca~"""

3 2006).

:~

~

4

74. The County has determined that its wraparound services program is

5 effective. In 2004, the County conducted an outcome study of twelve (12) randomly 6 selected wraparound participants in its program and found that II of the 12 to be

7 doing well. Another study of two groups of 52 children - one group that received

8 wraparound services and the other that did not - found the recidivism rate back into

9 group care for the children in wraparound to be only 17% while those without

10 wraparound services had a 74% recidivism rate. The County has found the II program to be an extremely effective delivery model to serve children and to maintai

12 them in their homes and community settings, thereby reducing the need to more

13 costly out of home care. Exh. 30 I at 4-7, (Minutes from March 20, 2006 General

14 Meeting of the Los Angeles Commission for Children and Families).

15

75. As of February 28,2006, there were approximately 539 children

16 enrolled in the Wraparound program. Exh. 302 at 4, (Board of Supervisors Letter, 17 dated April 18, 2006). In April 2006, the County announced an expansion in its

18 wraparound program that had the potential to result in almost 1000 new slots by 19 April 2009. ld. DCFS projects enrollment levels to reach approximately 800 by 20 April 30, 2007, 900 by April 30, 2008 and 1000 by April 30, 2009. Id.

21

76. Thirty-four (34) providers offered to contract for a minimum of 25 new

22 wraparound slots each. (Decl. of Michael J. Rausa). Several providers proposed to

23 expand by 100 slots or more. In May 2006, the County initiated a start-up phase

24 permitting providers to start with one Service Planning Area ("SPA") and one team,

25 serving eight (8) children, for an increase of only 262 slots, until the County and

26 provider was comfortable with wraparound model fidelity. (Dec!. of Dr. Michel 1. 27 Rausa at ~~ 2 and 3.)

28

HOA.402196.2

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77. In the first month of the new expansion, new providers, and exist._i,ng
2 providers moving into new areas of the County, were referred one new child Qbr
.'::
3 team by the County. (Dec!. of Dr. Michel J. Rauso at ~ 3.) In the following two
\/~I
4 months, these providers were each referred two new children per month per team. Id.

S As of August 31, 2006, total wraparound capacity in the County reached 644 slots

6 and as of September 30, 2006 total capacity was at 674 slots. Id.

7

78. On October 1,2006, the County and the providers started an

8 expansion plan, which allows the providers to increase the number of service slots to

9 contract limits of capacity. (Decl. of Dr. Michel J. Rauso at ~~ 2 and 3.)

10

79. The County has not yet identified how many wraparound slots will be

II added in the expansion phase, other than what was projected in the Board of

12 Supervisor's April 2006 letter. (Exh. 302).

13

80. The initial 262 slots will bring overall capacity to 800 wraparound

14 service slots. Exh. 302 at 4. The additional slots are, however, not limited to class

15 members and only include children who are in or at risk of placements at RCL 12 or

16 above.

17

81. In August of 2005, the Panel recommended an expansion in wraparound

18 services for class members: 500 additional slots for a total of 1000 slots by June 30,

19 2007 and another 500 by June 30, 2008. The Panel also recommended that the

20 County "should expand eligibility for Wraparound services to include children who

21 do not have intact families and those placed in level 10 and above residential

22 settings."

23

82. Paragraph 7 of the Agreement expressly requires the County to "expand

24 wraparound services" as one measure to meet the objectives of Paragraph 6 of the

25 Agreement. The County has begun in good faith to fulfill, but has not completely

26 fulfilled, these terms of the Agreement by its above-mentioned efforts to expand

27 wraparound services.

28

HOA 402196 2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 20 of 34 Page ID #:447

83. The Court adopts the Panel's recommendation that wraparound ,'~ • ..J
2 services should ultimately be made available to class members who are in or,fat risk :?
3 of placement in facilities of RCL 10 and above and/or who do not have intac.t;
;/~I
4 families.

5

84. The Court also ORDERS that the County achieve a further

6 increase of not fewer than 500 wraparound slots by June 30, 2008. Such an

7 increase reasonably reflects the current needs of the class and the requirements of

8 the Agreement. The Court further finds that this expansion can be accomplished in a

9 well planned and orderly fashion consistent with high quality and good outcomes.

10

XII. Therapeutic Foster Care

II

85. Plaintiffs have given the following description ofTFC:

12

Therapeutic foster care is an intensive, individualized mental health service

13 provided to a child in a family setting, utilizing specially trained foster parents.

14 Therapeutic foster care programs: (a) place a child singly, or at most in pairs, with a

15 foster parent who is carefully selected and matched with the child's needs;

16 (b) create, through a team approach, an individualized treatment plan that builds on

17 the child's strengths; (c) empower the therapeutic foster parent to act as a central

18 agent in implementing the child's treatment plan; (d) provide intensive oversight of t e

19 child's treatment, often through daily contact with the foster parent and child; (e)

20 make available an array of therapeutic interventions to the child, the child's family,

21 and the foster family (interventions may include behavioral support services for the

22 child, crisis planning and intervention, coaching and education for the foster parent

23 and the child's family, mobile therapy for the child and child's family, and medicatio

24 monitoring); and (f) enable the child to successfully transition from therapeutic foste

25 care to placement with the child's family or alternative family placement by continui g

26 to provide therapeutic interventions. Katie A, v Bonta, 433 F.Supp.2d at IOn. This

27 Court has previously found that TFC may be medically necessary for foster children

28 with mental health care needs. /d, at 1076-78.

HOAA02196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 21 of 34 Page ID #:448

86. The Panel has recommended that the County Defendants implelll~nt .~)
2 TFC to address the unmet needs of SED children placed in congregate care settings
3 inappropriate to their needs. In August of2005, the Panel recommended the ~~t
\,',1
4 development of300 TFC slots by June 30, 2007, with an additional 200 slots by Jun

5 30,2008.

6

87. The entire County is divided into eight different SPAs. As part of

7 Phase One of the County Plan, on June 30, 2006, the County issued a Request for

8 Services ("RFS") to add 80 Multidimensional Treatment Foster Care slots for

9 Intensive In-home Mental Health Services for DCFS clients in three of the eight

10 SPAs of the County. Supplemental Decl. of Gregory Lecklitner at ~7.

11 Multidimensional Treatment Foster Care is a particular model ofTFC chosen by the

12 County because it is widely recognized as the most proven, highest quality, model.

13 The County has generally committed to further expansion of Multidimensional

14 Treatment Foster Care in Phase Two of the County Plan, but has not yet projected

IS any specific service capacity for this program pending an evaluation of the

16 effectiveness and utility of Multidimensional Treatment Foster Care in Phase One.

17 The County currently has no plans to adopt any other form of treatment foster care.

18 (Supplemental Declaration of Gregory Lecklitner at ~ 7)

19

88. Paragraphs 6 and 7 of the Agreement requires the County to "provide

20 more individualized, community-based emergency and other foster care services to

21 foster children," so that class members are "afforded stability in their placements,"

22 and "promptly receive necessary, individualized mental health services in ... the

23 most homelike setting appropriate to their needs."

24

89. The County acknowledges that an increase ofjust 80 TFC slots alone

25 does not meet the mental health needs of class members and thus does not satisfy

26 the requirements of the Agreement.

27

28

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 22 of 34 Page ID #:449

90. The Court finds that the Panel's recommendations are reasonable and

':~~I

2 that the County should provide class members with not fewer than 300 TFd~lots

'p

3 by January 1, 2008.

:~;

~(',

4

XIII. Traininl:

5

91. The Panel has stated that reforming a child welfare system begins with

6 the employees who provide services. The Panel has repeatedly emphasized that the

7 County needs to change the training of front-line staff to implement the Agreement

8 successfully. See, e.g., Fifth Panel Report at 25-28. Meeting class members' needs

9 requires "change in practices among thousands ofDCFS, DMH and provider staff."

10 In the Panel's opinion, the County must "undertake a major training initiative,

11 including both skills-based and hands-on training for DCFS and DMH staff, as well

12 as staff at private agencies."

13

92. The Panel has found that DCFS' efforts to train line staff to implement

14 the Agreement have been "essentially superficial," adding that current DCFS trainin

15 does not effectively impart the foundations of good practice engaging families, 16 effective teaming and coordination, thorough assessment of strengths and needs,

17 individualized planning, and effective interventions. Relying heavily upon brief,

18 large-group instruction, the training does not help staff acquire discrete skills. The

19 Panel believes that, as a result, training does little if anything to improve caseworker'

20 ability to serve children with mental health needs,

21

93. The County Plan does not provide the training recommended by the

22 Panel. The County contends that it is not obliged by the Agreement to adopt any

23 particular training. The County also contends that the State mandates the current 24 curriculum, and it claims that additional training would wastefully require the

25 allocation of many resources. The Panel noted that there is no "regulatory 26 impediment to improving the current curriculum as long as key State requirements ar

27 retained." In the Panel's opinion, "the provisions of Paragraph 6 will not be 28 achieved unless through training or other means, the quality of practice is improved."

HOAA02196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 23 of 34 Page ID #:450

94. The County maintains that the Settlement Agreement does not r~guire 2 the adoption of specific training approach and that the current County trainin-~'
.:z.
3 process, developed in cooperation with local universities, is adequate to mee('ihe
0'.
4 needs of the Class.

5

95. The County should elicit feedback from those DMH and DCFS

6 workers who have received training to provide the mental health covered by the

7 County Plan, and should share that feedback with the Panel.

8

96. This gathering of information should be helpful to uncover any

9 limitations of the current training curriculum to provide skills-based training as well s

10 improve front-line practice, as outlined by the Panel. Fifth Panel Report at 25-28.

11 The Court OVERRULES the County's objection to this paragraph.

12

XIV. Funding of Services

13

97. The County proposes to fund the County Plan primarily with EPSDT

14 funds through Medi-Cal. Approximately $1.8 million of County-only funds out of a

15 total cost of $19,024,000 is being designated for Phase One of the County Plan.

16 The County also proposes to use a portion of its Mental Health Services Ad funds,

17 but has yet to provide clarity about the amount of those funds or the use to which

18 they will be put. The County also plans to use the remaining "MacLaren Designatio

19 Funds," created by Paragraph 7(g) of the Agreement, and possibly Senate Bill No. 20 163 funds.5 The County Plan is similarly unclear about the amount or use of these

21 funds.

22

98. Based on the information provided by the County, the Panel found that

23 the funds committed by the County Plan are "insufficient to meet the number and
24 _ _ _ _ _ _ __

25

4Welf. & lnst. Code § 5878.1-5878.3. [See Glossary for description of the

Act].

26

5Senate Bill No. 163 ("SB 163"), Stats. 1997, Ch. 795, §§ \-\0. Under SB

27 163, the funding for wraparound services consists of 40% from the state and 60%

from the counties. Under this statutory scheme, a child who is currently placed qr

28 would be placed in a RCL facili!), of 10 or higher is eligible for wraparound services

Welf. & Inst. Code § 18251(c)(3).

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 24 of 34 Page ID #:451

needs of plaintiff class members." The Panel also found that: the County hasJailed
",J
2 to pursue available funding opportunities; the County has not "engaged the FR:A's in ~:::
3 delivering new, more effective services ... , is not maximizing Medical/Medi~aid
;/"'I
4 reimbursement or IV-E training dollars, and has been slow to consider a

5 comprehensive strategy for reinvesting savings from reduced placement costs into

6 front-end services." The "Panel has identified ... a significant opportunity to 7 expand mental health services by making more efficient use of the federal Early

8 Periodic Screening, Diagnosis and Treatment (EPSDT) dollars." And, the Panel

9 notes, "[t]he County has access to federal financial resources that could be used to

10 expand intensive home-based services."

11

99. The Panel has previously made numerous recommendations about ways

12 the County can maximize its funding opportunities, including securing state and

13 federal EPSDT funding and Title IV-E federal reimbursement. For example, the

14 Panel recommended that the County retain consultants to help maximize Title XIX 15 and Title IV-E funding, as well as an expert in clinical utilization management to hel

16 the County reduce the needless use of institutional and congregate care. In the

17 Panel's opinion, the County's "use of expert technical assistance [is] vital to [the

18 County's] generating sufficient funds to permit compliance with Paragraph 6 of the

19 Settlement Agreement."

20

100. The Panel has also recommended that the County reinvest its savings

21 from the reduced reliance on group care and into front-end services.

22

101. Thc County has pursued a waiver of regulations restricting how Title

23 IV-E funds may be spent. The waiver will allow the County to utilize federal funds,

24 previously available when children were removed from their homes, to provide some

25 families with services to avoid the need for removal of the child from the home and

26 to keep the family intact and the child safe. Examples of these services include:

27 training and intervention to improve parenting skills; mental health and addiction

28 services; and other innovative services that are aimed at keeping families united. Th

HOA 402196 2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 25 of 34 Page ID #:452

State and Federal Government have reached agreement on the details of the 'Yjl-iver

2 and the current target date to begin implementation is sometime between OctQber 1, .~ ,1;'
3 2006 and January 1,2007. The County has also adopted some of the Panel's :,";
:,("1
4 recommendations regarding funding. However, citing a number of concerns,

5 including the risks of audit disallowance, the County has not undertaken to act on

6 several any of the Panel's above-mentioned recommendation or suggestions. Exhibit

7 302. (Title IV -E Child Waiver Demonstration Project Questions and Answers).

8

102. The County should continue to evaluate the Panel's proposals to obtain

9 additional or new funding and seriously consider pursuit of any proposals the Panel 10 recommends.

11

103. The County Plan should be updated to include information about how

12 the County intends to redirect funds saved through the newly approved federal IV-E

I3 waiver, which potentially gives the County much greater flexibility to spend funds 0

14 services for class members.

15

XV. IBHIS System

16

104. The County is acquiring an Integrated Behavioral Health Infonnation

17 System ("IBHIS") to make more clinical information available electronically, such a

18 patient medical records. In April 2006, the County Board of Supervisors approved

19 retention of a consultant to assist the DMH with design specifications and

20 procurement of an IBHIS. The County currently projects IBHIS to begin operation

21 in December, 2008. Decl. of Robert Greenless at ~ 2.

22

105. The County Plan states that, in the future, the County will track some

23 information about class members through assigned mental health case managers who

24 are located in the same offices with DCFS case workers. The County Plan also

25 discusses the development of a standardized tool to monitor the status of children

26 receiving services who are determined to be SED ("outcomes measurement tool").

27 This tool would collect data on a class member's social functioning, educational

28 performance, and mental and physical health which would be centrally stored and

HOA.402196,2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 26 of 34 Page ID #:453

which could be analyzed. In a newly submitted declaration, the County expl~ips that
2 its intended use of this tool has now been expanded to encompass all class m~~ber 3 children newly receiving services under the County Plan. (Supplemental Decf~"ration
:/"~.
4 of Gregory Lecklitner at ~ 9.) The County Plan, as originally written, or as recently
5 described, does not adopt any data collection or class survey recommendations of

6 the Panel, and does not contemplate use of the outcomes measurement tool for 7 children who are already receiving mental health services.

8

106. The Panel has found that there is an "urgent need to monitor progress"

9 that "cannot wait until DMH completes its new automated system in 2008." The 10 "ability to track" basic information about the Plaintiff class "is crucial" to determinin 11 the County's compliance with the Agreement. The Panel has stated that the County

12 has not implemented these measures. As a result, the Panel has concluded that the

13 County can neither identify accurately the size and needs of the class nor track the

14 impact of initiatives on the class. The Panel concluded that there is "no reliable

15 method for tracking the long term outcomes of the plaintiff class, for assessing the

16 degree to which their current status is acceptable, for evaluating the quality ofDCFS

17 and mental health services or the types, intensity and duration of the mental health

18 services they receive. "

19

107. The Panel has previously described the need and use for data to assess

20 progress under the Agreement. Because the DCFS data system cannot identify

21 whether children have been screened or assessed as needing mental health services,

22 the Panel and DCFS had previously agreed that DCFS would track a group of

23 children who were known to have mental health service needs based on

24 characteristics that DCFS could track. This group included, for example, children

25 placed in treatment facilities and children in D-rate homes. While this group is

26 considerably smaller than the total Plaintiff class, it could theoretically provide some

27 basis for tracking and evaluating the County's performance in implementing the

28 Agreement. Although, as agreed, DCFS has provided the Panel with specific data

HOA 402196 2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 27 of 34 Page ID #:454

about this proxy population, the data lacks infonnation about the specific mel),.tal

....1

2 health services these children receive or the efficacy of these services.

~~I

."-

3 Moreover, DMH lacks such infonnation, making it difficult to assess progres£,even

~,"'I

4 for this small proxy group.

5

I08. The County's plans are flawed. It is unclear how the activities of case

6 managers wiII result in any actual tracking or evaluation of the plaintiff class becaus

7 the Plan does not describe how infonnation wiII be collected and evaluated. While

8 the County's plan to use a standardized tool is promising, it is an incomplete

9 solution. The scope of the County's intended use of the tracking tool remains 10 unclear as is the time line for actual implementation of the tool. Exh. 163 at 3, 6-7.

11

109. The County has contended that a more fonnal system for identifying

12 and tracking infonnation about the Plaintiff class is unnecessary because the County 13 intends to screen every child who enters foster care system to detennine the child's

14 needs for mental health services. Exh. 170 at 2-3.

15

110. Nevertheless, the fact that County staff are screening children provides

16 no guarantee that children who require services wiII actually receive them. The entir

17 point of the tracking system recommended by the Panel is to allow the County to

18 detennine whether its strategy of screening children is actuaIIy working, that is,

19 whether the screening is identifying children with mental health needs and whether t e

20 children who are screened actually are appropriately assessed and served. Second,

21 the County's screening strategy is focused on children who wiII enter foster care, not

22 those already in foster care. The County has not offered any assurances that there

23 wiII be a system for identifying children already in care who need mental health

24 services and for having them properly assessed and served. Moreover, to the extent

25 the County has any plan to address this need, the County has proposed no way to

26 track whether its plan is working.

27

111. The County previously agreed with the Panel to track class members

28 and outcome indicators for a subset of class members known to need mental health

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 28 of 34 Page ID #:455

services by matching data from both the County DCFS and DMH. Exh. 304 (April
--I
2 27, 2004 letter from C. Pratt to Paul Vincent). The County shall attempt in g~od
z:
3 faith to extend such tracking, using the previously agreed upon indicators,10 all
',f';,
4 class members and the County will be expected to provide reasonably

5 meaningful "outcome indicators" to plaintiffs even before the IBHIS is fully

6 operational. Although the Court declines to order the County to require

7 altogether new data collection mechanisms, it expects the County, on an

8 ongoing basis, to evaluate the data it already is collecting to comply with this 9 provision.

10

XVI. Qualitative Service Reviews

11

112. The Panel has stressed the need for an in·depth review of the quality

12 and impact of the mental health services being provided class members. The Panel

13 has urged that DCFS participate in a qualitative service review ("QSR") focusing on

14 200 class members, selected randomly but stratified according to various 15 characteristics.

16

113. The Panel has found that the State mandated case review process is

17 different from, and not duplicative of, the QSR and described those differences in 18 detail in its Third Report.

19

114. The Panel has stated that the QSR process is the primary process used

20 throughout the nation to monitor "service fidelity and client outcomes" in systems

21 serving foster children and children with mental health needs. Such QSRs have been

22 conducted in at least 14 other states. The Panel explained that, in seven of those

23 states, they have been conducted as part of monitoring progress and compliance in

24 class action litigation.

25

115. According to the Panel, the proposed QSR could "quickly and reliably

26 identify the strengths and weaknesses of [ ] services to the plaintiff class and more

27 importantly, point to the strategies that would enable class members to be served

28 consistently with the settlement agreement."

HOA.4021962

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 29 of 34 Page ID #:456

116. The County objects to such a QSR. Instead, the County asserts ~at it ,.~
2 regularly conducts quality assurance reviews as required by the State and thatlihe
,:..~
3 review proposed by the Panel would be duplicative. Further, the County claiIbs that
~,"':I
4 the universal-screening and outcomes-measurement-tool features of the County Plan

5 will provide it with reliable and accurate information about the Plaintiff Class.

6

117. The County has also indicated it plans to contract with a local university

7 to conduct an evaluation of County Defendants' implementation of the County's

8 Plan. The County has indicated that this study will not do any reviews of the actual

9 services provided, as does a QSR.

10

118. The Panel has explained its views on why the proposed QSR is needed

11 and how it differs from the County's quality assurance reviews. Quantitative data 12 "must be paired with an approach to examine qualitative factors. .. [T]he qualitativ

13 review approach helps identify why outcomes are not being achieved, information

14 vital to developing plans for corrective action. It is the opinion of the Panel that [the 15 qualitative review] processes should be in place to measure progress, to identify

16 barriers to progress and to strengthen accountability."

17

119. At this time the Court declines to order that the County develop a

18 QSR.

19

XVII. Exit Criteria

20

120. County Defendants believe that establishing measures of compliance

21 with the Agreement is necessary. Exh. 170 at 7-8. To that end, the County had

22 previously proposed the following goals: (I) reduce the percentage of children in

23 congregate care to a level below Philadelphia, New York, and Chicago; (2)

24 demonstrate a 10% increase in the number of children receiving intensive

25 home-based services since entry of the Agreement; (3) place at least 60 children into

26 a treatment foster care program; (4) screen 80% of the children for mental health

27 needs within 60 days of their removal from family; and (5) formally assess 80% of

28 children with a positive screen for mental health needs within 90 days. Citing

HOA.402196,2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 30 of 34 Page ID #:457

numerous factors it claims are beyond its control, the County subsequently ~:l
2 proposed benchmarks of screening 90% of children "some time shortly after ~
z
3 detention" and formally assessing 90% of children "some time after a positive.S
:,1")
4 screen".

5

121. The County concedes that above-mentioned criteria do not constitute

6 compliance with the Agreement.

7

122. The Court has found that comparison of the County to other

8 jurisdictions, while acceptable as a relevant factor of consideration, may not serve as

9 a fundamental feature for any plan to measure County progress.

10

123. The County's suggested goals are unambitious (e.g., a 10% increase

11 from the very low base of the number of children receiving intensive home-based

12 services; placement of only 60 children in TFC in one of the largest counties in the

13 U.S.). The goals also represent what could be described only as preliminary

14 measures (e.g., screening, assessment). The County could meet all these goals and

15 yet still deny most class members the mental health services they need. Exh. 165

16 (matrix) at 5. Moreover, these targets do not directly address other core objectives

17 of the Agreement, such as preventing children from being removed from their homes

18 affording stability in placements, and delivering services consistent with good child 19 welfare and mental health practice. Agreement at ~6(b)-(d) (Exh. 160). The County

20 acknowledges its obligation to develop a more comprehensive monitoring plan than

21 those measures previously proposed to the Court.

22

124. The Panel has proposed a three-fold measure of compliance: successful

23 completion of a meaningful implementation plan (i.e., a plan approved by the Court),

24 a passing score from a qualitative review, and acceptable progress on outcome

25 indicators. Before the Court adopts or approves with finality any "Exit 26 Criteria," it will require additional information, such as the impact of this set

27 of findings and conclusions on the County's compliance.

28

HOA.402J96.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 31 of 34 Page ID #:458

XVIII. Corrective Measures by the County and the Panel

,',

-"

2

125. The Agreement provides that the Court will dismiss the CompladIt

;;~:.

3 against the County Defendants and terminate its jurisdiction of the claims agaInst

~I")

4 them if the "County Defendants have fulfilled the objectives in Paragraph 6 and have

5 met their obligations under Paragraph 7" and "have systems in place that will

6 continue to fulfill the objectives set forth in Paragraph 6 and meet the obligations set

7 forth in Paragraph 7 for the upcoming twelve months," Agreement, at ~ 19.

8

126, Although the Agreement took effect more than three years ago, County

9 Defendants have not fulfilled the objectives in Paragraph 6 and have not met their

10 obligations under Paragraph 7. Nor does it appear that they will soon meet these II terms of the Agreement. Hence, in July of this year, the Court extended jurisdiction 12 over the claims against County Defendants, and the role of the Panel, for an

13 additional 18 months (or through and including January 16, 2008).

14

127, The Agreement expressly provides that the County Defendants "shall

15 confer with the Advisory Panel to develop a plan to address all areas of

16 non-compliance and to set deadlines for obtaining such compliance,"

17

128. The Agreement further provides that once this plan has been developed,

18 it shall be reviewed by the Panel and approved by the Court. Neither the Panel nor

19 the Court approves the County Plan in its current form, as it both fails to address all 20 areas of noncompliance and to set deadlines for obtaining such compliance.

21

129. County Defendants are ordered to confer with the Panel and to amend

22 the County Plan to address all areas of non-compliance, including all the areas 23 discussed above, as soon as possible. County Defendants shall also solicit and

24 consider input from Plaintiffs' counsel on the contents of this corrective action plan.

25 At a minimum, this corrective action plan should set forth the specific activities to b

26 undertaken, including the estimated human resources and funding required. For eac

27 activity, the corrective action plan should at least set forth: (a) the County official 28 with direct responsibility for the activity; (b) the expected outcomes; (c) the

HOA.4021962

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 32 of 34 Page ID #:459

1 projected date for commencement of and completion of the activity; and (d) "Y:~ich
2 of the objectives in Paragraph 6 of the Agreement the activity is intended to ~~et. 3 County Defendants should try to set deadlines for completion of all these acti"~-ities
:,r;.
4 that are as expeditious as possible but realistic. This plan shall also include "exit

5 criteria," that is, specific measurable conditions under which County Defendants shal

6 be deemed to have fulfilled the objectives of Paragraph 6 and to have met their 7 obligations under Paragraph 7 of the Agreement.

8

l30. County Defendants and the Panel shall advise the Plaintiffs and the

9 Court when they can expect to receive a final version of this amended plan.

10

131. This Order shall not be construed as preventing County Defendants

11 from continuing to implement any of their existing measures to comply with this 12 Agreement.

13

132. Consistent with the Panel's August 30, 2006 letter, County Defendants

14 shall provide monthly progress reports, in the form of a "tracking log," to the Panel,

15 Plaintiffs and the Court detailing its progress in implementing the current County PI

16 and the future corrective action plan. The first such report shall be due no later than

17 December I, 2006. The reports shall include, at a minimum, the following

18 information: (a) the specific goals to be achieved; (b) the steps or tasks necessary to

19 achieve those goals; (c) progress in achieving those steps or tasks; (d) a specific

20 timetable for achieving the steps and tasks; (e) provide interim benchmarks with

21 indicators of achievement of developmental steps towards achievement of the task; 22 and (t) specific activities occurring since the last progress report.

23

133. In addition to the above specific progress report information, the

24 County shall provide the following additional information on a periodic basis, as

25 determined necessary and appropriate by the Panel and County and to the extent it

26 does not require the development of a new tracking system: (g) the relevant scope of

27 resources devoted to the task; (h) barriers impeding completion; and (I) the measure

28 of task achievement.

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 33 of 34 Page ID #:460

134. Where data is collected or available, the County shall provide th~.Panel
_..J
2 with the outcome indicators, as agreed to between the Panel and County Defe~dants,
3 that describe the progress of class members towards achievement of the Agreg~ent ;;:1
4 objectives, to the extent that it may require the development on new data systems.

5

135. County Defendants shall set a specific schedule for the next twelve

6 months to meet in person with the Panel and Plaintiffs to discuss activities and

7 progress towards meeting the obligations in the Agreement. The Panel shall provide

8 County Defendants and Plaintiffs with that proposed schedule, as well as any terms 9 or circumstances for such meetings, in writing. County Defendants shall ensure that 10 key high level department officials or representatives are present at the meeting dates II and times proposed by the Panel. In addition, County Defendants shall assist the 12 Panel, as necessary, to set up periodic meetings with community stakeholders,

13 including mental health and social services providers, when the Panel requests to do 14 so.

15

136. The Panel shall continue to provide reports to the Court, as outlined in

16 the Agreement, every six (6) months, starting with another report, on

17 January 15, 2007, and continuing until such time as the Court orders that they be

18 modified or discontinued, or the Panel is no longer authorized to serve in this

19 capacity.

20

137. County Defendants shall develop a proposal for a formal

21 monitoring plan to measure how and to what extent County Defendants have

22 implemented the County Plan.

23

138. After implementation of the County Plan, as modified and approved by

24 the Court, the County may move for dismissal of this lawsuit by the Court on the

25 basis that the County has fulfilled its duties under the Settlement Agreement and, tha 26 the designated outcome measures of the monitoring plan, discussed more fully 27 herein, have been achieved.

28

HOA.402196.2

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Case 2:02-cv-05662-AHM-SH Document 499 Filed 11/20/06 Page 34 of 34 Page ID #:461

XVIII. Modification of Findings Based Upon Later Ninth Circuit

•..J

2

Ruli•ngs

z..u

z

3

139. All parties shall retain the right to seek modifications to any of the

~r,

4 findings of facts or conclusions of law that are agreed to or disputed herein, based

5 upon any subsequent rulings on this or any related case.

6

XIX. Findings of Fact and Conclusions of Law

7

140. All of the foregoing constitute the Court's findings of fact and

8 conclusions oflaw. To the extent that factual recitals also constitute legal

9 conclusions and to the extent legal conclusions also constitute factual recitals, such

10 recitals, findings and conclusions shall be so construed.

11

XX. Attorneys' Fees. Costs and Expenses

12

141. The Court retains jurisdiction to determine whether Plaintiffs are entitle

13 to recover their reasonable attorneys' fees, costs and expenses in connection with

14 these motions and, if so, the amount of such fees, costs and expense. The parties

15 shall make good faith efforts to resolve their differences over any claim for, and

16 amount of these fees, costs and expenses. If agreement cannot be reached on this

17 issue, then Plaintiffs' counsel may file a motion no later than 90 days from entry of

18 this order. The above deadline to file any such motion shall supercede the

19 previous set filing deadline pursuant to a stipulation between plaintiffs and County

20 Defendants.

21

22 DATED:

23

24

IT IS SO ORDERED.

25 Dated: NovemberdU-, 2006

26

HONORABL A. HOWARD M TZ

UNITED STA ES DISTRICT JUDGE

27

28

HOA.402196.2

-34-

 </s> Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 1 of 8 Page ID #:1986

1 EDMUND G. BROWN JR. Attorn~ General of the State of California
2 JENNIFER M. KIM
Supervising Deputy Attorney General
3 KAREN ACKERSON-BRAZILLE, SBN. 157514 CARMEN D. SNUGGS, SBN. 221935
4 Deputy Attorneys General 300 South Spring Stree~ Suite 1702
5 Los Angeles CX 9001 j
Telephone: (213) 897-2448 6 Fax: (213) 897-1805
Email: Karen.AckersonBrazille@doj.ca.gov 7
Attorneys for Defendants
8
ROBERT D. NEWMAN, SBN 86534 9 KIMBERLY LEWIS, SBN 144879
WESTERN CENTER ON LAW & POVERTY 10 3701 Wilshire Boulevard, Suite 208
Los Angeles, CA. 90010 . 11 (213) 487-7211; Fax: (213) 487-0242
EmaIl: rnewman@wclp.org
12 Attorneys for Plaintiffs
13 [Additional counsel appear on next page]

14

IN THE UNITED STATES DISTRICT COURT

15

FOR THE CENTRAL DISTRICT OF CALIFORNIA

16

WESTERN DIVISION

17

., y an roug er nex nen

Michael Ludm; MARY B., by and through CV-02-05662 AHM (SHx)

18 her next friend Robert Jacobs; JANET C.,

by and througll her next friend Dolores

JOINT STATUS REPORT

19 Johnson; HENRY D., by and through his PURSUANT TO COURT'S

next friend Gillian Brown; AND GARY SEPTEMBER 22, 2008 ORDER

20 E., by and through his next friend Michael

Ludin, individually and on behalf of others Date:

October 29, 2008

21 similarly situated,

Time:

Submitted

Courtroom: 8

22

Plaintiffs, Judge:

The Honorable A.

v.

Howard Matz

23

DIANA BONTA, Director of California

24 Department of Health Services; LOS

ANGELES COUNTY; LOS ANGELES

25 COUNTY DEPARTMENT OF

CHILDREN AND FAMILY SERVICES;

26 ANITA BOCK, Director of the Los

Angeles County Department of Children

27 and Family Services; RITA SAENZ,

Director of the California Department of

28 Social Services, and Does 1 through 100,

inclusive,

Defendants.

Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 2 of 8 Page ID #:1987

1 Attorneys for PlamtIffs
2 [Additional counsel]

3 MELINDA BIRD, SBN 102236 .
4 American Civil Liberties Union of Southern California 1616 Beverly Boulevard
5 Los Angeles, CA 90010 (213) 977-9500; Fax: (213) 427-8767
6 MARILYN HOLLE, SBN 61530
7 Protection & Advocac:x, Inc. 3580 Wilshire Blvd., #902
8 Los Angeles, CA 90010 (213) 427-8747; Fax (213) 427-8767
9 IRA BURNIM (vrohac vice)
10 ALISON BARKOFF (pro hac vice) Bazelon Center for Mental Health Law
11 1101 Fifteenth St., NW, #1212
Washington, DC 20006 12 (202) 467-5730; Fax: (202) 223-0409

13 JOHN F. O'TOOLE, SBN 62327

PATRICK GARDNER, SBN 208119

14 LEECIA WELCH, SBN 208741

15

National 405 14th

Center Street,

F15otrh

Youth Floor

Law

Oakland, CA 94612-2701-

16 (510) 835-8098; Fax (510) 835-8099

17

18

19

20

21

22

23

24

25

26

27

28

2

Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 3 of 8 Page ID #:1988

1 State Defendants Directors of the California Department of Health Care

2 Services (DHCS) and California Department of Social Services (CDSS) - and

3 Plaintiffs Katie A.,?t at., respectfully submit the following joint status report to the

4 Court in accordance with its September 22, 2008 Order:

5 On September 22,2008, the Court directed the parties to make "a good faithjoint

6 effort... to develop letters and notices that the State Defendants will disseminate to

7 all of the County Mental Health Plans (,MHPs'), and to as many eligible recipients

8 (or their individual and institutional representatives) as possible." Order on Plaintiffs'

9 Renewed Motion for a Preliminary Injunction (Order) at page 12. The Court

10 explained that these "negotiations will surely assist the parties in reducing or

11 eliminating the confusion about wraparound's Medicaid [sic]/Medi-Cal status" and

12 that they "likely also will reduce or eliminate the concern of MHPs, providers and

13 recipients as to whether such services will be reimbursed." Id. " The Order directed

14 the parties to undertake these negotiations "promptly" and specified that, "the letter

15 and notices that the parties shall develop shall list specifically, and in plain language,

16 the components ofwraparound defined by Dr. Redman that are covered by Medi-Cal,

17 and it should explain how these services properly may be characterized and billed."

18' Id.

19

Counsel for State Defendants and California Department of Mental Health

20 (DMH) met with counsel for Plaintiffs on September 15, 2008, before entry of the

21 Court's Order, and again on October 14, 2008. On October 21, 2008, State

22 Defendants delivered a draft DMH Letter to Plaintiffs. On October 23, 2008,

23 Plaintiffs delivered their response to State Defendants with their written comments

24 concerning this draft DMH Letter. Later that same morning, the parties had a

25 telephonic conference call concerning, among other things, the draft DMH Letter.

26 State Defendants delivered to Plaintiffs a revised, near final version of the DMH

27 Letter on October 28, 2008, and intend to provide Plaintiffs with the final version of

28 the DMH Letter in the afternoon of October 29, 2008. State Defendants intend to

3

Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 4 of 8 Page ID #:1989

1 disseminate the final version of the DMH Letter on or about October 30,2008. A

2 true copy of the final version of the DMH Letter will be filed upon dissemination.

3

While the parties have agreed to keep the above communications confidential,

4 we can report that the exchange between the parties has been cordial and progress

5 was made during their negotiations with regard to the contents of the DMH Letter.

6

If the final version of the DMH Letter is essentially the same as the version of

7 the DMH Letter that was provided to Plaintiffs counsel on October 28, 2008, then

8 Plaintiffs believe that dissemination of the new DMH Letter will be a constructive

9 step but that it will not constitute full compliance with the above-mentioned Order

10 (e.g., notices still need to be developed and sent to eligible recipients and their

11 representatives and further written materials need to be developed and sent to

12 providers and MHPs). However, it is the position of the State Defendants that the

13 dissemination of the new DMH Letter to the MHPs and representatives of the

14 eligible recipients does constitute full compliance, and that further written materials

15 are unnecessary at this time.

16

17

18

19

20

21

22

23

24

25

26

27

28

4

Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 5 of 8 Page ID #:1990

1 Dated: October 29,2008

2

Respectfully submitted,

3 EDMUND G. BROWN JR.

4

Attorney General of the State of California

JENNIFER M. KIM

5 6

S~pervising Deputy Atto.gley General

Jf> " " 1
1 •

,i>':~

'

,

-

-

-

-

1r1\, .,

I
a

Cl/

Y

\

'

t'
0t l'

I.i-
J

:1

7

KAREN ACKERSON-BWLLE Deputy Attorney General

8

Attorneys for Defendants

9

10

Dated: October 29, 2008

WESTERN CENTER ON LAW & POVERTY PROTECTION AND ADVOCACY, INC.

11

BAZELON CENTER FOR MENTAL

HEALTH LAW

12

NATIONAL CENTER FOR YOUTH LAW

AMERICAN CIVIL LIBERTIES UNION OF

13

SOUTHERN CALIFORNIA

14

15

By: --R~O~B~E~R~T~D~.~N~E~W~M~A~N~---------

16

Attorneys for Plaintiffs

17

18 LA2002CV1625
KatieAJointSC report (v2).wpd
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Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 6 of 8 Page ID #:1991

1 Dated: October 29, 2008

2

Respectfully submitted,

3

EDMUND G. BROWN JR.

4

Attorney General of the State of California

5

JENNIFER M. KIM

.

Supervising Deputy Attorney General

6

7

KAREN ACKERSON-BRAZILLE Deputy Attorney General

8

Attorneys for Defendants

9

10

Dated: October 29,2008

WESTERN CENTER ON LAW & POVERTY PROTECTION AND ADVOCACY, INC.

11

BAZELON CENTER FOR MENTAL

HEALTH LAW

12

NATIONAL CENTER FOR YOUTH LAW

AMERICAN CIVIL LIBERTIES UNION OF

13

SOUTHERN CALIFORNIA

14 15

By: ~,d~

ROBERI' D. NEWMAN

16

Attorneys for Plaintiffs

17

18 LA2002CV 1625
KatieAJointSC report (PI. changes).wpd
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\.

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Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 7 of 8 Page ID #:1992

DECLARATION OF SERVICE BY U.S. MAIL

Case Name:

KATIE A. v. BONTA

USDC CASE No.: CV-02-05662 AHM (SHx)

I declare:

I am employed in the Office of the Attorney General, which is the office of a member of the California State Bar, at which member's direction this service is made. I am 18 years of age or older and not a party to this matter. I am familiar with the business practice at the Office of the Attorney General for collection and processing of correspondence for mailing with the United States Postal Service. In accordance with that practice, correspondence placed in the internal mail collection system at the Office of the Attorney General is deposited with the United States Postal Service that same day in the ordinary course ofbusiness.

On October 29,2008, I served the attached JOINT STATUS REPORT PURSUANT TO COURT'S SEPTEMBER 22, 2008 ORDER by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid, in the internal mail collection system at the Office ofthe Attorney General at 300 South Spring Street, Suite 1702, Los Angeles, CA 90013, addressed as follows:

SEE ATTACHED MAILING LIST

I declare under penalty ofpCljury under the laws of the State of California the foregoing is true and correct and that this declaration was executed on October29, 2008, at Los Angeles, California.

Nonna L. Herrera-Orr Declarant

Signature .

Case 2:02-cv-05662-AHM-SH Document 633 Filed 10/29/08 Page 8 of 8 Page ID #:1993
MAILING LIST
Ira Burnim, Esq. Alison Barkoff, Esq. Bazelon Center for Mental Health Law 1101 15th St NW, Ste., 212 Washington, DC 20006
Jerry M. Custis Los Angeles County Counsel Children's Services Div 201 Centre Plz Dr., Ste., 1 Monterey Park, CA 91754-2143
Marilyn Holle, Esq.
Protection & Advocacy, Inc.
3580 Wilshire Blvd., #902 Los Angeles, CA 90010
John F O'Toole National Center for Youth Law 405 14th St, 15th FI Oakland, CA 94612-2701
Catherine J. Pratt Children Services Division 201 Centre Plaza Dr, Ste 1 Montery Plaza, CA 91754-2143
Robert D. Newman, Esq. .Kimberly Lewis, Esq. Western Center for Law and Poverty 3701 Wilshire Blvd., #208 Los Angeles, CA 90010-2809
Melinda Bird, Esq. Mark D. Rosenbaum, Esq. American Civil Liberties Union of Southern California 1313 W. 8th Street Los Angeles, CA 90017

 </s> Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 1 of 70 Page ID #:4791

1 THOMAS E. PEREZ, Assistant Attorney General

EVE HILL, Senior Counselor to the AssIstant Attorney General

2 ALLISON J. NICHOL, Chief

SHEILA FORAN, Special Legal Counsel 3 KATHLEEN R. WO!--g~1 Actmg Special Legal Counsel

RENEE M. WOHLE1'lt1AUS, Deputy Chief

4 TRAVIS W. ENGLAND, Trial Attorney, NY SBN 4805693 Travis.Englandcmusdoj.gov

NOV I 8 2011

5

U.S. Departmentof Justice

950 Pennsylvania Avenue, N.W. - NYA

6

Washington, D.C. 20530

CENTRAL DISTRICT OF CALIFORNIP.

BY

____ D[i'YJL__

Telephone: (202) 307-0663

7

F~cslmile: (202) 307-1197

ANDRE BIROTTE JR.

8 United States Attorney

LEON W. WEIDMAN

9 Assistant United States Attorney

Chief Civil Division

10 ROBYN-MARIE LYON MONTELEONE

Assistant United States Attorney

11 Assistant Division Chief,

Civil Rights Unit Chief, Civil Division

12 CalifornIa Bar Number: 130005

Robby.Monteleonecmusdoj .gov

13

Room 7516 Federaf'Buildmg

300 North Los Angeles Street

14

Los Angeles, California 90012

Telephone: (213) 894-2458

15

FaCSImile: (213)894-7819

ATTORNEYS FOR0}ITTED STATES

16

17

UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA

18

WESTERN DIVISION

KATIE A. by and through her next

19 friend Michael Ludin; MARY B. by

20 and through her next friend Robert

Jacobs; JANET C. by and through

21 her next friend Dolores Johnson;

HENRY D. by and through his next

22 friend Gillian Brown; AND GARY

E. by and through his next friend

Michael Ludin; mdividually and

23 behalf of others similarly sItuated,

24

Plaintiffs,

25 v.

CASE NO. CV-02-05662 AHM (SHX)
CLASS ACTION COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Hearing Date: Dec. 1, 2011

Time:

2:00 p.m.

Courtroom: 14

Judge:

A. Howard Matz

TOBY DOUGLAS, Director of 26 California Department of Health 27 Care Services;.LOS ANGELES
COUNTY; LvS ANGELES
28

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 2 of 70 Page ID #:4792
COUNTY DEPARTMENT OF CHILDREN AND FAMILY SERVICES; ANITA BLOCK, 1 Director of the Los Angeles Coun!}' 2 Department of Children and Family Services; WILL LIGHTBOURNE, Director of the California 3 Del'artment of Social Services, and 4 DOES 1 through 100, Inclusive,
Defendants.
5~----------------------~
6
7 8
9 10 11 12
13 14
15 16 17
18 19
20 21 22
23 24 25
26 KATIE A., ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX);
27 COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT
28

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 3 of 70 Page ID #:4793

1

TABLE OF CONTENTS

2 BACKGROUND ............................................................................................. 6

3 THE PARTIES' SETTLEMENT AGREEMENT .......................................... 7

4 STATUTORY AND REGULATORY BACKGROUND ............................ 10

5 A. The ADA and the Integration Mandate ............................................... 10

6 B. The EPSDT Requirements of the Medicaid Act... ............................... 12
7
COMMENTS IN SUPPORT OF THE AGREEMENT ................................ 14 8
9 A. The Agreement is Likely to Reduce Institutional Placements and further the State's Compliance with the Integration Mandate of title II of the ADA.. IS
10 B. The Agreement is Consistent with the State's Obligation to Provide
11 Medically Necessary Services Under the EPSDT Requirements of the Medicaid 12 Act. ............................................................................................................. 16

13 CONCLUSION ............................................................................................. 19
14

15

16

17

18

19

20

21

22

23

24

25

26

27

2

28

KATIE A.• ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 4 of 70 Page ID #:4794

1

TABLE OF AUTHORITIES

2 Cases

3 Baird ex reI. Bairdv. Rose, 192 F.3d 462 (4th Cir. 1999) ...................................... 11

4 Churchill Vill., L.L.C v. Gen. Elec., 361 F.3d 566 (9th Cir. 2004) .................... 5, 15

5 Collins v. Hamilton, 349 F.3d 371 (7th Cir. 2003) ................................................. 13

6 Disability Advocates, Inc. v. Paterson, 598 F. Supp. 2d 289 (E.D.N.Y. 2009) ...... 16

7 In re Bluetooth Headset Products Liability Litigation, 654 F.3d 935 (9th Cir. 2011)

.......................................................................................................................... 5, 15
8
9 In re Mego Fin. Corp. Sec. Litig., 213 F.3d 454 (9th Cir. 2000) ............................ 14

10 Katie A. v. Bonta, 433 F. Supp. 2d 1065 (C.D. Cal. 2006) ................................. 9, 18

11 Katie A., ex reI. Ludin v. Los Angeles Cty., 481 F.3d 1150 (9th Cir. 2007) .. passim

12 Olmsteadv. L.e., 527 U.S. 581 (1999) ............................................................ passim

13 Parents' League for Eff. Autism Servo V. Jones-Kelley, 339 Fed. Appx. 542 (6th

Cir. 2009).............................................................................................................. 14
14
Pediatric Speciality Care, Inc. V. Ark. Dep 't ofHuman Servs., 293 F.3d 472 (8th
15
Cir. 2002) .............................................................................................................. 13
16
17 Pereira V. Kozlowski, 996 F.2d 723 (4th Cir. 1993) ............................................... 13

18 Pittman V. Sec 'y, Fla. Dep 't ofHealth & Rehab., 998 F.2d 887 (llth Cir. 1993). 13

19 Rosie D. V. Romney, 410 F. Supp. 2d 18 (D. Mass. 2006) ................................ 12,18

S.D. ex reI. Dickson v. Hood, 391 F.3d 581 (5th Cir. 2004) ............................. 13, 18
20
Sanchez V. Johnson, 416 F.3d 1051 (9th Cir. 2005) ............................................... 11
21
22 Torrisi V. Tucson Elec. Power Co., 8 F.3d 1370 (9th Cir. 1993) ............................ 15

23 Zukle V. Regents ofUniv. ofCalifornia, 166 F.3d 1041 (9th Cir. 1999)................. 11

Statutes
24
25 29 U.S.C. § 794 ....................................................................................................... II

26 42 U.S.C. § 12101(a)(2) ............................................................................................ 6

27

3

28

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 5 of 70 Page ID #:4795

1 42 U.S.C. § 12101(b)(I) ............................................................................................ 6

2 42 U.S.C. § 12117(b)................................................................................................. 7

3 42 U.S.C. § 12131 ..................................................................................................... 1

4 42 U.S.C. § 12132 ............................................................................................... 6, 11

5 42 U.S.C. § 12134(a) ................................................................................................. 7

6 42 US.C. § 1396a(a)(10)(A) ............................................................................... 1,12

7 42 U.S.C. § 1396a(a)(43) .......................................................................................... 8

8 42 US.C. § 1396a(a)(43)(B) ..................................................................................... 8

9 42 US.c. § 1396a(a)(43)(C) ............................................................................... 1,12

10 42 U.S.C. § 1396d(a)(13) ........................................................................................ 13

11 42 U.S.C. § 1396d(a)(4) ............................................................................................ 8

12 42 US.C. § 1396d(a)(4)(B) ................................................................................. 1, 12

13 42 U.S.C. § 1396d(r) ................................................................................................. 9

14 42 US.C. § 1396d(r)(5)....................................................................................... 1, 12

15 Other Authorities

16 Executive Order 12250,45 Fed. Reg. 72995 (1980) ................................................ 7

17 Massachusetts State Plan for Medical Assistance, State Plan Amendment # 08-004

18 .............................................................................................................................. 13

19 Nevada State Planfor Medical Assistance ............................................................. 13

20 Oregon State Planfor Medical Assistance § 3.1a................................................... 13

21 Regulations

22 28 C.F.R. § 35.130(b)(7) ........................................................................................... 8

23 28 C.F.R. § 35.190(a) ................................................................................................ 7

24 42 C.F.R. § 41.51(d) ................................................................................................ 11

25 42C.F.R. § 440.130................................................................................................... 9

26

27

4

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 6 of 70 Page ID #:4796

1

The United States respectfully submits these Comments in support of final

2 approval of the Proposed Settlement Agreement (hereinafter, the "Agreement").

3 The United States has a strong interest in the resolution of this matter because it

4 advances the important public interest of compliance with title II of the Americans

5 with Disabilities Act, 42 U.S.C. § 12131 et seq., and the Early and Periodic

6 Screening, Diagnostic and Treatment ("EPSDT") provisions of Title XIX of the

7 Social Security Act ("Medicaid Act"), 42 US.C. § 1396 et seq., including the

8 prevention of segregation, isolation, and unnecessary institutionalization of

9 individuals with disabilities. See Olmsteadv. L.C, 527 US. 581, 607,119 S.Ct.

10 2176, 2190 (1999). The Agreement between Plaintiffs and the State defendants is

11 "fair and reasonable," see In re Bluetooth Headset Products Liability Litigation,

12 654 F.3d 935,946 (9th Cir. 2011) (citing Churchill Vill., L.L.C v. Gen. Elec., 361

13 F.3d 566,575 (9th Cir. 2004)), and addresses Plaintiffs' allegations that

14 Defendants violate federal law by failing to provide needed community-based

15 mental health services to children in or at imminent risk of placement in the State's 16 foster care system. l Accordingly, the United States respectfully urges this Court to

17 grant final approval of the Agreement.

18

19

20 1 The United States recognizes that the Agreement advances the objective of 21 facilitating the delivery of an array of medically necessary mental health services
in a coordinated, comprehensive, and community-based fashion to full-benefit
22 Medi-Cal eligible class members. (See Settl. Agr. ~~ 20(a)-(g),(i)). As discussed
23 more fully below, pp. 9 to 11, the EPSDT requirements of the Medicaid Act mandate Defendants to ensure the provision of mental health services that are
24 within the permissible scope of the traditional Medicaid benefit to all full-benefit 25 Medi-Cal-eligible children for whom such services are medically necessary. See 26 42 US.c. §§ 1396d(a)(4)(B); 1396d(r)(5); 1396a(a)(10)(A); and 1396a(a)(43)(C).

27

5

28

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 7 of 70 Page ID #:4797

1

BACKGROUND

2

Plaintiffs represent a statewide class of children in California that this Court

3 earlier certified, who:

4

(a) are in foster care or are at imminent risk of foster care placement,z and

5

(b) have a mental illness or condition that has been documented or, had an

6

assessment already been conducted, would have been documented, and

7

(c) need individualized mental health services, including but not limited to

8

professionally acceptable assessments, behavioral support and case

9

management services, family support, therapeutic foster care, and other

10

medically necessary services in the home or in a home-like setting, to

11

treat or ameliorate their illness or condition.

12 (Settl. Agr. ~ 3; see also Order Re Class Cert., ECF No. 92, at 21-22.) This lawsuit

13 alleges that Toby Douglas, current director of the California Department of Health

14 Care Services ("DHCS"), and Will Lightbourne, current Director of the California

15 Department of Social Services ("CDSS") (together, the "Defendants") fail to

16 provide Plaintiffs and members of the Class with necessary community-based

17 mental health services, and instead rely on services provided in restrictive,

18

19

20 2 The Parties have stipulated that "imminent risk of foster care placement" means

21 that

within the last 180 days a child has been participating in voluntary family

22

maintenance or voluntary family reunification placements and/or has been

23

the subject of either a telephone call to the Child Protective Services hotline

or some other documented communication made to a local Child Protective

24

Services agency regarding suspicions of abuse, neglect or abandonment.

25 (Settl. Agr. ~ 3; see also Proposed Stip. J. Pursuant to Class Action Settl. Agr.,

Appx. A. to Settl. Agr. ECF No. 755, ~ 2(c).)
26

27

6

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 8 of 70 Page ID #:4798

1 congregate, and institutional placements, in violation of the Medicaid Act and the 2 ADA. (Pis.' First Am. Comp!. ("Comp!."), ECF. No. 33, ~~ 47,76,80-87.)3

3

THE PARTIES' SETTLEMENT AGREEMENT

4

The Agreement expresses four objectives: (a) to "[fJacilitate the provision of

5 an array of services delivered in a coordinated, comprehensive, community-based 6 fashion that combines service access, planning, delivery, and training into a 7 coherent and all-inclusive approach;" (b) to "[s]upport the development and 8 delivery of a service structure and a fiscal system that supports a core practices and

9 services model, as described in (a);" (c) to "[s]upport an effective and sustainable

10 solution that will involve standards and methods to achieve quality-based

II oversight, along with training and education that support the practice and fiscal 12 models;" and (d) to "[a]ddress the need for certain class members with more

13 intensive needs ... to receive medically necessary mental health services in their 14 own home, a family setting or the most homelike setting appropriate to their needs,

15 in order to facilitate reunification, and to meet their needs for safety, permanence,

16 and well-being." (Sett!. Agr. ~ 19.)

17

In furtherance of these objectives, the Agreement requires Defendants to,

18 among other things, support the development and delivery of an array of 19 coordinated, community-based mental health services and develop a process "to 20 identify class members and link them firmly to services." (See id. ~~ 20(a)-(g), (i». 21 Defendants must develop and disseminate a Medi-Cal Specialty Mental Health 22 documentation manual ("Documentation Manual") designed to inform and instruct

23

24

25 3Plaintiffs also allege that Defendants' actions violate their rights under the Due

Process clauses of the United States and California Constitutions. (See 26 Compl. ~~ 77-79,88-90.)

27

7

KATIE A., ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX);
28 COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 9 of 70 Page ID #:4799

1 providers on the provision of Intensive Care Coordination ("ICC,,)4 and Intensive

2 Home Based Services ("IHBS,,)5 consistent with Core Practice Model Principles

3 and Components ("Core Practice Model"),6 and to submit to the Centers for

4 Medicare and Medicaid Services ("CMS") amendments to the California State 5 Medicaid Plan to include ICC and IHBS consistent with this approach (Settl. Agr. 6 ~~ 20(a)(1), (b)l, (c)). Defendants must also specifically facilitate the provision

7
4 The Agreement defines ICC as a service "responsible for facilitating assessment, 8 care planning, and coordination of services." (Appx. E to SettJ. Agr..) The 9 components of ICC include a "strengths-based, needs driven comprehensive
assessment," development of an Individual Care Plan ("ICP"), referral, monitoring 10 and related activities to meet the needs identified in the ICP, and development of a 11 transition plan when the individual has achieved the goals outlined in the ICP.
(Jd.) 12

13 5The Agreement defines IHBS as services that are "individualized, strength-based interventions designed to ameliorate mental health conditions that interfere with a
14 child's functioning." (Appx. D to Settl. Agr..) The interventions are designed to 15 help the child "build skills necessary for successful functioning in the home and
community and improving the child's family'S ability to help the youth 16 successfully function in the home and community." (Jd.) Services are designed to 17 educate and train the child's family in managing the child's disorder, to provide
medically-necessary skill-based remediation of disorders, to improve the child's 18 self-care, self-management of symptoms, and social decorum, and to support the 19 development and maintenance of social support networks, employment and
educational, and independent living objectives. (Jd.) 20

21 6 The Core Practice Model, defined in Appendix "B" to the Agreement, is designed, among other things, to facilitate the provision of a full array of necessary
22 mental health services to class members, and to ensure that services are
23 individualized, delivered through a multi-agency collaborative approach, and provided in the child and family'S community. (See Appx. B to Settl. Agr.) The
24 Documentation Manual must outline that ICC and IHBS are to be provided
25 utilizing a Child and Family Team, as defined in Appendix "c" to the Agreement.
(See Settl. Agr. ~ 20(b)(l)). 26

27

8

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 10 of 70 Page ID #:4800

1 ofICC and nIBS to a Subclass ofplaintiffs.7 (See Id. ~ 19(d)(1); Special Master's

2 Rept. Pursuant to Agr. ("Special Master's Rept."), ECF No. 751, at 8.) The

3 Agreement further requires Defendants to include in the Documentation Manual

4 instructions to providers regarding the provision of Therapeutic Foster Care

5 ("TFC") services, as defined in Katie A. v. Bonta, 433 F. Supp. 2d l065, l072

6 (C.D. Cal. 2006). (See Settl. Agr. ~ 20(a)(2).) The Agreement stipulates that TFC

7 services:

8

(a) place a child singly, or at most in pairs, with a foster parent who is

9

carefully selected, trained, and supervised and matched with the

10

child's needs;

11

(b) create, through a team approach, an individualized treatment plan

12

that builds on the child's strengths;

13

(c) empower the therapeutic foster parent to act as a central agent in

14

implementing the child's treatment plan;

15

(d) provide intensive oversight of the child's treatment, often through

16

daily contact with the foster parent;

17

(e) make available an array of therapeutic interventions to the child,

18

the child's family, and the foster family (including behavioral

19

support services, crisis planning and intervention, coaching and

20 _ _ _ _ _ _ __

21 7 The Agreement defines Subclass members as children and youth who are full-

scope Medi-Cal eligible, meet medical necessity, have an open child welfare

22 services case, and either: (a) are currently in or being considered for wraparound,

23 therapeutic foster care or other intensive services, therapeutic behavioral services,

specialized care rate due to behavioral health needs or crisis stabilization!

24 intervention; or (b) are in or being considered for a group home (RCL 10 or

25 above), a psychiatric hospital or 24 hours mental health treatment facility, or has

experienced [3] or more placements within 24 months due to behavioral health 26 needs. (Settl. Agr. ~ 19(d)(1).)

27

9

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 11 of 70 Page ID #:4801

1

education for the foster parent and child's family, and medication

2

monitoring) ... ; and

3

(f) enable the child to successfully transition from therapeutic foster

4

care to placement with the child's family or alternative placement

5

by continuing to provide therapeutic interventions.

6 (See Settl. Agr. ~ 20(a)(2)) (referring to the definition ofTFC in Katie A., 433 F.

7 Supp. 2d at 1072).8

8

STATUTORY AND REGULATORY BACKGROUND

9 A. The ADA and the Integration Mandate

10

Congress enacted the ADA in 1990 "to provide a clear and comprehensive

11 national mandate for the elimination of discrimination against individuals with

12 disabilities." 42 U.S.C. § 12101(b)(1). Congress found that "historically, society

13 has tended to isolate and segregate individuals with disabilities, and, despite some

14 improvements, such forms of discrimination against individuals with disabilities

15 continue to be a serious and pervasive social problem." 42 U.S.c. § 12101(a)(2).

16 For those reasons, Congress prohibited discrimination against individuals with

17 disabilities by public entities:

18

[N]o qualified individual with a disability shall, by reason of such

19

disability, be excluded from participation in or be denied the benefits

20

of the services, programs, or activities of a public entity, or be

21

subjected to discrimination by any such entity.

22 _ _ _ _ _ _ _ __

23 8The Agreement stipulates that, to the extent that "activities and/or components of TFC services" are covered under the Medicaid Act, "the State Plan needs to be
24 amended to cover TFC services that are covered under the Medicaid Act but are 25 not covered in the State Plan." (Settl. Agr. ~ 20(a)(2)(A)(3).) Any amendment to
the State Plan must first be submitted to CMS for approval.
26

27

10

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 12 of 70 Page ID #:4802

1 42 U.S.C. § 12132.

2

As directed by Congress, the Attorney General issued regulations

3 implementing title II, which are based on regulations issued under Section 504 of 4 the Rehabilitation Act.9 See 42 U.S.C. § 12134(a); 28 C.F.R. § 35.190(a); Exec. 5 Order 12250,45 Fed. Reg. 72995 (1980), reprinted in 42 U.S.C. § 2000d-1. The

6 title II regulations require public entities to "administer services, programs, and

7 activities in the most integrated setting appropriate to the needs of qualified

8 individuals with disabilities." 28 C.F.R. § 35.130(d). The preamble discussion of

9 the "integration regulation" explains that "the most integrated setting" is one that

10 "enables individuals with disabilities to interact with nondisabled persons to the

11 fullest extent possible...." 28 C.F.R. Pt. 35, App. B at 673 (2011).

12

Twelve years ago, the Supreme Court applied these authorities and held that

13 title II prohibits the unjustified segregation of individuals with disabilities.

14 Olmstead, 527 U.S. at 596. There, the Court held that public entities are required

15 to provide community-based services to persons with disabilities when (a) such

16 services are appropriate; (b) the affected persons do not oppose community-based

17
9 Section 504, like title II, prohibits disability-based discrimination. 29 U.S.c.

18 § 794(a) ("No otherwise qualified individual with a disability ... shall, solely by

19 reason of her or his disability, be excluded from the participation in, be denied the

benefits of, or be subjected to discrimination under any program or activity

20 receiving Federal financial assistance ...."). In all ways relevant to this

21 discussion, the ADA and Section 504 of the Rehabilitation Act are generally

construed to impose similar requirements. See Sanchez v. Johnson, 416 F.3d 1051,

22 1062 (9th Cir. 2005); Zukle v. Regents ofUniv. ofCalifornia, 166 F.3d 1041,1045

23 n.11 (9th Cir. 1999). This principle follows from the similar language employed in

the two acts. It also derives from the Congressional directive that implementation

24 and interpretation of the two acts "be coordinated to prevent[ ] imposition of

25 inconsistent or conflicting standards for the same requirements under the two

statutes." Baird ex rei. Baird v. Rose, 192 F.3d 462,468-69 (4th Cir. 1999) (citing

26 42 U.S.C. § 12117(b)) (alteration in original).

27

11

KATIE A., ET AL. V. DOUGLAS. ET AL., CV-02'{)S662 ARM (SHX);

28

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Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 13 of 70 Page ID #:4803

1 treatment; and (c) community-based services can be reasonably accommodated,

2 taking into account the resources available to the entity and the needs of others

3 who are receiving disability services from the entity. Id. at 607.

4

To comply with the ADA's integration requirement, a state must reasonably

5 modify its policies, procedures, or practices when necessary to avoid

6 discrimination. 28 C.F.R. § 35. 130(b)(7). The obligation to make reasonable

7 modifications may be excused only where a state demonstrates that the requested

8 modifications would "fundamentally alter" the programs or services at issue. Id.;

9 see also Olmstead, 527 U.S. at 604-07.

10 B. The EPSDT Requirements of the Medicaid Act

11

Under the EPSDT provisions of the Medicaid Act, participating states must

12 provide coverage to categorically Medicaid-eligible individuals under the age of

13 twenty-one for all medically necessary treatment services described in the

14 Medicaid Act at 42 U.S.C. § 1396d(a), which sets forth the scope of the traditional

15 Medicaid benefits package. 42 U.S.C. § 1396a(a)(43); 42 U.S.C. § l396d(a)(4); 42

16 U.S.c. § 1396d(r)(1)-(5). Such treatment services must be covered for EPSDT-

17 eligible children and youth, even if the State has not otherwise elected to provide

18 such coverage for other popUlations. 42 U.S.C. § I396d(r)(5).

19

The EPSDT mandate requires states to effectively inform EPSDT-eligible

20 individuals "of the availability of [EPSDT] services," 42 U.S.C.

21 § 1396a(a)(43)(A), and to provide or arrange for "screening services in all cases

22 where they are requested," 42 U.S.C. § 1396a(a)(43)(B). Thus, a State must make

23 available comprehensive assessments ofEPSDT-eligible children who have

24 behavioral, emotional or psychiatric impairments. 42 U.S.C. § 1396a(a)(43)(B);

25 see also Rosie D. v. Romney, 410 F. Supp. 2d 18, 52-53 (D. Mass. 2006) ("[T]he

26

27

12

28

KATIE A.. ET AL. V. DOUGLAS, ET AL., CV·02·05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 14 of 70 Page ID #:4804

1 EPSDT provisions ofthe Medicaid statute require, by their very language,

2 comprehensive assessments of children with [serious emotional disturbance].").

3

The State must also arrange for (either directly or through referral to other

4 agencies) corrective treatment, the need for which is discovered by the screening.

5 42 U.s.C. § 1396a(a)(43)(C). The scope of the treatment to be provided for is

6 defined by 42 U.S.C. § 1396d(r) and includes dental, hearing and vision services,

7 and "[s]uch other necessary health care, diagnostic services, treatment, and other

8 measures described in [42 U.S.C. § 1396d(a)]. .. to correct or ameliorate defects

9 and physical and mental illnesses and conditions discovered by the screening

10 services, whether or not such services are [otherwise] covered under the state plan .

11 " 42 U.S.C. §§ 1396d(r)(I)-(5); see also 42 C.F.R. § 440.130.

12

Thus, under § 1396d(r)(5), states must "cover every type of health care or

13 service necessary for EPSDT corrective or ameliorative purposes that is allowable

14 under § 1396d(a)." Katie A., ex rei. Ludin v. Los Angeles Cty., 481 F.3d 1150,

15 1154 (9th Cir. 2007); (citing S.D. ex reI. Dickson v. Hood, 391 F.3d 581, 590 (5th

16 Cir. 2004); Collins v. Hamilton, 349 F.3d 371, 376 n.8 (7th Cir. 2003); Pediatric

17 Speciality Care, Inc. v. Ark. Dep 't ofHuman Servs., 293 F.3d 472, 480-81 (8th Cir.

18 2002); Pittman v. Sec'y, Fla. Dep't ofHealth & Rehab., 998 F.2d 887, 891-92

19 (lIth Cir. 1993); Pereira v. Kozlowski, 996 F.2d 723,725-26 (4th Cir. 1993)). A

20 service must be covered by the EPSDT program if it can properly be described as

21 one ofthe services listed in the Medicaid Act, 42 U.S.C. § 1396d(a). See, e.g.,

22 Dickson, 391 F.3d at 594-97 (finding that incontinence supplies were within the

23 scope of home health services described in § 1396d(a) and that the state violated

24 EPSDT provisions by denying Medicaid-eligible children such services); Parents'

25 Leaguefor EfJ. Autism Servo V. Jones-Kelley, 339 Fed. Appx. 542, 546 (6th Cir.

26

27

13

28

KATIE A, ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 15 of 70 Page ID #:4805

1 2009) (affirming preliminary injunction enjoining state from restricting

2 rehabilitative services for Medicaid-eligible children with autism).

3

States must provide all component services required under § 1396d(a), and

4 they must provide those services effectively. Katie A., 481 F.3d at 1159 ("States 5 also must ensure that the EPSDT services provided are reasonably effective.")

6 Where necessary to meet the needs of children with serious emotional or

7 behavioral disorders, the services must be provided in a coordinated fashion. !d. at 8 1161. Many children will need all services for the effective treatment of their

9 condition, and the delivery of all services in a coordinated fashion will be

10 necessary to avoid unnecessary and harmful institutionalization.

11

COMMENTS IN SUPPORT OF THE AGREEMENT

12

The denial of community-based mental health services results in significant

13 harm to Plaintiffs and class members, including the exacerbation of their

14 conditions in inappropriate foster placements, deterioration to the point of crisis,

15 and unnecessary institutionalization in violation ofthe ADA. (See Compl. " 4-7;

16 47); see also Katie A. v. Bonta, 433 F. Supp. 2d at 1078 (noting grave harm of

17 unnecessary institutionalization), reversed and remanded on other grounds, Katie

18 A., 481 F.3d at 1156-57. The United States recommends that this Court grant final

19 approval of the Agreement because it represents a "fundamentally fair, reasonable, 20 and adequate" resolution of this litigation that addresses the significant harms 21 identified in the Complaint. Fed. R. Civ. P. 23(e)(2); see also In re Mega Fin. 22 Corp. Sec. Litig., 213 F.3d 454,458 (9th Cir. 2000).10 Further, the Agreement

23
10 To determine whether a settlement is "fair reasonable and adequate," a court

24 generally looks to the following factors: (1) the strength of Plaintiffs' case, (2) the

25 risk, expense, complexity, and likely duration of litigation, (3) the risk of

maintaining a class action status throughout the trial, (4) the amount offered in

26 settlement, (5) the extent of discovery completed and the stage of proceedings, (6)

27

14

28

KATIE A., ET AL V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 16 of 70 Page ID #:4806

1 advances the public interest in moving Defendants towards compliance with

2 federal law.

3

4 A. The Agreement is Likely to Reduce Institutional Placements and

5

further the State's Compliance with the Integration Mandate of title II

6

of the ADA.

7

Plaintiffs brought this action seeking declaratory and injunctive relief, in

8 part, under the ADA and the Medicaid Act. (See Compl. ~~ 55-63,76,80-87.) By

9 failing to offer services at home, and in home-like and other community-based

10 settings, and instead requiring Plaintiffs to enter restrictive, institutional settings to

11 receive services, Defendants fail to provide services in the most integrated setting

12 appropriate to Plaintiffs' needs, in violation ofthe ADA and Section 504 of the

13 Rehabilitation Act and their implementing regulations. (See CompI. ~~ 7, 18,23,

14 27,29,40,52,80-87); 42 U.S.C. § 12132; 29 U.S.C. § 794; 28 C.F.R. §§

15 35.130(d), 41.51(d); Olmstead, 527 U.S. at 600-01; see also Katie A., 481 F.3d at

16 1160 ("[t]he district court, however, did describe plaintiffs' vulnerability, complex

17 needs, and ongoing 'unmet mental health needs and the harms ofunnecessary

18 institutionalization. "') (emphasis added). The Agreement reflects the strength of

19 Plaintiffs' claims by requiring Defendants to expand community-based services

20 within the State's foster care and mental health systems to reduce the systems'

21 -----------------------------------------------------------
the experience and views of counsel; (7) the presence of a governmental

22 participant; and (8) the reaction of class members to the settlement. In re

23 Bluetooth Headset Products Liability Litigation, 654 F.3d at 946 (citing Churchill

Vill., L.L. C. v. Gen. Elec., 361 F.3d 566, 575 (9th Cir. 2004); Torrisi v. Tucson

24 Elec. Power Co., 8 F.3d 1370, 1375 (9th Cir. 1993)). The United States addresses

25 only the first factor - the strength of Plaintiffs' case and the degree to which it is

reflected by the Agreement - but concurs that the weight of these factors warrants

26 final approval of the Agreement.

27

15

--------------~KA~T~IE~A~.~ET~A~L~.V~.~DO~U~G~LA~S~,E~T~~~.,~C~V.~02~-O~56~62~AH~M~(S~HX~)-;--------------------
28 COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 17 of 70 Page ID #:4807

1 reliance on institutional placements. See Disability Advocates, Inc. v. Paterson,

2 598 F. Supp. 2d 289, 316-19 (E.D.N.Y. 2009), appeal docketed, 10-235-CV(L) (2d

3 Cir. 2010) (holding that the defendants' planning, funding, and administration of a

4 service system reliant on institutional placements is sufficient to support an

5 Olmstead claim). The Agreement contains legally binding commitments from the

6 Defendants to ensure the expansion of intensive mental health services available to

7 foster children and youth with intensive mental health needs, and to reform the

8 manner in which mental health services are provided. (See Settl. Agr. ~~ 20(a)-(g),

9 (i).) The expansion of these services promotes the important aim of title II's

10 integration mandate to reduce reliance on costly, inappropriate, and unnecessary

11 institutional placements. See Olmstead, 527 U.S. at 607.

12 B. The Agreement is Consistent with the State's Obligation to Provide

13

Medically Necessary Services Under the EPSDT Requirements of the

14

Medicaid Act. .

15

Plaintiffs' Medicaid Act claims arise from the Act's EPSDT provisions,

16 which, as discussed above, pp. 9 to II, require states participating in Medicaid to

17 ensure the provision of all Medicaid-coverable services to EPSDT-eligible

18 individuals for whom the services are medically necessary. 42 U.S.C.

19 §§ 1396d(a)(4)(B); 1396d(r)(5); I396a(a)(10)(A); and I396a(a)(43)(C). Plaintiffs

20 assert that by depriving Medicaid-eligible children in foster care medically

21 necessary mental health services, Defendants violate the EPSDT requirements of

22 the Medicaid Act. (Compl. ~~ 55-63, 76). The Agreement defines certain

23 expanded community-based mental health services, to include ICC, II-illS, and

24 TFC, and to facilitate the provision of medically necessary services to EPSDT-

25

26

27

16

28

KATIE A, ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 18 of 70 Page ID #:4808

1 eligible individuals who are members of the Subclass. I I Under the Medicaid Act, a 2 state is permitted to cover many of the various components ofICC, nillS and TFC 3 outlined in the Agreement as "diagnostic, screening, preventative, and 4 rehabilitative services ....,,12 See 42 U.S.C. § 1396d(a)(13). Other Medicaid 5 authorities may also be available for the coverage of these services. CMS has, in 6 other States, approved coverage of intensive mental health services similar to those 7 outlined within the Agreement. See, e.g. Massachusetts State Plan/or Medical 8 Assistance, State Plan Amendment # 08-004, effective Apr. 1,2009 (relevant 9 excerpts attached as Exhibit 1) (covering EPSDT services under Rehabilitation 10 Services); Oregon State Plan/or Medical Assistance § 3.la, pp. 6-f--6-f.2 11 (relevant excerpts attached as Exhibit 2) (covering EPSDT services as Behavioral 12 Rehabilitation Services); Nevada State Plan/or Medical Assistance, (relevant 13 excerpts attached as Exhibit 3) (covering EPSDT services under Rehabilitation 14 Services). This Court and the Ninth Circuit Court of Appeals found that the 15 Plaintiffs presented persuasive evidence that the intensive mental health services 16 outlined within the Agreement are likely covered services under the Medicaid Act. 17 See Katie A., 481 F.3d at 1156 (stating that "the District Court cited those [other] 18 states' practices as support for its conclusion that wraparound and TFC are
19

20 II As noted supra, n. 1, the United States recognizes that the Defendants' 21 obligations under the Agreement are narrower than what is required under the
EPSDT requirements of the Medicaid Act, which requires Defendants to ensure the 22 provision of medically necessary service to all EPSDT-eligible individuals.

23
12 Section 1396d(a)(13) defines as covered medical services any "diagnostic,

24 screening, preventative, and rehabilitative services, including any medical or

25 remedial services ... for the maximum reduction of physical or mental disability

and restoration of an individual to the best possible functional level." 42 U.S.C. §

26 1396d(a)(13).

27

17

28

KATIE A.. ET AL. Y. DOUGLAS. ET AL., CY·02.Q5662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROYA.L OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 19 of 70 Page ID #:4809

I Medicaid-covered services. Evidence in the record supports the Court's findings,

2 and defendants have not presented any strong evidence to the contrary."); Katie A.,

3 433 F. Supp. 2d at 1075 (stating that "[t]he Court finds it likely that virtually all of

4 the corresponding categories of § 1396d(a) identified by Plaintiffs do, in fact,

5 encompass the linked-to service [described in Plaintiff s declaration].").

6

If such EPSDT services are medically necessary to correct or ameliorate a

7 mental health condition, the statute requires the State to provide coverage for them.

8 See Dickson, 391 F.3d at 595-96 ("CMS's approval of state plans affording

9 coverage for [the services sought by plaintiff] demonstrates that the agency

10 construes [the Medicaid Act] as encompassing that type of medical care or service"

11 and therefore required to be covered under EPSDT). If medically necessary, it is

12 the State's obligation to provide the type ofEPSDT required services that are

13 included in therapies like ICC, HrnS, and TFC services effectively to eligible 14 children. Katie A., 481 F.3d at 1160 (discussing a prior case in which a

IS Massachusetts district court concluded that adequate in-home behavioral support

16 services was a required EPSDT service which the state had failed to provide);

17 Rosie D., 410 F. Supp. 2d at 52-53 (state violated EPSDT provisions by failing to

18 provide to children with serious emotional disorders adequate and effective

19 comprehensive assessments, ongoing case management and monitoring, and in-

20 home behavioral support services). Thus, by expanding the availability of

21 medically necessary services for EPSDT-eligible children and youth with

22 significant behavioral health needs, the Agreement advances the important goal of

23 furthering the State's compliance with the EPSDT requirements of the Medicaid

24 Act.

25

26

27

18

KATIE A, ET AL. V. DOUGLAS, ET AL., CV·02·05662 AHM (SHX);

28

COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 20 of 70 Page ID #:4810

1

CONCLUSION

2

For the foregoing reasons, the United States respectfully urges this Court to

3 grant final approval of the Agreement.

4

5

6 DATED: November 18,2011
7

Respectfully submitted,

8
9 ANDRE BIROTTE United States Attorney
10 Central District of California
11
LEON W, WEIDMAN 12 Assistant United States Attorney 13 Chief, Civil DiviSion
/
14

THOMAS E, PEREZ Assistant Attorney General
EVE HILL Senior Counselor to the Assistant Attorney General

15

16

17 ~~~---4--~~~----------

ROB -

YON

18 MONTELEONE,

19 California Bar Number 130005

20 Assistant United States Attorney

Assistant Division Chief, Civil Rights

21 Unit Chief, Civil Division

22

23

24

25

26

lsi ALLISON 1. NICHOL, Chief KATHLEEN R. WOLFE, Acting Special Legal Counsel SHEILA FORAN, Special Legal Counsel RENEE M, WOHLENHAUS, Deputy Chief TRAVIS W, ENGLAND, New York SBN 4805693 Trial Attorney Civil Rights Division Disability Rights Section

27

19

KATIE A., ET AL. V. DOUGLAS, ET AL., CV·02·05662 AHM (SHX);
28 COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 21 of 70 Page ID #:4811

1

u.s. Department of Justice

950 Pennsylvania Avenue, N.W. - NYA

2

Washington, D.C. 20530

3

Telephone: (202) 307-8987

Facsimile: (202) 307-1197

4

travis.england@usdoj.gov

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

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KATIE A., ET AL. V. DOUGLAS, ET AL., CV-02-05662 AHM (SHX); COMMENTS OF THE UNITED STATES IN SUPPORT OF FINAL APPROVAL OF THE PROPOSED SETTLEMENT AGREEMENT

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 22 of 70 Page ID #:4812
EXHIBlTl

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 23 of 70 Page ID #:4813

DEPARTMENT OF HEAL'lH & HUMAN SERVlCES Centers for Medicare« Medicaid Services
JFK Federal Building, Government Center
Room 2275 Boston, Massachusetts 02203

CAIS

Division of Medicaid and awdren's Heal.fh OperationS / Boston RegIonal Office

June 4, 2009·
JudyAnn Bigby, M.D., Secretary Executive Office ofHeaJth and Human Services I Ashburton Place, Room 1109 Boston, Massachusetts 02! OS .
. Dear Or. Bigby:
We have reviewed Massachusetts State Plan Amendment (SPA) No. OS-004, received in the Boston Regional OffiCe on March 25, 2()()S. Thm amendment adds Early Periodic Screening, Diagnosis, and Treatment services fur individuals under age 21 with severe emotional disturbance ;md implements the judgment of the Federal District Court in RoSie D. v. Romney. Based on the infurmation provided, we are pleased to inform you that Massachusetts SPA 08-004·is approved, with an overall effective date ofApril!; 2009, but with the fullowing effective dates for the individual services contained bthe SI>A:.
• Mobile Crisis Intervention. - July 1,2009 • In-Home Behavioral Services - October 1,2009 . • In-HomeTherapy Services - November I, 2009· • Therapeutic Mentarlng Services - October I, 2009 • Family Support and Training - July 1,2009 .
Enclosed. is a copy of the eMS:179 form, as wen as the approved pageS for incorporation.in the '. Massachusetts Medicaid State Plan. The Remarks section of the CMS-179 indicates the changes' .that were mutually agreed to during the processing of this SPA.'
Please contact Aaron Wesolowski afmy staffifyou have any question. Aaron'Wesolowski can
be reached at 617,565-.1325 or by e.mail at aaron.wesolowski@Cms.hhs.gov.
Sincerely,

Richard R. McGreal Associate Regiona! Administrator'
ce: Thomas Dehner, Medicaid Director Michael Coleman, State Plan Coordinator

.Exhibit 1 22

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 24 of 70 Page ID #:4814

Supplement to Attachment 3.I·A
Page,la , State PIa••nder Title XIX .fthe 800lal Security Act
Slate; M.s,achusett.
Umltatlons to Servloes ProvIded to tho CategorlcaUyNeody

Item 2.a: Outpatient Hospital Services
See Supplement to Atlnchment3.1-A, page I, item I, #1 and #4.
Item 4.8: Nursing Facilities Services
If a utilization review team recommends that a iecipient in a multi-Ievellong-term·care facility be changed 1:0 a lower level of care, the facility is responsible for relocating a recipient to the recommended level ofcare within the facility. The recipient has Ihe right 1:0 appeal the recommendation.
Item 41!;' Early and Periodic Screening, Diagnostic and Treatment services for individuals under 21 years of age, and treatment of conditions fonnd.
In addition to all other medic~lly necessary services covered 'for individuals under age 21, the following services
are,covered a. Rehabilitation services as defined in 42 USC I396d (a) (13), These services are provided to, or
directed exclusively toward Ihe treatment of, the Medicaid eligible individual:

••' Mobile Crisis Intervention (Services described in this section are effective July 1,2009,) Mobile CrIsis Intervention provides ~ short tenn service,that is mobile, on-site, face-te-face therapeutic response
to a youth experiencing a behavioral health (mental health or substance abuse) crisis for the purpose of identifYing, assessing, treating, and stabilizing the situation and reducing the immediate risk of danger to the
youth or others consistent with the youth's risk management/safety plan, if any, Services are available 24 hours a day, 7 days a week, Phone contact and, consultation may be provided as part oflhe intervention. Mobile crisis services may be provided by a single crisis worker or by a team of professionals tlult are qualified providers who are trained in crisis intervention.

Mobile Crisis Intervention includes the following activities when perfunned to resolve 111. immediate crisis:

• Assessment

• Crisis counseling including individual and fainilycounseling;

• Clinical consultation and coordination with other health care providers;

,

'

• ' Psychopharmacological management, including availability of on-site prescriber;

,

• Identification and inclusion of professional and natural supports (e.g" therapist, neighbors, relatives)

who can assist in stabilizing the situation and offer ong<>ing support;

• Development of a risk management/safety plan, In cases where the youth does not already have

such a plan, Mobile Crisis Intervention 'creates Ii risk management/safety plan in concert :wilh Ihe , parent(s)/gwirdian(s)/caregiver(s) and any existing service providers (e.g., ICC, In-Home Therapy

Services, outpatient ~herapist); and

'

,

• 'Referral to other services as needed.

OFFICIAL

TN: 08·004 , Supersedes: 06·005

Approval Date: 06/04109

'Eff.olive Date; 04101109

Exhibit 1 23

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 25 of 70 Page ID #:4815

Supplement to Attachment 3.t-A

.

Page tb

·State Plan under TItle XIX of the Social Securily Act

Stale: Massacbusetts

Umitatlons to Semes Provided to the CategorlcaUy Needy

Settings: Mobile Crisis Intervention is provided where the child is located.
Providers: <1>mponents ~fMobile Crises Crisis [ntervention are provided by p.....otitione.... as described below. Practitione... must be working under an employment or contractual arrangement with one ofthe following: outpatient hospitals, commWllty health centers, mental health centers and other Clinics.

• Assessment - LlCSWs, LCSWs, LMFTs,· LMHCs, licensed Psychologists, master's level counselors,· marriage and fumily therapy interns,. mental health counselor interns, psychiatric nurse mental heaJth·clinical specialists, psychiatric nu.... mental health clinical specialist trainee, psychiatric nur:;es, psy<:hiatrists, psychiatry residents, psychology interns, social work interns

• Crisis counscllng Including individual aud family counseling - LICSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master'. level counselors, marriage and family therapy interns, mental health counselor interns, psychiatric nurae mental health clinical specialists, psyohiatric . nurse mental health clinical specialist trainee, psychiatrio nurses, psychiatrists, psychiatry residents, psychology' interns, social work interns, bachelor-level cOWlselors/paraprofessionals, LADC Is .
• Clinical Consultation and coordination with other health care providers - L1CSWS,. LCSW., LMFTs, LMHCs, licensed psychologists, master's level counselors, marriage and faoiily therapy interns, mental health counselor intems,. psychiatric nurse mental health clinical specialists, psychiatric nurse mental healtb clinical specialist trainee, psychiatric nurses, psychiatrists, psychiatry residell!s, psychology interns, social work intorns, bachelor-level counselors/paraprofessionals, LADC Is

• Psychopharmacological management - Psychiatric nurse mental health clinical specialists,

psychiatric nurse mental health clinical specialist ninee, board-certified 'or board-eligible child

psychiatrists,psychiatry residents.

.

• Identification and inclusion of professiOllal and I1!IturaI supports (e.g., therapist, neighbors, relatives) who can assist in stabilizing the situation and offer ongoing. support - L1CSWs, LCSWs. LMFTs, LMHCs. licensed psychologists, muster's.level counselors, marriage and family therapy inteI'D', mental health counselor interns, psychiatric nurse mental health cl!nicai specialists, psychiatiic nurse mental health clinical specialist trainee, psychiatric nurses, psychiatrists. psychiatry residents, psychology interns, social work interns; assoCiate-level counselors/paraprofessionals, bachelor-level counselors/paraprofessionals, LADC Is, LADC lIs, LADC Ills, LSWs, and LSWAs,

• Development of a risk management/safety plan -LICSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master'S level oounselo,.., marriage and family therapy interns, mental health counsel6r interns, peychiatric nurse mental health clinical ·specialists, psychiatric nurse mental health clinical specialist trainee, psychiatric nurses, psychiatrists, psychiatry residents, psychology interns, social work interns
OFFICIAL

TN: ij8-004
Sup.rsedes: 06-()05

Approv.1 Date: 06104/09

Effective Date: 04101109

Exhibit 1 24

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 26 of 70 Page ID #:4816

Supplement to Attachment 3.I-A
Page lc State Plan nnder Tide XIX of d.e Social S.""rity Act
State: Massachuse«s
Llmltadon. to Servl... Provided to the CategorlcaUy Needy

• Referral to other services as needed: L1CSWs, LCSWs, LMFrs, LMHCs, licensed psychologists, master's level counselors, marriage and family therapy interns, mental health
counselor interns, psychiatric nurse mental health clinical specialists, psychiatric nurse mental health clinical specialist. trainee, psychiatric nurses, psychiatrists, psychiatry residents, psychology interns, social work interns, associate-level counselors/paraprofessionals, bachelorleve) ""unselors/paraprofessionals, CADACs, CADAC lIs, LADC Is, LADC lIs, LADC Ills, LSWs, and LSW As.

b. In-Home Behavioral Services: (Services described in this section are effective October 1,2009.)

This service provide's for the development of a highly speCific behavior plan; supervision and coordination of int.rventions; and training other interveners to eddress specific behavioral objectives or performance goals in order to treat challenging behaviors thst interfere with the youth's successful functioning. An In-Home Behavioral service includes two componentS: behavior management therapy and behavior management monitoring. It is delivered by one or more members of a team of qualified providers consisting of professional and paraprofessional staff.

I. Behavior management therapy: Bebevior management therapy includes activities thai are required to develop, implement, monitor and updall> a behavior plan, including overseeing activities of the behaVior management monitor. Behavior management therapy is performed by a licensed clinician who meets the qualifications of a Behavior management therapist as ~escn'bed in the provider
qualifications section below.

Behavior management therapy includes the foHowing:

• Functional behavioral assessment;

• Development ofa focused JJehavior' plan that identifies specific behavioral and measurable

objectives or perfomiance goals and interventions that are designed to diminish, extinguish,

or improve specific behaviors fOlaled to a youth's behavioral health. (mental health or .

substance abuse) condition(s);

. • Development or ",vision of a youth's risk management/safety plan to address the. specific

behavioral !leeds ofth. youth: .

.

• . Counseling the ~nt(s)lguardi.n(s)lcaregiver(s) on how to implement strategies identified

in the behavior plan;

,

• Working closely with the behavior management monitor to ensure the behavior plans and

risk management/safety plan are implemented as developed, and to make any necessary

adj ustments to the plans;

.'

• Clinical consultation and coordination with other behavioral health (mental health or

substance abuse) care providers; and

• Referral t6 other services. as needed.

OFFICIAL

TN: OS-004 Supersedes: 06-005

Approval Date: 06104/09

Effective Date; 04/01/09

Exhibit 1
25

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 27 of 70 Page ID #:4817

Supplement to Atteehment3.1-A

Slate Plan under Title XIX of tb. Soelal Security Act

Pageld

State: Massachusetts

'

Limitation, to Services Provided to the Categorically Needy

2. ,Behavior management monitoring, This service includes activities related to'the implementation of
the behavior plan and a risk management/safety plan as needed. Behavioral management monitoring ~Iso inol~des mon!toring the youth's behavior, reinforcing implementation' of the
behavior plan by the parent(s)/guardian(S)/caregiver(s), and reporting to the behavior management therapist on implementation of the behavior plan and progress toward behavioral objectives or performance goals,

Behavioral managementmonitoring is performed by a paraprofessional who meets the qualif'ications of a behavior management monitor as described in the definitions section below.

Behavior managem~nt monitoring includes the following:
• Monitoring the youth's progress on implementation of the goals of the behavior plan
6,. developed by the behavior management therapist;
• Assisting the youth in implementing the goals of behavior plan developed by the behavioral management therapist;
• Providing guidance to the parent(s)/guardian(s)/caregiver(s) in implementing the plan; and' • Working closely with the behavior management therapist to ensure the behavior plans and
risk management/safuty plan are iinplemented as developed.

Settings: , In-Home Behavioral Services may be provided in any setting where the ~hild is nsturally

loeated including, but not limited to, the home (including foster homes and therapeutic foster homes),

schools, cJ,i1d care centers, and other community settings.

'

Providers The following practitioners may provide any component of behavior management therapy as described above: Developmental-behavioral pediatricians, developmental-behavioral pediatric
fellows. L1CSWs; LCSWs, LMFfs, LMHCs, licensed psychoiogists, master's level couhselors,'
marriage and family therapy interns, mental health counselor interits,psychiatric nurse mental health
clinical specialists, psychiatric nurse mental health clinical speciaiist trainee; psychiatric nurses, psychiatrists, psychiatry residents, psychology interns and social work interns. Behavior management
monitors may provide any component ofbehavior management monitoring as described above.

Qualified Practitioners of behavior ';'anagement therapy also must have'two years relevant experience providing direct services to youth and families who require behavior management to address behavioral health (mental health or substance abuse) needs; course work and training in conducting functional behavioral assessments, and selecting, implementing and evaluating intervention strategies; sUjl\lrvised experience conducting function'al behavioral assessments and designing, implementing. and monitoring
behavior analysis programs for clients and other qualifications established by the state. Practitioners
must be working under an employment or contractual agreement with one of the following: outpatient hospitals, communityhea!th centers, mental health centers, other clinics, and private ogencies certified
by the Commonwealth.

TN: 08-004 Supersedes: 06-005

Appro.al Date: 06104/09

Effective Date: 04101109

Exhibit 1 26

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 28 of 70 Page ID .....__' _ . ___' ___._.•. _. ____ ..__

R., .,_ .R.....

.• , R.. '_' '."R" .R_.'_.______ ._...... __ •..•,.

,~,

#:4818

Supplement to Atta.btnell! 3.1-A Page 1. '
State Pia••nderTltl. XIX of the Sodal Security Act
'0 State: Massachusetts
Limitations Servlces,Provhled to the Categori~.lIy Needy

c. In-Home Tberapy SeniC<!S: (Services described in this section are effective November I, 2009.J

This service provides for the development of an individualized treatment plan; supervision and

coordination of int~rventions for the purpcse of treating ,the youth's mental health and substance abuse

needs. The intervention is designed to enhance and improve the family's capacity to improve the

youth's functioning in the home and community nnd may prevent the need for the youth's edmission to

an inpatient hospital, psychiatric residential treatment facility or other treatment setting. This service is

delivered by One or more members of a team of qualified providers 'consisting of professional and

paraprofessional staff, offering a combination of niedically necessary in home therapy and therapeutic' '

training and support.

I.

In Home Therapy: fu-home therapy is 8 structured, consisten~ Strength-based therapeutic relationship

between a licensed clinician and the youth and family. The licensed clinician, in collaboration with the

family and youth, develops an individqalized treatment plan and, using established psychotherapeutic tec~njques, and intensive family therapy works with the entire family or a subset of the family to

implement focused structural or strategic interventions to advance therapeutic goals. In addition, the

,clinician assists in identifying and utilizing community resources and develops and maintains

naMal supports for the youth and parent(s)/guardian(s)/caregiver(s) in order to promote, sustainability

of treatment gains. Phone contact and consuliation are provided as 'part of the intervention. In·Home

therapy is pe.ronned by a licensed clinician who meets the qualifications of an in-home therapist as

described section below.

In-Home Therapy includ~ the following:

• . Assessments;

'

• Development of an Individualized treatment plan by the qualified practitioner in partnership with

the youth and parent(s)/guardlan(s)/caregiver(s) and"with required consent, in consultation with

other providers that is designed to address the youth's mental health or sllbstance abuse condition;

• 'ongni~g monitorillg and modification of the individualized treatment pl"lJ as indicated;

., Review/development of• risk management/safety plan;

• Phone and face-to..face ~onsu~ation with oiner' providers, individuals and entities who may impaot

tha youth·s b-eatment plan;.

.

• Family counseling through which the licensed clinician works with the entire family, or a sub5et of the family, to advanCe therapeutic goals; and

• Referral to other services as needed.

OFFICIAL

TN: OS"()04 Supersedes: 06-005

Approval Date: 06104/09

Effective Date: 04101109

Exhibit 1 27

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 29 of 70 Page ID #:4819

Supplement to Attachlllent 3.1·A Page 1f
State Plan under Title XIX ofth. Social Seeurtty Act , St.te: M....chusetts '
Limitation. to Services Provided to tbe Medically Needy

2. TIlerapeutic training and support is • service provided bY .n associate-level ,or bachelor-Ie.el
paraprofessional working under the supervision of a olinici!ll1 to support implementation of the inhome 1herapists treatment plan in order to achieve the goals of the th.t plan. The paraprofessional assists a licensed clinician in implementing the therapeutic objectives of the individualized
treatment pian. Phone colitact and consultation may be provided as part ofthe intervention.

Therapeutic training and support includes tl)e following:

• Providing guid.nce' to the youth and p.rent(s)/guardian(s)/caregiver(s) in implementing the

treatment plan;

,

• Providing skills training for youth and parent(s)lguardian(s)lcaregiver(s) in support ofthe treatmeni

~~~

"

.

.

• Monitoring the youth's and parent(s)/guardian(s)/caiegiver(s) progress on achieving treatment plan

'goals and oommunicating regularly with the clinician so that the treatment plan can be modified and

'necessary.

'

Settings: 'In home therapy services may he provided in any setting where the child is naturally locaied

including. but oot limited to, the homo (including foster homos and therapelltic fostechomes), schools,.

child care centers, ,and other oommunity settings. "

'

Providers: The following practitioners may provide any component of in-home therapy as' descn'bed above: In-home therapy services are delivered by the following practitioners: LICSW, LCSW, LMFT, LMHC, Licensed psychologis~ Master's level oounselors, marriage and family therapy, interns, mental health counselor interns, psychiatric nurse men~l health clinical specialists, psychiatric nurse mental
health clinic specialists trainee, psychiatric nurses, psychiatrists, psychiatry residents, psychology
,interns. The following practitioners may provide any component of therapeutic training and support as describeil above: Associate-level oounselors / paraprofessionals, bachelo....level counselors / paraprofessionals, Practitioners must b. working under an employment or contractual arrangement with
one of the following o'utpatient hospitals, communit¥ health centers, mental health centers, other clinics and ,private agencies c.rtified by tho Commonwealth.

TN: ~8-004
Supersedes: 06-005

Approval Oate: ()Ii/04lO9

Effective Oate: 04101/09
Exhibit 1 28

-----_C.a_s.e_2-:-0-2---c-v--0_5.6_6-2--AHM-SH Document 771 Filed 11/18/11 Page 30 of 70 Page ID
#:4820

Supplement to Attachment 3.1,A Page II!
State Pia. under Title XIX .ftbeSoclal Security Act Stale: Massachusetts'
Limitation. to Services Provided to the CategorlcaDy Needy -

d. Therapeutic Ment'Oring s~rviceS: (Services described in this section are effective October I, 2009:)

Therapeutic mentoring services are structured, one-to-one, strength-based services that are designed to help ameliorate behavioral health (mental health or substance abuse) related conditions which prevent the youth from appropriate social functioning. These services must be delivered according to an individualized treatment plan developed by either an outpOltient clinician, an i~-home therapy clinician or, for youth enrolled in Intensive Care Coordination, a care planning team. Progress toward meeting the
identified goIIl(s) must be d9Cumented.and reported regularly to tho provider responsible forth. youth's
treatment plan.

The therapeutic mentor does not provide social, educational, artistic, atblelic, recreational or vocational

servioos.

.

,

Settings: Therapeutic mentoring services are provided to youth in any setting where the youth resides,
such as the hoine'(including foster homes and therapeutic foster homes), school, child tare.conters and

other community settings,

.

. Providers: Therapeutic mentoring services 'are delivered by tller.peuuc mentors•.Practitionersmust be working under an employment or contractualainmgement with on ofthe following: outpetient hOspitals, communiiy health cente<s,.lnental health centers, other clinics, and private agencies certified by th., Commonwealth. Providers of therapeutic'meritoring utilize therapeutic mentors to provirlll these
service's,.

I
--1

TN: 08-004
Sup....edes, ou.-005.

OFFICW

Appr.val Date: 06f(l4I09

Effective Date: 04/01/09

Exhibit 1 29

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 31 of 70 Page ID #:4821

Supplement to Att••hment3.1'A
Pagelh State PI•• under Title XIX of lb. Social Security Act
Stale: M....chusetls Limitations to Services Provided to lbe Categorically Needy

e

Family Support and Training: (Services described in this section are effective July 1, 2009.)

A family support and. training partner addresses goals established in an individualized treatment plan in

order to resolve or ameliorate the youth's mental health, behavioral and emotional needs through

enhancing the capacity of the parent(s)/guardianslcaregivers} to ,implement activities required to meet

the goals oflbe plan. Family support and training is a skill-building support and not a form oftherapy or

counseling. The individualized treatment plan inust be, developed by either an outpatrent clinician, an In_ .

home therapy clinician or, for youth enrolled in Intensive Care Coordination, a care planning team. ,

These services, include the following when they are relevant to the goals in the youth's individualized

care plan:

'

• " providing guidance to parent(s)/guardians(s)/caregiver(s) on navigating systems that support youth

with mental health, behavioral and emotional needs, suoh,1Il! working effectively with state agency

, , case managel', school system offioials, provider agency staff and clinicians;

• fosiering empowerment of parent(s)lguardian(s)lcaregiver(s} by offering supportive guidance for parents of youth with m~nlal health needs and encouraging participation in peerlparent support and'

self-help grouPS;,

,.

'

~ providing guidance to the Pllfent(s)lguardjan(s)lc8regiver(s) bow tofinel, access and use formal anjl

informal. community-based resources (e.g., after..chbol programs, food assistance, housing

res,ouree,; youth-serving systems, etc.); a n d '

, ,

• modeling these 'kills for parent{s)/guardians(s)l!"'re&iver(s).

Family support and training services do not include respite care or child care, services.

Settings: Family support t\Ild training services are provided ';n any setting where the youth resides, such as the home (includingfoster homes and therapeutic foster homes), and other oommunity settings,

Provid~rs: 'Family s~pport and training 'setvi';" are delive;~d by a family support and trajning partner,

'A family support and. training partner must be working under an' employment or contractual

arrangement with one of the following: outpatient hospitals; community health centers, mental health

centers, otller clinics and private agencies, certified by the Commonwealth.

-1

TN: 08-004 Supersedes: V6·005

Approval!).t,,: 0.6/04109

, EffectiVe Date: 0.4/01109

Exhibit 1 30

-_.,,:.-.,_..C-a~s-- e.2-- :0.."2,. -"c,'v-05662-AHM-SH

Document 771 Filed 11/18/11 #:4822

Page 32 of 70

Page ID

Supplement t. Attacbment 3.1-A
Page 11 Siale PI;'D uuder Tille XIX .rthe Social Security Act
State: Mal;88chusetts limitations to Services ProVided to the Categorically Needy

Definitions:

AssoClate-ievei connse)ors/paraprofessionaJ '

' ,

'

Associate-level coun,selors/paraprofessionals must have an aSsociate's degree in a human services field from

an accredited academic institution and one (I) year of relevant experience working with families or youth.

If the associate's' degree i.s not in a human services field, additional life or, work experience may be 'considered in place of the, human services degree. As~ociate-Ievel counselors/paraprofeSsionals are

supervisea by a LlCSW" LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse or Nurse

Clinical Specialist

Bacbelor-level "Counselors/paraprofessIonal Bachelor-level counselors/paraprofessionals must haVe a bachelor'. degree 'in a human services field from an accredited,academlc ,institution and one year of relevant experience working'with families or youtll. Ifthe
of bachelor's degree is not in a human serv(ces field, additional life or work experience may be considered in
place the ~uman services degree. Bachelor-level counselors/paraprofessionals are supervised by a LICSW, LMFT~ LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist.

Behavior Managem,ent Monitor Behavioral management 1110ni!ors lIluS! have 'a bachelor's degree in a human services field from an' accredited university and ()ne (I) year of relevant experience working with families, children or adolescen~
who require ,,"havior management, ()r an'associate's degree and a minimum of two (2) years of relevant
experience ,working with families, children or adolescents who require behavior management. Behavior
management monitors are supervised by a L1CSW, 'LMI'T, 'LMHC, LCSW; LADC I, Psychologist,
Psychiatric Nurse or Nurse Clinical Specialist..

Certified AicobollstillIJrng Abuse Counselor (CADAC) Certified by the private Massachusotts, Boara of Substance Abuse Counselor Certification (MBSACC). CADAC certiflcation requires a combination of either a Master's degree in a "behavioral science area" and
2,000 hours of supervised ex.perience or a Bachelor's degree in a behavioral seiectce area and 4,000 hours of supervised experience or an Associates' degree in a behavioral science area and 6,000 hours of supervised' experience. CertificatiOn also requires documentation of having received a minimum of 270 clack hours of continuing education related to 1I1e five domains for' alcohol and other drug abuse. Consistent with applicable state licensure requirements; certified alcoholism/drug abuse counselors are supetvised by .. LlCSW, LMFT; LMHC, LCSW, LADC I, PsyChologist, Psychiatric Nurse or Nurse Clinical Specialist.

Certified Alcoholism/Drug Abuse Counselor II (CADAC iI) Certified by the private Massachusetts Board of Substance Abuse Counselor Certltioalion (MBSACC); CADAC II certification requires a master's degree (or higher) from a regionally accredited academic .institution in a human ,services behavioral seiences field with a clinical application (i.e., practicum); 2,000 hours of supervised experience and documentation of completion of 300-hour practicum. Consistent with applicable Slate licensure requirements, certified alcoholism/drug abuse counselor lis are supervised by a LICSW, LMFT, LMHC, LCSW, LADC 1, Psychologist, Psychiatric Nurse or Nurse C1i~ical Specialist..
OFFICIAL

TN: 08-004 Su persedes: 06-005

Approval Date: 06/04/09

Effective nate: 04/01/09

Exhibit 1 31

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 33 of 70 Page ID #:4823

Supplement to Attachment 3.I-A Page Ij
State Plan under TIUe XIX orthe Social Security Act . State: Massachusetts
Limitations to Services Provided to Ibe Categorically Needy

Thlvelopmenial-Behavioral Pediatriciall
A person with a current, valid, unrestricted license to practice medicine issued by the MassachusettS Board
of Registration in Medicine, who is board-certitied in Pediatrics and either board-eligible or board-oertitied in Developmental-Behavioral Pediatrics

Developmental-Behavioral Pediatric Fellow
A person with a current, valid, unrestricted license to practice medicine issued by the Massachusetts Board of Registralion in Medicine, .who is board-certified in Pediatrics and enrolled in a training program in
·Developmental-Behavioral Pediatrics. accredited by the Accreditation Council for .Graduate Medical Bducation (ACGME). Services provided by the Developmental-Behavioral Pediatric Fellow must be provided in a setting approved for t(aining by the sponsoring training institution, under supervision of a
bOllrd certified or eligible Developmentsl'Behavioml Pediatrician, consisteitt with applicable state. licensure requirements ..

· Family SUpPQrt "!I'd Training Partner A family Sllpport. and training worker must have experience as a caregiver of a youth with special needs, · preferably youth with. behavioral health needs, experience in navigating any oftbe youth and family-serving systems and teaching family members who are involved with th. youth and family serving systems, and either: a bachelor's degree in a human services field from.an accredited academic institution, or an
associate's degree in.a hl.\man services field ITom anaccrOdited acadettlic institution and one (1) year of experience working with childrenladolescents/transition-ag. youth and families, or a high school diploma or
General Education Development (OED) and a minimum of two (2) years of experience working witb childrenladolescentsliransiti'on age youth and families. If the bachelor's or associate's degree is not in a buman services field, additional life or work experienc~ msy be. considered in place of the human services degree. Family partners are sqpervised by a. L1CSW, LMFT, LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist

LicenSed Alcohol and Drug Coonsolor I - LADe I
A person licensed by the 'Department of Public' Health to conduct an independent practice of alcOhol and
· drug Counseling, and to provide supervision to other alcohol and drug counselors, as defined in lOS CMR 168.000. These requirements include: a master's or doctoral degree iii behavioral sciences, a minimum of 270 hours of trailiing in substance abuse counseling. 300 hours of supervised practical training and 6,000 hours bf supervised .a1cohol and drug counseling work experience.

Llcen.~ Alcohol and Drng Counselor II - LADC II ,

.

A person licensed by the Department of Public Health to practice alcohol and drug counseling under clinical

supervision, as defined in 105 CMR 16&.000. These requirements include: a high scl!ool diploma or

equivalent, a minimum of 270 hours of training in substance abuse counseling, 300 hours of supervised·

practical training and 6;000 hours of supervised alcohol and drug counseling wo* experience (4,000 if

applicant holds a bachelor's degree). Consistent with ~pplicable state licensure requirements, LADC lis are

supervised by • LICSW, LMIT, LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse or Nurse

Clinical Specialist.

.

OFFICIAL

TN; 0S-004
Supersedes: 06-005

Approval Oate: 06/04/09

Effective Date: 04/01/09

Exhibit 1
32

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 34 of 70 Page ID #:4824

Supplement to Atta.bment 3.I·A Page Ik .
State Plan under Title XIX .flb. Social Security Act
Slate: Massa.b~••tIa
Limitations to Service. Provided tothe Categorlc.ny.Needy

Licensed Alcohol and Drug Counselor Assistant - LADC ill A person licensed by. the Department of Public Health to provide recovery based services under direct
clinical and administrative supervision, as defined in lOS CMR 168.000. These requirements include a high
school diploma or equivalent, 2,000 hours of work experience in the alcohol or drug abuse field and a
minimum of 50 hours of training in substance abuse counseling. Consistent with applicable state licensure requirements LACD Ills are supervised by a LlCSW, LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist.

Licensed IndependeDt Clinical Social Worker (LICSW)

.

A person with a current, valid, unrestricted license to practice as an LICSW, issued by the Massaohusettr;

Board of Registration of Social Workers. These requirements include: master's or doctoral degree in Social

Work from a program accredited by the Council on Social Work Education and two years supervised

experience.

Licensed Clinical Social Worker (LCSW) A person with a current, valid,. unrestricted license to practice as an LCSW, issued by the Massachusetts
Board of Registration of Social Workers. These requirements include: master's or doctoral degree in Social
Work from a program 'accredited by the Council on Social Work Education. Consistent with applicable . state licensure requiiements, LCSWs are supervised by Ii L1CSW, LMFT, LMHC, LCSW, LA~ .; Psychologisl,Psychiairic Nurse or1'lurse Clinicaj Specialist.

Llcensed'Social Worker(LSW).

.

A person with a curren~ valid, unrestricted license to practice as an LSW, issued by the Massachusetts

Board of Registration of SOcial Workers. These requirementS include: a bachelor's degree in Social Work .

ftom a program accredited by the Council on SoclafWork Education or a baehs!or'. degree in any subject

and 3500 hours of supervised experien~ providing social work services. Consistent with applicable state

licensure requirements, LSWs are supervised by a· L1CSW, LMFT, LMHC, LCSW, LADC I,: Psychologist,

Psychiatric NurseorNurse Clinical Specialist.

Licensed Social Work Associate (LSWA) A person with a current, valid, unrestricted license to practice as an LSWA, issued by the Massachusi>ltS
Board ofRegistration of Social Workers. These requirements include: an associate degree, or.at least silrty credit hours of college education, in the fields of social work, psychology, counseling ~r other similar
human services field, from an accredited college or university; or a baccalaureate degree in any field from an accredited college or university; or a minimwn of one thousand (1000) hours of education in socia! work theory and methods in courses or programs approved by' the Board of Registration of'Soci,1 Workers. Consisten! with ,ppliciahle state licensure requirements, LSWAs are supervised by a LlCSW, LMFT, LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist.

Licensed MaFl"iage and Family Therapist {LMFI}

A person with a current, valid, unrestricted license to practice as. LMFT, issued by the Massachusetts

Board of Registration of Allied Menta! Health Professionals. These requirements include: a master'. degree

in the mellla! health field (including, but not restricted to, counseling, family tberapy, psychology, etc.) from

OFFI an accredited college or university and two years supervised e

C~

TN: 08-004 Supersedes: 06'()05

Approval Date: 06104109

Effective Date' 04/0\109

Exhibit 1
33

Case 2:02-cv-05662-AHM-SH _D...o,--c_.u,._m_..e. n..,._t#-.7:."4.7,.8.12-5,._F..-il'-e' d 11/18/11 Page 35 of 70 Page ID

I

!

Supplement to Attachment 3.1-A

I I

State Pian under Titl. XIX of tb. Social Security Act

Page 11

I

State: M....chu..tt. Limitations to Services Provided to the Categorically Needy

I

Licensed Mental Health Counselor (LMHC)

A person with a current, valid, uprostricted license to practice as a LMHC, issued by the Massachusetts

Board of Registration of Allied Mental Health Professionals. These requirements inoludo: a master~s degree

in the mental health field (including, but nm restricted to, counseling, family therapy, psychology, ,etc.) from

an accredited college or university and two years, supervised experience.

'

Licensed Psychologist

,

A person with current, valid, unrestricted license to practice psychology issued by tlie Massachusetts Board

of Registration in Psychology, These requirements inolude a dootoral degree from a progt;lm accredited by

the American Psychological Association and two years supervised eXperienCe

Marriage and Faoilly Therapy Intern
The marriage and family therapy intern must be a second-year", clinical-track student in a structured field placement that is 8 ,component of a master's in marriage and family therapy or a master's in a counseling prograrr that is fully accepted by the Board of Allied MentQI Health and Human Services Profession. The marriage and family therapy intern must provide services under the direct supervision of a L1CSW, LMFT, LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse; or Nurse Clinical Specialist
consistent with applicable state licensure requirements. ,

, Master's Level Counselor" A person with a master's or doctoral degree in a mental health fle1d (including, but not restricted to, counselin~ family therapy; social work, psychology, etc.) from an accredited college or university who i,
supervised by. LICSW, LMPT, LMHC, LCSW, LADe I, Psychologist; Psyphlatric Nurse, or Nurse
Clinical Specialist.

Mental Health Counselor Intern

a The Mental Health Counselor Intern must be ;, second-year, clinical-track student in a
'structured field placement that is component of a master's in mental health counseling or a master's in a

counseling psychology program that is fully accepted by the Board of Allied ,Mental Health and Human

Services Profession Consistent with applicable state licensure requirements, the Mental Heath Cnunselor

Intern provides services under the supervision of a LlCSW, LMPT, LMHC, LCSW, LADe I, Psychologis~

Psychiatric NUrs. or Nurse Clinical Specialist.

'

Psycbiatric Nurse

' ,

A person with a current, valid, unrestricted license to practice as a registered nurse issped l,1y the Board of

Registration in Nursing, a m.ster's degree in the mental health fields and o,ne (I) year of experience

delivering mental health services to families 'and youth. Consistent with applicable state licensure

requirements, the Psychiatric Nurse provides services tmder the supervision of a LlCSW, LMPT, LMHC,

LCSW, LADe I, Psychologist, Psychiatric Nurse Or Nurse Clinical Specialist.

Psychiatric Nurse Mental Health Clinical Specialist A person with' a current, valid, unrestricted license to practice as a registered nurse issued by the Massachusetts Board of Registration in Nursing and cU!Ten~ valid, unrestricted authorization by the Massachusetts Board of Registration in Nursing to practi~ as a Psychiatric Nurse Mental Health
Clinical Specialist

TN: 08-004 Supersedes: 06--00:5

Approval Date: 06104/09

Effective Date, 04101/09

Exhibit 1 34

-- __- - Case 2:02-c..-v-..0...5'6-6-2--AH-M-'--S'-H'-"-D..o. c..• um....e_.n.._t#....7:..4.78.1,.2.-...6. --F-.i.l.e-d-1-1-/18/11 Page 36 of 70 Page ID

.Supplement to Attachment 3.t-A
Page 1m Sta te Pion uuder Title XIX ofthe Social Security Act
State:M.ssachusetls Limitations to Sonl... Provided to the categorleaUy Needy

Psychiatric Nurse Mental Health Clinical Specialist Trainee
A person with a curr.nt, valid, unrestricted Iicens•. to practice as·a registered nurse issued by the Massachusetts Board of Registration in Nursing who is enrolled in a Psychiatric Nurse Mental He&!th Clinical Specialist training ptogrwn recognized by the Massachusetts Board .of Registration in Nursing. Consistent with applicable state licensure requirements, services provided by the psychiatrio Nurse Mental Health Clinical Specialist trainee are ptovided under supervision of a Psychiatric Nurse Mental Health
Clinical Specialist

Psychiatric Reslde~t

..

A person With a current, valid, full or limited license to practice medicine issued by the Massachusetts

Beard of Registration in Medicine, who is enrolled in an Accreditation Council for Graduate Medical

&lUllation (ACGMEHccredited residency training program in eitber adult psychiatry or child and

adolescent psychiatry. Services provided by the Psychiatric intern are provided in a setting approved for

residency. training by tho sponsoring training institution, under supervision of· a board ceJ1ified or

eligible child psychiatrist, consistent with appliCable state Hcensure requirements.

Psycblatrist..

.

.

.

A person with a cllrrent, valid, unrestricted license to practice medicine issued by Ihe Massachusetts Board

of Registration in Medicine. PsychiatristS treating youthl\ges 0 to 19 shall be board-ilertified or boaro-

eligiblO in child and adolescent psychiatry. PsychiatriSts treating youth ages 19 to 21 shall be trained in .

adult psychiatry.

Psycbology Intern .

.

The psychology intern must be admi~ to doctoral candidacy in a structured clinical, Qr counseling,

American Psychological Association (APA)-approved doctoral program. Consistent with state licensure·

requirements, services provided. by a psychology intern .... ·pi-ovidedunder the direct supervision of a

. licensed psychologist.

.

I I
I I i
I
I
---1I; ,

TN: CS-004
.Supersedes: 06-005

OFFICIAL

Approval Da\<: 06/04109

Effective Date: 04101/09

Exhibit 1 35

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 37 of 70 Page ID #:4827

Supplemeilt to AttaebmenI3.I·A,

of Slate Plan under Title XIX Ihe Sotlsl Security Act

, Page In

Stale: MassaCkuseltll

Umllations to Services Provided to the Categorically Needy

Socjal Work Intern The Social Work Intem must be a second·y~r, clinical-track slud.nt in a structured field practicum that is a componellt of an MSW program that is fully "",credited by the Council on Social Work Education. Consistent with applicable state, licensure requirements, services are provided under the
direct supervision of a LlCSW, LMF1', LMHC, LCSW, LADC I, PsyehOlogist, Psychiatric Nurse or
Nurse Clinical Specialist.

Therapeutic Mentors

, Therapeutic mentors must be 21 years of age or older and have either: • bacheior's degree, in a human

service field from an accredited academic institution and one (I) year of relevant elqlOrience working

with Children/adolesCents/transition age youth; or, an associate's degree in a human services fieJd

from an accredited .academic institution and one (I) year of relevant experience working with

chlldrenladolescents/transitlon age "'youth; or, a high school diploma or' General Educational

'Development (OED) .and a minimum, of two (2) years of .xperience working with

child~nladolescents/transition age youth. If the ba\'helor's or associate's degree is not in a human

services field, additional life or work experience may be considered'in place of the human services

degree. Therapeutic.mentors must be supervised by a ,LICSW,. LMFT, LMHC, LCSW, LADe I,

Psychologist, I'sychilitric Nurse or Nurse Clinical Specialist. " '

'

Item 5: Physician'. Services'

. See SuppltimenttoAttachm.enl 3.I-A, 1'.1, Item 1,111.

,

,

OFFICIAL

TN: 08-0~ Supersedes: 06·005

Approval Date: 06/04109

,Effective Date, Q4jjJl/09'

Exhibit 1
36

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 38 of 70 Page ID #:4828

Supple.,ent to AltachmentJ.t-B Page \a
State Plan under Title XIX of the Soolal Security Act State: M.....huset..
Limitations to Servl.es Provided to the Medically Needy

nem l.a: Outpatient Hospital Services
See Supplement to Attachment 3.1~A, page I, Item I, #1 and #4.
Item 4••: Nurslug Facilities Servlc~
If. utilization review team recommends that. recipient in a multi·level long-term-care facility b. changed to a lower level of car., the facility Is responsibl. for relocating a recipient to the recommended level.ofcare within the facility. The recipient has the rigbl to appeal the recommendation.
Item 4b: Early and Periodic Screening,»iagnostic and Treatment seMie.. for Individuals under 21 years of age, and treatment of conditions found.

In addition to all other medioally necessruy services covered for indIViduals under age 21, tho following' services are covered as Rehabilitation services as defined in 42 USC 1396d (a) (13). TI1ese services are provided to, or directed exclusively toward the treatment of, the MediCAid eligible individual:

a. Mobile Crisis Interventioo (Services described in this section are effective July 1,2009.) . Mobile Crisis Intervention provides a short tenn service that is mobile, on-site, face-to-face therapeutic response . to a youth experiencing a behavioral health (mental health or substance abuse) crisis for the purpose of identifying, assessing, treating, and stabi1izii1~ the situation and reducing the immediate risk of danger to tt1e
youth or others consistent with the youth's risk management/safety plan, if any. Services are .vaileble 24 hours a day, 7 days a week. Phone' contaCt and consultation may be provided as part of~le intervention:Mobile crisis
services may be provided by a single crisis worker or by ..team of professionals that are qualified providers who
are trained in crisis intervention.

Mobile Crisis I nterventioo includes the following activities when performed to resolve the immediate crisis:

• Assessment;

• Crisis cOunseling inclu.ding individual and family counseling;

• Clinical consultation and coordination·with other health care providers;

• Psychopharmacological management, including availability of on-site prescriber,

• ld.ntifi~ion and inclusion ofprofessio.nal and natural supports.(e.g., therapist, neighbors, relatives)

who can.assist in stabilizing the sitUation and offer ongoing support;

.

• Development of a risk management/safety plan. In cases where the youth does not already have

such a plan, Mobile Crisis Intervention creates a risk management/safety plan in concert with the

parent(s)/g\lardian(s)lcaregiver(s) and' any existing service providers (e.g., ICC, In-Home Therapy

Services, outpatient therapist); end

• . Referral to other services as· needed.

OFFICIAL

TN: 08-004 Supersedes: 06-005

Approval Date: 06104109

Effective Date: 04/01109

Exhibit 1 37

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 39 of 70 Page ID
_ _ • _ _ _ ~,, _ _ , _ ' _ _ 0 _ _ " _~_.
#:4829

Supplement to Attachmeot 3.1-8
Pog.lb Stat. Plao under Title XIX of Ibe 80<:101 Security Act
State: Massachusetts LimitatioDS to Services F:rovlded 10 the Medically Needy

Settings: Mobile Crisis Intervention is provided where the child is located.
Providers: Components of Mobile C~i5es Crisis Interventi,m are provided by practitioners, as !\escribed below. Practitioners must be working under an employment or contractual arrangement with one of tho following: outpatient hospitals, community health centers, mental health centers and other clinics.
e Assessment· L1CSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master's level counselors, marriage and family. therapy interns, mental health comselor interns, psychiatric nurse "mental health clinical specialists, psYchiatric nurse mental health clinical specialist trainee, "
. psychiatric nurses, psychiatriSts, psychialry.residents, psychology interns, social work interns
e Crisis counseling Including individual and famUy counseling - LlCSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master's level counselors, marriage and family therapy interns, mental health· counselor interns,. psychiatric nurse mental health clinical specialists, psychiatric nurse mental health clinical specialist trainee, P'D'chiatric nurses, psychiatrists, psychiatry residents, p~chology interns, social work interns, bachelor. level counselorslparsprofessionals, LADC Is
e Clinical consuJtntion and cOordination with olher healtbcare providers'- LICSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master's level counselors, marriage and family therapy interns, mentol healtl, counselor interns, psychiatric nurse mental health clinical. specialists, psychiatric nurse mental health clinical specialist trainee, psychiatric nurses, psychiatrists, psychiatry residents, psychology interns," social work interns, bachelor·level counselors/paraprofessionals, LADe Is .
• Psychopharmacological management - Psychiatric nurse mental health clinical specialists, psych iatric nurse mental heahh clinical specialist trainee, board-certified or board-~ligible child psych iatrists, psychiatry residents.
e· Identification and inclu.ioll of professional and natural supports (e.g., therapist, neighbors, relatives). who can assist I. 'stabllizlng the sltnation and offer ongoing support. LlCSWs, LCSWs; LMFTs, LMHCs, licensed psychologists, master's level counselors, marriage and family therapy interns; mental health counselor in !ems, psychiatric nurse mental health 'clinical specialists,. psychiatric nurse mental heal1ti clinical specialist trainee, psychiatric. nurses, psychiatrists, . psyohiatry residents,· psychology interns, social work interns, associate-level
counselors/paraprofessionals, bachelor-level counselors/paraprofessionals, LA.JX: Is, LADC lls,
LADC lIIs, LSWs, and LSW As.
e Development of a risk management/safety plan -L1CSWs, LCSWs, LMFTs, LMHCs, licensed
psychologists, master's level counselors. maniage and family therapy interns, mental health
counselor interns, psychiatric nurse mental health clinical specialists, psychiatric nurse mental health clinical speCialist trainee, psychiatric nurses, psychiatrists, psychiatry resIdents, psychology interns, social work interns

TN: 08-004 . Supersedes: 06'005

OFFICIAL
Approval Date: 06/04109

Effective Date: 04101109

Exhibit 1
38

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 40 of 70 Page ID #:4830

Supplement to Attachment 3.I-B

Pagelc

State Plan under Title XIX of the Social Security Act

,

State: Massachus.tts

Limitations t. Se."ices Provided to the Medically Needy

• Referral to other services as needed: L1CSWs, LCSWs,

LMFTs, LMHCs, licensed

psychologists, master's level counselors, m8lTiage and family therepy interns, mental health

counselor interns, psychiatrio nurse mental health clinioal specialists, psychiatric nurse mental

health clinical specialist trainee, psychiatric nurses, psychiatrists, psychiatry residents,

psyohology interns, social work interns, associate-level counselors/paraprofessionals, bachelor-

level counselors/paraprofessionals, CADACs, CADAC lis, LAl)C Is, LADC lis, LADC Ills,

LSWs, and LSWAs.

"

b. " In-Home Behavioral Services: (Services described in this section are 'effective October I, 2009.)

This service provides for the development of a 'highly specific behavior plan; supervision and

ooordination of interventions; and training other interveners to address specific behavioral objectives or

performance goals in order to treat ohallenging behaviors that interfere witlt the youth's successful

functioning, An In-Home Behavioral service includes two colnponents: behavior management therapy

and behavior management monitoring. It is delivered by one or more members of a team of qualified

, providers conSisting ofprofessional and paraprofessional staff.

'

, I; Behavior management therapy: Sehavior management therOpy lncludes activitie. that are required

to develop, implement, monitor and update a behavior plan, including overseeing activities of the

behavior management mohitor. Behavior management therapy is performed by a licensed clinician

who meets the qualifications ()f a Behavior management therapist as described in !he provider

qualifications section below.

'

Behavior management therapy includes the fullQwing:

• , Functional behavioral assessment;

• Development of a focused 'behavior plan that identifies specific behavioral and measurable objeetives Dr performance goals and interventions that are designed to diminish, extinguish,

or improve specific behaviors related to a youth's behavioral health (mental health Dr,

substance abuse) condition(s);

• Development or revision of a youth's risk management/safety plan to address the specifio

behavioral needs ofthe y o u t h ; ,

• Coumseling the parent(s)Iguardian(sYcaregiver(s) on how to ill'!plement strategies identified

in tli. behavior plan;

.

• Working closely with the behavior management monitor to ensure the behavior plans and

risk managementlsafety plan are implemented as developed, and to make any necessary

adjustments to the pians;

• CHnieRI consultation and coordination with other behavioral health' (mental health or

substance abuse) Care providers; and

'

• Referral to other services as needed,

OFFICIAL

TN: 08-004 Supenedes: 06-005

Appro.amate: 06104/o~

Effective Dat.: 04/01/09

Exhibit 1
39

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 41 of 70 Page ID #:4831
I
!
Suppleme.t to Altachment3.1-B Pageld
Slate Pia. under Tille XIX of the Social Security Act. State: M....chu..tts
Limitations 10 Services Provided to the Medically N..dy

2. Behavior management monitoring. This se;"'ice includes activities related t~ the implementation of the 'behavior plan and a risk management/safety. plan as needed. Behavioral management monitoring also includes monitoring the youth's behavior, reinforcing implementation of the behavior plan by the parentCs)lguardian(s)lcaregiver(s), and reporting to the bohavior management therapist on implementation of the behavior plan and progress toward behavioral objectives or performance goals.

B';l1avioral ;"anagement monitcring 'is performed by .paraprofessional who meets the qualifications

ofa behavior management monitor as described in the definitiOns section below.

.

.

Behavior management monitcring includes the following:

• Monitoring the youth's progress on implementation' of the goals of !be behavior plan

developed by the behavior management therapist; .

• ASsisting the youth in implementing the go~ls of the behavior plan developed by the

behavioral management therapist;

.. .

• Providing guidance to the parent(s)lguardian(s)lcaregiver(s) in implementing Ibe plan; and

• Working closely with the behavior management therapist to ensure the behavior plans and

risk management/safety plan are implemented as developed.

.

Settings: In-Home Behavioral Serv.lces may be provided in any setting where the child is naturally located including, but not limited to, ~,e home (including foster homes and therapeutic foster homes), schools; child care centers, and' <lU,er community settings.
Providers' The fol1owing practitionecs may provide any component of behavior manageme~t therapy as. described above: Developmental-behavioral pediatricians, developmental-behavioral pediatric 'feIlows, LICSWs, LCSWs, LMFTs, LMHCs, licensed psychologists, master's level coullSeiors, marriage and family therapy interns, mental health counselor interns, psyohiatrio nurse inontal health clinical speci.lists, psychiatric nurse mental health clinical specialist trainee, psychiatric nurses, psychiatrists, psychiatry residents, psychology interns and social work interns. Behavior management monitors may provide any component ofbeha~ior management monitoring as described above.

Qualified Practitioners of behavior managemeni therapy also must have two years relevant experience providing direct services to youth and families who require behavior management to address behavioral health (meqtaJ health or suosian.e abuse) needs; course work and training in conducting functional behavioral assessments, and selecting, implementing and evaluating intervention strategies; supervised experience conducting functional behavioral assessments and designing, implementing, and monitoring
behavior ·analysis programs for clients and other quaJifications established by the state. Practitioners must be working under an employment or contractual agreement with one of the following: outpatient hospitals, community health centers, mental health centers, other clinics, and private agencies certified
by the Commonwealth.
OFFICIAL

TN: 08-004
Supersedes: 06-005

. Approval Date: 06104/09

Effective Date: D4IOlr09

Exhibit 1
40

_-_ Case 2:02-cv-05662-AHM-SH

Document 771 #:4832

Filed

11/18/11---.P--a--g.e-_4....2.__.o,_f.-7--0--

.

P.....a_.g•..e

ID..

..

. .. --'~

Su~plemeDt to Attacbment3.t-B Page Ie
State Pia. under Title XIX .fth. Social Security Act State: lI1assach usetts
Limitation, to Services Pr~vlded to the Medically Needy

Co ' In-Home Therapy Services: (Services described in this, sectioJl are effective November I. 2009.)

This service provides for the development of an individualized trealm""t plan; supervision and

coordination of interventions for the purpose oftreallng the youth's mental health and substance abuse

needs. The intervention is designed to enhance and improve the family's capacity to improve the

youth's functioning in the home and community and may prevent the need for the youth's admission to

an inpatient hospital, psychiatric residential treatment facility or other treatment setting. This service'is

delivered by one or more members of a: team of qualified providers consisting of professional and

paraprofessional"staff, offering a combination.ofrnedically necessary in home therapy and therapeutic

~ning and support. ,

\.

In· Home Therapy: In-home t!)erapy is • structured, consistent, $lrength-based therapeutic relatiQnsliip

between. licensed clinician and the youth and family. The licensed clinician, in collaboration wi~l the .

family and youth, develops an individualized treatment plan and, using established psychotherapeutic

techniques, and intensive family therapy works with the entire family or a subset of the family to

implement focused structural or strategic interventions to advance therapeutio goals. In additiOn, the

clinician assists in identiJYing and utilizing community resources and develops and maintains

nalural SUpports for the youth and parent(s)/guardian(s)/oaregiver(s)"in order to promote .ustainability

of treatment gains. Phone, contact and consultation are'provided, 8S part of the intervention. :In-Home

therapy is perf<>rmed by a licensed clinician who meets the qualifications ofan in-home therapiSt as

described section below.

.

In-Home Therapy includes tho followil;g:

, • Assessments;

• Development of an individualized treatment plsn by the qualified practitioner in partnership widl the youth and pareot(s)/guardian(s)fcaregiver(s) and, with required consent, inocnsultalion witil
other providers that is designed to addressthe youth's mental nealth or substance abuse condition;

• Ongoing monitoring and modification ofthe individualized treatment plan as indicated;

• Revi'ew/development of a risk management/safety plan; ,

• Phone and face-to-face consultation with other providers, individuals and entities who may impact the youth's treatment plan;

• Family counseling through which the licensed clinician works with the entire family, or a subset of

the family, to advance ,therapeutic goals; and

.

III Referral to other services as needed.

OFFICIAL

.'

TN: 0&.004
Sapersedes: 06-005

Approval Date: 06104/09

Effective Date: 04/01/09

Exhibit 1
41

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 43 of 70 Page ID

-"""-----"--

#:4833

Supplement to t.ttachment M-B
Page If
State Plan under Tltie XIX of tbe Social Security Act Stete: Massaehusetts
Limltatlons to Servi••• Provided to the MedicallY Needy

2: Therapeutic training and support is a service provided by an asSociate-level or bachelor·level
paraprofessional working under the supervision of a clinician to support implementation of Ibe in·
home therapists treatment plan in order to achieve the goals of the that plan. The paraprofessional assists a licensed olinician in implementing the" therapeutic objectives of the individualized
treatment plan. Phone contact and consultation may be provided as part ofthe intervention.

Therapeutic training and support includes the following:

• "Providing guidance to the youth and parent(s)lguardian(s)lcaregiver(s) in implementing the

treatment plan;

• Providing skills training for yoUth and parent(s)/gUardiari(S)/caregiver(s) in support ofthe treatment

plan go.ls; and

". Monitoring the youth'. and parent(s)/guardian(s)/caregiver(s) progress on achieving treatment plan

goals and communicating regularly with the cliniCian so that the treatment plan Can be modified and

necessary.

"

In Settings: home therapy services may be provided in any setting wh~re "the child is naturally located care " including, but not limited to, Ibe home (including foster hom.,. and therapeutic foSter homes), scbools,
child centers, and other oommunity settings.

Providers: The following practitioners may provide any component "of in-l1ome" therapy as descnlled above: In-home therapy &elYices are delivered by the following practitioners: L1CSW, LCSW, LMFr, LMHC, Licensedpsychologis~ Master's level counselors, marriage and family therapy interns, mental health "counselor. interns, psycl'iaIric nurse mental health clinical ~ialists, psychiatric nurse mental health oiioic specialists traine., psychiatric nurses, psychiatrists, psychiatry residents, psychology interns. The following practitioners may provide any component of therapeutic training and support as described above: Associate-level counselors" I "paraprofessionals, badhelor-Ievel counselors I. paraprofessionals. Practitioners must be working under an employment or contractual arrangement with one of the following outpatient hospitals, community heal1h centers, mental heal1h centers, other clinics" and" private agencies" certified by the" Conunonwealth.·
..

OFFICIAL.

TN: 08-004 Supersedes: 06-005

Approval DIlte: 06l0410~

Effective Date: 04/01109
Exhibit 1·
42

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 44 of 70 Page ID #:4834

Supplement to Attachment 3.1-8

Pagelg

State Plan under Title XIX of tbe Social Security Act

.

State. Massachusetts

Limitations to Services PrQvided tq tbe Medically Needy

d. Therapeutic Meuwrlng Services: (Services described in this section are effective October 1, 2009.)

Therapeutic mentoring services are structured, one-to-one, strength-based services that are designed to

help ameliorate behavioral health (mental health or substance abuse) related conditions which prevent

tbe youth from appropriate social functioning. These services niust be delivered according to an

individualized treatment plan developed by either· an outpatient clinician, an ·in-home therapy clinician

or, for youth enrolled in Intensive Care Coordination, a care planning team. Progress toward meeting the

identified goal(s) must be documented and r.ported regularly to the provider responsible for the youth's

. . treatment plan.

.

The ther3jleutic ,mentor does not provide social, educational, artistic, athletic, recreational. or vocational
services.

Settings: TheraPeutic ine~ring services are pr~vided to youth in any setting Yfhere the youth resides,

such as the home (including foster homes and therapeutic foster homes), school, child care centers and

~thet community s~ngs.·

.

Providers: Therapeutic mentoringservices are delivellld by th~jJeutic mentors. Practitioners must be . . working under an employment or contractual arrangement with on ofthe folloWing: outpatient hospitals, . commu!,ity health centers,' ment.1 health conters, other clinics, and private agencies certified by the
Commonweaith. .Provider. of therapeutic> mentoring utilize therapeutic mentors to provide these services ..

OFFICIAL

TN:. 08-004 Supersedes: 06-005

Approvai Date: 06/04i09

Effective Date: 04/01109
Exhibit 1
43

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 45 of 70 Page ID #:4835

Supplement to Attachment 3.1-B Page Ib
StBte Pia. "oder Title XIX Gf the Social Security Act State: Massachusetts
Limitations to 8.rvlcO/l Provided t. tb. Medlcally·Needy

e

Family Support and Training: (Services described in this section 8l'e effective July 1,2009.)

A family support and training partner addresses goals established in an individualized treatment plan in

order to resolve or ameliorate the youth's mental health, behavioral and emotional needs through

enhancing the capacity of the parent(s)/guardians/caregivers) to implement activities required to meet

the goals. of the plan. Family support and train!ng is a skill-building suppert and not a form oftherapy or·

counseling. Th. individualized !reatmeni plan must be developed by either an outpatient clinician, an In-

home therapy clinician or, for youth enrolled in Intensive Care Coordination, a care planning team,

These services include the following when they are (,levant to the·goals in the youth's individualized·

care plan:·

..

•. providing guidance to parent(s)/guardians(s)/caregiver(s) on navigating systems that suppert youth with mental health, behavioral and emotional needs, such as working effectively with state agency

case managers, school system officials, provider agency staffand clinicians;

• fostering empowermen.t of parent(s)/guardian(s)/caregiver(s) by offering supportive guidance for

parents of youth with mental health needs and encouraging participation in peer/parent suppert and'

self-help groups;

..

..

• providing guidance to the parent(s)/guardian(s)/caregiver(s) how to find, access and use formal and infonDal community-based resources (e.g., after-school programs, food assistance, housing resources, youth-serving sYstems, etc.); and

• ,!,odeling these skills for parent(s)/guardians(s)/caregiver(s).

Family support and training services do not include ~pite care or child care services.

Settings: Family support and training services are provided in any sOtting where the youth resides, Such as the home (including foster homes and thetspeutic foster homes), and other oommunlty settings.

Providers; Family supp.;rt and training services are delivered by a family support and training partner.
A family support and training Partner must be working under ·an employment or oontractual ·arrangementwith one of the following: outpatient hospitals, community health centOtS, mental health centers, other· clinics and .private agencies certified by the Commonweruth.. . ;

OFFICIAL

TN: 08-004
Supersedes: 06-005

ApprDval Dale: 06104/09

Effective Date: 04101109
Exhibit 1 44

Case 2:02-cv-05662-AHM"" .-..S...H~.. . Document 771 Filed 11/18/11 Page 46 of 70 Page ID #:4836

Supplement to Attech'ment 3.1·8 PageU
State Plan under Title XIX of the Social Security Act
State: Massachusetts .
Limitations to Services Provided to tbe Medic:aU,. Needy

Definitions:

Assocla1e-level couns.lors/paraprofessional

Associate-level counselors/paraprofessionals must have an as.sociate's degree in a human services field from

an accredited academic institution and one (1) year of relevant experience working with families or youth.

If the associate's degree Is not in a human services field, additional life or work experience may b.

considered in place of the human services degree. Associate-level counselors/paraprofessionals are

supervised by a LICSW; LMFT, LMHC, LCSW, LADC I, PsychologiSt, Psychiatric Nurse or Nurse

Clinical Specialist. '

'

Bachelor-level counselors/paraprofessional Bachelor-level counselors/paraprofessionals inust have a bachelor's'degree in a human services field from an accredited academic institution and one year ofrelevant experience working with fami! ios or youth, If the bachelor's degree is not in .. human services field, additional life or work exparience may be considered in place of the human services degree. Bachelor-level counselors/parllprofessionals are suparvised by a' L1CSW, LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist.

Behavior Mallagell!ent Monitor

.

.Behavioral management monitors milst have a bachelor's degree in a human services fie.ld frOm an

accredited university and one (1) year of relevant experience working with families, children or adolescents

who requite behavior management, or an associate's degree and a miniinWD of two (2) years of relevant

experience working with families, children or adolescents who require behavior management Behavior

management monitors are suparvised by • ,L1CSW, LMFT, LMHC, LCSW, LADe I, Psychologist,

Psychiatric Nurse or Nurse Clinical Specialist..

. .

Certified Alcoholisrn/Drog Abuse Counselor (CADAC)

,

Certified by the private Massachusetts BOard of Substance Abuse Counselor Certification (MBSACC).

CADAC certification requires a combination of either a Master's degree in a ''behavioral science area" and

2,000 hours of supervised experience or a Bachelor's degree in a behavioral science area and 4,000 hours of

supervised experience or an Associates' degree in a behavioral science area and 6,000 hours of supervised

experience, Certification also requires documentation of having received a minimum of 270 clock hours of

continuing education related to the five domains for alcohol and other drug abuse. Consistent with

applicable state licensure requirements, certified alcoholism/drug abuse counselors are suparvised by a

L1CSW, LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse orNurse Clinical Specialist

Certlf"lCd AlcoholismfI>rog Abuse Counselor n (CADAC ll)
Ceriified by the private Massachusetts Board of Substance Abuse Counselor Certification (MBSACC). CADAC \I certification requires a master's degree (or higher) from a regionally accredited academic institution in a human services behavioral sciences field with a clinical application (i.e."pra.cticum); 2,000 hours of supervised experience and documentation· of completion of 300-hour practicum. Consistent with applicable State licensure requirements, certified alcoholism/drug abuse counselor TIs are supervised by a L1CSW, LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse or Nurse Clinical Specialist..

OFFICIAL

TN: 08·004 Supersedes: 06-005

Approval Date: 06104/0?

Effective Date: 04101109

Exhibit 1
45

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 47 of 70 Page ID #:4837

Supplement to AttachmeDt3.1-B . Pagelj .
State Plan under Title XIX of the Social Security Act State: M....ch.setts
Limitations to Servi... Provided to the MedIcally Needy

Developmental-Bebavioral Pediatrician
A person with a current, valid, unrestricted license to practice mediCine issued by the Massachusetts Board
of Registration In Medicine, who is board-certified in Pediatrics and either board-eligible or board-cei1ified
in Developmental-BehaviOJ:a1 Pediatrics

. Developmental-Behavioral Pediatric Fcnow A person with a current, valid, unrestricted license to practice medicine issued by the Massacbusetts Board of Registration in Modicine, who is board-certified in Pediatrics and enrolled in a training program in Developmental-Behavioral Pediallics accredited by the Accreditation Council for Graduate Medicsl Education (ACGME). . ServiCes provided by the Developmental-Beh.vioral Pediatric Fellow must be provided in a setting approved for training by die sponsoting training institution, under supervision of a board certified or eligible Developmental-Behavioral Pediatrician, consistent with applicable state lic!>nsure
requirements.

Family Support alld Training Partner A,family support and training worker must have .xperience as a caregiver of a youth with special needs,
preferably youth with behavioral health needs, experience in navigating any oflbe youth and family-serving systems and teachjng mmil)' members who are.involved with the youth and family serving syst~ms, and
either: a bachelor's degree in a human services field from an accredited academic institution, or ·.an
associate's degree in a human services field frOm an accredited academic institution and one (1) year of . . experience working "lith children/adolescontsltransition.age youth and families, or a high school diploma or
General Education Development (GED). and a minimum of two (2) years of experience working with children/adolescents/transition age youth and families. If !lie bachelor'S or associate's degree is not in a human serv·ices field, additional life or work. experienee may be considered in place of the human services degree. Family partners are supervised by a LICSW, LMFT, LMHC, LCSW, LADe I, Psyehologist; Psychiatric Nurse or Nurse Clinical Specialist.

licensed ~cohol an~ Drug Counselor I '- LADe I A person licensed by the Department of Public Health to conduct an independent practice of alcohol and drug coiln,eling, and to provide superVision to other aloohol and drug counselors, as defined in 105 CMR 168.000. These requirements include: a master's or doctoral degree iobehaviora! sciences, a minimum of 270 hours of training .in substance abuse counseling, 300 hours of supervised practical training and 6,000 hours 'of supervised alcohol and drug counseling work expetience.

Lleen~ Alcohol and Drug Counselor II-LADC II

.

A person licensed by the Department of Public Health to practice alcohol and drug counseling under clinical

supervision, as defined in 105 CMR. 168.000. These requirements include: a high school diploma or

equivalent, a minimum of 270 hours of training in substance abuse counseling, 300 hours of sUJ10rvlsed

practical training and 6,000 hours of'supervised olcoliol and drug counseling work experience (4,000 if

applicant holds 0 bachelor's degree) .. Consistent with applicable state licensure reqUirements, LADC Us are

supervised by a LlCSW, LMFT, LMHC, LCSW, LADC I, Psychologist, Psychiatric Nurse or Nurse

Clinical Specialist

OFFICIAL

TN: OS.004 Supersedes: 06-005

Approval Date: 06104/09

Efrectlve Date: 04/01109

Exhibit 1
46

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 48 of 70 Page ID #:4838

Supplement to Attachment 3.1·8 Pagelk
State Plan under Tille XIX Dflbe Social Security Act
State: Massackusetts
L1mltatJons to Services ProYlded to the Medically Needy

Lkensed Alcohol and Drug Counselor Assistant- LADC ill A person licensed by the Department of Public Health to provide recovery based services under direct clinic.land administrative supervision, as defined in 105 CMR 168.000. These requirements include a high,
school diploma or Muivalent, 2,000 hours of work experience in the alcohol or drug abuse field and a
minimum of SO hours of training in substance abuse counseling. Consistent with applicable slate licensure ' requirements LACD Ills are supervised by a LlCSW, LMFT, LMHC, LCSW, LADC I, Psychologis~ Psychi~tric Nurse or Nurse Clinical Speci.list,

Licensed 'Independent Clinical Social Worker (UCSW)

,

A person with a current; valid, unrestricted license \0 practice as an LlCSW, issued by the Massachusetts

Board of Registration of Social Workers. These requirements include: master's or doctoral d.gree in Social Work from a program .ccredited by the Council on Social Work Ed~cation and ,two years supervised

experience.

, Licensed Clinical Social Worker (LCSW) A person with a current, valid, unrestricted Iieimse to practice as an LCSW, issued by the Mas"achusetts Board of Registration of Social Workers. These requirements include: master's or doctoral degree in Social Work from a program accredited, by the Council on Social Work Bducati(}n. Consistent with applicable state licensure requirements, LCSWs are supervised by a LICSW, LMIT, LMHC, LCSW, LADC'I,
Psychologist, Psychiatric Nurse or Nurse Clinical Specialist.

Licensed Social Worker (LSW) A person with a current, valid, unrestricted license to practice as an LSW, issued, by the Massachusetts Board of Registrotion of Social Workers. These requirements include: a bathelor's deS1:ee in Social Work
from a program accredited by the Council on Sooial Work '&!uoation or a bachelor's degree in any subject and 3500 hours of supervised experience providing social work services. Consistent with appJicable state licensure requirements, LSWs are supervised by a LICSW, LMFT, LMHC, LCSW, LADe I, Psychologist, Psychiatric Nurse or Nurse Cliniclil Specialist,

Licensed Social'WorkAssociate (LSWA) ,

A person with a current, valid, unrestricted licen!", to practice as an LSWA, issued by the Massachusetts '

Board of Registration ofSoeial Workers, These requirements include: an associate,degree, ~ at least siJtty, credit hours of college education, in the fields of social work, psychology; counseling or other si~ilar

, -,,

human services field, from an accredited college or university; or a baccalaureate degree in any field from

an accredited college or university; ,or a minimum of one thousand (1 000) hours of education in social work

theory and, methods in courses or programs approved by the Board of Regist,.pon of Social Workers.

Consistent with applicable slate licensure ,requirementa, LSWAs are supervised by a L1CSW, LMFT,

LMHC, LCSW, LADe I, Psychologist, Psychistti,c Nurse or Nul'S. Clinicsl Specialist

'

Licensed Marrlage aDd Family Therapist (LMFI)
A person with a current, valid, unrestricted license to practice as • LMFT, issued by the Massachusetts
Board of Registration of Allied Mental Health Professionals. These requirements include: a master's degree
.uoFFiciAL in the mental health field (including, but not restricted to, counseling, family therapy, psychology, etc.) from
an accredited college or university and two years

i

TN: 08-004 Supersedes: 06-005

Approval Date: 06104109

'EffectIve nate: 04/01109

Exhibit 1
47

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 49 of 70 Page ID

#:4839

I i

Supplement to Altachment 3.1-8

Slale Plan uDder Tille XIX oflhe Social Security Act

Pag.U

State: Massacbusetts

Limilations-IoSer.vi.es-l!rovlded_to Ihe-Medically-Ncedy----

Licensed Mental Health Couu..lor (lMHC)

A person with a curnnt, valid, unrestricted license to practice as a LMHC, issued by the Massachusetts

Board of Registration ofAllied Mental Health Professionals. These requirements include: a master's degree

in the mental health field (including, but not restricted to, counseling, family therapy, psychology, etc.)from

an accredited college or university and two years supervised experience.

_ _

-

Licensed Psychologist

A person with currel1~ valid; unrestricted license to practice psychology issued -by the Massachusetts Board

of Registration in Psychology. These requirements include a doctoral degree from a program accredited by

the American Psychological Associ.tion and two years supervised experience - -- -

_. _

Marriage and Family Therapy Intern

The - marriage and family therapy intern must be a second-year, clinical-track student in a _strUctured field pl~cement that is a component of a master's in mmiage and family therapy or a master's in

a counseling _program that 'Is fully accepted by the Board of Allied Mental Health and Human Services

Profession. The marriage and family therapy intern must provide services under the direct supervision of a

L1CSW, LMFT, LMHC, LCSW, -LADC I, Psychologist, Psychistric Nurse, or Nurse Clinical Specialist

consistent with applicable state licensure requirem~nts.'

-

Master's Level CORm..lor

_

- A person with a master's or doctoral d~gree ih a mental health field (including, but not restricted to,

counseling, family therapy, _social worle, psychology, etc.) from an accredited college or university who is

supervised by a LICSW, J.,MFT, LMHC, LCSW, LADe I, Psychologist, Psychiatric -Nurse, or Nurse

Clinical Specialist: '

Mental Health Counselor Intern

.

_

The Mental Health Counselor Intern must be a second-year,' clinical-track student in a

structured field placement that is a component of a master's in mental health counseling Or a master's in a

counseling psychology program that is fully accepted by the Board of Allied Mental Health and Human

Services Profession Consistent with applicable state licensure requirements, the Mental Heath Counselor

Intern provides service. under the supervision ofa LICSW, LMFT, LMHC, LCSW, LADe I, Psychologist,

Psyoh iatric Nurse- or Nurse Clinical SpeCialist.

PsyChIatric Nurse

A person with a current, valid, ullrestricted license to practice as _a registered nurse issued by tbe Board of

Registration in Nursing, a master's degree in the mental health fields and one (I) year of experience

delivering mental health services to families and youth. -Consistent with applicable state licensul'e

requirements, the Psychiatric Nurse provides services under the supervision of a LICSW, LMFT, LMHC,

LCSW,

LADC

I,

Psycholo.gist,

Psychiatric

Nu.rse

or

Nurse

Clinical -

Specialist.

PsychiatriC Nurse Mental Hcalth- CUDical Specialist A perSon with a current, valid, unrestricted license to practice as a registered nurse issued by the
Massachusetts Board of Registration in Nursing and currenf, valid, unrestricted authorization by
OFFIClALl - t11~ ~assach~ Board of Registration in Nursing to practice ~a/~chiatric Nurse Mental Health
CIIDIcal SpecIalist.

TN: 08-004
Supersedes: 06-005

Approval Date: 06/04/09-

Effective Date, 04/01/09

Exhibit 1 48

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 50 of 70 Page ID #:4840

Supplement to Attachment 3.1-8

.

Page 1m

State Plan under TIUe XIX of the S••lal Security Act·

.

State; M.....ch.setts

Limitation, to Services Provided to tbe MedlcaUy Needy

Psychiatric Nurse Mental Health Clinical Speclali't TraIn..

,

A person with a current, valid, unrestricted license to practice as a registered nurse issued by the

Massachusetts Board of Registration in Nursing who is enrolled in 8 Psychiatric Nurse Mental Health

Clinical Specialist training prog(llm reCognized by the Massachusetts Board of Registration in Nursing.

Consistent with applicable state licensure requirements, services provided by the Psychiatric Nurse Mental

Health Clinical Specialist trainee are provided under supervision of a Psychiatric Nurse Mental Health

Clinical Specialist.

'

Psychiatric Resident A person with a current, valid, full or limited license to practice medicine issued by the Massachusetts Board of Registration in Medicine, who is enrolled in an Accreditation Council for Graduate Medical Education. (ACGME)-accredited 'residency training program in either. adult psychiatry or child and adolesCent psychiatry. Services provided by the Psychiatric intern are provided in 8 setting approved for
residency'trainmg by the sponsoring training inatitution. under supervision of a board certified or
. eligible child psychiatrist, consistent with applicable state licensure requirements ..

Psychiatrist

,

A person with a current,vatid, unrestricted license to' practice medicine issued by the Massachusetts Board

of Registration in Medicine. Psychiatrists treating youth ~ges 0 to 19 shall be board-certified or board:

eligible in child and adolescenl psychiatry, Psychiatrists treating youth ag;;" 19 to 21 shall be trained in

adult psychiatry. ' .

'

Psychology Intern 'The psychology intern must b. admitted to doctoral candidacy in a structured clinical, or counseling, . American Psychological Association (APA)-approved, doctoral, program. Consistent with state licensure requirements, services provided by a psychology Intern are provided under the direct supervision of a licensed p~ychologist.

OFFICIAL

TN: 08-004
Su persedes: 06-()05

Approval Date: 06/04109

Effective Date: 04101109
Exhibit 1
49

-_._--C---a-s--e--2-::-0:-2-.--c~v-..-..0...5...6. 62-AHM-SH

Document 771 Filed 11/18/11 #:4841

Page 51 of 70

Page ID

Supplement to Attachment 3.1-B

, Page In

State Plan und.. Title XIX oflhe Soelal Seeurily Act

,

State: Massachusetts

Limitations to Services P'l'vlded to the Medically Needy

Social Wor,l< Intern

,

,

The Social Work Intern must be 1\ second-year, clinical·track student in a structured field practicum

that is a component of an MSW prosrarn that is fully accredited by the Council On Social Work

Education. Consistent with applicable state licensure requirements,services are provided under the

direct supervision of a LICSW, LMFT, LMHC, LCSW, LADC I, Psychologist, PsychiatrIc Nurse or

Nurse ClinicalSpecialist

Therape\ltic Mentors "

'

,

"

'Therapeutic mentors must be 21 years of~e or older and have either: a bachelor's degree in a human

service field from an accredited academic institution and one (1) year of relevant experience working ,

with childrenladolescentsltransition ,age youth; or, ,an associate's degree in a human services ,field'

from an' accredited ac;adernic ipstitulion and one (I) year of relevant experience working with

childrenladolescientsltransition ,age youth;' or, a high school diploma or General Educational ,

Development (GED) and',. minimum of two (2) years of experience working with,
childrenladolescentsltransition age yotith. If the bachelor's or associate's degree is not in a human

services field, additional life or work experience may be considered in place of the human services

degree, Ti)erapeutic mentors must be supervised by iI L1C&W, LMFT, LMHC, LCSW, LADC I,

F!sychologist, Psychiatric Nurse or Nurse Clinical Speciillist ,

Item 5: Physician's Seryices See Supplement to Attachment 3.l-A, P-.1, Item'l, #1.

OFF~CIAL,

TN: 08-004 Supersedes: 06-005

Approval Date: 06/04/09

Effective Date: 04101109
Exhibit 1
50

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 52 of 70 Page ID #:4842

Attachment 4.19-8

Page2C

State Plan Under Title XIX of the 80<Iai SecuTl1y Act

,

State; Massachusetts

Methods and Standards for Establishing Payment Rates - Other Types of Care

t.

Early and Periodic Screening, Diagnostic and Treatment services for indivicuali under 21 years

ofl!ge, and· treatment of" conditioni found.

"

.,'

The rate methodology used to create the following fee schedules for lij"e based on a model bUdget
that accounts for program costs (direct and indirect) and maximum productive time specific for the provision of each $Orvice. The data sources for program costs include cost reports from providers of similar behavioral health services and budget data from other purchasers of similar
iervic... Maximum productive time for each service was derived by assessing the time available for direct billable contacts by eligible direct care staff.

Mobile Crisis Intervention - fee schedule established by lbe Division of Health Care Finance and Policy. The fee..for-service rates werese! as of December, 15 2008. These fixed raleS are effective for service provided on or after July I, 2009. All rates are published on www.mass.govfdhcfp. Except as otherwise noted in the plan, state developed fee schedule rates are the same forboth governmental and private providers.

Behavioral Management Therapy - fee schedule established by the Division of Health Care Finance and Policy.. The fee-far-service rates were set as of December, 15 2008. These fixed rates are effective for service provided on or after July I, 2009. All mtes are published on www.mass.govfdhcfp. Except as otherwise noted in the plan, state developed 'fee schedule rates are the same for both governmental and private providers;

Behavioral Management Monitoring - fee schedule established by the Division of Health Care Finance and Policy. The rates were set as of Dmber, 152008. These fixed rates are· effective for service provided on or after July 1,2009. All rates are published on www.mass.govfdhcfp. Except as otherwise noted In the plan, state developed fee schedule rates are the same for both governmental and private providers.
In-Home Therapy - fee schedule establis~ed by the Division ofHealth Care Finance and Policy.. The fee..for·service rates were set as of December, 15 2008. These fixed rates are effective for service provided on or after July I, 2009. All rates are published on www.mass.gov/dhcfp., Except as otherwise noted in the plan, state developed fee schedule rates are the same for both governmental and private providers.

Therapeutic training and aupport - fee schedule established by lbe Division of Healtli Care

Finance and Policy. The fee-far-service rates were set as of December, 15 2008. These fixed

rates are effective for service provided on or after July I, 2009. All rates are publisbed on

www:mass.govfdhcfp. Except as otherwise noted in lbe plan, state developed fee schedule rates

are the same for both governmental and private providers

'

OFFICIAL

TN: OS-004 Supersedes: N/A

Approval Date: 06/04/09

Effective Date: 04101109

Exhibit 1
51

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 53 of 70 Page ID #:4843

AUa.hmenI4.19-B

Page 11)

State Phon Under Tttle XIX of the Social Security Act .

Stale: Massa.husetts

.

Metbods and Standsrds for Establisbing Payment Rates - Other Types of Care

Ii ,.
!

Therapeutic Mentoring Services - fee schedule established by the Division of Heakh Care Finarce and Policy. The fee-for-service rates were set as of December, 15 2008. These fIXed rates are effective for service provided on or after July I, 2009. All rates are published on www.mass.gov/dhcfp. Except as otherwise noted in the plar, state developed fee schedule rates are the same for both governmental ard private providers.

Family Counseling Support Services - fee schedule established by the Division of Health Care
Finance and Policy. The fee-for-service rates were set as of November I, 2008. These fixed mes are effective for service provided on or after July 1, 2009. All rates are published on www.mass.gov/dhcfp. Except as otherwise noted in the plan, ~te developed fee sched~le rates
are th.e same for both governmental ard private providers.

TN, 08-004 Supersedes, N/A

OFFICIAL

Approval Date: 06104/09

Effective Date: 04101109

Exhibit 1 52

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 54 of 70 Page ID #:4844
EXHmIT2
Exhibit 2
53

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 55 of 70 Page ID #:4845

STATE OF OREGON

Transmittal #04-09 Attachment3.l-A Page 6-f

13 .e. Behayior Rehabilitation Services

Behavior Rehabilitation Services are provided to children/youth to remediate debilitating psycho-social, emotional and behavioral disorders. To provide early intervention, stabilization and development of appropriate coping skills upon the recommendation of a
licensed practitioner ofthe healing arts within the scope oftheir practice within the law.
Prior approval is required.

Service Description

Behavior Rehabilitation Services may be provided in a variety of settings and consist of
interventions to help childreniyouth acquire essential coping skills. Specific services include milieu th~rapy, crisis counseling, regular scheduled counseling and skills training. The purpose ofthis service is to remediatespecific dysfunctions which have been explicitly identified in an individualized written treatment plan that is regularly

.TN # 21:ll2... Supersedes TN #98-04

Date Approved 214/05

Effective Date.1LUQ1

Exhibit 2 54

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 56 of 70 Page ID #:4846

STATE OF OREGON

Transmittal #98-04 Attachment 3.1-A Page 6-f.l

LIMITATION ON SERYICES

reviewed and updated. Client centered treatment services roay be provided individually or

in groups and'may include the child's/youth's biological, adoptive or foster family.

Treatment is focused upon the needs ofthe child/youth, not the family unit. These services

, may be in conjunction with orin sup~ of my other professional treatment services the

child/youth may be receiving as reqUIred by 1:\1e diagnosed condition.

'

'The services will include crisis intervention and counseling on a 24-hour basis to stabilize

the child'slybuth's behavior until resolution ofthe problem is reached. or until the

child/youth can be assessed and treated by a qualified,Mental Healtli :Professional or

licensed Medical Practitioner.,

"

, ReSl!lar scheduled counseling and therapy is p.rovid~d to remediate ,specific dysfunctions

which have been explicitly identified in the treatment plan.

'

Skill training is l?rovided to assist the child/youth in the develoJlment of appropriate :

responses to soclal and emotional behaviors, peer and family relationships self-care;

conflict resolution, aggression reduction, anger control, and to reduce or elIminate impulse

and ,?onduct d i s o r d e r s . ,

,

Milieu therapy refers 'to those activities performed with children/youth to normalize their psycho-social develo!;,ment and promote the safety of the childlyouth and stabilize tbeir environment The clilld/youth is monitored in structured activities which may be develo,Pmental, recreational, academic, rehabilitative, or a variety of productIve warle activitIes. As the child/youth is monitored, planned interventions are provided to remediate the identified dysfunctional Of maladll{Jtive behaviors and promote their replacement with more developmentally appropnate responses.

Population To Be Served.

The population serviced will be EPSDT eligible children/youth who have primary mental,

emotii:mal and behavioral disorders and/or developmental disabilities that prevent them .

from functioning at developmentally appropriate levels in their home, school, or

community. They exhibit such symptoms as drug and alcohol abuse, anti-social behaviors

that require close supervision and intervention and structure," sexual behavior problems,

victims of severe family conflict, behavioral disturbances often resulting from psychiatric

disorders ofthe Earents, medically compromised and developmentally disabled

childret)lyouth who 'are not otherwise served by the Stllte Mental Health Developmental

Disability Services Division. '

,

TN# 98-04 Supersedes
TN # ..2l:1l

Date Approved 6/4/98 Effective Date 111/98

Exhibit 2
55

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 57 of 70 Page ID #:4847

STATE OF OREGON

Transmittal #98-04 Attachmept 3.l-A Page 6-f.2

LIMITATIO~ ON SE1WlQES

Provider Qualifications. '.

Program Coordinator: Responsibilities include supervision ofstaff, providing overall direction to the program, planning and coordinatin~ program activities and delivery of services, and assure the safety and protection of childreniyouth and $if.

The Minimum Q,ualifications- A Bachelor's De~ee, preferably with major study in

psychology, SOCiology, Social Work, Social SCIences, or a closely allied field, and two

years experience in the supervision and management of a residential facility for care and

treatment of children/youth.

.

Social Service Staff: Responsibilities include Case Management and the·develol'ment of
service plans; individual, group and family counseling; individual and group skills
training; assis.t the Child Care Staff in providing appropriate treatment to children/youth, coordinate services with other agencies; document treatment progress. The Minimum Qualifications- A Masters Degree with major study in Social Work or a . . closely allied field and Ol)e year of experience in the care and treatment of childrenlyouth, or a Bachelor'S Degree with major stuCiy in Social Work, psychology, Sociology, or II ; close\y allied field and.two years experience in the care and treatment of children/youth.
Child Care staff: Responsibilities include direct supervision and control ofthe daily living'
activities of children/youth, assisting social service Staff in providing individual, group and family counseling, skills training, provide therapeutic interventions to children/youth as directe~ by the !odividual treatment pl:ms to address behavi<;>ral and eIl:lotional problems as . they anse, momtor and manage the children'sfyouth's beha.vlor to proVIde a safe, structured Iivmg enVironment that is conducive to treatment.

Minimum Qualifications- Require that no less than 50% of the Child Care Staffin a

facility have a Bachelor's Degree. Combination offOllDal -education and experience

working with children/youth may pe substituted for a Bachelor's Degree. Chi!d Care are

members of the treatment team and work under the direction of a qualified Social Service

staff or a Program C o o r d i n a t o r . .

.

'. .

TN# 98-04 Supersedes TN# 91-11

Date Approved 6/4/98 Effective Date ~

Exhibit 2 56

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 58 of 70 Page ID #:4848
EXHIBIT 3

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 59 of 70 Page ID #:4849

State: Nevada

ATTACHMENT 3.1-A Page 6a

A. Diagnostic Services. Provided under the EPSDT program.
B. Screening Services. Annual mammography provided to women aged 40 and over. Screening
services also provided ~mder the EPSDT program.
C. Preventive Services. Annual gynecological and breast examinations with pap smear tests provided to women who are or have been sexually active or are age 18 and over. Preventive services also provided under the EPSDT PROGRAM.
D. Rehabilitative Services:
I. Mental Health Rehabilitation Services
Mental health rehabilitation assists individuals to restore andlor retain psychiatric stability, social integration skills, personal adjustment andlor independent living competencies in order to experience success and satisfaction in environments of their choice and to function as independently as possible. Interventions occur concurrently with clinical treatment and begin as soon as clinically appropriate.
The services must be recommended by a physician or other licensed practitioner of the healing arts, within theirscope ofpractice and prescribed on an individualized treatment plan to achieve maximmn reduction of a mental disability and restore the recipient to their optimal level offunctioning.

lNNo. 07-009 Supersedes lNNo. 08-017

Approval Date: October 31, 2008 Effective Date: November I, 2008
Exhibit 3 58

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 60 of 70 Page ID #:4850

State: Nevada

ATTACHlv1ENT 3.l-A Page 6b

Each individual service must be identified on a written rehabilitation plan. This is also referenced as the treatment plan. Providers are required to maintain case records. Components of the rehabilitation plan and case records must be consistent with the federal rehabilitation regulations. Rehabilitation services may only be covered by Medicaid ifthey are not the responsibility of other programs and if all applicable requirements of the Medicaid program are met. Services covered under the Title IV-E program are not covered under the rehabilitation program. Room and Board is not an allowable service under the mental health rehabilitative program. Services are not provided to recipients who are iomates of a public institution.
These services require utilization review according to the individual intensity ofneed and are time limited.
Rehabilitative mental health services may be provided in a community-based, outpatient services, home-based, and school-based environment. Depending on the specific services they may be provided in a group or individual setting. All collateral services that are delivered to aperson that is an integral part ofthe recipient's environment such as medically necessary training, counseling and therapy, must directly support the recipient.
Services are based on an intensity of needs detennination. The assessed level of need specifies the. amount, scope and duration ofmentaI health rehabilitation services required to improve, retain a recipient's level of functioning or prevent relapse. The detennination cannot be based upon the habilitative needs of the recipient.
Intensity of needs determination is completed by a trained Qualified Mental Health Professional (QMHP) or Qualified Mental Health Associate (QMHA) and is based on several components related to person- and family-centered treatment planning. These components include:
• A comprehensive assessment of the recipient's level of functioning; • The clinical judgment of the QMHP; or • The clinical judgment of the case manager working under clinical supervision who is
trained and qualified in mental health intensity of services determinations; and • A proposed Treatment Plan.
A re-determination of the intensity of needs must be completed every 90 days or anytime there is a substantial change in the recipient's clinical status.
Nevada Medicaid utilizes an intensity of needs grid to deterlnine the amount and scope of services based upon the clinical level of care of the recipient. The grid is based upon the current level ofcare assessments: Level ofCare Utilization System (LOCUS) for adults and Child and Adolescent Services Intensity Instrument (CASII) for children. The determined level on the grid guides the interdisciplinary team in planning treatment.

TN No. 07-009 Supersedes TN No. 05-015

App1"Oval Date: October 31. 2008 Effective Date: November I, 2008
Exhibit 3 59

i
: . _ 1

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 61 of 70 Page ID #:4851

State: Nevada

ATTACHMENT 3.1-A Page 6b.1

Within each level there are utilization standards for the amount of services to be delivered. The six levels are broken out by the following categories in order from less intense to more intense;
Level of Care Utilization System (LOCUS)
• Level 1- Recovery maintenance and health management, • Level 2- Low intensity community based services, • Level 3- High intensity community based services, • Level 4- Medically monitored non-residential services, • Level 5- Medically monitored residential services, and • Level 6 -Medically managed residential services.
Child and Adolescent Services Intensity Instrument (CASII)
• Level 1- Basic services, Recovery maintenance and health management, • Level2-Outpatient services, • Level 3- Intensive outpatient services, • Level 4- Intensive integrated services, • Level 5- Non-secure, 24 hour services with psychiatric monitoring, • Level 6- Secure, 24 hour services with psychiatric management.
All mental health rehabilitation services must meet the associated admission and continuing stay criteria and go through utilization management per the intensity of needs grid.
Service Array:
1. Assessments: Covered for problem identification (diagnosis) and to establish measurable treatment goals and objectives by a Qualified Mental Health Professional or designated Qualified Mental Health Associate in the case of a Mental Health Screen. An assessment is not intended for entry into each of the services. It is provided as an overall assessment ofthe recipient's needs. Assessments are limited to two per calendar year. Additional assessments may be prior authorized based upon medical necessity. Re-assessments utilizing the appropriate CPT codes are not subject to the initial assessment limitations.
2. Mental Health Screens: Determine eligibility for admission to treatment program. This is completed through a clinical determination of the intensity of need of the recipient. The objective of this service is to allow far the 90 day review for the intensity of needs determination and to determine either SED or SMI ifit has not ah·eady been determined. The provider must meet the requirements of a QMHA.
3. Neuro-cognitivelpsychological and menial status testing: This service is perfOlmed by a QMHP. Examples oftesting are defined in the CPT; neuropsychological testing,

TN No. 07-009 Supersedes TNNa. 05-015

Approval Date: October 31, 2008 Effective Date: Navember 1. 2008
Exhibit 3 60

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 62 of 70 Page ID #:4852

State: Nevada

ATIACHMENT 3.l-A Page 6b.2

neurobehavioral testing, and psychological testing. Each service includes both interpretation and reporting ofthe tests. This service requires prior authorization.

4. Basic Skills Training: Services in this category are rehabilitative interventions that target concrete skills training such as: monitoring for safety, basic living skills, household management, self-care, social skills, communication skills, parent education, organization skills, time management, and transitional living skills. This service is provided in a variety of settings including community-based, outpatient services, and the home environment. The level ofprofessional providing the services is dependent upon the needs ofthe recipient and the utilization management criteria. This service is provided by a QMHP or QMHA, under
the direction of a QMHP, or provided by a QBA under the direct supervision ofa QMHP or
QMHA. This may be provided in a group (four or more individuals) or in an individual setting. These services require utilization review according to the individual intensity ofneed and are time limited.

5. Psycho-social Rehabilitation: Services in this category are rehabilitative interventions that target specific behaviors. These services may include: behavioral management and counseling, conflict and anger management, interpersonal skills, collateral interventions with schools and social service systems, parent and family training and counseling, community transition and integration, and self-management. This service is provided in a variety of settings including, community-based, outpatient services, and the home environment. The level ofprofessional providing the services is dependent upon the needs ofthe recipient and
the utilization management criteria. This is provided on an individual basis or in a group
consisting of at least four individuals. Service is provided by a QMHP or a QMHA. The services provided may be directly attributable to an individual provider. Recipients must either be severely emotionally disturbed or seriously mentally ill. The level of care of the recipient is consistent with the high intensity community based services. These services require utilization review according to the individual intensity ofneed and are time limited. This service is reim.bursed in IS minute increments.

6. Crisis Intervention: A service provided by a QMHP to recipients who are experiencing a
psychiatric crisis and a high level ofpersonal distress. Crisis intervention services are brief, immediate and intensive interventions to reduce symptoms, stabilize the recipient, restore the recipient to hislher previous level offimctioning, and to assist the recipient in returning to the community as rapidly as possible. if the recipient has been removed from their natural setting. The individual demonstrates an acute change in mood or thought that is reflected in the recipient's behavior and necessitates crisis intervention to stabilize and prevent hospitalization. The Individual is a danger to himself, others or pmperty or is unable to care for selfas a result ofpersonal illness. These services may be mobile and may be provided in a variety of settings, including, but not limited to, psychiatric emergency departments, homes, hospital emergency rooms, schools, child protective custody and homeless shelters. Crisis intervention services include follow-up and de-briefing sessions to ensure stabilization and continuity of care.

TN No. 07-009 Supersedes
TN No. 05-015

Approval Date: October 31. 2008

Effective Date: November 1, 2008

Exhibit 3
61

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 63 of 70 Page ID #:4853

State: Nevada

ATTACHMENT 3.1-A Page 6b.3

The service may be provided telephonically, as long as the service meets the definition of crisis intervention. Face to face crisis intervention is reimbursable for either one QMHP or
a team that is composed of at least one QMHP and another QMHP or QMHA. This service
is allowable for all levels ofcare. These services require utilization review according to the individual intensity of need and are time limited.
6. Medication Management Training and Support - Provided by a QMHP other than a physician. Typically this service is provided by a registered nurse. This service is for monitoring of compliance, side effects, recipient education and coordination ofrequests to a physician for changes in medication(s). This service may be provided in the home and cormnunity-based program. This service is provided at all levels ofcare. This service is not the same as medication management that is provided by a physician under physician services.

7. Mental Health Therapy: Provided by a QMHP for individual, group, andlor family therapy with the recipient present and for family therapy without the recipient present. Therapy delivered must be of a direct benefit to the recipient. Minimum size for group therapy is three individuals and a maximum therapist to participant ratio is one to ten. Mental health therapy is billed utilizing the appropriate CPT codes for licensed professionals. Mental health therapy is available at all levels ofcare. The intensity ofthe service increases based on the need of the recipient. These services require utilization review according to the
individual intensity of need and are time limited.

8. Day Treatment Program: A community-based psycho-social program of rehabilitative services desigoed to improve individual and group functioning for effective community integration. This is not an Institution for Mental Illness (IMD), a Residential Treatment Facility, nor is it an institution as defined under federal regulation. Admission to this program requires: severe emotional disturbance or serious mental illness and recipient's clinical and behavioral issues require intensive, coordinated, multi-disciplinary intervention within a therapeutic milieu. Day treatment is provided in a structured therapeutic environment which has programmatic objectives such as but not limited to: development of skills to promote health relationships and learn to identify ingredients that contribute to healthy relationships, development of coping skills and strategies, development of aggression prevention plans, problem identification and resolution, ability to learn respectful behaviors in social situations, development of the ability to demonstrate selfregulation on impnlsive behaviors, development of empathy for peers and family and develop a· clear understanding ofrecipients cycles ofrelapse and a relapse preventionplan. Services must be provided by a QMHP or by a QMHA under the direct supervision of a QMHP. The services provided may be directly attributable to an individual provider. The staff ratio is one to five p81ticipants. The average time per day this program is offered is three hours per day. Mental health therapy is a separate billable service under the appropriate CPT codes.

TN No. 07-009 Supersedes TN No. 05-015

Approval Date: October 31, 2008

Effective Date: November 1. 2008

Exhibit 3
62

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 64 of 70 Page ID #:4854

State: Nevada

ATTACHMENT 3.l-A Page 6b.4

Mental health therapy and day treatment cannot be billed for the same time period. This service is consistent with intensive integrated outpatient services. These services require utilization review according to the individual intensity of need and are time limited. This service is reimbursed in hourly increments.

10. Peer-Io-Peer Support Services: These supportive services assist a recipient andlor their family with accessing mental health rehabilitation services or community support services for needed stabilization, preventive care or crisis intervention. These services may include: empathic personal encouragement, self-advocacy, self-direction training, and peer recovery. These serviceS must be a direct benefit to the recipient. Services may be provided in a group (requires five or more individuals) or individual setting. The services are identified in the recipient's treatment plan and must be provided by a Peer Supporter working collaboratively with the case manager or child and family team/interdisciplinary team. A minimum amount ofservices are offered based on the intensity ofneeds and prior authorization is required for utilization of services above the minimum amount. These services require utilization review according to the individual intensity ofneed and are tiroe limited.

A Peer Supporter is a qualified individual currently or previously diagnosed with a mental health disorder who has the skills and abilities to work collaboratively with and under the direct supervision of a QMHP in the provision of supportive assistance for rehabilitation services as identified in the treatment plan. Peer Supporters at'e contractually affiliated with a Behavioral Health Community Network, psychologist, or psychiatrists in order to be
provided with medical supervision. Supervision by the QMHP must be provided and documented at least monthly. The selection of the Peer Supporter is based on the best interest of the recipient. The Peer Supporter must be approved by a QMHP. A Peer Supporter can not be the legal guardian or spouse ofthe recipient. A Peer Supporter must meet the miniroum qualifications of a QBA.

Service Limitations

Rehabilitation mental health services are therapies or interventions identified in the treatment plan that are intended to result in improving or retaining a recipient's level of functioning. These services are person- and family-centered, culturally ·competent, and must have measurable outcomes. The amount and duration of the service is reflective of the intensity of needs determination ofthe recipient. Services require authorization through Nevada Medicaid's QIO-like vendor. The level ofprofessional providing the service is dependent upon the needs ofthe recipient and the utilization management criteria.

Provider Oualifications

a. Qualified Mental Health Professional: A person who meets the definition ofa QMHA and also meets the following documented minimum qualifications: 1) Holds any of the following educational degrees and licensure; Doctorate degree in psychology and license; Bachelor's degree in nursing, APN (psychiatry), graduate degree in social work with

TN No: 07-009
Supersedes TN No: 08-017

Approval Date: October 31. 2008 Effective Date: November L 2008
Exhibit 3 63

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 65 of 70 Page ID #:4855

State: Nevada

Attachment 3.1-A Page6b.5

the following: a graduate degree in counseling and a license as a marriage and family

therapist, or a clinical professional counselor, or is employed by the State ofNevada mental

health agency and meets class specification qualifications of a Mental Health Counselor.

The following licensed intems are covered as a QMHP: Licensed clinical social worker

intern, licensed marriage and family therapist intern, and licensed clinical professional

counselor interns. Interns must be supervised in accordance with state regulations and may

only provide services within the scope of their licensure.

b. Qualified Mental Health Associate: A person who meets the following minimum

documented qualifications; I) Registered nurse OR 2) holds a bachelor's degree in a social

services field with additional understanding of mental health rehabilitation services, and

case file documentation requirements; AND 3) whose education and experience

demonstrate the competency under clinical supervision to direct and provide professional

therapeutic interventions within the scope of their practice and limits of their expertise,

identify presenting problems, participate in treatment plan development and

implementation, coordinate treatment, provide parenting skills, training, facilitate discharge

plans, and effectively provide verbal and written communication on behalfofthe recipient

to all involved parties, AND 4) Has an FBI background check in accordance with the

provider qualifications of a QBA.

c. Q~JaIified Behavioral Aide: A person who has an educational background ofa high·school

diploma or GED equivalent. A QBA may only provide the following services: basic skills

training and peer support services. A QBA must have the documented competencies to

assist in the provision ofindividual and group rehabilitation services which are under the

direct supervision- of a QMHP or QMHA, read, write and follow written or oral

instructions, perform mental health rehabilitation services as documented in the treatment

plan, identify emergency situations and respond accordingly, communicate effectively,

i

document services provided, maintain confidentiality, successfully complete approved training program, CPR certification, and have completed an FBI criminal background

i
I ,
I

check to ensure no convictions of applicable offenses have been incurred. QBA's are

- - I!

required to participate in and successfully complete an approved training program which

includes -basic training, pedodic and continuing in service training. Training must be

interactive and not solely based on self·study guides or videotapes and should ensure that a

QBA will be able to interact appropriately with individuals with mental health disorders.

Training must also include:

• Case file documentation; • Recipient's rights; • HIPAA compliance; • Communication skills; • Problem solving and conflict resolution skills; • Communication techniques for individuals with communication or sensmy
impairments; and • CPR certification

TN No. 09·012 Supersedes 1NNo. 07-009

Approval Date: January 25,2010 Effective Date: October 1, 2009
Exhibit 3 64

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 66 of 70 Page ID #:4856

State Nevada

Attaclnnent 3.1-A Page 6b.6

The entity that is providing supervision over the QBA shall provide annually a minimum of eight hours of service training for each QBA. The purpose of the annual training is to facilitate the development of specialized skills or knowledge not included in the basic training and/or to review or expand skills or knowledge included in the basic training. Consideration must be given to topics suggested by recipients. Documentation of the completed training and achieved competencies meeting this requirement mllst be maintained by the entity. Training requirements may be waived if the QBA can provide written verification of comparable education and training. The entity must document this validation.

TN No. 07-009 Supersedes TN No. 08-017

Approval Date: October 31, 2008 Effective Date: November 1. 2008
Exhibit 3 65

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 67 of 70 Page ID #:4857

State Nevada

Attachment 3.I-A Page6b.7

approved training program, CPR certification, and have completed an FBl criminal background check to ensure no convictions of applicable offenses have been incurred. QBA's are required to participate in and successfully complete an approved training program which includes basic training, periodic and continuing in service training. Training must be interactive and not solely based on self-study guides or videotapes and should ensure that a QBA will be able to interact appropriately with individuals with mental health disorders. Training must also include:

• Case file documentation; • Recipient's rights; • HIPAA compliance; • Communication skills; • Problem solving and conflict resolution skills; • Communication techniques for individuals with communication or sensory
impairments; and • CPR certification
The entity that is providing supervision over the QBA shall provide annually aminimlun of
eight hours of service training for each QBA. The purpose of the annual training is to
facilitate fue development of specialized skills or knowledge not included in the basic
training andlor to review or expand skills or knowledge included in the basic training. Consideration must be given to topics suggested by recipients. Documentation of the completed training and achieved competencies meeting this requirement must be maintained by the entity. Training requirements may be waived if the QBA can provide written verification of comparable education and training. The entity must document this validation.

1N No. 05-015 Supersedes 1NNo.NEW

Approval Date: Februmy 23. 2007

Effective Date: Januarv 1. 2006
Exhibit 3 66

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 68 of 70 Page ID #:4858

State Nevada

(Reserved)

Attachment 3.1-A Page 60

TN No. 95-04 Supersedes TN No. 93-18

Approval Date: Oct 12, 1995

Effective Date: Ju1 01. 1995
Exhibit 3
67

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 69 of 70 Page ID #:4859

I

PROOF OF SERVICE BY E-MAIL AND MAILING

2

I am over the age of 18 and not a party to the within action. I am employed

3 by the Office of United States Attorney, Central District of California. My

4 Business address is 300 North Los Angeles Street, Suite 7516, Los Angeles,

5 California 900 12

6

On November 18,2011, I electronically/mailed served:

7 Comments of the United States in Support of Final Approval of the Proposed Settlement Agreement
8 on each person or entity named below bye-mailing a pdf copy addressed as shown

9 below following our ordinary office practices. I am readily familiar with the

10 practice of this office for e-mailing and mailing.

II

Date of e-mail and mailing: November 18. 2011. Place of e-mailing and

12 mailing: Los Angeles. California.

13

Person(s) and/or Entity(s) to Whom e-mailed was sent:

Fiza A. Ouraishi National "Center for Youth Law Email: fg,uraishi@Youthlaw.org

John F O'Toole National Center for Youth Law 405 14th St, 15th FI Oakland, CA 94612-2701 510-835-8098
Kirk A Hornbeck, Jr Hunton & Williams LLP Email: khornbeck@hunton.com
Melinda Ruth Bird Disability Rights California Email:melinda.bird@disabilityrightsca. org
Patrick H Gardner National Center For Youth Law Email: pgardner@youthlaw.org

Robert D Newman Western Center on Law & Poverty Email: rnewman@wclp.org

Case 2:02-cv-05662-AHM-SH Document 771 Filed 11/18/11 Page 70 of 70 Page ID #:4860

1 Antionette D Dozier Western Center on Law and Poverty
2 Email: adozier@wc1p.org
3 Carmen Denise Sn(j:gs
4 Office of Attorney eneral of California
5 Email: carmen.snuggs@doj.ca.gov

Katherine M Bowser County ofLos Angeles Office of Counry Counsel Email: kbowser@counsel.lacounty.gov
Jennifer M Kim Office of CA Attorney General Email: jennifer.kim@doj.ca.gov

6 Ernest Martinez
Office of Attorney General of 7 California
Email: ernest.martinez@doLca.gov 8
Brandon T Nichols 9 Los Angeles County Counsel
Email: 10 bnichols@counsel.lacounty.gov

Lionel Zevi Glancy Glancy Binkow & Goldberg LLP Email: 19lancy@glancylaw.com
Sara Ugaz Office of the City Attorney, Los Angeles Email: sara.ugaz@lacity.org

11 I declare under penalty ofperjury under the laws ofthe United States of
12 America that the foregoing is true and correct.
13 I declare that I am employed in the office of a member of the bar ofthis
14 court at whose direction the service was made.
15 Executed on: November 18. 2011, at LO'~l.Il~eles, California.
16

17

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 </s> Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 1 of 33 Page ID #:5401

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UNITED STATES DISTRICT COURT

9

CENTRAL DISTRICT OF CALIFORNIA

io

WESTERN DIVISION

11

12 KATIE A., et ai., 13

14

v.

15 DIANA BONTA, et ai.,

16

17

Case No. CV-02-05662 A.H1v1 (SHx) Plaintiffs, SPECIAL MASTER'S REPORT ON
PROGRESS TOWARD COMPLETION OF THE KATIE A. IMPLEMENTATION PLAN Judge: ·Honorable A. Howard Matz Defendants. Crtrm: 14

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Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 2 of 33 Page ID #:5402 2

1

TABLE OF CONTENTS

2

3 PART ONE: INTRODUCTION

3

4

Purpose of this Progress Report to the Court

4

5

Katie A. Negotiation Workgroup Composition

4

6

Organization of this Document

4

7

8 PART TWO: SPECIAL MASTER'S EVALUATION OF THE IMPLEMENTATION

9 PLAN PHASE ONE AND REVIEW AND COMMENTS PHASE TWO

10

Introduction

7

11

Section 1, Core Components

8

12

Section II, Family and Youth Involvement

14

13

Section III, Service Delivery and Rollout

16

14

Section IV, Training and Technical Assistance

19

15

Section V, Data and Quality Assurance

21

16

Section VI, Joint Management Structure

23

17

Special Master's Findings for Phase One, and Review and Comments on Phase Two 25

18

19 PART THREE: SPECIAL MASTER'S RECOMMENDATIONS

31

20 EXHIBITS

21

Exhibit 1: Katie A. Implementation Plan and Appendices - Date August 24, 2012 33

22

Exhibit 2: Katie A. Negotiation Workgroup Members

60

23

Exhibit 3: Core Practice Model Fiscal Taskforce Charter

62

24

Exhibit 4: Joint Management Structure Taskforce Charter

66

25

Exhibit 5: Accountability, Communication and Oversight TaskForce Charter

72

26

27

28

29

30

31

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 3 of 33 Page ID #:5403 3

l.

2

PART ONE

3

INTRODUCTION

4

This report is submitted to the Court in accordance with the Katie A. Court's Orders

5 dated December 1,2011, SETTLEMENT AGREEMENT. Subsequent orders issued by the

6 Court on July 17,2012 and July 23,2012, further clarified expectations regarding the Special

7 Master's evaluation of the Implementation Plan. As a result of these orders, the Special

8 Master's evaluation was divided into two phases. Phase One of the Implementation Plan will

9 be reviewed on September 14,2012; Phase Two will be reviewed on December 13, 2012.

10

It is my pleasure to report that on August 24,2012, the parties have reached agreement on

11 a Proposed Implementation Plan (hereinafter referred to as Implementation Plan). The

12 Implementation Plan is divided into two Phases. Phase One activities and de~iverables are to

13 be completed within the 2012 calendar year and ,Phase Two reflects activities;tha~:may,ormay

14 .not begin in2012 but will extend into 2013 and beyond. As specified in the; ClOlllt'sJuly 23-;,

',' '

15 2012 Order,Phase Two shall describe the 'framework and expectations, the 'aiiticip'ated'

16 timelines' and 'any discussion about Phase Two will be meant to assure an understanding of

17 what will be necessary to complete an Implementation Plan for Phase Two by December 13,

18 2012.' Since the Special Master's report does not need to contain the,fmalbr ,corripleted •

"1~' ,••./"!; ".; '·':19·~~:: :Pliase Two ,llirplemerifafion Plan/the" Slie'ciar Masfer' s evaluatro:l1'WiIHSe piiiiiariry;focilsectoii:,.. '::";,

,. __. _ 2D~ .I>hase o.ne~ ofthe Implementation Plan.

21 . ".,TheProposedKatieA. ImplementationPlan,Exhibit l,reflects the consensus ofthe"

22 Parties, including the Negotiation Workgroup. The Special Master's evaluation oithe Katie

23 A. Implementation Plan and its recommendations are those of the Special Master only, and

24 does not necessarily represent the views ofthe various parties and partners involved in

25 developing the Katie A. Implementation Plan, who may provide the Court with their own

26 written responses to this report.

27

The Implementation Plan has been deVeloped through an intense and collaborative effort.

28 Since January 2012, the Negotiation Workgroup has been engaged in a process that supports

29 the development of the Implementation Plan, including meeting as an entire group on a

30 weekly basis and leading various workgroups, completing specific tasks and facilitating the

31 development of the subgroup charters to help guide further development of the

i

.

I~--------·-------·----·-·- ~ --.--~- - - - - - - - - - - - - - - - - . - - - - - . - - - - - - - - - - - - - -----~---. - - - - - - - - - - - - - . - - - - - . - - - - - --~-------

i

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 4 of 33 Page ID #:5404

4

..- - - - - .

,. :' >,,),.. '

1 implementation plan.

2

3 The Purpose Of This Report

4

This report's has two purposes: (1) to inform the Court regarding Phase One of the

5 Katie A. Implementation Plan and to make recommendations consistent with Paragraph

6 25(b) of the Settlement Agreement, 'the Special Master shall determine whether the

7 Implementation Plan is reasonably calculated to ensure that State Defendants meet the

8 terms ofthe Agreement and objectives set forth in Paragraph 19', and (2) consistent with

9 the Court's Order Dated, July 23,2012, to describe what is contemplated in PhaseTwo

10 ofllie Implementation Plan -'the framework and expectations and anticipated timelines,

11 etc.' that assures 'an understanding ofwhat will be necessary to complete an

12 Implement~tion Plan for Phase Two by December 13,2012'.

13 Katie A~ .NegotiationWorkgroup Composit!on..

" ' , ' ': : '··-·::~'·:~.~.<7<"L-

,~'''.

'", " . . ..... '.;.'~ '~';"~._

..: .... ""~ -

, ' , ;.•
.

'.'<:

14

The Negotiation Workgroup composition has not changed since my lastprogress:":i;i';".~

. . . ~, .'.'''....... :.~~~.\'": .•\-.

'.

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", '>':"

.;.

,"

',", : j ' : " .. .'~;., '_, .. .

15 report in April 2012. (A complete list of participant names and titles is included in

16 Exhibit 2 at the end of this Report.)

17

The Negot~~!ion Workgroup includes representatives of the California Department

.:. -;'.

18 . .. of Social ._.:.. ". ofJI~alth,Care S~rvices,(CDH:CS);C:;tljfQrpj.a,pepaJj:QJ.ent

. .. .,." "; . n_:. ", . ~ ~.'''.' .~~ ~:<",

.. <" ': . : ,.:; 'j'I" .. '>:~:

~.;;~:';;:;'.-: 1::,....:. :>,~ ~.'! '_~~' ':"''';' .~. ,.1>'-<"-: ' ' .., ~ : ': • ,•. -. '"":. ~'. '.j

~ -;J~;~,

'''--.! '~~.':, ~[;: J::~.~

Service.~JODS.S);

I.', -l. • :

<- . . · ... ":-.-..' ":>. ; " '._ '.<",

) I ' · l... ··r\.;.:~

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19 the Department of State Hospitals, formerly the Department of Mental Health; the:;.:: -:'.. ':
- _._-- --- -- -. .._- ._-- " - . ----'-. - ...
20 Califo~a Dep~ment of Justice, Office of the Attorney.General; representatives-?f the' .
. .' ~ , .' ".

21 class and class perspective including counsel, parents, families, and provider

22 organizations (the youth representative position is currently vacant); the County Welfare

23 Directors Association of California; the California Mental Health Directors Association;

24 and the County of Los Angeles.

25 Organization ofthis Document

26

The remainder of this report to the Court is divided into the following parts: Part Two

27 presents the Special Master's evaluation of the Katie A. Implementation Plan, Phase One as

28 required in the AGREEMENT paragraph 25(b) and the Court's Orders dated July 23, 2012 and

29 Phase Two as required by the Court's Orders dated, July 23,2012; a brief overview at the end of

30 Part Two summarizes the Special Master's Findings for Phase One and Special Master's Review

1- ----~--.------------.-------. - ------- - ---------------------- --- ---~-- --- -- - ------------ --- ---
Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 5 of 33 Page ID #:5405
5

1 and Comments on Phase Two.

1--
I

I~"

••

..'

'.

2

3

PART TWO

4 SPECIAL MASTER'S EVALUATION OF THE IMPLEMENTATION PLAN PHASE

5

ONE AND REVIEW AND COMMENTS PHASE TWO

6

DATED AUGUST 28, 2012

7

This section of the report to the Court presents the Special Master's evaluation

8 and recommendations regarding the Katie A. Implementation Plan. The Special

9 Master, in order to ensure theCourt receives a comprehensive evaluation of the

10 Implementation Plan, will identify not only the areas of agreement but also concerns

11 identified by the Negotiation Workgroup regarding the two phase approach to the

12
13
. >";,':
',':14 -
15

Iniplementation Plan.

; ~ .: :

~ .

..' ",

The'challengewith(designing and implementmg-8:'plan as comprehensive and far"': '

.'

. . ; . , .' • ".

• ->"

,"",

"~: ':

•• •

-.'

reaching asthe-Katie A:-SettlementAgreementistoframethe various objectives and,:>,,:

. . " , . ~ ", . -

. .' "

activities of the strategy into a holistic approach that does not split apart into

16 disconnected activities as different groups work independently to solve the many

17 problems associated with preparing the state and counties for full implementation of

18 '.' : 19
'20 -

the plan.-The lnlplym~ntatipn Plan has

.) ,- ";"",

:: ":-'.,', ; ..~:~.., ...';;<... '"' ':', ':~ .' .•.. ",' ",.-;,

be
. ,"

end
.... ".

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yi
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~

yd ip-to ,s.i~
~':;:,.~;~.:: "', ,'_ ' :

:p' bj:et':c' ti.ves:

Cor,.e', .;..

Components;:FamilyandYouth Involvement, Service Delivery:and RolloutTraining,<.

_._--- - ...

-- - - - _ . - --.~---

.. - -

-

and Technical 'A.-ssistance, Data and Quality Assurance and Joint Management"

21 Structure. The six objectives continue to fit into the KatieA. Five Point Plan structure

22 as presented to the Court in previous reports. The addition of the Family and Youth

23 Involvement Objective connects to all five points ofthe Plan. The goal is to have a

24 holistic and comprehensive system of individualized services that is capable of

25 addressing the complex and interrelated needs and strengths of children and youth in

26 the Katie A. class and their families. In the interest of keeping the integrity and

27 connectedness of this$ ettlement Agreement at the forefront of the many

28 implementation planning activities and tasks currently underway and identified in the

29 Implementation Plan, the Special Master has developed the following diagram:

30

1i -

-----~-------~~------------ ----~------~----

---

!

Case 2:02-cv-05662-AHM-SH Document 819

Filed 08/28/12 Page 6 of 33 Page ID #:5406 6

Katie A. Five Point Pt"an (in draft)

Joint Management

>-

Joint Managemen
Structure

Core Components
Training and Support

Service
"-------_----' -< Delivery Stakeholder Feedback

Data and Quality Assurance

1
2

3

4

The diagram illustrates that the CDHCS and CDSS Joint Management Team would

5 oversee the broad Katie A. effort. And - within the context of the larger statewide effort - the
". " " .6>;:~:8 -local cQunty)oint'Man~g~m,y,~t'Te'¥lls ~ould·WWl:§!ge,':tn.~Cpr.ePractic~.:Model andiYi>;"'::~"
,', .
,'.0.. :;7 .. ;,:;intensivelTI~gtalh~altl1 ~eryices.tln:ough the utilizati()n of;m.anll:':l:~s, trainil1,g;and supp0rt,;andi.~~,:,:;;.;,;::.

8 service delivery. Local and state quality assurance and accountability efforts would provide

9 transparent stakeholder feedback to the state and <;;Olli,lty Joint Management Teams to learn

10, from arid improve on implementation activities and ensure that members of the Katie A. class

.' ,11 .t.~d their ~amilies are ben~~ti~g;fro~services as inteJ:l~~~j~;the S~tt~e.mentAgreement.

~, :
--, ."... ~. . . .'

", .12 ... ;;:.: . The .®pl~rp.~1J.#tio~P.lan inclucles an ,introductiqIl aJ:1.c1·six'~bj ~cti;esJ4at outlille:shprt:.,:~' ,.,... . '. .' -",'

13 -.' and long-term implementation.activities, timelines·and responsible parlies.organized in:fuiO .., . , ...

14 . phases: Phase One covers a period for activities that are in progress or in development and

15 slated for completion within the 2012 calendar year; Phase Two reflects activities that mayor'

16 may not begin in 2012 but will extend into the year 2013 and beyond. The purpose and

17 anticipated results taken from the Settlement Agreement are included to provide additional

18 context taken from the settlement agreement. Accomplishments to date are summarized in an

19 addendum to reflect the intensive efforts that have been invested in navigating and completing

20 work that is related to implementation. The Special Master's evaluation begins below with

21 the Introduction to the Implementation Plan and then proceeds to review each of the six

22 objectives: Core Components, Family and Youth Involvement, Service Delivery and Rollout,

23 Training and Technic-al Assistance, Data and Quality Assurance and Joint Management

24 Structure.

I-~~------------------- -~----~----~-~-- - - - - - - - - - - - - - - - - - - - - -~---- - - - - - - - - - - --~--------~ - - - - - - - - - - -
Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 7 of 33 Page ID #:5407
7

1

As currently structured, the Implementation Plan is organized by the six objectives listed

2 above. Additionally, the term 'objective' is also used throughout the Implementation Plan to

3 identify specific indicators for each of the six objectives. For the purpose of clarity and

4 consistency, the remainder of the Special Master's Report will use the term 'sections' to refer

5 to the six 'objectives' used in the Implementation Plan so as not to be confused with the'

6 Settlement Agreement, Paragraph 19 objectives (a-d) used by the Special Master in his

7 evaluation of the Implementation Plan. In addition, under each of these 'sections' of the

8 Implementation Plan the term 'objectives' will be referred to as 'goals'.

9

As indicated above, the intent is for the Implementation Plan to be holistic and

10 comprehensive, but for the purposes of this report the Special Master will be evaluating each

11 of the Implementation Plan's six sections individually to determine "whether, Phase One of

12. tp.e Implementation Plan is reasonably calculated to ensure that State Defendants meets the

., 13, _, terms oftJ:!e Agreement and objectives se~forthin Paragraph 19 of the Settlement'

... i.,·:- :.:. .;. . '~.,,;".:~.:~~"?/":'r}i~f.:'" ,~;~~,..'

:~:.' l' .:.;;..:"' ' "~'~"'~'.. " ~":i :

:L\·;'~:·'·:~·'~·:~:~>-\'·'~.;~"· .~'~':".~ ::·).<..~>':-:.:·)·~:·:::~·i-r'· :~l.,t. , . "':; , "

. . ".

t:.'

. '; 14 Agreement". I expect a number of the Implementation Plan Sections will not -in themselves, '", ".'

,.;;: ;' 15""" b~'~~;~ffi2t~~t to m~6~;~~~'~li set~f~~p~'~t~~{~ris set forth in'th~S~tti~~ent Agr~e1ne~t, '; ;;,... ,..

16 Objectives, Paragraph 19(a-d) or the Agreement Terms, specifically Paragraph 20 (a-m). The

17 Special Master will, upon completing his evaluation of all six sections of the Implementation

. 18 _Plan, provide Implementation Plan Findings for Phase One, and Special Master's Review and

19,' Coi:riments on Phase Two.

20 ... '

. '. "" ..

'. '- .:.~.: . -'~;.

. .:';'..

. ~.:.

...•.

21 Introduction

22

Overall, the introduction has established the primary purposes of the Implementation

23 Plan. It outlines how the Implementation Plan is organized, which includes a two phase

24 approach. Phase One and Phase Two of the Implementation Plan have identified timeframes

25 and activities, with goals and anticipated results. There is a recognition that the

26 Implementation Plan is a road map, and is a work in progress that will evolve over time.

27

The Implementation Plan acknowledges the important role the Negotiation Workgroup

28 has performed and will continue to perform in assisting and guiding the Parties. The Special

29 Master would add, in his evaluation of the introduction, a commendation to the members of

30 Negotiation Workgroup for theIr expertise and commitment to the Katie A. Interest Based

31 Decision Making Process.

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 8 of 33 Page ID #:5408 8

1

The introduction to the Implementation Plan is sufficient in that it provides a high level

2 overview, sets the tone, establishes priorities and provides direction with one exception. It

3 would have been valuable, on page 1, paragraphs 3 and 4, of the Introduction, to identify the

4 'remaining Settlement Agreement requirements', specifically those found in Section III,

5 Service Delivery Roll Out, Section V, Data and Quality Assurance and Section VI, Joint

6 Management Structure of the Implementation Plan. The Special Master understands I'

7 additional work is currently underway in consultation with the Negotiation Workgroup on

8 these and other sections of the Implementation Plan, some of which will be addressed to the

9 Court that will further detail implementation activities, strategies and deliverables. Evaluation

10 of Phase Two of the Implementation Plan will occur at the December 13, 2012 hearing.

11

The Special Master sees a critical role for sections V and VI in ensuring the overall long

12 term success of the Agreement, expressed in,Paragraph 19, objectives (a-d) andParagraph20,

'13 . :{a::;yn}which;could have been highlighted in,theillltroduction, section. ,j The:,experiences;~:, ':'.~;
"14';~:6ha:116riges~~d'~~~cesses~fthe CountY 'ofLas kgde~' imple~entatio~: ~tits~iatie. A"~' '

. . ;: r ~.

' •. "': .. ~,;,,: ,.. ,,' " .

,. " " "

• I.' .

, •

• j'

• _.

~ ••

15 "settlement and the early lessons learned from the~CDSS implementation of its Galifornia ii.• _

16 Partners in Permanency (CAPP) initiative underscore the importance ofthese two sections.

17 The Special Master will discuss sections V and VI later in his report.

.

--."

18' The Pathways to Mental Health Services Objectives

. ~.. ' j

\ . 1 . ' , '::. ~I·. ':::-

·19 .':'" "Section.]. Core Components :,

-

--

---.---

20' ·PlrrtA. CoreC;omponentElements

. ". '"

~.;~

21

Core Component Elements, Phase One, Part A, ofthe Irriplementation Plari identifies

22 goals, the activities, deliverables, and timelines to ensure: the production and statewide

23 dissemination of a Medi-Cal Documentation Manual for ICC and IHBS; basic orientation

24 training is provided to counties, providers and stakeholders on the Documentation Manual;

25 technical assistance is provided on the Documentation Manual; sufficient progress in made on

26 completing the Core Practice Manual (CPM) Guide for early calendar year 2013 distribution.

27

Phase Two, which will not be evaluated at this time, reflects activities and timelines

28 intended to: finalize and disseminate the Core Practice Model (CPM) Guide; release basic

29 orientation and training on the CPM Guide; identify the TFC model/services, Medi-Cal

30 coverage, and add or update billing rules to the Medi-Cal Documentation Manual that mayor

31 may not begin in 2012 but will extend into 2013 and beyond.

.., .'~

~"

".";'""-. , .

I ------------------------- - - - - - - - - - - - - - - - I~-------------~-----~--- --------------------------------------~~-------------

I

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 9 of 33 Page ID #:5409 9

1 Special Master's Evaluation -Core Components Element, Part A, Phase One

2

Core Components, Part A, Phase One includes the Implementation plan, the activities,

3 deliverables and timelines that ensure the Documentation Manual for ICC and IHBS is

4 developed and distributed statewide and the, necessary steps have been taken to enable

5 counties to deliver ICC and IHBS services no later than the end ofthis calendar year.

6

The Special Master has determined the implementation activities, deliverables, and

7 timelines described in Section I, Part A, Phase One of the Implementation Plan have the

8 sufficient steps and correct timeframes identified that, when accomplished, will have

9 satisfied the following Terms and Objectives ofthe Settlement Agreement:

10 Paragraph 20

."'- '
, ,
:.~ .':0' ~ . ',," \.,

11 12 13 14

15

• (a)(I) (develop and disseminate Documentation Manual) (Page 6-7);

• (b)U-:})(J)C!,qumentation consistentvvith Gore Pr.Clctice Model}{DocumentatiQn "

'.::::: •• :\'~"'~!'.. _.' '.'~'"....:' ..:'_:..'

. . .' ' :.: .•..:" .....:.;;: , .... ~ ..\:..~\.. .. ~. • :;. . -.....

."

. ' :\ .. :;:'t.... ' '~" .., . , ._.,

,/lif!l'l!jf!:l4f}ve:lop~:~jn collabor(ltive sr(lk.eh..qldf~pr:9..C;~ss.)(post dr(Jfi OfP09,~M(!r!X4fip:n '.... "

. . . . . -;. .. ," ,_

". ', . . . . .: : .

.

. ' . _,". _.'

.

""

.. I,:,.,

,.

iJfcrrl14.qlfqr P't/,pl,ic:,,comment) (Page];.8)'fln,Cl, ~_

.:: ....

. - ',. " ~

satisfied, in part, the following Terms and Objectives ofthe Settlement Agreement:

16 Paragraph 19

17

,. ,(a){[a.cilitqt(dhe;provision... arrqy ofservices .... delivered in a coordinated;,:... . ':

18

- -, . fashio'n . .. into a·coherent and all iliclusive approach) (page: 5);,

19

• (d)(address needfor certain class members . .. "lOre intensive needs . .. subclass io

20

receive . .. mental health services in . .. own home . .. appropriate to their needs . ..

21

facilitate reunification . .. safety, permanence and well-being) (Page 5);'

22 Paragraph 20

23

• (g)(I) (guidance on state andfederallaws ... to implement this Agreement . ..

24

provide ongoing technical assistance to include manuals, policy-guidance, education

25

' and training, program development . .. fidelity . .. to principles . .. CPM) (Page 11).

26

Part A, Phase One, also identifies the activities that are underway and intended to produce

27 a CPM Guide ready for statewide distribution in early calendar year 2013. The Special Master

28 has determined the activities and timelines described in Section I, Part A. Phase One, to

29 'Develop a CPM Guide' have the sufficient steps and correct timeframes identified that, when

. I-~------- .--.~-~--.----.----------------.-------.---.-----~------~ --~ .--~--.--------.---.-------.------.-.---. Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 10 of 33 Page ID #:5410 10

1 accomplished, will have

2 satisfied, in part, the following Terms and Objectives of the Settlement Agreement:

3. Paragraph 19

4

• (a)(facilitate the provision . .. array ofservices ... delivered in a coordinated . ..

5

fashion . .. into a coherent and all inclusive approach) (Page 5);

6 Paragraph 20

7

• (d)(CDMH and CDSS ... consultation Negotiation Workgroup . .. develop . .. Core

8

Practice Model Guide (Page 9);

9

• (g)(l) ) (provide ongoing technical assistance to include manuals, policy-guidance,

10

education and training, program development ... fidelity . .. to principles . .. CPM)

11

(Page 11).

.12

. , i ;',13' Special Master'sReview'a7id Comments - Core Component Elements; Part A.' Phase Two ~~.E< .'

.i"rr":~~>.··- ,

~'/. «,' ,<.J")., .,:/i/ii.?,; .....,.L;..~~- . :.'/.~

.~:.... :

/~. ::':.:. - <~:""::".. .

" .'~, .'d;~·

"'14 ',' ' Core CC)1uponents','Part A 6fthe ImplementatiollPlan, Phase'Two,will notbe'evaluated:;';~"

15 at this time. Th~"Spe2{al Maste~ will revie\v'aridprovide commetitson Phase Two ofthe

';', :,
,> .

16 Implementation Plan to ensure there is a framework, expectations and the anticipated

17 timelines described in Phase Two that indicate what will be necessary to complete an

18 Implementation Plan for Phase Two by December 13,2012.·
""'19

20

Phase
.

One,

but

has .

an
.

iplplementation
"

timeframe '.'

of 2013

.

.

and

b' eyo. nd, as

well-.as·a~different.

":;:,

::.'<;..; •.:.

21. set of activities and timelines intended to ensure: Core Practice Model CPMGuide is.finalized:

22 and disseminated; basic orientation training is provided on the CPM Guide; TFC

23modellservices and Medi-Calcoverage are identified; Medi-Cal billing rules are added or

24 updated in the Documentation Manual.

25

The Goals and Anticipated Results for Part A, Phases One and Two provide an excellent

26 framework and set the correct expectations for Part A ofthe Implementation Plan. Activities

27 and timelines are identified and appear reasonable for producing and disseminating the CPM

28 Guide. The activities for TFC appear wen thought out and adequately describe what needs to

29 be done to identify and determine the TFC services/model, Medi-Cal coverage and update the

30 billing guide. The timelines have yet to be determined. The Special Master recognizes and

31 appreciates the full set of issues that need to be addressed in this matter. Perhaps at the

;_ _ _ _~c_~ _ _ _ _ _ ~_~_~________~ __ ~__ ~ _ _ _ _~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ ~ _ _ _ _ _ _ ~ _ _ _ _ _ _ _~_ _ _ _ _ _ ~ _ _ _ _ __
Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 11 of 33 Page ID #:5411 11

1 December 13,2012 Courthearing these timelines can be further defined.

2

.Section 1. Core Components

",j Part B. Core Practice Model Adoption

4

Section 1, Core Components of the Implementation Plan Part B, Phase One, Core

5 Practice Model Adoption identifies goals, the activities, deliverables, timelines and the

6 anticipated results that are intended to: finalize CPM Guide; establish and charter the CPM

7 Fiscal Task Force (theCPM Fiscal Task Force Charter can be found in Exhibit 3, at the end of

8 this report); establish and charter the Joint Management Task Force (the Joint Management

9 Fiscal TaskForce Charter can be found in Exhibit 4, at the end of this report).

10 Special Master's Evaluation -Core Components, Part Eo Core Practice Model Adoption Phase One

11

. Core Components, Part B, Core Practice Model Adoption, Phase One, of the. Implementation Plan ... ,

It ';~'identifiesthe actiyities·;: deliverables,'and.:t:huelines. to. ensure: ·the·CPM Guide. wil1befm~izec:l;' a: Q.Qrce.: ~;: .

n':<. ,

:;:\~.f-;:

:" :.

."., .

",:,';; ':'

....• J3;:~. __J)iacticeModel Taskforce'is'chartered arid'established;. a JointMana~in~rit.Taskforce (JMT)is..; ,:" . c.:_

. ·14 "'chartered and established.

15

The Special Master has determined the implementation activities, deliverables, and timelines

16 described in Section I, Part B, Phase One, have the sufficient steps and correct timeframes identified

•.' 17 that, when accomplished, will have

..',.

. " ;

"~'. ~

-' i '-,-
18 .~~tisfied, jj-lPar1:' theJo~16wm.g Telinsand Objecti"es <?fthe'Settlem~ntAgreement:··c'

19 : Paragraph 19

20

• (a)(Services delivered in a coordinated, comprehensive 0 0 0 all-inclusive approach)

21

(Page 5);

22

• (b)(Structure 0 '0 0 supports core practices 0 0 0 described in (a) above) (Page 5);

23 Paragraph 20

24

• (b)(1-3) (Manual consistent 0 o. Core Practice Model 0 0 0 developed 0 0 0 collaborative 0

25

0 0 public comment) (Page 6-7);

26

• (d)(CDMH and CDSS 0 0 0 established shared management structure, 0 0 develop core

27

practice guide) (Page 9);

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 12 of 33 Page ID

#:5412

12·

1 - (e)(consultation withjoint management tasliforce . .. develop ... training . . , quality

2

control) (Page 10);

3 - (m)(1-3)(CPM Fiscal Task Force . .. State . .. Negotiation Workgroup. .. strategic

4

plan. .. delivery services within core practice model) (Page 15-16).

5 Special Master's Review and Comments - Core Practice Model Adoption. Part Bo Phase Two

6

Core Components, Part B, Phase Two of the Implementation Plan will not be evaluated at this

7 time. The Special Master will review and provide comments on Phase Two of the Implementation

8 Plan to ensure there is a framework, expectations and the anticipated timelines described in Phase

9 Two that indicate what will be necessary to complete an Implementation Plan for Phase Two by

10 December 13,2012.

11

Core Components, Part B, Core Practice Model Adoption, Phase Two share the same goals

......... -- . . ---.~~

.. - - -~'-.~ '-

. . . .~

.. -

,._. _._.,...... ~

-- , ..

.~ - .."- .

-.-

12 and anticipated results as Phase Qne but have an implementation timeframe of2Q13 .and beyond as

~':":"". .' ·-~f:i:~·:.i·:,-, ':; ... , =.'"~!:,." r~ • \i";~"~'-:';.;;;'>~::·': ..".,

...I,':.~':--~.~~:.~_.:.'.' • "( ... ',

.",

. ,:, •. :'~:~.:;~<' .~:

?:~."

,' . •_

13 w~ll as drlferent set ofactIvItIes IJ:lten~e~ to ensm,~: .baSIC onentatIOn and a~~ptlOn:; strategIes' fot .... j. , :;, ,.. ,

..., ....

' . ·:'. . . . ~,.i~.· ··~_t.:.;.·,. ,'c-,

:.

k.: "'.:.'; .• :'.~~.:'''~ . •

.':.; .... :.~.~.~..

.'...

, . "":.:'~"":',:>

." . ;

14 the CPMguide; notice to counties that describe ICC and IHBSwithin'a CPM'apprbf.tch;thatTFC ...•.. ,.. ;:

.

"

15 is included in CPM Guide; that the CPM Fiscal Taskforce develops a strategic plan and

16 incorporates it into the Implementation Plan; that CDHCS and CDSS consult with the JMT to

17 develop training, practice tools, protocols and quality review systems.

J8 .', .

The G('.)als and Anticip~"te'd:R"es,ults for Part B,; ,;.>p, hases On.e and Two provide,.an~excellent .

19. ~·framew.Qrkand· set the correct expectations. for the .Implementation Plan.' Activities,;·deliver-ables....... .... '" '"

20 and timelines are identified and appear reasonable for providing traifiing and developing initial' .

21 adoption strategies for the CPM Guide and noticing counties. TFC activity is well- described but

22 the timeline needs to be determined. As suggested in Part A, TFC timelines should be further

23 clarified in the December 13,2012 report to the Court. Activities and timelines around decision

24 making and deliverables for the CPM Fiscal Taskforce and JMT need to be elaborated on and

25 described in more detail. It's not clearly described how these two Taskforces products will get

26 developed and decisions will be made. It will be important to add this additional detail into the

27. Phase Two plan presented at the December 13,2012 hearing.

28

29 Special Master Summary Evaluation - Core Components, Part A & B Phase One

r-~

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 13 of 33 Page ID

I

#:5413

13

I

I

1

The Special Master will now provide an evaluation of the sufficiency of Section 1, Part A and

I

!

2 B, Phase One ofthe Implementation Plan. As identified and described in an earlier:part ofthe

3 Special Master Report, it was anticipated that no one section of the Implementation Plan would in

4 itself have the sufficiency to fully satisfy the requirements set forth in the Settlement Agreement.

5 I'm pleased to determine that Section 1, Part A and B activities and deliverables, specifically the

6 development and distribution of the Medi-Cal Documentation Manual and the development of

7 CPM Manual, have sufficiently responded or met key terms of the Settlement Agreement. All

8 parties shoUld be commended for this effort.

9

The Special Master notes for the Court, that Core Component Part A and B, goals, activities,

10 deliverables, timelines and anticipated results do not ensure the Sub-Class Members will receive

11 the medically necessary, all inclusive and coordinated services as identified in Paragraph 19(a) and

12 Paragraph,20 (i} and (1) of the agreement.H, does not ensure Katie A. Class m~m~ers will receive

13, servicesconsist~nt;~ith the CPM guide. ,Tl1e Speciallv1~ster anticipates this:area'ofconc!IDl':wilk ,_

,'.. ',~ ,-. ';)".'\, . .'.-...n;~·.::·~;.••.. ,.,,'" ,'". .... . ' . ":) '" "~::f-"" ./< •... ':" ,.,' :.~'.<~"-

"":

be address~d ii17flitUre 'sedionsof'the' hnpleinel1tatlqn,Plan."':;

" '

15

Speti~lM~~t~r;shas tWo generalcoifurielit~ cfud sugg~stions thatpertairi to'allsixS~6tions of

16 the hnplementation Plan. Suggestion one, in the future it would be helpful, perhaps on a Gantt

17 Chart, if the state would identify what state department, division or branch and the individuals

18 and/or team is responsible for the various task, activities and responsibilities identitiedin' the'

, '19' ,,' ,ImplemerifcitionPl8ii.' Per-naps'at the DecemheflJ, 2012'Cburt hearmg'suckachait/wcirlQ'plan'!':';',;",:",,:: '::
20~, .n{{ght beayaitaplt{:~':Sllgge~1:{0l1tWo,p~~baps',~t ~he' Degember 13, 20'1 i Court]ieaiingad,aitionai .'

,21 information on resources, or potential resources will have been identified and can:'be :shared with",
,22 the Court. 'The'Speciai Master does not question the State's commitment to i~plement the Kati~

23 A. Settlement through the Implementation Plan under the Court's review on September 14 and

24 December 13,2012, but a question undoubtedly will be asked regarding the identification of the

25 necessary resources to accomplish the activities, tools and deliverables identified in the

26 Implementation Plan.

27 Special Master SummaJY Review and Comments - Core Components. Part A & B Phase Two

28

Core Components, Part A and B, Phase Two of the Implementation Plan will not be

29 evaluated at this time. The Special Master will review and provide comments on Part A and B,

30 Phase Two of the Implementation Plan to ensure there is the framework, expectations and the

31 anticipated timelines described in Phase Two indicating what will be necessary to complete an

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 14 of 33 Page ID

#:5414

14

1 2 3 4 5 6 7 8 9 10 11 12 , ":,,,,-13,
'." ,,:;~': ::: '14
". ,.
, 15
16
17
18 :,,,, "';TCU9
'" .._- ....
20
,21
22 23
24
25
26
27

Implementation Plan for Phase Two by December 13,2012. Overall, Phase Two, Core Components, Part A & B has established a sound framework and
the correct expectations for Part A and B of the Implementation Plan. It should provide the necessary direction to develop the additional activities for Phase Two of the Implementation Plan, however many of the activities are too general and do not describe how the deliverables will occur and, in some cases, the steps or processes to arrive at a decision are not well defined. This was most noticeable with the JMT and CPM Fiscal Taskforces. Timelines for TFC have been discussed earlier and will not be repeated now.
The Negotiation Workgroup did reach consensus on the Implementation Plan. There were concerns from numerous members ofNegotiation Workgroup regarding the possible unintended consequences of adopting a two phase approach. The possible unintended consequences identified by some meIllbers of the Negotiation W()r:k.group are: that ifICC and IHBSis 'on the ground' ,beforeever:ytlIingelse is in place thef(~ wi)bbe little incentive by counties and;providers;rn.:;> ;;' :,~~
to participate,:-adopt,or;;tpp~rt:the-lmplementati0~foB±lie()therse~tions ofImplementation\pi~;
especiallytlre adoptioridfthe core practice appro~chtrhe CPMModel); the other sections,';'" :.:~:;~;':"
which in the long run may have more transformative potential and effect on the overall system, may be more difficult to implement; just doing more ofthe same, providing service and conducting business as usual, could provide little motivation to engage with,the othersections of~::", the':Impleinenta:t:iorr'Plair.~:A:l1 members 'ofthe Negofiatiori'Workgro:tip, inc1uding:thoseindst~;'!~;"~::'
concerned,ie~ognize tli~rihere is a. Settlement A~~el)ient in' place, With speCific term~Cll1it· ;;:" ,:\;:;,':',
objectives',that Inustbe;addressed,some wit~in 'a:shorter time frame than others; In spite DL,these'" concerns, the Negotiation Workgroup remains energized and committed to get the Implementation Plan launched and 'not let theperfect be the enemy of the good'. The State Team and key stakeholders, continue to focus on how to implement all sections ofthe Implementation Plan as quickly and successfully as possible to address head on the 'unintended consequence' concerns that may arise and to ensure the overall success of the Katie A. Agreement.

28

Section II Familv and Youth Involvement

29

The Family and Youth Involvement Section II, Phase One of the Implementation Plan

30 identifies goals, the activities, deliverables and anticipated results intended to: engage and

31 support youth in joining the Katie Negotiation Workgroup; develop funding sources to

I
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___________ ~~

__

~~

~~

____ ~_~

______

~

_

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_

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_

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_

_

_

_

_

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_

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__

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 15 of 33 Page ID

I

!

#:5415

15

I

1 continue to support family and youth participation and input in the design.

2

The Special Master has determined the implementation activities, deliverables and

3 timelines described in Section II, Phase One are aimed in the right direction. The goals and

4 anticipated results form a clear pathway, identified activities are intended to address the goals

5 and anticipated results of this section. There are sufficient steps and correct timeframes

6 identified that, when accomplished, will have

7 satisfied, in part, the following Terms of the Settlement Agreement:
8 Paragraph 20

9

• (b)(2)(d)(Documentation Manual . .. developed . .. collaboration . .. negotiation

10

workgroup) (establish a shared management structure to develop . .. in consultation

11

with . .. negotiation workgroup) (Page 7);

12''''

3' (j) (4f(Datd:a;:Z:iiQuaiit/Task Force'.' ; .. stakeholder ]neeting' .': -: Ideas:.' . . aboutdata)'(p(;,gL!!<~"J~

,.

- .......

.

'

.

:'-: '13:" <'C""",

. '. ".';, . . :.-.:.~ ,,~~~t.:, 1':

.f L"':"':;"14' r,... (k)(2)(Modei{ .:readirii;s assessment infor~edby:' ..jamilY m~mbers ... and youth) (Page.

15

14).

" . .16

Although the;;Specia,IMaste~,has determined the implementCition,activities, deliverablesand.

,-'lY:.~·:::It.4neJ.inesdes~ribed.jl1.;:~:~!Qtionn;,.:rl1ase;:One ,are Cli11l~~' iD,:t.h~~Itghtdi~e()ti21¥:and· the;goal&8J.1.d .

.

.

.

.

... :18' :.'anticipated.r~~ulfs:f6!llia~lear'pathway,.the:re lackssuffl.cierit c1arityaround, Activity.q, Dev.¢lop~,: ::~ : 0::
. ., - ~

19 .. ; Funding and :what are the, ;:J,ytiyities that.:will result. in. funding., .The Special Master suggests this. actiy~ty· '."

20 .be updated for the December 13,2012 Court hearing.

21 Special Master Summary Review dnd-Comments- Family and Youth Involvement. Phase Two

22

Family and Youth Involvement, Phase Two, ofthe Implementation Plan will not be evaluated

23 at this time. The Special Master will review and provide comments on Phase Two of the

24 Implementation Plan to ensure there is a framework, expectations and the anticipated timelines

25 described in Phase Two to indicate what will be necessary to complete an Implementation Plan for

26 Phase Two by December 13,2012.

27

Family and Youth Involvement Phase Two share the same goals and anticipated results as

28 Phase One but has an implementation timeframe of 2013 and beyond as well as different set of

29 activiti'es and deliverables intended to incorporate family and youth in state and county

-------.--.------- --------- . ,
I r---~---.

--------------.--------~--- -------~--~--------'----------~--.--------.----

--------------~---

I,
!

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 16 of 33 Page ID

#:5416

16

1 implementation, rollout, training and quality assurance activities.

2

Overall, Phase Two has established a sound framework and the correct expectations in the

3 Family and Youth Involvement section of the Implementation Plan. This should provide the

4 necessary direction to develop the additional activities for Phase Two of the Implementation Plan.

5 There remains work to be done in developing Phase Two of the Implementation Plan describing

6 activities on how to ensure family and youth participation occurs. For example, Phase Two,

7 activity B, 'State and Counties will work to incorporate ... ' reads like a plan to plan, which is

8 good, but does not describe how or what the plan is that would actually result in the family and

9 youth being included. The parties should consider identifying activities that describe families and

10 youths' role in providing training and technical assistance. The Special Master looks forward to

11 additional detail in the Implementation Plan activities and deliverables on how to ensure their

12 inc~usion in the December 13., 2012, CoUl1: hearing..

,., 7,,)3·'•. ~. . AH,']?fl,fties haye,founq., th~:ffuJlily;fu"1¢yputh voice,.perspectiye.ap.d ~xpertise: pptical in " ', ....".' '.. . ':~5..•~.:.

• .... '" ,,, •

,.. ~.

• . .'

.• "

\ ," ~::'

' . J. ~,I ".

.

. .. '. .

,_ . : ' ' .

'.

.' ~.. ._, .

.'.'

.,~, '.'",'+,14--,:,' 'fmalizing; the Settlement Agre~meIltandIndeveloping theImph~m~n1:ation:,Plan';:~;phe SpeciaL"" .~'. ."," T

'IS" IyIaster~and Negotiation Workgrouphave'added the Family Voice arid'the Youth Voice as one of ,"

16 the criteria to evaluate the options that guided the parties in reaching Settlement Agreement

17 consensus. Family and youth participation has been emphasized throughout each phase of the

."'··18· "Katie A. negotiation 'and plan development-process. This sectionofthe Implementation Plan is an "

'):,k9J.~~¥P';affempHofack:D:owted:ge;t1iat:pa1:ent"fuid·:youtb>ihVolveirierit'is'ciiticaJ;fokffie'~O'~eram;siiccess 'of":';;F':':' .,. ...-'::"~ '20' -"lUJpieni'enting and susta.inhig' theTerms :~iid Obj ectives onhe Settlement' Agreement.

" ...

21

Section III Service Delivery and Rollout

22

The Service Delivery and Rollout Section of the Implementation Plan, Phase One, has

23 identified goals, the activities, deliverables, timelines and anticipated results to ensure: ICC,

24 IHBS, (and after (date to be determined), TFC), can be claimed by counties and providers to

25 Medi-Cal; the Medi-Cal Documentation Manual is disseminated to counties and providers;

26 information is provided to counties that ICC and IHBS are an entitlement under the law; a

27 description of the identification and referral process, including those entitled to the services is

28 provided; implementation ofICC and IHBS for availability statewide; dissemination

29 statewide of the CPM Readiness TooL

30

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 17 of 33 Page ID

#:5417

17

Special Master's Summary Evaluation -Service Delivery and Rollout, Phase' One Service Delivery and Rollout, Phase One of the Implementation Plan identifies goals, the
activities, deliverables and timelines to ensure: ICC and IHBS, (and after (date to be / determined), TFC), are claimable by counties; issuance of a notice to counties regarding entitlements and subclass definition; the development and dissemination statewide of the CPM Readiness Tool; issuance of the Medi-Cal claiming and documentation requirements/manual; implementation ofICC and IHBS implementation ofICC and IRBS for availability statewide December 31,2012.
The Special Master has determined the implementation activities, deliverables and timelines described in Phase One have the sufficient steps and correct timeframes identified that, when accomplished, will have

'.- ';'< :',,:';... _:: -.t."-,_.,.':_" \!; •.... .

, ~ '.

14

• (a)(Services delivered in a coordinated, comprehensive . .. all-inclusive approach)

. 15

(Page 5);

16

. "!" ... (d) (address needfor certainclassJ11.,~m9~rs~.. . more intensive.needs......subclassto.

". /tfJ.'r~~:':rece.,j?(1.:·§.f!~.;j.i.mentalheaJth serviqf§.AJ;l·i;'~··;; 'Qr!":11; ~ho,?'le:.;:..'..;appropr~q!e.{q1/J/~.ir~.Y.le:e;tls.{ ~;~;' i'

:18 """ ":-:. fac;ilitate.reunificatirJYl,. ,". si!f~ty, p~nrtane.rJce qnd well-:being) (Page 5-6);·_·····

19 Paragraph 20

20

• (a)(l) (develop and disseminate Documentation Manual) (Page 6-7);

21

• (g)(l) (guidance on state andfederallaws ... to implement this Agreement . ..

22

provide ongoing technical assistance to include manuals, policy-guidance, education

23

and training, program development . .. fidelity . .. to principles . .. CPM) (page 11);

24

e (k)(l-7)((Models . .. conduct readiness . .. collaborative input . .. select counties . ..

25

transfer knowledge) (Page 14-15).

26

The activities and steps to develop, finalize and implement the CPM Readiness Tool are

27 not sufficiently described. It's the Special Master's understanding that the Negotiation

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 18 of 33 Page ID

#:5418

18

1 Workgroup is currently finalizing a work plan, with specifics regarding the Readiness Tool's 2 development and implementation. Additionally, implementation ofICC and IHBS for
".) statewide availability is not the same as ICC and IHBS being provided statewide. This was
4 discussed in some detail in Section I, Core Practice Component, Part A. It will be important 5 to add this additional detail into the Phase Two Implementation plan that will be presented at 6 the December 13, 2012 hearing.

7 Special Master Summary Review and Comments - Service Delivery and Rollout. Phase Two

8

Service Delivery Rollout, Phase Two, ofthe Implementation Plan will not be evaluated at

9 this time. The Special Master will review and provide comments on Phase Two of the

10 Implementation Plan to ensure the framework, expectations and the anticipated timelines

11 described in Phase Two indicating what will be necessary to complete an Implementation Plan

..
~ ;'

...

" .

12 for Phase Two bypecember 13,2012.

., ... ,

.'

- ',';

~ ", -. :::'~.""'.

. " .:.-.; .... '

.

r;:

.'.'? t:.';~:;\~:.i" ':"

-

J .. ,~"

..

13

. SerVice D~livery and Rollout, Phase Two, shares the same goals and anticipate"@:;:resllits'as

, :", '\'"::J.:).\-.;. '.::.;;-:" '..;" :", "."( . ";.

-, :"::"~::' :,.,

;-:

-'''''7~.:':: .. : :;,~:_:".

_,

14 Phase One, but ha~ an implementation timeframeof 2013 and beyond as we1l. as different set '.n·

~. 'do.",..,:.. , : :. '. _ __

.'

, .. '

......

_ .,_, ," .. "

. . .,

,. .

15 of activities, deliverables, and timelines intended to: encourage counties and providers to

16 utilize the CPM Guide in all services; provide consultation and guidance for counties

17 regarding subclass members; clarify the relati~,ns~ip,?ern:een ICC and IHBS and medical

!,: .' ~.'<' ,.c;L8.•,::f:H~e~$.~'~~~;;.~1~~~,9B;;~~1~y~~~~;and ~iI]~~ffi7.s.tq~.,t~;~~t.l~, ~~at,I~f~)YS, .\g~!~ t9,~k~;·g~t?,~~?t~~4.):.;;~\,..
.. ,. ,.' 19. TEC},m:e .available statewide to subclass memberS;,selec.t Early ImplementerCQuuties:anct;: :.:..,. <:'c, .
.. --
20 utilize feedback for contiimous improvement and to promote statewide adoption olthe CPM; -, -, _. , .-- -, ..

21 provide technical assistance and support to counties regarding CPM Readiness Tool and

22 implementation activities; determine TFC billing codes and implement TFC statewide.

23

Overall, Phase Two has established a sound framework and the correct expectations in

24 the Service Delivery and Rollout section ofthe Implementation Plan. The goals and

25 framework of this section are very powerful and outcome orientated. Excellent. It should

26 provide the necessary direction to develop the additional activities for Phase Two of the

27 Implementation Plan. Although there remains work to be done in developing Phase Two of

28 the Implementation Plan, the goals for this section easily align with identified activities.

29 Activities that result in deliverables, or reference a process and/or a plan, need to be described

30 in more detail in order to determine ifthe activity is calculated or has the power to accomplish

31 the intended results for the activity. Not all the activities in this section lack the necessary

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 19 of 33 Page ID

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19

1 details.

2

The Goals and Anticipated Results for Service Delivery and Rollout, Phases One and

3 Two, align with the Settlement objectives and terms ofthe Settlement Agreement and

4 establish the necessary framework and expectations for the Implementation Plan. Activities

5 and timelines are identified and appear reasonable for providing training and developing

6 initial adoption strategies for the CPM Guide and noticing counties. TFC activity is well

7 described but timelines need to be established as suggested earlier in Section I, Part A. TFC

8 timelines should be updated in the December l3, 2012 report to the Court. Activities and

9 timelines around decision-making and deliverables for the CPM Fiscal Taskforce and JMT

10 need to be elaborated on and described in more detail. It's not clearly described how these

11 two Taskforce products will get developed, recommendations made and decisions reached

12 that lead to supporting the implementation of CPM st~tewide. ~~ditionally, the activities and

_>;": .. <"'~ :<d3 " d~iiverablesthat;,~nJel3:ci to ~~suiing that ICC,IH13S(and~fter((dat~;to be:deteli:nined;;:5FRG)':k1>.; C:.' : :;;;,~

:; "•.'. ro';." .. ,:"'

"', .•

•

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. .

" .

:,.

"

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.". .

.

. ;"

., ."; .; :.' 1.4· '. are availabletosribcla.ssmembersstatewide need :to be sufficiently described: At this~time~iik1;~:~.'!

15 reads like a plan to plan. The activities will need to be described including the steps/process

16 that will be used to 'identify class members in order to link to services' and how the'CPM

17 and IHBS, ICC and TFC will be brought to scale statewide':

18
" '."""\" .,.

qt .' . The Sp~~ic;tlM(i~t~.rJs,. iwpressed with tll,e ,rang~. ac;ti:y~ties ~q. cle~iyer8;ble$setJor1:bjn,- ::;- :,'

,-.~ •.:" .... 'r'_""~."'!~~~·:'·"~.:;~,<'._L;"~'~~~" ",''-I :,t·,.: /~~":";~:i

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... ~

,. . . . • . . -,

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Phase Two1.ofthis.section.: It-will be critical}as.the·partiesfurth~rdevelopPhase Two.of1he>.":::,;'; ..

"," 20" Implementatron;PHi:nfortheCourt's review,that it inc1u~es a~tivities,deliverab.les;-and· ,,,.:,

21 timelines necessary to: implement and sustain the CPM approach at the county level and

22 describe how it will incorporate the CPM Fiscal Task Force recommendations; develop

23 activities for ensuring- that IHBS, ICC, (and after (dateto be deterinined), TFC) are available

24 to subclass members; identify the process used to select the Early Implementer Counties. The

25 Special Master is aware that the Negotiation Workgroup is focused on proposing a range of

26 activities, deliverables and timelines for Phase Two Service Delivery and Rollout that address.

27 the issues identified above.

28

Section IV. Training and Technical Assistance

29

Training and Technical Assistance section ofthe Implementation Plan, Phase One,

30 identifies goals, the activities, deliverables, timelines and anticipated results intended to

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 20 of 33 Page ID

#:5420

20

l' ensure: a process is underway to develop cross-system training curritulum and education 2 materials; instruction to state and county auditors on billing and documentation guidelines;. 3 training for counties and providers on Medi-Cal documentation, coverage and billing ICC and 4 IHBS; collaboration with counties on the provision of on-going technical assistance and 5 support on activities identified in the readiness tool.

6 Special Master's Summary Evaluation - Training and Technical Assistance, Phase One

7

Training and Technical Assistance, Phase One, includes the Implementation Plan

8 activities, deliverables and timelines to ensure: a cross-system training curriculum and

9 educational materials for staff; instruction to state and county auditors on billing and

10 documentation; initial and ongoing training to county MHP and providers on Documentation

11 Manual, coverage and billing; collaboration with counties on the provision of on-going

12 technical assistance and support on activities identified in the readiness tool. The Special

; I.' ...•• ;.; ,:::: .:13:': '{cl\1~sterh~s ·determine.d:tJi6>iinplbnentatidn>activities;:deliveniblesan&tiniel~es',de;cribedjnL;;:;:i ,~b{ci:~ ,~~{,;:;;-;

, .' .

.' ' . '

~

-

"" '," .';' > ;:,;'T4"i;;,Phase 'One have the~sufficient:steps'ancl conect tinieframes'identified·:tha:t,fwhenaccomplishe.d~'

15 will have

16 satisfied, in part, the following Terms and Objectives of the Settlement Agreement:

. .~. ;:.......

"' .....

.'

.' u

, •• ~ :-'

...
. ': <?:....q;:.:..':. {.~ .. ;::~ ~. ,."

.. . ..:~'

1.8 " ., •.", - (b){Supp~rt -' . ,delivery of a services structure, ... a supports core practices::and,servjces.,,:~,:)(P.ag( ..

19

5);

20

• (c)Support ... sustainable solution ... along with traiiring and education ... )(Page 5);

21 Paragraph 20

22

• (£)(1-3)( ... develop cross system training curriculum and materials for ... staff)(...

23

initiate a request to ... STEC ...develop process and timeline ...)(... materials are

24

intended to be used ... counties and providers ... including a joint tool kit ...

25

teams)( ... curriculum ... promote ... teaming ...) (Page 10-11);

26

• (g)(2)(Ensuring audits compliance ... follow ... guidelines developed ... consistent ...)(page 1r

27 Special Master Summmy Review and Comments - Training and Technical Assistance. Phase Two

I - - ,------------ - - - - - - - - - - - - - - - - - -

- - - - --

- - - - - -----

-

-- - - -- - -- ------ -

---- -

- - - - - - - - --~----- - - - -

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 21 of 33 Page ID

I

#:5421

21

Training and Technical Assistance, Phase Two of the Implementation Plan will not be evaluated

at this time. The Special Master will review and provide comments on Phase Two of the

Implementation Plan to ensure the framework, expectations and the anticipated timelines described

in Phase Two indicate what will be necessary to complete an Implementation Plan for Phase Two by

December 13, 2012.

Overall, Training and Technical Assistance, Phase Two, has established a sound framework and

the correct expectations for the Implementation Plan. This should provide the necessary focus and

direction to develop the additional activities for Phase Two of the Implementation Plan. Training

and Technical Assistance, Phase Two, shares the same goals and anticipated results as Phase One

but has an implementation timeframe of 20 13 and beyond as well as different set of activities,

deliverables, and timelines designed to: determine and develop curriculum and coaching products;

determine the content of a County Implementation Team Guide; develop and identify a Statewide

Training plan (CPM) and other activities targeting training and technical assistaJ1£e"to counties;.·,c ..". I'" >i'.
14 . provid~~;~d' ~tJi~h;lders;pr;~rcl~ ;~git~y':griid~b~,-educaiio:nand trai~lng~:ilig~~~r~th·.CF~1:\ ,·":~':-.:~,;j"l'

IS" Overall, Training and Technical Assistance, Phase Two of the Implementation'Plan: generally . ',' :':'::.::::)t"-~·;<;·'·· ,,",:.'J !~::·r.:':'/··'::~·~";.;i,;:;;.\;<·~:·:·:· ',,';"'::.,' : ", '"'.":" ~ :-1";::.'0' .~"'"

"';. ':'~': '.. ~;~\.

" ' . ; ..:;,, _', ", .~ -....'~. . '.'.:-:.....

.:'~. :'I'~';'"

16 needs more specifics on the activities that will result in the deliverables. The Special Master

17 recognizes that this section is currently under development with the Negotiation Workgroup and it is

18 reasonable to expectthe necessary specific details will emerge and· beready:forthe:December 13,

'- '.~ (:',,', "

....... , .. , .
·.... ..". f.--·'I~"·',.,...,

..... _.

..... ~

~-

20'" , Section y .. Ddtaand,()1ialir;;'AssUiance -- .' -- .

'':'"

"'~'"

. , . :.~.

.

21

. "Data and Quality Assurance Section, Phase One ofthe Implementation Plan,identifies

22 goals, the activities, deliverables, timelines and anticipated results intended to: establish an

23 Accountability, Communication and Oversight (ACO) Taskforce; establish a short term

24 method to track use of ICC, lliBS (and after (date to be determined), TFC), pending further

25 development of the Data and Quality Assurance component in Phase Two.

26 Special Master's Summary Evaluation - Data Collection and Quality Assurance

27

Data and Quality Assurance Phase One, includes the Implementation Plan goals, the

28 activities, deliverables, timelines and anticipated results to ensure: the Accountability

29 Communication and Oversight (ACO) Taskforce begins meeting and makes recommendations

30 consistent with its Charter; an initial plan that identifies data sets capable of measuring those

i r------------'-------------~'--------'

------------'-

---,----------------,

'-'--~--

- - - - - - - - - - - - - .---

---~-----------------

---

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 22 of 33 Page ID

#:5422

22

..... '
. ";,'

1 in need of and those receiving mental health services, pending further development of a cross 2 system Data and Quality Assurance Component intended to emerge during the 3 implementation of Phase Two. The charters establishing the ACO Task Force were developed 4 and adopted by the Negotiation Workgroup (the ACO Charter can be found in Exhibit 5, at 5 the end of this report).

6

The Special Master has determined implementation activities, deliverables and timelines

7 have the sufficient steps and correct timeframes identified that, when accomplished, will have

8 satisfied. in part. the following Terms and Objectives ofthe Settlement Agreement:

9 Paragraph 19

10
'IF .'
'. 12,

• (b)(Support ... delivery service structure . .. supports a . .. practice.: . services-model .. -)(Page·

';""".\,~··~:.:·~·~~::tj.,::.,;t-·,>,··· :.:

:.,. . . . ';'~ ,'.·,-'.·~r;~~:

'" :..... :.>:....

. ,"

, ..: . .r·.::,.'~:':'~,~.'.<,.~'y···'.? ,".

,.'

.• . (c}(SupporJ, .. sustainable SO!zft{Orz.,, "; stqiidr;lrd,1J'll!thods .. c.,quality bfils~c.l-oy-exstght ....)(page 5);·

.... ,:.... '. ''": ,"., •. :, r'·'

.... . .' .. ' ,.... :...•. "

13 Paragraph 20

14

• (j)(1-5)( .. establish a Data and Quality Taskforce)(Establish a method to track . . .

',:, ~ .:~. , ' I : •. , : :~;~~.'. ' . •

.

• •.

•

,

.'

."'

".> .

15

ICc'...,,/H8S . . , TFC) (Utilize External,Qu,al,ity Review and: Califorrzia Chilfi(ln.4 :.'., . " -.("

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16

. FamilyBervices Review requirements .•.. develop i.l.plan ... ·collection of:, ;:...... "::,:'

•> •

•

- • ~-

17'

, - data :'; )(Coll'ect data·ez-ements:.. 'io·evaluateutilization . .. iJ.ccess to care.)(:.'

18

stakeholder meeting . .. what data . .. produce and post . . .) ( .. to post data on ....

19

.websites)(Page 13-14).

20 Special Master Summary Review and Comments - Data and Duality Assurance, Phase Two

21

Data and Quality Assurance, Phase Two, of the Implementation Plan will not be

22 evaluated at this time. The Special Master will review and provide comments on Phase Two

23 of the Implementation Plan to ensure there is a framework, expectations and the anticipated

24 timelines described in Phase Two to indicate what will be necessary to complete an

25 Implementation Plan for Phase Two by December 13,2012.

26

.Overall the Data and Quality Assurance, Phase Two, has establlshed a sound framework

27 and the correct expectations for the Implementation Plan. This should provide the necessary

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 23 of 33 Page ID

#:5423

23

1 focus and direction to develop the additional activities for Phase Two of the Implementation

2 Plan.

3

Data and Quality Assurance, Phase Two, shares the same goals and anticipated results as

4 Phase One, but different activities, deliverables and timelines and has an implementation

5 timeframe of 2013 and beyond as well as different set of activities intended to ensure: the

6 Data Mapping Group inventories the current array of ongoing data, statewide; the ACO

7 Taskforce begins meeting and makes recommendations; the Joint Management Structure

8 established by CDHCS and CDSS develops outcome and accountability linking to the ACO;

9 the Joint Management Structure considers ACO recommendations and adopts cross-system

10 quality assurance system; a proposal for production and posting of data is developed; ideas are

11 solicited from stakeholders about what data should be routinely produced and posted; posting

12 all report and tiIl1~~4t~.s.g"~:Websites... ,Overall, this seotiol1rofthe Implementation Plan needs more specifics on the,activities:'an:d"Y1J:,\,,',~ ','
d~li~erables. ;Th~"Spe~i~dv'Iaster'rec~gni~es tha~;~~lCh~ohl1e; detaIl needed WilLbe defi,ri.ed: . ," ' ~...' : ~dd~t~~~6~'i~"~~'t~'~~ work ofthe '~2dj~i~phlg~':XCo't~siaorce andth~Joint .

Management Taskforce and ultimately by the decisions made by CDHCS and CDSS.

17 Accordingly, it's reasonable to expect additional detail for Phase Two of the Implementation

, 18 Plan on the Data and Quality Assurance System and Joint Management Structure i8to ~be,:,',' ,; """,

."'

,

,r . . '

, ,,', 19 discussed and mayor may"notbe deterinined by the December '13, 2012 C6Urtheaiingd It+, ",r

,~ .... ".

may that not a where •

• '-- -

•

.~,

"

• 'II •• ..., •• I

•• - - .

.......

'be 'the work 6ftheTaskforces wiifhave' progressecfio point

-'.
the optioris~~~,

--:: . ~ "

.:~". ",' -';:. ~

21 for either the Joint Management Stru.cture and the Data and Quality Assurance System are, ';., " , '

22 available or that CURCS and criss have not made decisions on either recommendation. In

23 either case, it is expected the Court would be informed at the December 13,2012 review on

,24 the status of these Taskforces and/or when a decision is expected by CDHCS and CDSS.

25

Section VI Joint Management Structure

26

Joint Management Structure (JMS) of the Implementation Plan, Phase One, identifies

27 goals, activities, deliverables, timelines and anticipated results intended to: begin convening

28 monthly meetings of the Joint Management Taskforce (JMT) and the Core Practice Model

29 (CPM) Taskforce.

30

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 24 of 33 Page ID

#:5424

24

1 Special Master's Summary Evaluation - Joint Management Structure

2

Joint Management Structure, Phase One, identifies the convening ofthe monthly meetings

3 of the JMT and CPM Fiscal Taskforce as the first step that is expected to result intended in

4 recommendations that, when implemented, will successfully satisfy key terms and objectives

5 of the Settlement Agreement.

6

The Special Master has determined Phase One implementation activities, deliverables and

7 timelines, have the sufficient steps and correct timeframes identified that when accomplished,

8 will have

9 satisfied, in part, the following Terms and Objectives ofthe Settlement Agreement:

10 Paragraph 19

.1J ,>,_",.

(b)(Sp.pPon .", ~,_qelj~~ry',~~r.vice strlJ.ctQr~,:", ,~;Upp()rts.~.... practige, ... servi~es: moqel ,. :' ;.}(P~ge. . ~..:

. _ ,..,.,,,•.. ~,.._........".~.~ .....

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.: .....

5).;"."'-/::<. ;.....,..~ .. ;".~'~.-.!;;.·(~/:::.,:~;;7.; .:.~~.'

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(c)(siipport .,,'>. ,sustaina1Jl~solutio~ :. : startdardilieth64~ '-·.:~qul:ilitybased oversight,....'" KPage 5i)b1

14 Paragraph 20

iI' ..-.- ,'"
i

-15

, .
,11,"

. "

''-- ,

19

• (d) ))(1-4).:; ".;establishaJoint Management Taskforce)(Establishment. .. joint,

'management stktf..'cture betWeen'CDMH-and"CDSS:;:;. ;:;J:(Bititdirig3upon existing~"":',' "

rela&mship ;.'";,;i~te" ag~hci~s' .. C7~~atinga~;c;~osi'"~y;t~m .manage"ment ... ;. at:the c :~"~",..,,,_

"

'

countyllocalievel.)(Developing models . . :local agencies . ... work more effectiyely,

" '"

; ' : ' . :' ,"~'

together . .-.) (Page 9-10).

20

The impact of this fIrst step should not be underestimated. The decisions that will emerge

21 at this end of this process will ultimately affect the trajectory of meeting many, ifnot all, of the

22 terms and objectives set forth in Katie A. Settlement Agreement.

23 Special Master Summary Review and Comments - Joint Management Structure. Phase Two '
24 Joint Management Structure (JMS), Phase Two, of the Implementation Plan will not be '25 evaluated at this time. The Special Master will review and provide comments on Phase Two of 26 the Implementation Plan to ensure the framework, expectations and the anticipated timelines 27 described in Phase Two indicate what will be necessary to complete an Implementation Plan for

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 25 of 33 Page ID

#:5425

25

1 Phase Two by December 13,2012.

2

Overall, the Joint Management Structure Section, Phase Two, has established a solid and

3 clear framework and the correct expectations for the Implementation Plan; This should provide

4 the necessary focus and direction to develop the additional activities for Phase Two of the

5 Implementation Plan.

6

Joint Management Structure (JMS), Phase Two, shares the same goals and anticipated

7 results as Phase One with different activities, deliverables and timelines and has an

8 implementation timeframe of 2013 and beyond as well as different set of activities intended to

9 ensure: JMS is established and that it incorporates CPM; JMS at the county level is

10 encouraged; the JMT issues communication and guidance regarding the State and County

11 structures; CDHCS and CDSS promote the JMS and ACO structures and CPM fiscal strategies

12 statewide; analysis and evaluation of utilization, and access to care data specific to the class and

··.··,:;:::13·. / subclass; the data is sharedpublic1yth1!Oughpostings.

'; ,-;

.... -'-., .", "'",.

.

H'" "."' •• ; •• ::;'''';'./0 .

'" ;',!"··~14'· ' ..•. Timelines are not yet identified in Phase Two on when~follo~ingthe JMT;'r:>~ . . , "\"":>:':','

,.,,: .~15.,d 5:. '~~C:dmili~ndation6n:establishin~a;lMS~;:~rdeciSion will be madb ;6ri'esf~blishingthe' JMS. Ws" .....,." """'

16 also not described how the CPM taskforce recommendations will be integrated into the

17 Implementation Plan or how the JMT or the JMS, if established, will' incorporate the

18<:. recommendations.. Activities focused pn:analyzing and posting datafoHhe:public,need

. .~ '. --.. ···'.v

.':L9·'i.:',itdditie>nal descripti'Ollregarding-howtliey. tie'to:gether;'Withth6,aOtivitfes',and.{UeliiVerables 'iIT~·';':"~'?1':· ''';'

,20,: . ,Se_~tio~ V. Data and. QualiJ:y_Asstirance,', The Spe~ial Ma:ster ~ouldexpect th~.Court, at the"· .. "~:' .. ;.,:,-'," .

~ .. ,

. .' -

,21· , ,~ December 13, 2012,llearing on the entire ImplementationPlan, particularlywith'Phase'Two :.i";···

22 activities, receive an update on the progress of the JMT in addressing the tasks and deliverables

23 identified in their Charter. The Charter adopted by the Katie A. Negotiation Workgroup

24 establishing the JMT sets forth a direction and a set of tasks that, by all accounts, should yield

25 exceptional recommendations for DSS and DHCS to consider before making its decision.

26

27 Special Master's Findings for Phase One, and Review and Comments on Phase Two

28

The Special Master, before discussing Firidings for Phase One and the Special Master's

29 Review and Comments on Phase Two, wants to identify key individuals, from the State and

30 Plaintiff's Team. Without their professionalism, tireless patience, persistence, expertise, and

31 commitment to see the Katie A. Settlement Agreement fulfill its potential, the Implementation

r-----~-~~-

.. ~--~--------

Case 2:02-cv-05662-AHM-SH

Document 819 Filed 08/28/12 #:5426

Page 26 of 33

Page ID 26

1 Plan before the Court would not have been as clear or thoughtful in addressing the requirements

2 set forth in the Settlement Agreement.

3

The plan exceeds expectations and goes beyond just sufficientlydeseribing Phase One,it

c(
4 lays out a solid and clear framework and expectation for further development of Phase Two

5 activities and deliverables. Although the Implementation Plan was developed jointly, the

6 Special Master requested the State Team to take the lead in drafting the Implementation Plan

7 while collaborating with the plaintiffs and the Katie A. Negotiation Workgroup. Taking the

8 lead on this assignment turned out to be no easy task for the State Team when you consider the

9 breadth and scope of what needs to be addressed and the time, resources and personal energy

10 required. Putting all the pieces together in order to draft the Implementation Plan before the

11 Court, incorporating input from the equally thoughtful, insightful and passionate plaintiffs and

,ri.' \". Il.:'

12 otherm.embers ofthe Negotiation Workgroup, and integrating their comments, edits and

B . options, was., a ,herculean effort. and ac,cornplisr.1IIlent. ":, ." .

' . ' . ':::;;"'·;7':':'·"·:.:;~t:::

'.

'.

.

'.'. ~'J 4.; :~.,,};,,~,jrhere·,aie too many individuals to thank byiIia.rne but the State, Teai:n:rincitrding:itS:'new

-"15' 'merribets-;'arid:theoDeputyAttbrney Gen~ta1§: a~'signedto this matterftbIn theD'epartmenf'of

" "< • :~'.' i, .
,',.

16 Justice need to be provided a special thanks and appreciation. The leadership and

i

17 professionalism of the entire State team should be commended. I do want to single out the

i

I

! .- .

. 1:8 ~ ,:, .leaderslrip, tireless support and, commitmentprow.ided by Greg Rose, .Deputy Director, Btate·

..;~ ";'j "·,,,:,,\,;-,·"li9~· 'i;,'Departineiinof'£.Q'CiaL Services "and Bina;K:01ck6s,:,(}Qnzales~~;:Chief;'P·togta:ri::i',P6iicy;-ah.aQua:lity.. .. ··-"'I":':~:;."·_"-­
20 :~: AssUr:anceBranch, Mental·Health -ServicesDivi~i6n,- State DepartmeIit of H~a1th Care-Services

'-.'

21 .-- representing. their:Directors, -Will Lightbourne, State Department ofSocial' Services andA:'oby

22 Douglas, State Department of Health Care Services. I also want to thank two members ofthe

23 Plaintiffs Team, Kim Lewis, Managing Attorney, California, National Health Law Program

24 and Patrick Gardner, Deputy Director, National Center for Youth Law, for their tireless

25 commitment, professionalism, and thoughtfulness in working collaborativeIy with the State

26 Team in drafting the Implementation Plan.

27 Findings Phase One:

28

The following .Implementation Plan, Phase One activities and deliverables have

29 the sufficiency, that when implemented, on or before December 31, 2012 satisfy

30 specific sections or sub-sections, Paragraph 20, of the Settlement Agreement:

31

• Develop and Disseminate a Medi-Cal, ICC and IHBS Documentation Manual;

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 27 of 33 Page ID

#:5427

27

1

• Identify two arrays of services, ICC and IHBS as part of the Medi-Cal Menu of Services;

2 . Develop a Core Practice Model CPM Guide;

3

• Describe how the provision of services are consistent with the Core Practice Model;

4

• Collaboratively develop the Medi-Cal Documentation and CPM Guide;

5

• Post Medi-Cal Documentation and CPM Guide for public comment;

6

• Establish a Joint Management Taskforce;

7

• Establish a CPM Fiscal Taskforce;

8

• Establish an Accountability, Communication and Oversight Taskforce (Data and Quality

9

Assurance);

10

• Initiate a request to the Statewide Training and Education Conimittee to develop curriculum.

11

In addition, most, if not all Phase One adiv~ties and deliverables met, in part, the

,:12

: terms:ofthe.Agre.cm)..~ntand objectives~setiorth-iFl;Pm:.agraph 19~; of the SettleI'l1ent:p,...".:., .... :~,.;.,

..; ,". ~ ~; ., ~ ' ,

14

Review and Comments Phase Two:

15

The Special Master's Review and Comments on Phase Two ofthe Implementation

16

Plan have, in part, been presented in earlier sections of this report. Overall, Phase Two .

;):·''';·'.L:':.~·'

.. .:.,. •. :.. ~"-.;

".;..:~'.";'>~"''':..e'.J_;'' ,-._.r.,.,;,:"

:':. . :. -.:·: ..~;·~·'·;.I .. ~-.·"

.

:~ .

.' ._'.' .. J7 ' '.', .pre~~p!~.;~~~r~,,9QA1pl~te framework, ~..~xtensive set.ofexpectations anq.deFvefabl~s ...

: !:.~~-.:~~. :.~.,~,",J~~'~'.-:.',: ",:: "~ ':; ." """-:'~~:'~~F ,":; .1"'::::~:};'.~ ·:~~.::I~~';~~~?:i~l:r*;::,"·~;;.?' _:ij?;'··;;-::~7f:;;:~,~:·~r. . . ~ -',",::",~.:.~",;::":: 't."· ;'''' ".~ ~ !'.'~:--i.t! :<~_ f7:";'::"~:', "~~~~:r . :7;'·...··:· r',":,~ '";. '_, ',: ":',',: - ""~"'. ::'•.•..'.:.,.' .,:~:--:; <::::. "'r~:~. ·,~;rs:t.s~;.;~ ~ !:.~.

18

that was more than was expected. That is cOIllIl}§ndable. The Implementa.tionPJanh(is •.

,...:... ~:.~ ..... ..'. ~. .. ~ ., .'

."

..

.

begun tlie~process of developing descriptIve activities, defined deliverable::; and projecting· ..

. . :'-";:.::~ ':);~:~;.,. ::;:'. ; ,,;,:::.~.t ..;-:.

. ".~..

. ' - ! ..," ~•. :.~;~ -:-.~ , •.

• ••.,~~'.;••7<:;..;.:= ....'

20

timelines that will need to be refined and updated, as necessary, when Phase Two is .

21

reviewed at the December 13, 2012 Court hearing. Consistent observations across every

22

sectiori. of the Irnplementation plan Phase Two activities, is that the plan needs to describe,

23

with some detail, how the activity will go about accomplishing what it intends.

24

The Special Master will now summarize and comment on key sections ofthe

25

Implementation Plan. While this section is repetitive, it is the one section ofthe Report

26

where all the sections can come together to reflect the whole plan and thus be commented

27

on.

28

Section I, Core Components, A and B, Phase Two, anticipates finalizing and

29

disseminating the Core Practice Model (CPM) Guide and initiate basic training statewide.

- - - - - - - - - - f----~-~,~--~~ ~-~~--~---- -----~--~--~--~-- ----~~- ---~-----------~----------- -~------- ------~---~ -----~--

---~-~----

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 28 of 33 Page ID

#:5428

28

1

Concurrently, it identifies the need to develop a plan/strategy for statewide adoption of the

2

CPM Guide. It also anticipates determining the best services/model program for

3

California and the components eligible for Medi-Cal coverage. This is a 'giant first step'

4

in accomplishing Section I goals.

5

The Special Master and the parties recognize that it will take a sustained but flexible

6

effort over many years, well beyond the Court's jurisdiction, to take the Core Practice

7

Manual (CPM) to scale. The Negotiation Workgroup has identified many of the

8

opportunities and challenges ahead in moving CPM from a practice manual on the ground

9

to an adopted and utilized practice across Mental Health and Child Welfare state and local

10

systems. The experiences of the Los Angeles County implementation of Katie A. and

11

CDSS California Partners in Permanency (CAPP) implementation have highlighted the

12

challenges in developing, implementing and utilizing a unified practice approach across

,':',,",;~,s:;:,.m:J:3,' _, Child Welfare 'and 'Mental Health agencies. and:workcultures~!)-The.Wo.rkgroupjs'-·~· ;i: ;:;'r::'::';1';i'~.· - ;':~:..~,., T . ~i.,.: 14 ~ , contimiouslY'inforrrred by 'its"membership' on the strategies; activities,' successes :and.~'\~~h::,~:;J'i'N'~':::·.:;:·;· ,"j:.:y

""15

challenges ofLos Angeles and CAPP efforts inthe implementation of the CPM'approach; ,1',::-(-";'

16

Through this process, the Special Master has become all too aware of the importance data

17

and quality assurance can have in improving practice. Although not specifically identified

,;~;: ·18

in this Section, the experiences from Los Angeles and CPSSCAPP implementation:. '

21-.~
22

~ that data and quality assurance has in promoting and'-sustaining statewide adoption ofth~.;:;:· CPM approach should not be overlooked. Section V of the Implementation Plan, Data ~

23

and Quality Assurance, will be evaluated elsewhere in the Special Master's Report.

24

The,Special Master remains concerned about the time required to resolve the TFC

25

questions. The time needed to resolve this matter has exceeded the Special Master's

26

timeline presented to the Court in earlier reports. The activities outlined in Section I are

27

reasonable to resolve the TFC questions. Establishing tiinelines has become problematic

28

for the parties. Upon my direction, the State established a series of timelines to resolve

29

the TFC questions which have not been accepted by the plaintiffs at the current time. The

30

State should be commended for being flexible in the waning hours of finalizing this plan

31

for meeting the plaintiffs interests and agreeing to postpone establishing the date. The

~-~---~~-~~- ~~ -~----~ ~-----~~~

- - - - - - - - - - - - - - - - - - - ----

-

-----~---

--~

- - ~~-~----~---~-~~--~~---~

--~-~---

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 29 of 33 Page ID

#:5429

29

1

parties will evaluate the progress over the next few months and should have resolved this

2

matter on or before the December 13,2012 Court hearing. The TFC remains a work in

3

progress with the following questions not resolved at this time: which components of TFC

4

are covered under Medi-Cal and which are Title IV-E eligible; what are the preferred

5

services/models and how the services/components should be claimed, if at all, to Medi-

6

Cal. Regrettably, this has taken longer than all parties would have desired. There are

7

numerous reasons for this delay, but primarily the delay is due to the parties taking a fresh

8

look at what the State of Califorilia wants in its TFC program. This includes addressing

9

the range of financing options, services array, provider qualifications and accountability.

10

The Special Master feels confident that the national consultants working with CDHS,

11

CDSS, Plaintiffs and the relevant subgroups ofthe Negotiation Workgroup will resolve

12

this matter with an elegant solution within the timeframe. identified in Phase Two of the

.,~c:" '~:,~,.~·.;;'·',B:~:~~';" '/Implementation ,Pla.1Tto' be reviewed;hy the Courto-Decemher 13,;2:01;2., ",;;(;". :;~.:, i .ii:;.,;;' ,',:i,,;}jj

t."'

! l,~·· "',.' ,..<:,,'

14 ,', Section II, Phase Two, and Youth Involvement, identifies'expectati9ns:ancL: ~,
,." ·~·····;·~··;··1··:~·····'

. :....

F~ily
" " ."'~"'." '''':'''>~': ........ ""!'!."'. ,.,....' ....' -, .. ,' ...... ~.

. ' , •... , .•..•...; ';" .•.• ~.~.,:,.:-..... ".:.,.!.> .• ,',.,

~.'"

.

:,'

15 activities for family and youth to be engaged in meaningful participation at the practice,

16 program and system levels and all phases of implementation of CPM. Initial activities have

17 been identified and move in the correct direction. Additional activities and deliverable,may
. ',: -: ; . ; . ~::.::' . "

.. ,';, -' -;- ~ .~ ··.19· :·:.ofthe Implementation: Plan was discussed earlier in this report 'c .", -.- .-~ : ",'...... ,- ..........

,

,

~

" , ~;:.

..... ~. ~!. • . • .'~.~ ' . .:.'..

''''''·20 21 22 23 24 25 26

", ,~ Section III; Phase Tw6; Service Delivery and Rollout ainis at developing implementation.;
activities and strategies that will bring to scale statewide - CPM for all class members and ICC,IBHS and TFC in the context of CPM for all subclass members. As discussed earlier in this report, additional detail needs to be described in the areas of activities and deliverables. It's the Special Master's understanding that the Negotiation Workgroup is working on this section and will have further developed and refined Phase Two for the December 13,2012 Court hearing.

27

Section IV, Phase Two, Training and Assistance, focuses on providing the additional

28 resources to build system and staff capacity. The goals and expectations are very powerful

29 and establish the correct tone. Parallel, on a separate track, are the pending recommendations

l----'------~-------'-----'~---------------------------- --------~-----,-------- ,---------.-----~-----------,-~-,~-,

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 30 of 33 Page ID

#:5430

30

1 from the CPM Fiscal Task Force and Joint Management Task Force that will be considered by 2 CDHCS and CDSS. The decision made by CDHCS and CDSS should provide the policy and 3 administrative direction, resources and practical solutions to support the implementation of 4 the each of the six sections, especially, Section IV, Training and Technical Assistance. The 5 Special Master is looking forward to further development of Phase Two and the Court's 6 review on December 13, 2012.

7

Section V, Phase Two, Data and Quality Assurance, and Section VI, Phase Two, Joint

8 Management Structure implementation creates exciting and new opportunities. There is

9 inherent power in the selected methods and processes that, over time at the state and county

10 level, can transform how the Child Welfare and Children's Mental Health systems collaborate

11 to effect outcomes for children and families and fulfill the Terms and Objectives of the Katie

12 A. Settlement Agreement. The Charters to establish the two Task Forces set forth a

".:.:....";:'.~ .. : .• _t;...:.• :-· ...::.!~:~~

.',"

. _"

~. ,,:.j*~ -: ~"'~'''I,...,.v • • ",:., ..,; •..• _:.4,,;.o-.~..

.".:..._:::".,' ':~.~.

~: _ -'. ,," r~p._:,.

.' .~:~

. i ,....

13'
.'

framework
..:':..':",,:::::' ',.:'.,....

and
....

ex..p.e.c.t.ati.o' n>:..

p"";,r.o,,';v.;i-d'.<ip:,;g.y:d" ir.e' ..c'ti-:on,...a.. r,i,'d,.

focus for these
" : '.. ,.

tWo sectiQns\ofiilie:nr'
. . "......,.,.' .... ""."'" .. ,

: !•.'" •.,' '14: ,dinpleI11lentationplan~··.

• -

0- ' . , , . • . ' " ~ • , , - , ~ "

• ,.

•

' : ' . ' , <'.'

...' ii!;. ,:

15

These two sections of the Implementation Plan and the decisions that will be reached by

. ,',:: ' .~ .;,;J ~

16 CDHCS and CDSS in Phase Two, will have a lasting effect on the sustainability ofwhat is

17 ~tended in the Settlement Agreement. DHCS and CDSS, informed by the recommendations

.. 18 . from the'Jo~nt Management Task ForGe, tp.e f.,ccountability,COJ;nmunicati9:P;and··' " .' '..

• • ".. -,.....:..... :-:. I ."

. .... '. ~ ~ ~ '::~.',- , - '::' ': .',";.

<I ; : ..... ••

••~!: :::::.~'

~'A,.' '. "::.:;.. • ~",,, .:"~':" •. ::!'::: '. ,..'- ." '.~ < -:.: "::.:~•• ·;-;··i·.~ < : ••••:. )j::.~' .~ . r2.';:r~.d'· ~".

. '--!-":: "::.:;' •.• " •. :;"~':~.':; ~ ."~~'; : ~::' .::.<::".:., ",'" .~ .'. -.' , . ,,-

.. ,. '~.". '" ".,

'

.--: ...
" ... .i.,

'-;::19 .: Authorization Task Force;.and therCore Practice'Fiscal Task Force,will make,decisi6ns6n:~""

"
'20 .'

."

.

.- . .

-

the ~oint Management S~ctur.eto b~ put in pla?_e~ its scope of responsibility ahd decision -,"

...-~ ......-.

-,

~

21 . ;~g ~~tl~~;ity; ihe colhib6rati;~-D~ia~d-cihality Assurance system, it;c~~ss system and

22 collaborative framework, the quality improvement approach, and use of data and review

23 processes; the Core Pracfice Model strategies-and resources to promote statewide adoption;

24 the fiscal and administrative decisions, incentives, and tools. These are foundational decisions

25 intended, over the long term, to achieve most, if not all of the Terms and Objectives,

26 Paragraph 19, (a-d) set forth in the Settlement Agreement. It's likely that all these decisions

27 will be reached after January 2013. The Special Master looks forward to the work of the

28 Taskforces and their recommendations. It was anticipated that some of the work of the

29 Taskforces and CDHCS and CDSS decision-making would occur after January 2013. Current

30 timelines established for convening JMT and Core Practice Model Fiscal is October 2012 and

31 for the Accountability Communication and Oversight Taskforce (Data and Quality Assurance)

r-~
I

- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - ~-- --~-----~------~~~---

------------~----~-----~

~----- ------------------~-------~~--------------------

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 31 of 33 Page ID

#:5431

31

1 is February 2013. Parties should be prepared at the December 13,2012 Court hearing to 2 discuss Phase Two, Implementation Plan deliverables and timelines and how they affect the 3 implementation of other. Sections of the Implementation Plan.

4

PART III

5

SPECIAL MASTER'S RECOMMENDATIONS TO THE COURT

6

Based upon the sufficiency review of the Proposed Katie A. Implementation Plan to

7 determine if Phase One is reasonably calculated to ensure that State Defendants meet the

8 terms of the Agreement and objectives set forth in Paragraph 19, and a general review and

9 comment of Phase II, framework, expectation and timelines, the Special Master makes the

10 following findings and recommendations.

.1• •
;, ~1'~~: .
,\

11
.. 12..".
13
14

.',

Recorillrieridafitm ·1 :'

.. .. :'. • ,.",~" _ •• M •• -

• • • "~

;" .~ ,

)~:

.

.

TheSpeciaLMaSter fi11ds,that the.KatieA~·Iniple11lentatioti Plan, Phase Oneis'fe,asonably.and': ',:

,";" . ,, . >...... . ~: ."~:~~:~~,::,~,~~~~~,;,:-::.-;;

... \

~'" :~'~.: '.'.":

":"':?':'~'";:"~~'{ .. ~':"'"

sufficiency c8.lculated to meet the terins oftheagreemelit and objectives set f6rthParagrapli:

15 19 as identified in this report, and recommends the Court approve the Katie A.

16 Implementation Plan, Phase One.

17

19 . 20

::.:';~:,•• ; . ' ~~":' .. ~.'.: - •••:."."''''~'::::~~.-;'

"

• -

• ":~"~";\ .:~ ,.-; .~~.: ••"'::.,":---" -:"~!,~" ••'"

.... _ - .... --~--

.-

_ •••.• ' ".,

-

".

The Special Master finds that the Katie A. Implementation Plan, Phase Two;.fea~0nably~'\" ..;,·

.', .•.•

~

'!':,,~.,

. . •' ..... :.-

'_0. h-.·'········· . - , ' - ' . . . . . . . .".,- ""7".: .,"'" -

..

~.,

."

'.

:

":'~ ~

',~..,.,.;, .,; ,,,'

.•• ~- . . . . ."

'.-.

describes' the 'framework and expectations alidanticipafed timelines':arid wilLafter addressing· ".;:'...

21 the Special Master's comments, be sufficient to meet the expectations of the Court and

22 complete an Implementation Plan for Phase Two by December 13,2012.

23

24

25

26 Recommendation 3:

27 The Special Master recommends the Court review the entire Katie A. Implementation Plan,

28 Phase One and Two at the December 13,2012 Court hearing.

29

30

In closing, as Special Master I would like to thank the Court for affording me the

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 32 of 33 Page ID

#:5432

32

1 privilege of serving as Special Master for the Katie A. case. I am very proud of the

2 remarkable accomplishments made by the parties and Negotiation Workgroup as reflected in

3 the Implementation Plan, and I look forward to the opportunity to continue to work with the

4 parties and the Court in preparing for the Court's Implementation Plan Review, Phase One

5 and Two on December 13,2012.

6

7 Dated: August 28,2012

8

Respectfully submitted

9

10

/s/ Richard Saletta, LCSW

11

~~S,. . 8~~,n.... . 1

L<.,Sl,....j-

12

Richard Saletta, LCSW

13

Special Master

14

Case 2:02-cv-05662-AHM-SH Document 819 Filed 08/28/12 Page 33 of 33 Page ID #:5433

CERTIFICATE OF SERVICE

Case Name: KATIE A., et al. v. BONTA, et al.

No. CV-02-05662 ARM (SHx)

I hereby certify that on August 28,2012, I electronically filed the following documents with the Clerk of the Court by using the CMlECF system:
SPECIAL MASTER'S RE,PORT ON PROGRESS TOWARD COMPLETION OF THE KATIE A. IMPLEMENTATION PLAN
Participants in the case who are registered CMlECF users will be served by the CMIECF system.

I further certify that some of the participants in the case are not registered CMlECF users. On August 28,2012, I have mailed the foregoing document by First-Class U.S. mail, postage prepaid, for delivery within three (3) calendar days to the following non-CMlECF participants:

Catherine J. Pratt, Esq. Children Services Division 201 Centre Plaza Dr., Suite 1 Monterey Park,CA 91754-2143

John F. Toole, Esq. National Cenfer for Youth Law 405 14th Street, 15th Floor Oakland, CA 94612-2701

Gerald M. Custis, Esq. Monterey County Counsel Children's Services Division 201 Centre Plaza Drive, Suite 1 Monterey Park, CA 91754-2143

I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct and that this declaration was executed on August 28,2012, at Los Angeles,
California.

M. Chacon Declarant

IslM. Chacon , Signature

LA2002CV1625 51100178.doc

 </s> 1

2

3

4

5

6

7
UNITED STATES DISTRICT COURT
8

9

CENTRAL DISTRICT OF CALIFORNIA

10
WESTERN DIVISION

11

KATIE A., etc., et al,
12

) CASE NO. CV-02-05662 AHM (SHx) )

13
v.
14

Plaintiffs,

15 TOBY DOUGLAS, etc., et al,

16

Defendants.

) ) ORDER AWARDING ATTORNEYS’ ) FEES, COSTS AND EXPENSES ) PURSUANT TO SETTLEMENT ) AGREEMENT )

17

)

)

18

)

19

20

21

22

23

On December 5, 2011, the Court entered the Stipulated Judgment pursuant

24 to the parties’ Settlement Agreement. Docket No. 779. Under ¶36 of the

25
Settlement Agreement, State Defendants have agreed to pay to Plaintiffs’ counsel

26
$3.75 million as an all-inclusive attorneys’ fees sum, including costs and expenses.
27
Pursuant to Federal Rule of Civil Procedure 23(h), Plaintiffs have moved for an
28
award of $3.75 million in fees, costs and expenses. No class member has objected

to this portion of the Agreement.

1

______________________________________________________________________________________

ORDER AWARDING ATTORNEYS’ FEES, COSTS AND EXPENSES

PURSUANT TO SETTLEMENT AGREEMENT

1

2

During the course of this nearly decade-long litigation, the Court has

3 reviewed scores of pleadings, encompassing thousands of pages of documents; has

4
presided over dozens of hearings; and, with the consent of the parties, served as a

5
mediator on fees and costs issues. The Court has also reviewed Plaintiffs’
6
memorandum and declarations filed in support of the motion, and State
7
Defendants’ responding memorandum. Based on this extensive familiarity with all
8
aspects of this litigation, the Court concludes that $3.75 million is a reasonable
9

award. Indeed, Plaintiffs’ lodestar through March 2011 – based on the reasonable
10

11 number of hours worked times a reasonable hourly rate for each attorney, paralegal

12 and law clerk on the case – is substantially more than that amount.

13

Accordingly, the Court orders State Defendants to pay to Plaintiffs’ counsel

14 $3.75 million. Pursuant to ¶37 of the Settlement Agreement, interest shall accrue

15 on this amount at the rate of 7% beginning December 6, 2011.

16

The check shall be issued to the Western Center on Law and Poverty, which

17 is authorized to accept payment on behalf of its co-counsel.
18

19

20 DATED: December 06, 2011
21

22

23

24

____________________________________________

A. HOWARD MATZ
25
United States District Judge

26

27

28

2 ______________________________________________________________________________________
ORDER AWARDING ATTORNEYS’ FEES, COSTS AND EXPENSES PURSUANT TO SETTLEMENT AGREEMENT

 </s> 1 MARK D. ROSENBAUM (59940) BEN WIZNER ~1572~
2 AMERICAN CI IL LI ERTIES UNION OF SOUTHERN CALIFORNIA
3 1616 Beverly Boulevard Los Angeles, California 90026-5752
4 Telephone: &2l3) 977-9500 Facslmile: ( 13) 250-391COPY
5 LEW HOLLMAN (58808~
6 LIN MIN KONG (183512 LAUKA DlAMONJ) ~1l:)5U62~
7 KATRINAMCINTO H¥10 59) CENTER FOR LAW IN HE
8 PUBLIC INTEREST 10951 W. Pico Blvd., 3rd Floor
t 5 9 Los Angele California 90064-2126 Telephone: 310 470-3000 10 FaCSImile: 310 474-7083
11 Attorneys for Plaintiffs!

RONALD C. PETERSON (54312) CARLYLE W. HALL III (184842) HELLER EHRMAN WHITE &
McAULIFFE LLP 601 S. Figueroa Street, 40th Floor Los Angeles, CA 90017-5758 Telephone: (2l3) 689-0200 Facsnwle: (213) 614-1868

12 [Additional counsel appear on signature page]

13

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA/WESTERN DIVISION

14 KATIE A.l by and throug~ her next friend 15 Michael Ludin; MARY B. by and througp
her next friend Robert Jacobs; JANET C.

Case No.: 02-056662 AHM (SHx) [CLASS ACTION]

16 by: and through her ne?'t friend Dolores Johnson; HENRY D. by and through his

UNLIMITED JURISDICTION

17 neft friend Gillian Brown; AND GARY E. by and through his next friend Michael
18 Ludin, individually and on behalf of others similarly situated,

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

19

Plaintiffs,

20

v.

DIANA BONTA, Director of California 21 n~partment of Health Services; LOS

ANGELES COUNTY,; LOS ANGELES

22 COUNTY DEPARTIVIENT OF

CHILDREN AND FAMILY

23 SERVICES; MARJURIE K.)!;LLY

Acting Director of the Los Angeles County

24 Department of Children and Family Services; RITA SAENZ; Director of the

25 CalifornIa Department or Social Services,

and DOES 1 tbrough 100, inclusive,

26

Defendants.

27 1 Plaintiffs are proceeding under fictitious names and satisfy the requirements of Rule lOra) of the
Federal Rules of Civil Procedure. Pseudonvm litigation should be permitted in this case because
28 plaint1ff~ meet the following requirements laid out in Rule lOCal: plaintiffs are Children, they are
cha,11e,ngmg govertrn;lentai.activ!ty,.and pres.smg the lawsuit using their real identities would compel the plamtitIs to reveal hIghly mtlmate mformatlOn.
FIRST AMENDED COlViPLAiNT FOR DECLARATORY AND INJUNCTIVE RELIEF" ....--..---- ------Case No.: 02-056662 ARM (Six)

1

Plaintiffs allege as follows:

2

I. JURISDICTION AND VENUE

3

1. This class action lawsuit challenges the failure of Diana Bonta, Director of

4 the California Department of Health Services to provide necessary health care services

5 to correct or ameliorate the mental health conditions of foster children in California.

6 Plaintiffs also challenge the unlawful denial to children in the custody of the Los

7 Angeles County Department of Children and Family Services (DCFS), or at imminent

8 risk of being placed in DCFS custody, ofncccssary mental health, behavioral support,

9 and case management services in community settings. This court has jurisdiction over

10 this action pursuant to 28 U.S.C. §§ 1331, 1343, and 1367. Plaintiffs' action for

11 declaratory and injunctive relief is authorized by 28 U.S.C. §§ 2201,2202, and 1343,

12 and by Fed. R. Civ. P. 57 and 65.

13

2. Venue is proper pursuant to 28 U.S.C. § 1391(b) because a substantial part

14 ofthe events or omissions giving rise to the claims herein occurred in this district, and

15 because all Defendants named herein reside in, maintain offices in, or are responsible for

16 enforcing the laws relevant to this litigation in this district.

17

II. INTRODUCTORY STATEMENT

18

3. More than 90,000 children are in foster care in California; virrually all of

19 these children receive their health care services, including mental health services,

20 through Medi-Cal, California's Medicaid program. In addition, a significant number of

21 children tmder the supervision of a county chilo welfare agency or otherwise at risk of

22 foster care placement are eligible for Medi-Cal.

23

4. Los Angeles County's foster care system is our nation's largest, responsible

24 for some 50,000 children, nearly all of them indigent, and the vast majority African

25 American and Latino. Tragically, many thousands of children with behavioral,

26 emotional, and psychiatric impairments who are in the custody of the Los Angeles

27 County Department of Children and Family Services, or at imminent risk of being

28

2

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1 placed in DCFS custody, desperately need, but are not being provided, necessary and

2 legally mandated - mental health, behavioral support, and case management services in

3 community settings. That the situation has reached a crisis point caunot seriously be

4 disputed: numerous reports by state and county commissions, as well as grand jury

5 findings, media articles, and published research, attest to the dismal failure of the child

6 welfare system to provide appropriate care to the children who need it most. Far too

7 many children with behavioral and emotional problems are bounced between multiple

8 foster placements and gruup hume~ lhat UU Ilut meet their individual needs; then, when

9 their conditions predictably deteriorate, they are effectively abandoned by the system,

10 cunsigned to languish in psychiatric hospitals and secure congregate facilities such as

11 MacLaren Children's Center under notorious and deplorable conditions.

12

5. Children in the foster care system with severe mental health and behavioral

13 problems find themselves, in the words of one state commission, "cast into a maelstrom

14 of rules and regulations that are not based on their best interests," or even on their most

15 basic needs. Treatments are doled out according to a bureaucratic rationing process

16 whereby available "slots," rather than individualized assessments, dictate which services

17 will be provided to which children. The results of such a cruelly haphazard system have

18 come to seem mevltable: children whose emotional, educational, and familial needs are

19 not met in traditional foster homes or group homes invariably "fail" in those placemcnts

20 and, after the traumatic process has been repeated numerous times, are deemed by the

21 system to be "unplaceable." At that point, the system relegates them to group facilities

22 like MacLaren, which purports to be a temporary emergency shelter with stays of no

23 more than 30 days, but has in fact become the long-term placement oflast resort for

24 children who have endured multiple "failed" placements.

25

6. Despite widespread agreement among children's mental health experts that

26 restrictive, congregate shelters are actually a harmful environment for children with the

27 most severe emotional and behavioral problems, the dependency care system provides

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 virtually no alternative for children with such problems. This is so even though the

2 experiences of numerous other jurisdictions have proven that intensive, community-

3 based mental health services, including therapeutic foster care, behavioral support

4 services, psychiatric or other clinical services, and comprehensive case management

5 services, can be successfully and cost-effectively provided in the home or in a home-like

6 setting, even to children with the most severe emotional and behavioral problems.

7 Indeed, intensive, community-based mental health services are not only legally required,

8 but they are less expensive than the congregate and institutional placements upon which

9 the system has relied for too long.

10

7. By failing to create and support such therapeutic services in community

11 settings, and by instead confining children with emotional and behavioral problems in

12 restrictive, institutional settings with dozens of other similarly troubled children, the

13 system is setting these children up for needless psychiatric hospitalizations and, in many

14 cases, "graduation" to the juvenile delinquency system. The cost to taxpayers of failing

15 to provide necessary treatment and services to children is well documented: inadequate

16 care leads to a worsening of symptoms, with costlier consequences requiring more

17 expensive responses. The cost in lost opportunities to the children themselves - most

18 of whom will never receive a high school diploma, many of whom will end up in the

19 juvenile and criminal justice systems, and some of whom will be institutionalized for the

20 rest of their lives - cannot be calculated.

21

8. The Constitution and laws of the United States, as well as of the State of

22 California, require the Defendants named herein to provide appropriate diagnosis and

23 treatment of children's mental health and behavioral needs. The tive named Plaintitfs

24 are part of a class of similarly disabled and needy children in foster care, or at imminent

25 risk of being placed in foster care, who are entitled to, but have not received, necessary

26 mental health services in a home-like setting.

27
28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

9. This class action lawsuit seeks prospective injunctive relief ordering

2 Defendants to meet their statutory and constitutional duties to children in their care and

3 custody who suffer from psychiatric, emotional, and behavioral impairments. The

4 problems described herein have long been recognized and have been the subject of 5 numerous reports and proposals, but little has been done to address the crisis.

6 Defendants' violations of the law will continue absent injunctive and declaratory relief

7 ensuring that Plaintiffs are provided the treatment and services to which they are entitled

8 by law.

9 10 Plaintiffs

III. PARTIES

11

10. Plaintiff Katie A. is a 14-year-old Caucasian girl who has been in foster

12 care for ten years. Katie was removed from her home at age four on account of neglect;

13 her mother was living on the street and her father was incarcerated.

14

11. During her ten years in DCFS custody, Katie has not been provided with

15 necessary mental health treatment and services. By age five, Katie's assessments

16 indicated that she was a trauma victim in need of intensive trauma treatment, with

17 supportive services for her caretaker. Pleas for support from Katie's caretaker as well as

18 multiple assessments identliymg Kane's needs were ignored by DCFS, and Katie never

19 received trauma treatment or other necessary individualized services.

20

12. Katie's early assessments also indicated that she required a stable and

21 secure home. Instead, DCFS has shuttled her from one inappropriate placement to

22 another - 37 placements in all- repeatedly warehousing her in psychiatric facilities or at

23 MacLaren when there were no available "slots" in which to place her. Numerous

24 professionals have documented that Katie responds best to one-on-one attention and has

25 difficulty with peer relations, yet since the age of eight Katie has been placed in a

26 succession of congregate care facilities with other behaviorally and emotionally

27 disturbed children, where she has received limited individual attention.

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INruNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1

13. Katie has also suffered significant educational deterioration as a result of

2 Defendants' failure to provide her with appropriate treatment and care. As a

3 kindergartner, Katie was identified as a bright child with some minor behavioral

4 problems. At age nine, she read at the 8th grade level. Five years later, she read at a 7th

5 grade level and had made almost no progress in math or spelling. Yet Katie remains

6 engaging and articulate, she enjoys reading and art, and she hopes to become a

7 pediatrician when she grows up.

8

14. III ht:r ten years in DCFS custody, Katie has been subjected to 37 out-of-

9 home placements. In the nearly four years since her eleventh birthday, Katie has had 30

10 different placements, among them four different group homes, 19 stays at eight different

11 psychiatric hospitals, including a two-year stay at Metropolitan State Hospital, and

12 seven stays at MacLaren. Katie last lived in a family setting in 1995, at age eight, when

13 she stayed in two different foster homes for a total of five days. Katit: currmtly m;idt:s

14 at a hospital facility, and she brings this action through her next friend, Michael Ludin.

15

15. Plaintiff Mary B. is a 16-year-old, legally blind, Latina girl who has been

16 in foster care for three years_ Mary was removed from her home at age 13 after being

17 physically and emotionally abused and left unsupervised by her mother. Following her

18 entry mto DeliS custody, Mary was diagnosed with a sexually transmitted disease, and

19 she disclosed that between 1994 and 1996 she had been sexually abused by her maternal

20 uncle and stepfather.

21

16. Notwithstanding her repeated psychiatric hospitalizations and clear

22 evidence of severe trauma, Mary has never received a comprehensive psychiatric

23 assessment since her entry into DCFS custody. In September, 1999, after Mary had

24 undergone two foster home placements, two hospitalizations, and more than a month in

. 25 MacLaren, the DCFS case worker characterized Mary's emotional needs as "hormones
26 acting up." Even her hospital records did not include thorough psychiatric or

27 psychological evaluations. Moreover, Mary did not receive therapy until her fourth

28

6

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 foster placement, two years after her removal from home, although she had been abused

2 for years as a young child, had been rejected by her parents, and had social

3 disappointments connected in part to her visual impainnent.

4

17. Mary continues to have hope for her future. She is learning Braille, and she

5 wants to complete high school and attend community college. She has told a foster

6 mother, "I'm not crippled; I'm only blind."

7

18. In her three years in DCFS custody, Mary has been subjected to 28

8 placements, including 16 hospital stays at seven different hospitals and three stays at

9 MacLaren. In October, 200!, a Department of Menta! Health screening committee

10 suggested that a specialized foster home with ''wraparound'' services in place could meet

11 Mary's needs, but DCFS instead placed Mary in a large, residential facility. Mary last

12 lived in a family setting in September, 2000, when she was briefly sent home to her

13 mother without any supportive services. Mary currently resides in a high-level,

14 restrictive group home, and she brings this action through her next friend, Robert

15 Jacobs.

16

19. Plaintiff Janet C. is an ll-year-old, African-American girl who has been

17 in foster care for more than two years. Janet was first removed from her parents'

18 custody m October, 1999, following reports of physical abuse in the home.

19

20. Janet was in DCFS custody for nine months, with several psychiatric

20 hospitalizations, before Defendant DCFS provided her with a mental health evaluation.

21 Despite her numerous placements, and a wide spectnlm of different anrl inconsistent

22 psychiatric diagnoses, no assessment has analyzed and evaluated the multiple traumas

23 Janet experienced.

24

21. DCFS has failed to identify Janet's individual needs and the specific

25 services that would meet her needs. Rather, the DCFS case plan calls for "age

26 appropriate, child oriented services." A progress report prepared by a therapist states

27 that Janet can show "tremendous growth with intensive therapy." However, DCFS has

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 failed to provide Janet with the consistent, intensive mental health services and other

2 support that she needs. As a result, Janet has been left to languish at MacLaren for the

3 past six months, interrupted only by two hospitalizations, and her condition continues to

4 deteriorate.

5

22. Janet has a network of family and friends who are involved in her life and

6 who are concerned about her well-being. From a young age, Janet has been a family

7 caretaker, looking after her young siblings and elderly grandmother. She has a strong

8 sense ofjustice and defends those who are being treated unfairly. Indeed, she has been

9 physically restrained at MacLaren for attempting to intervene on behalf of another child

10 who was being disciplined.

11

23. In less than two and a half years in DCFS custody, Janet has been subjected

12 to 25 placements, including five with family members, 12 hospital stays at seven

13 different hospitals, and Llu'ee stays at MacLaren. She last lived in a family setting in

14 November 2001, when she was briefly sent home to her mother without any supportive

15 services. Janet is currently placed at MacLaren, and she brings this action through her

16 next friend, Dolores Johnson.

17

24. Plaintiff Henry D. is a nine-year-old, legally blind, African-American boy

18 in his second entry into foster care. He was first removed from his mother's care at the

19 age OffOUT, following reports of physical and sexual abuse by his mother's boyfriend.

20 Despite written documentation of Henry's serious behavioral and emotional problems

21 just weeks after his removal, Defendant DCFS failed to provide him with a mental

22 health evaluation or with appropriate mental health services upon his first removal from

23 home. After placements in several foster homes and in two group homes, Henry was

24 returned to his mother's custody but, without the mental health services that he needed,

25 Henry's condition deteriorated.

26

25. At the age of seven, Henry was voluntarily placed into foster care by his

27 mother after further evidence of abuse by his mother's boyfriend. Notwithstanding

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AlIM (SHx)

1 many early indications that Henry had significant emotional problems, he apparently

2 received no psychological evaluation until May, 2001 when he was eight years old, four

3 years after his initial removal from the home. Even after he was belatedly diagnosed

4 with Major Depression and Post Traumatic Stress Disorder, he was not provided with

5 intensive individual therapy until more than a half year later. DCFS's current case plan

6 for Henry fails to identify his individual needs nor any specific services to be provided

7 to him.

8

2G. Yet Hemy is resilient and is still able to form trusting relationships. He is

9 an affectionate child, and his records have consistently indicated that he responds well to

10 one-on-one attention and positive reinforcement.

11

27. In the 14 months following his second removal from home, Henry was

12 subjected to 12 out-of-home placements, including six hospital stays at three different

13 hospitals and one stay at MacLaren - all befure his ninth birthday. He last lived in a

14 family setting - a ten-day stay in a foster home - in September, 2000. Henry

15 currently resides in a group home with children of various ages, and he brings this action

16 through his next friend, Gillian Brown.

17

28. Plaintiff Gary E. is a 14-year-old Caucasian boy who has recently returned

18 home after six months in out-of-home foster placements. Gary's mother voluntarily

19 placed him and his older sister into foster care because she felt overwhelmed and was

20 unable to cope with her children's behaviors in the absence of supportive services.

21

29. During his six months in foster care, Gary was placed at MacLm~n and fit

22 two group homes. In an educational plan developed while Gary was in his second group

23 home placement, a therapist documented Gary's signiticant emotlOnaJ and behavlOraJ

24 problems which have impeded his educational progress. However, at no time following

25 his removal from home did Gary receive appropriate mental health and behavioral I

26 support services.

27

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02·056662 AHl\1 (SHx)

1

30. Gary was returned to his mother's home because, as DCFS reported to the

2 juvenile court, "there is no indication that DCFS knows of a facility that is capable of

3 meeting [Gary's] educational, physical, and emotional needs. [Gary's] continuing

4 pattern of failure in foster case is detrimental to his overall well-being." However, Gary

5 and his family are still without necessary supportive services.

6

31. Gary's therapist reports that Gary has the ability to be charming, humorous,

7 and gracious. He enjoys playing the guitar and working with people. He has a strong

8 u~sir~ to relllain at home with his mother, sister, and niece, but without appropriate

9 mental health, behavioral support, and other supportive services for him and his family,

10 Gary faces the imminent risk of another traumatic entry into the foster care system.

11 Gary currently resides at home, and he brings this action through his next friend,

12 Michael Ludin.

13 Defendants

14

32. Defendant DIANA BONTA is the Director of the California Department of

15 Health Services ("DHS"). DHS is the single state agency responsible under federal law

16 for the administration of the Medi-Cal program in California. Defendant Bonta's duties

17 include supervision and control of the Medi-Cal program to secure full compliance with

18 the governing laws. Defendant BONTA is sued in her official capacity.

19

33. Defendant LOS ANGELES COUNTY ("County") is a local governmental

20 entity, duly authorized and formed under the laws of the State of California. The

21 County oversees and monitors the Department of Children and Family Services.

22

34. Defendant LOS ANGELES COUNTY DEPARTMENT OF CHILDREN

23 AND FAMILY SERVICES ("DCFS") is the agency responsible tor adnumstenng chlld

24 welfare services in Los Angeles County, for locating placements for children in the

25 County foster care system, and for ensuring the safety and well-being of children untier

26 court supervision pursuant to Welfare and Institutions Code § 300.

27

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1

35. Defendant MARJORlE KELLY is the Acting Director of the Los Angeles

2 County Department of Children and Family Services and, as such, is responsible for

3 administering child welfare services in Los Angeles County, and for ensuring the safety

4 and well-being of children under court supervision pursuant to Welfare and Institutions

5 Code § 300. Defendant KELLY is sued in her official capacity.

6

36. Defendant RlTA SAENZ is the Director of the California Department of

7 Social Services ("CDSS"). CDSS is the single state agency responsible for supervising

8 and munitoring tht: administration of child welfare services in California. Defendant

9 Saenz is responsible for administering laws relating to child welfare services;

10 promulgating regulations and standards; supervising the administration of public social

11 services, including child welfare services; and investigating, examining, and making

12 reports on public offices responsible for the administration of public social service

13 funds. Welfare&InstitutionsCode§§ 10553, 10554, 10600, 10602. UnderWelfare&

14 Institutions Code § 1605, she has the authority to enforce state statutes and regulations.

15 Defendant SAENZ is sued in her official capacity.

16

IV. CLASS

17

37. This action is maintainable as a class action pursuant to Fed. R. Civ. P.

18 23(a) and 23(b)(2). PlaintitIs represent a statewide class of children in foster care in

19 California, or at imminent risk of foster care placement, who have a behavioral,

20 emotional or psychiatric impairment and who need individualized mental health

21 services, including but not limited to professionally acceptable assessments, behavior;]1

22 support and case management services, family support, crisis support, therapeutic foster

23 care and other necessary services in the home or in a home-like setting, to treat or

24 ameliorate their disabilities or impairments.

25

38. A subclass consists of children who are in the custody of the Los Angel'es

26 County Department of Children and Family Services (DCFS), or have been referred to

27 or are subject to referral to DCFS, who have a behavioral, emotional, or psychiatric

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 impailment, and who need individualized mental health services, including but not

2 limited to professionally acceptable assessments, behavioral support and case

3 management services, family support, crisis support, therapeutic foster care, and other

4 necessary services in the home or in a home-like setting, to treat or ameliorate their

5 disabilities or impairments.

6

39. The requirements of Fed. R. Civ. P. 23 are met in that the class is so

7 numerous that joinder of all members is impracticable. Furthermore, the class is fluid in

8 that new members are regularly created.

9

40. All the members share common issues oflaw and fact in that Plaintiffs,

10 while under the custody and care of Defendants, or at imminent risk of being placed in

11 Defendants' custody, are not being provided legally mandated services within

12 appropriate, community-based settings able to meet their individual needs, resulting in

13 multiph;, unsuccessful placements, in violation of federal and state laws.

14

41. The claims of the named Plaintiffs are typical of the claims ofthe class they

15 represent.

16

42. Plaintiffs will fairly and adequately protect the interests of the class they

17 represent. Plaintiffs know of no conflict of interest among the class members.

18

43. Plaintiffs are represented by experienced cuunsd whu will ade4ualdy

19 represent the interests of the class.

20

44. Defendants have acted and refused to act and continue to do so on grounds

21 generally applicable to the class that Plaintiffs represent, thereby rendering appropriate

22 injunctive and declaratory relief for the class as a whole.

23

V. STATEMENT OF FACTS

24

45. Numerous studies have estimated that between 60 and 85 percent offoster

25 children nationwide have significant mental health problems. Yet in California,

26 according to a 2001 report of the Little Hoover Commission, "[m]ore than 50,000

27 children in the foster care system who may need mental health services do not get

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 them." As the Commission has observed, "While [foster] children may be. eligible for

2 an array of services, the system for delivering services is so fragmented, anemic, and

3 disorganized that it regularly fails to meet the needs of these children." In Los Angeles

4 County, these problems are particularly acute, and the County's abysmal record of

5 multiple foster placements and needless institutionalizations has all too often led to a

6 downward spiral of behavioral and emotional problems for children in its care.

7

46. Th.ere is virtual unanimity among mental health experts that children with

8 serious mental health problems require an array of individualized services tailored to

9 meet their needs. These services, which are required by law, include professionally

10 acceptable assessments, as well as behavioral support and case management services,

11 family support, crisis support, wraparound services, therapeutic foster care and other

12 mental health services, in a home-like setting. Around the United States such

13 individualized servil;es have been successfully provided to children in and out of foster

14 care, and have been shown to be more effective - and more cost effective - than

15 congregate and institutional care.

16

47. Notwithstanding this consensus among mental health professionals as to the

17 necessity of providing children with individualized treatment that meets their needs,

18 Defendants have failed to ensure that children in foster care, or at imminent risk of being

19 placed in foster care, receive the mental health services to which they are entitled by

20 law. The systemic failure to provide Plaintiff children with legally mandated

21 individualized services is the result ofnllmerons deficiencies, including:

22

(a) Failure to assess children's needs, including medical, mental health,

23 educational, and tinnily needs;

24

(b) Unavailability of such necessary mental health services as behavioral

25 support, psychiatric or other clinical services, comprehensive case management serv\ces,

26 wraparound services, and therapeutic foster care, in a home-like setting;

27 28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AlIM (SHx)

1

(c) Over-reliance on restrictive, congregate, institutional placements, including

2 locked psychiatric hospitals and so-called "emergency" shelters such as MacLaren

3 Children's Center;

4

(d) Multiple foster care placements - often with no attempt made to consider

5 geographic placement near the child's community or school- that are harmful to

6 children and disruptive offamily contact, educational continuity, and necessary mental

7 health treatment; and

8

(e) Excessi ve and unwarranted reliance on the removal of children from their

9 families and their placement into foster care, as opposed to providing necessary mental

10 health services in the home, including individually tailored family preservation services

11 where appropriate.

12

48. Los Angeles County's child welfare system has been under considerable

13 scrutiny for many years and has been the subject of numerous grand jury investigations,

14 management audits, and county commissions. In its 1999-2000 report, the Los Angeles

15 County Civil Grand Jury excoriated the County's foster care system, observing that

16 "[t]he best interests of the child are rarely paramount in considering the placement

17 options for children in thc system." The report concluded: "Despite a widely stated

18 child-first philosophy, declSIOns made throughout the system ... appear to be motivated

19 primarily by cost considerations and secondarily by shifting policies and politics.

20 Furthermore, the high volume of cases together with [caseworker] understaffing and

21 turnover result in a system built on a warehousing, 'board and care' model, not on

22 treatment and services to improve children's lives."

23

49. Instead of ensuring the development of legally mandated individualized

24 services, Defendants have relied excessively on out-of-home, geographically remote,

25 institutional settings, such as MacLaren, where children with mental health needs are

26 warehoused rather than treated. In the words of one mental health expert retained by

27 Defendant Los Angeles County to investigate conditions at MacLaren:

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

MacLaren becomes a necessary "holding pattern" in which to

put the child while the worker looks desperately for an

.

2

alternative. And the alternatives are limIted and come in rigid

packages, i.e. the "slots" prescribed by the purchase of servIce

3

contracting systems and nsk averse providers. The result is

placements made under 2ressure into "best available" program

4

slots which are likely to fail children) who over the years

become more ::mcl more clisenchantea and despairing.

5

Three years later, in 2001, the same expert conducted a follow-up investigation and
6
concluded: 7

8

The only practical alternative is to engage each child immediately upon arrival in the facility III a process that will

9

meet his or her individual needs and tliose of their family and move them with deliberate speed into their own or substItute

10

families with a string of servIces and supports wrapped around them.

11
50. The MacLaren Children's Center has a sordid history of difficulties and

12 controversies. The subject of no less than six county commissions and task forces in

13
recent years, it has come to epitomize the system's dysfunctional approach towards

14
caring for children with serious mental health needs. As acknowledged by County

15 Supervisor Gloria Molina in an October 27,2001 letter to the Los Angeles Times,

16
"MacLaren is really a symptom of the overall problems facing the Department of

17 Children and Family Services. If the Department fails to make the appropriate

18 placement on the front end, children will cycle in and out of MacLaren's doors ...." A

19 recent management audit of MaeLaren prepared by an independent audit finn engaged

20
by the Los Angeles County Civil Grand Jury 2001-2002 found that the population at

21
MacLaren is increasingly comprised of psychologically and emotionally troubled

22
children, but that the core staff working with children are not trained to provide direct

23 mental health services.

24 51. Though never intended a~ anything but a temporary emergency shelter with

25

!

stays of no more than 30 days, MacLaren has evolved into a placement oflast resort.for

26 children with serious behavioral, emotional, and psychiatric problems. The management

27 audit detennined that fully 86 percent of the children at MacLaren remained there for

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1 more than 30 days, and the average length of stay was three months. Between 1999 and

2 2000, including repeat admissions, two children had been in residence at MacLaren for

3 more than 700 days; 12 children had a length of stay of over 400 days; and 82 had a

4 length of stay of between 200 and 400 days. The audit noted that individualized therapy

5 was either non-existent or administered for as little as one hour per week, and it

6 recommended increased use of individualized mental health services, observing, for

7 example, that "wraparound [services] can help remove children from the ongoing cycle

8 of stays at MacLaren."

9

52. The absence of necessary individualized services results in a dysfunctional

10 system that allows children like Plaintiff Mary B. to experience 28 out-of-home

11 placements in three years, including 16 hospital stays at seven hospitals and three stays

12 at MacLaren, and Plaintiff Janet C. to experience 25 out-of-home placements in two and

13 a half years, including 12 hospital slays al seven hospitals and tlu'ee stays at MacLaren.

14 In a recent report, the Los Angeles County Auditor-Controller found that "[t]he majority

15 of children referred to residential care have suffered multiple placement failure and in

16 many cases are more severely disturbed than when they first entered out of home care."

17 Multiple placements are harmful to children for several reasons. Children have a limited

18 number of attachments they can form, and multiple placements can lead to long-lasting

19 attachment and trust problems. Children are fearful each time they go to a new place;

20 they often become preoccupied with trying to understand the expectations of each place.

21 Children who have experienced abuse or neglect have a heightened need for

22 permanency, security, and emotional constancy; each move may make them more

23 hopeless. The chance of being emotionally, physlcaUy, or sexually abused by other

24 children or caretakers increases as the child moves. Moving often discontinues therapy

25 and other services and usually means a new school for children who are behind in school

26 and lack social skills to move easily into a new school.

27

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1

53. Over-reliance on restrictive, institutional settings is similarly harmful to

2 children with mental health problems. Hospitals and restrictive facilities are designed to

3 offer short-term stabilization and behavior management, not intensive, individualized

4 services. In fact, during 16 separate psychiatric hospitalizations, Plaintiff Mary B. never

5 once received an adequate psychiatric or psychological evaluation. Moreover, children

6 with trauma-caused depression and anxiety do not make progress in short, restrictive

7 placements; to the contrary, group living often exacerbates children's behavior

8 prubkms. Chiklrt:n with serious mental health needs who require intensive

9 individualized treatment tend to deteriorate when they are indiscriminately confined in

10 congregate care facilities with other similarly traumatized children.

11

54. Beyond the obvious human costs of failing to provide timely and

12 appropriate treatment and services to children with serious mental health needs, the

13 systemic failure to deliver individualized services results in staggt:ring economic costs.

14 For example, during the fiscal year of 200 1-02, stays at MacLaren were estimated to

15 cost an average of $757 per day per child, or $276,287 per year. As a recent report by

16 the Little Hoover Commission observed, "unaddressed mental health needs result in

17 increased school failure, juvenile justice costs, and residential and state hospital costs."

18

VI. STATUTORY AND CONSTITUTIONAL BACKGROUND

19 A. The Medicaid Act, Early and Periodic Screening, Diagnostic and Treatment
(EPSDT) Services, 42 U;S.c. § 1396 et seq.

20 55. Medicaid is a cooperative federal and state funded program designed to

21
provide medical and remedial services to low income people under Title XIX of the

22 Social Security Act, 42 U.S.C. § 1396 et seq. States that choose to participate in the

23

Medicaid program receive federal matching funds for their own programs. To receive

24 those funds, states must adhere to the minimum ft:lkral requirements according to the

25

!

Social Security Act, its implementing regulations, 42 C.F.R. §§ 430 et seq., and the·

26 Supremacy Clause of the United States Constitution, Art. VI, Cl.2.

27

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

56. Federal law requires states to cover certain mandatory services, including

2 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, for

3 Medicaid-eligible children under the age of2l. 42 U.S.C. § 1396a(a)(lO)(A); 42 U.S.C.

4 § 1396d(a)(4)(B). Under EPSDT, states are required to provide screening services to

5 identify defects, conditions, and illness. States must then provide the necessary

6 diagnostic and treatment services to correct or ameliorate those conditions, whether or

7 not such services are covered under the state plan. 42 U.S.C. § 1396d(r)(1), 42 C.F.R. §

8 441.56(b), 42 U.S.C. § 1396d(r)(5).

9

57. California has chosen to participate in the Medicaid program. Under its

10 Medicaid program, known as Medi-Cal, California must provide EPSDT services to

11 eligible children under the age of 21.

12

58. For children with mental health problems, necessary services include

13 professionally adequate assessments and case management and, depending on the needs

14 of the child, may include behavioral support services, individualized wraparound

15 services, therapeutic foster care and psychiatric or clinical services provided in a home-

16 like setting. The provision of necessary services may require the development of an

17 individualized wraparound treatment plan.

18

59. Wraparound services are specific individualized community-based services

19 and supports designed for children who have serious mental or emotional disorders and

20 provided in the child's own home or an alterative family setting. Developed in response

21 to the inflexibility and inefficiency of delivery systems that denied needed services to

22 children, wraparound has been found effective for diverse youth with a wide range of

23 mental health needs. Although the key to wraparound is provIsIon of servIces and

24 supports tailored to the individual needs of each child, typical wraparound services

25 include crisis intervention, mobile therapy, therapeutic staff support, behavioral

26 specialist consultation, cognitive retraining, family based rehabilitation services,

27 specialized evaluations, family therapy, parent education and training, and other

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1 outpatient psychiatric and psychological services. Case management is essential to

2 coordinate the provision of these services and to coordinate health care services with

3 services available from other programs, such as child welfare and education. The

4 provision of wraparound services is necessary to treat or ameliorate certain mental

5 health conditions and permits treatment of children in the least restrictive, most

6 integrated setting appropriate to their needs.

7

60. California does not provide wraparound as a Medi-Cal service, nor does the

8 State make the components of wraparound available to Medi-Cul recipients on a

9 consistent statewide basis. As a result, many foster children with behavioral,

10 psychiatric, or emotional impairments. do not receive services necessary to treat or

11 ameliorate these conditions.

12

61. Therapeutic foster care (also known as treatment foster care) is an

13 important Medicaid benefit provided in other states. It consists of intcnsive and highly

14 coordinated mental health and support services provided to a foster parent or caregiver,

15 in which the foster parent/caregiver becomes an integral part of the child's treatment

16 team. In some cases, the foster parent or caregiver may be reimbursed for therapeutic

17 services provided to the child under the supervision of a licensed health care provider.

18 For children in the foster care system or who are at risk of out-or-home placement and

19 whose needs are too great for a conventional foster home (even with access to outside

20. mental health services) therapeutic foster care is an important alternative to placement in

21 an institutional or congregate care setting. California does not include therapeutic foster

22 care as a benefit under its Medicaid program, nor is this service available to Medicaid

23 beneficiaries on a consistent statewide basis through other means.

24

62. Case management services are a Medicaid benefit that assists Medicaid

25 beneficiaries in gaining access to needed medical, social, educational, and other

26 services.

27

28

19

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

63. In California, children in foster care with emotional and behavior problems

2 and who need specialty mental health services do not have access to Medicaid case

3 management on a consistent, statewide basis. For many children, there is no

4 coordination between the services provided to them through the Medi-Cal mental health

5 system and the services available to them through the child welfare care system. In

6 addition. neither system offers consistent coordination of services to which these

7 children are entitled under other programs such as special education under the

8 Individuals with Di~abilitit:~ Education Act (IDEA), Maternal and Child Health

9 programs under Title V of the Social Security Act, including programs for children with

10 special health care needs, and Social Services under Title XX of the Social Security Act.

11 B. Substantive Due Process under the 14th Amendment to the United States

Constitution and Article I, Section 7(a) of the California Constitution

12
64. The Fourteenth Amendment to the United States Constitution guarantees

13
that States will not "deprive any person oflife, liberty, or property without due process

14
oflaw," and protects those fundamental rights and liberties that are implicit in the

15
concept of ordered liberty such that sacrifice of them would prevent the existence of

16
liberty or justice.

17 65. While in direct custody of the State, children have a substantive due

18 process right to safety and to reasonable treatment consistent with professional

19
judgmc:;nt. Children have a constitutionally protected right to be free from unreasonable

20
and unnecessary intrusions upon their physical and emotional well being and to be free

21
from harm.

22 66. Article 1, Section 7(a) of the California Constitution guarantees that a

23 "person may not be deprived oflife, liberty, or property without due process oflaw."

24 The protections of substantive due process umkr Califurnia law have the same scope

25

I

and purposes as those under the United States Constitution.

26

27

28

FIRST AMF:NDF:D COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1C.
2

The Americans with Disabilities Act, 42 U.S.C. § 12132,28 C.F.R. &35.130; Section 504 of the Rehabilitation Act, 29 U.S.c. § 701 et seq.; ami Califorma Government Code § 11135 et seq., 22 C.C.R. § 98000 et seq.

3

67. The Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12131 et seq.,

4 prohibits public entities from discriminating against or excluding a qualified individual

5 with a disability from enjoying or participating in the benefits of semces, programs, or

6 activities of the public entity on the basis of disability. 42 U.S.C. § 12132,28 C.F.R. §

7 35.130.

8

68. Public entities must administer services, programs, and activities in the

9 most integrated setting appropriate to the needs of qualified individuals with disabilities.

10 28 C.F.R. § 35.130(d).

11

69. Public entities also must make reasonable modifications in policies,

12 practices, or procedures when necessary to avoid discrimination on the basis of

13 disability, unless the public entity can demonstrate that the modifications would

14 fundamentally alter the nature of the service, program, or activity. 28 C.F.R. §

15 35. 130(b)(7).

16

70. Section 504 of the Rehabilitation Act provides in pertinent part: "[N]o

17 otherwise qualified individual with a disability ... shall, solely by reason of her or his

18 disability, be excluded from the participation in, be uellieu the benefits of, or be

19 subjected to discrimination under any program or activity receiving Federal financial

20 assistance...." 29 U.S.C. § 794.

21

71. Under California law, "No person in the State of California shall, on the

22 basis of ... a physical or mental disability, be denied the benefits of, or be unlawfully

23 subjected to discrimination under any program or activity funded by the State or

24 receiving any financial assistance from the state." 22 C.C.R. § 98100.

25

72. California Government Code section 11135 provides that programs or !

26 activities conducted, operated, or administered by the state or by any state agency

27 funded directly by the state, or receiving financial assistance from the state, "shal1 meet

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1 the protections and prohibitions contained in Section 202 of the Americans with

2 Disabilities Act of 1990 (42 U.S.C. § 12132), and the federal rules and regulations

3 adopted in implementation thereof except that if the laws of this state prescribe stronger

4 protections and prohibitions, the programs and activities [receiving state funding] shall

5 be subject to stronger protections and prohibitions." Cal. Govt. Code § 11135(b).

6

73. Recipients of state funding must provide disabled persons with services that

7 are as effective in affording an equal opportunity to obtain the same result, to gain the

8 same benefit, or to n:adl tht: ~arllt: level of achievement as those provided to others. In

9 some situations, identical treatment may be discriminatory. 22 C.C.R. § 98101(c).

10

VII. REQUISITES FOR RELIEF

11

74. By reason of the factual allegations set forth above, an actual controversy

12 has arisen and now exists between Plaintiffs and Defendants. Plaintiffs contend that

13 their rights under the Constitution and laws of the United States amllht: Slale of

14 California are being violated, while Defendants are charged with enforcing and

15 complying with those legal requirements. A declaration from this Court that Plaintiffs'

16 rights have been violated is therefore necessary and appropriate.

17

75. Defendants' failure to comply with the requirements offederal and state

18 law will result m Irreparable harm to Plaintiffs. Plaintiffs have no plain, adequate, or

19 complete remedy at law to address the wrongs described herein. Plaintiffs therefore

20 seek injunctive relief restraining Defendants from engaging in the unlawful and

21 unconstitutional acts and policies described herein.

22

23

24

25

26

27

28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

VIII. CLAIMS

2

FIRST CAUSE OF ACTION

3

(Against DRS and Los Angeles County for Violation of the

4

Medicaid Act, Early and Periodic Screening, Diagnostic and Treatment

5

(EPSDT) Services, 42 U.S.C.§ 1396 et seq.)

6

76. Plaintiffs incorporate by reference the foregoing paragraphs of this

7 Complaint as though fully set forth herein.

8 Defendants, while acting under color oflaw, have developed and maintained customs,

9 policies, and practices that deprive Plaintiffs of statutory rights, in violation of 42 U.S.C.

10 § 1983, by failing to provide Medi-Cal-eligible children with the full range of services

11 covered by Medicaid when such services are necessary to treat or ameliorate a child's

12 condition, in violation of 42 U.S.C. § 1396d(r)(5).

13

SECOND CAUSE OF ACTION

14

(Against All Defendants for Violation of Substantive Due Process

15

under the 14th Amendment to the United States Constitution)

16

77. Plaintiffs incorporate by reference the foregoing paragraphs of this

17 Complaint as though fully set forth herein.

18

78. Defendants have restraineu Plaintiffs' persullallilJerty by taking these

19 minors into State custody, assuming responsibility for their safety and general well

20 being, and thereby rendering them wholly dependent on Defendants.

21

79. nefenclant~, while acting under color oflaw, have developed and

22 maintained customs, policies, and practices that deprive children with behavioral,

23 emotIonal, and psychiatric impairments of their constitutional rights, in violation of 42

24 U.S.C. § 1983, by failing to provide them with adequate living conditions, reasonable 25 safety and protection from harm, and adequate and appropriate medical care and

26 services. Such failures have caused Plaintiffs' conditions to deteriorate. These practices

27 of Defendants represent a substantial departure from accepted professional judgment,

28

23

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1 practice, and standards, and subject Plaintiffs to unsafe conditions and psychological and

2 physical harm, in violation of the Fourteenth Amendment to the United States

3 Constitution.

4

THIRD CAUSE OF ACTION

5

(Against All Defendants, for Violation of Americans with Disabilities Act,

6

42 U.S.C. § 12132,28 C.F.R. § 35.130), and Section 504 of the

7

Rehabilitation Act, 29 U.S.C. § 701 et seq.)

8

80. Plaintiffs incorporate by referem;e the foregoing paragraphs of this

9 Complaint as though fully set forth herein.

10

81. Children in DCFS custody with behavioral, emotional, and psychiatric

11 impainnents are qualified individuals with disabilities within the meaning of the ADA,

12 42 U.S.C. § 12131 (2), and are "otherwise qualified individuals with a disability" within

13 the meaning of the Rehabilitation Act.

14

82. Defendants are public entities subject to the provisions of the ADA. 42

15 U.S.C. § 12131 (1 )(A, ). Defendants receive federal financial assistance, and are thus 16 subject to the provisions of the Rehabilitation Act.

17

83. Defendants have failed to administer services, programs, and activities in

18 the most integrated setting appropriate to the needs of children in DCFS custody. 28

19 C.F.R. § 35.130(d). Defendants have placed children in restrictive, institutional settings,

20 where children are prevented from maintaining meaningful contact with their families,

21 schools, and communities.

22

84. Defendants have discriminated against Plaintiffs by denying them the

23 opportunity to participate in and benefit from Defendants' foster care and health

24 services, programs and activities; affording them an unequal opportunity to participate

25 in Defendants' foster care and health programs and services; and aiding and

26 perpetuating discrimination by assisting the other Defendant agencies in discriminating

27 against Plaintiffs. 28 C.F.R. § 35.130(b)(1).

28

FIRST AMRNmm COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02·056662 ARM (SHx)

1

85. Defendants have further discriminated against Plaintiffs in violation ofthe

2 ADA by utilizing criteria or methods of administration that have the effect of (i)

3 subjecting Plaintiffs to discrimination on the basis of disability; (ii) substantially

4 impairing accomplishment of the objectives of Defendants' foster care program; and (iii)

5 perpetuating discrimination by other Defendant agencies subject to COmmon

6 administrative control. 28 C.F.R. § 35.l30(b)(3).

7

86. Defendants have discriminated against Plaintiffs on the basis of their

8 llisabililits by failillg to make reasonable modifications in their policies, practices, or

9 procedures. Reasonable modification of Defendants' policies, practices, or procedures

10 would not fundamentally alter the nature of their services, programs, or activities, but

11 rather would further Defendants' stated goals. 28 C.F.R. § 35.l30(b)(7).

12

87. Defendants have discriminated against Plaintiffs solely on the basis of

13 disability in violation of the Rehabilitation Acl by: (i) failing to provide reasonable

14 accommodations to allow Plaintiffs to participate fully in Defendants' programs and

15 receive adequate services; and (ii) failing to provide and support appropriate

16 community-hased placements, instead requiring Plaintiffs to be confined in restrictive,

17 institutional settings without adequate services. Defendants' acts and omissions alleged

18 herein have denied and continue to deny Plaintiffs the opportunity to benefit from

19 Defendants' services, programs, and activities.

20

FOURTH CAUSE OF ACTION

21 (Against All Defendants for Violation of Substantive Due Process nnrler Article T,

22

Section 7(a) of the California Constitution)

23

88. Plaintiffs incorporate by reference the foregoing paragraphs of this

24 Complaint as though fully set forth herein.

25

89. Defendants have restrained the Plaintiffs' personal liberty by taking these

26 minors into State custody, assuming responsibility for their safety and general well

27 being, and thereby rendering them wholly dependent on Defendants.

28

25

FIRST AMENDED COMPLAINT FOR DECLARATORY AND IN.HJNCTlVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1

90. Defendants, through their acts and omissions, have deprived Plaintiff

2 children of their constitutionally protected liberty interest to be reasonably safe and free

3 from harm and to receive reasonable treatment as described in the foregoing paragraphs

4 of this Complaint. The practices of Defendants represent a substantial departure from

5 accepted professional judgment, practice, and standards.

6

FIFTH CAUSE OF ACTION

7 (Against All Defendants for Violation of California Government Code § 11135 et seq.,

8

22 C.C.R. § 98000 et seq.)

9

91. Plaintiffs incorporate by reference the foregoing paragraphs of this

10 Complaint as though fully set forth herein.

11

92. Defendants have discriminated against Plaintiff children by failing to make

12 reasonable modifications in their policies, practices, or procedures, that would allow

13 them to participate in and benefit from Defendants' fusler care and health services.

14 Reasonable modification of Defendants' policies, practices, or procedures would not

15 fundamentally alter the nature of their services, programs, or activities, but rather would

16 further Defendants' stated goals.

17

IX. PRAYER FOR RELIEF

18

WHEKEtURE, Plaintiffs respectfully request that this Court:

19

(a) Assert jurisdiction over this action;

20

(b) Order that Plaintiffs may maintain this action as a class action pursuant to

21 Rule 23(b)(2) of the Federal Rules of Civil Procedure;

22 (c) Declare unconstitutional and unlawful Defendants' failure to comply with the

23 mandates of the Medicaid Act; the Fourteenth Amendment to the United States

24 Constitution; the Americans with Disabilities Act; Section 504 of the Rehabilitation Act;

25 Article I, Section 7(a) of the California Constitution; and California Government Cocle §

26 11135 et seq.;

27 28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

(d) Pennanently enjoin Defendants from subjecting members of the Plaintiff

2 Class to practices that violate their rights;

3

(e) Award to the Plaintiffs the reasonable costs and expenses incurred in the

4 prosecution of this action, including but not limited to reasonable fees and costs

5 pursuant to 42 U.S.C. §§ 1988 and 1920; and

6

(f) Award such other equitable and further relief as the Court deems just and

7 proper.

8
9 DATED: December 20, 2002

10

HELLER EHRMAN WHITE & McAULIFFE LLP

11 12

ByLcY~ ~

13

RONALD C. PETERSON

14

AMERICAN CIVIL LIBERTIES UNION

OF SOUTHERN CALIFORNIA

15

16 17

By --L~~~k..=--~~=~=.=.~~",~...,tr!:-.-­

MARK ROSENBAUM

18

19

CENTER FOR LAW IN THE PUBLIC INTEREST

20 21

By L~~~

LEW HOLLMAN

22

Attorneys for Plaintiffs

23

ROBERT D. NEWMAN (86534)

24

KIMBERLY LEWIS (144879) WESTERN CENTER FOR LAW

AND POVERTY

25

3701 Wilshire Bou]evar<k Suite 208

26

Los Angeles, California ~0010-2809 Telephone: (213)487-7211

Facsmri1e: (213) 487-0242
27

28

27

FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 ARM (SHx)

1

MELINDA BIRD (102236)

.

2

MARILYN HOLLE (61530)

PROTECTION & ADVOCACY INC.

3

3580 Wilshire Boulevard, Suite 902

Los Angeles, California 90010

4

Telephone: (213) 427-8747

FacsImile: (213) 427-8767

5

CAROLE SHAUFFER (00226)

6

ALICE BUSSIERE (114680)

YOUTH LA W CENTER

7

417 Montgomery Street, Suite 900

San FranCISCo; California 94104

8

Telephone: ("1-15) 543-3379

Facsimile: (415) 956-9022

9 IRA BURNIM (pro hac vice)

10

MARY GILBERTI (oro hac vice)

BAZELON CENTER. FOR

11

MENTAL HEALTH LAW

1101 Fifteenth Stree~ NW, Suite 1212

12

Washington, DC 20v06

Telephone: (202) 467-5730

13

Facsllnile: (202) 223-0409

14

15

16

17

18

19

20

21

22

23

24
25

26

27

28

FTR.'lT AMF.NDF.D COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1 PROOF OF SERVICE BY MAIL
2

3

I, Debora K. Biggers, declare as follows:

4

I am employed with the law firm of Heller Ehrman White & McAuliffe LLP,

5 whose address is 601 South Figueroa Street, 40th Floor, Los Angeles, California 90017.

6 I am readily familiar with the business practices of this office for collection and

7 processing of correspondence for express mailing with the United States Postal Service;

8 I am over the age of eighteen years and not a party to this action.

9

On December 20, 2002, I served the following:

10

FIRST AMENDED COMPLAINT FOR DECLARATORY AND

INJUNCTIVE RELIEF
11

on the below parties in this action by placing true copies thereof in sealed envelopes,

12

addressed as shown, for collection and mailing pursuant to the ordinary business

13
practice of this office which is that correspondence for express mailing is collected and

14

deposited with the United States Postal Service on the same day in the ordinary course

15 of business:

16

17 Name: Richard T. Waldow

Facsimile Number: (213) 897-2805

18 Name: Jerry M. Custis

Facsimile Number: (323) 881-3791

19

20

I declare under the penalty ofpeljury under the laws of the United States of

21 America that the foregoing is true and correct and that 1 am employed in the office of a

22 member of the bar of this Court at whose direction the service was made.

23

Executed at Los Angeles, California, on December 20, 2002.

24

25

26

27

28

FIRST AM]?,NTl]?,n COMPLAINT FOR DRCLARATORY AND INJUNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

1

SERVICE LIST

2

3 BILL LOCKYER
4 Attorney General of the State of California JOHN H. SANnF,RS
5 Lead Supervising Deputy Attorney General 6 TAMMYCHUNGRYU
Supervising Deputy Attorney (jeneral 7 RICHARD T. WALDOW 8 CRISTINA FELIX-CARRASCO
Deputy Attorneys General 9 300 S. Spring Street, 9th Floor, North Tower 10 Los Angeles, California 90013 2501
Telephone: (213) 897-2456 11 Facsimile: (213) 897-2805

Attorneys for Defendants DIANA BONTA, Director of California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

12
LLOYD W. PELLMAN 13 County Counsel
14 ADA GARDINER Assistant County Counsel
15 DAWYN R. HARRISON 16 Senior Deputy County Counsel
JERRY M. CUSTIS 17 Deputy County Counsel 18 CATHERINE J . PRATT
Deputy County Counsel 19 Children's Services Division 20 201 Centre Plaza Drive, Suite 1
Monterey Park, California 91754-2143 21 Telephone: (323) 526-6106
22 Facsimile: (323) 881-3791

Attorneys for LOS ANGELES COUNTY

23 24 25 26
27
28

FIRST AMENDED COMPLAINT FOR DECLARATORY AND IN.TIJNCTIVE RELIEF CASE NO.: 02-056662 AHM (SHx)

 </s> Case 2:02-cv-05662-AHM -SH Document 779 Filed 12/05/11 Page 1 of 42 Page ID #:5054

1

2

3

4

5

6

7
UNITED STATES DISTRICT COURT
8

9

CENTRAL DISTRICT OF CALIFORNIA

10
WESTERN DIVISION

11

KATIE A., etc., et al,
12

13
v.
14

Plaintiffs,

15 TOBY DOUGLAS, etc., et al,

16

Defendants.

17

) CASE NO. CV-02-05662 AHM (SHx)

)

)

STIPULATED JUDGMENT PURSUANT TO CLASS ACTION

) SETTLEMENT AGREEMENT

)

) Date:

December 1, 2011

) Time:

2:00 p.m.

) Courtroom: 14

) Judge:

A. Howard Matz

)

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Plaintiffs and Defendants, the Director of the California Department of

23 Health Care Services (CDHCS), the Director of the California Department of

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Social Services (CDSS), as well as non-party (Real Party in Interest) the Director
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of the California Department of Mental Health (CDMH) (collectively “State
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Defendants”) have entered into a settlement agreement for resolution of this class
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action matter. Defendant Los Angeles County previously entered into a settlement
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agreement with plaintiffs which this court approved and entered judgment pursuant

thereto on July 17, 2003.

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STIPULATED JUDGMENT PURSUANT TO CLASS ACTION SETTLEMENT AGREEMENT

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Plaintiffs and the State Defendants (the Parties) have submitted the proposed

2 Settlement Agreement to the Court for final approval pursuant to, and in

3 compliance with Federal Rules of Civil Procedure, Rule 23, subdivision (e).

4
The Court found that the Parties gave notice of the proposed Settlement
5
Agreement to the Plaintiff class and others thereby affected in a reasonable
6
manner. Fed. R. Civ. P. 23(e)(1). On December 1, 2011, the Court conducted a
7
fairness hearing pursuant to Fed.R. Civ. P. 23(e)(2), affording the parties and all
8
other interested persons the opportunity to be heard in support of and in opposition
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to the proposed settlement agreement. After reviewing and considering the papers
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11 filed in support of the settlement agreement, the evidence, argument, comments

12 and objections submitted at the fairness hearing, the Court has made a finding that

13 the settlement agreement is fair, reasonable and adequate to bind class members.

14

The Court having fully considered the matter and good cause appearing,

15 hereby ORDERS, ADJUDGES AND DECREES as follows:

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1. The Court has jurisdiction over the claims for injunctive and

17 declaratory relief against State Defendants pursuant to 28 U.S.C. §§ 1331, 1343

18 and 1367. Venue is proper in the Central District of California pursuant to 28

19 U.S.C. § 1391(b).

20

2. This case has been certified as a class action for purposes of all claims

21
against State Defendants on behalf of a class of children in California who:
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(a) Are in foster care or are at imminent risk of foster care
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placement, and
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(b) Have a mental illness or condition that has been documented or,
25
had an assessment already been conducted, would have been documented, and
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(c) Who need individualized mental health services, including but
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28 not limited to professionally acceptable assessments, behavioral support and case

management services, family support, crisis support, therapeutic foster care, and

2 ______________________________________________________________________________________
STIPULATED JUDGMENT PURSUANT TO CLASS ACTION SETTLEMENT AGREEMENT

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1 other medically necessary services in the home or in a home-like setting, to treat or 2 ameliorate their illness or condition.
3

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For the purposes of this case, “imminent risk of foster care placement”

5
means that within the last 180 days a child has been participating in voluntary
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family maintenance services or voluntary family reunification placements and/or
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has been the subject of either a telephone call to the Child Protective Services
8

hotline or some other documented communication made to a local Child Protective
9

Services agency regarding suspicions of abuse, neglect or abandonment.
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3. Judgment is entered pursuant to the terms of the Settlement

12 Agreement incorporated herein, as though fully set forth, and attached as Exhibit A

13 to this Judgment.

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4. The Court orders the parties to the Settlement Agreement to perform

15 all of their obligations thereunder.

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5. The Court will retain jurisdiction over this lawsuit until 36 months

17 after court approval of the Settlement Agreement, at which time the Court’s
18 jurisdiction will expire. Pursuant to Paragraph 30 of the Settlement Agreement,
19 this expiration of jurisdiction shall not be extended, for any reason, beyond the 36-
20 month period following approval of the Settlement Agreement.
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6. Pursuant to Paragraph 15 of the Settlement Agreement, the Settlement
22
Agreement settles all claims against the State Defendants in this lawsuit.
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7. The Court finds that no just reason exists for delay in entering this
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Judgment pursuant to the Settlement Agreement. Accordingly, the Clerk is hereby
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directed to enter this Final Judgment.
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STIPULATED JUDGMENT PURSUANT TO CLASS ACTION SETTLEMENT AGREEMENT

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1

8. This Judgment is binding against State Defendants, their successors in

2 office, CDHCS, CDSS, CDMH1, the respective officers, agents and employees of

3 these state agencies.

4
9. The Court will subsequently dismiss this lawsuit against the State
5
Defendants in accordance with the terms of the Settlement Agreement.
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DATED: December 05, 2011
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____________________________________________

12

A. HOWARD MATZ

United States District Judge
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28 1 Because of the possible restructuring of CDMH, at this time it is uncertain as to whether

CDMH will be the State agency responsible for performing the obligations assigned to CDMH

pursuant to this Agreement. State Defendants agree that the State will perform CDMH’s

obligations under this Agreement.

4

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STIPULATED JUDGMENT PURSUANT TO CLASS ACTION SETTLEMENT AGREEMENT

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 </s> 433 F.Supp.2d 1065 (2006)
KATIE A., et al., Plaintiffs, v.
Diana BONTA, et al., Defendants.
No. CV02-5662 AHM(SHX). United States District Court, C.D. California.
March 14, 2006. 1066 *1066 Alison Barkoff, Ira Burnim, Washington, DC, Alissa Beth Kolek, Carlyle W. Hall, III, Robert Garcia, Robert
D. Newman, Ronald C. Peterson, Heller Ehrman White & McAuliffe, Benjamin E. Wizner, Mark D. Rosenbaum, Aclu Foundation of Southern California, Katrina McIntosh, Kimberly Lewis, Laura N. Diamond, Marilyn Holle, Melinda R. Bird, Protection & Advocacy, Los Angeles, CA, Gina L. Zaragoza-Cruz, Gina L. Zaragoza-Cruz Law Offices, Woodland Hills, CA, John F. O'Toole, Patrick H. Gardner, National Center for Youth Law, Oakland, CA, Lew Hollman, Lin Min Kong, Santa Monica, CA, for Plaintiffs. Catherine J. Pratt, Jerry M. Custis, Children Services Division, Monterey Plaza, CA, Erik S. Pitchal, Ira P. 1067 Lustbader, *1067 Marcia Robinson Lowry, Children's Rights, New York City, Jennifer M. Kim, Sandra L. Goldsmith, Office of the Attorney General, Lionel Z. Glancy, Glancy & Binkow, Brandon T. Nichols, Los Angeles County Counsel, Los Angeles, CA, for Defendants.
ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION
MATZ, District Judge.
TABLE OF CONTENTS
I. INTRODUCTION............................................................1067
II. DISCUSSION..............................................................1069
A. Legal Standard for Preliminary Injunctions..........................1069
B. Standing............................................................1070
C. Does the Medicaid Act Require That California Provide Wraparound Services and Therapeutic Foster Care to Plaintiffs?...............1071
1. Are They Services?..............................................1071
2. Does EPSDT Require Wraparound and Therapeutic Foster Care?......1074
III. CONCLUSION..............................................................1078 I. INTRODUCTION Plaintiffs are five troubled children with unmet mental health needs who were, at the time this suit was filed, in the custody of the Los Angeles County Department of Children and Family Services ("DCFS").

Defendants are Sandra Shewry, the current Director of the California Department of Health Services ("DHS"), and Dennis Boyle, the current Director of the California Department of Social Services ("DSS") (collectively, the "State Defendants").[1]
Plaintiffs in their First Amended Complaint ("FAC") allege that for foster children with "behavioral, emotional or psychiatric impairment[s]," FAC ¶ 37, adequate mental health services include, among other things, wraparound services and therapeutic foster care. Plaintiffs allege, and State Defendants agree, that virtually all foster children in California receive, or are eligible to receive, their health care services through Medi-Cal, which is California's Medicaid program. Id. ¶ 3; Answer 113. This means, according to Plaintiffs, that virtually all foster children in California who have "behavioral, emotional or psychiatric impairments" are entitled to wraparound services and/or therapeutic foster care where such services are medically appropriate.
Over Defendants' opposition, on June 18, 2003, the Court certified the following class:
[C]hildren in California who (a) are in foster care or are at imminent risk of foster care placement; and (b) have a mental illness or condition that has been documented or, had an assessment already been conducted, would have been documented; and (c) who need individualized mental health services, including but not limited to professionally acceptable assessments, behavioral support and case management services, family support, crisis support, therapeutic foster care and other necessary services in the home or in a home-like setting, to treat or ameliorate their illness or condition.
1068 *1068 Order Re Class Certification [of Statewide Class].[2]
On September 9, 2005, Plaintiffs filed a motion seeking a mandatory preliminary injunction requiring the State Defendants to provide wraparound services and therapeutic foster care to all members of the statewide class, within 60 days from the entry of an order granting the motion.[3] The proposed injunction would require Plaintiffs and the State Defendants to meet and confer to develop an implementation plan and to submit a joint status report thereafter. The Court conducted a hearing on October 31, 2005, and requested additional briefing. The supplemental briefs have helped clarify the issues and very recent decisions have reinforced the Court's initial view that Plaintiffs have satisfied the necessary prerequisites for injunctive relief.
Given the passage of time and the competing demands of the Court's caseload, in certain respects this Order necessarily will be streamlined. Thus, for example, because the parties are fully familiar with their respective contentions, the Court will not set forth in detail their arguments nor deal with all the voluminous evidence they proffered. Nevertheless, I am compelled to precede this analysis of the motion with relevant observations about this case.
First, at stake in this lawsuit is the health of thousands of children in California who are already in, or are likely soon to wind up in, foster care.[4] "[C]hildren with serious emotional disabilities are among the most fragile members of our society; their medical needs frequently extend across a spectrum of service providers and state agencies." Rosie D. v. Romney, 410 F.Supp.2d 18, 23-24 (D.Mass. 2006). The class of plaintiffs here, like the emotionally disturbed children in Rosie D., have "complex needs [and are] particularly vulnerable." Id. at 33-34. Indeed, Plaintiffs' needs are so compelling that Congress afforded them "rights" embodied in a federal statute. The statute is difficult to apply, however, which has led to this complex, hard-fought litigation, with the usual attendant delays and diversion of resources in determining the scope of assistance to which the class members are entitled. Even though the Government has agreed to provide aid to these children and has an interest in doing so, the adversary process risks swallowing up and interfering with both sides' mutual objectives.
1069 *1069 In addition to the needs and rights of foster children, also at stake is the impact on the State of California of complying with requirements of the Medicaid Act when the State's budgetary and administrative resources are badly strapped and the range of Medicaid-mandated services continually become ever-costlier.[5]
Finally, also at issue here is the capacity of any court to enforce a decree entailing the delivery of services to mentally-troubled youngsters caught up in a complex social welfare system that is, to say the least, beleaguered.

In California, the foster care system has been widely acknowledged to be failing. Can "EPSDT" (Early and Periodic, Screening, Diagnostic and Treatment Services) for children, to which Plaintiffs have a right, really provide significant benefits through wraparound services and therapeutic foster care? Perhaps the Court should not ponder that question. Perhaps the Court should do nothing more than simply recognize that these forms of treatment are part of Plaintiffs' EPSDT rights, and enforce them. From the hard lessons this Court has learned in enforcing the judgment in Emily Q. v. Bonta, 208 F.Supp.2d 1078 (C.D.Cal.2001), however, information about just how much the welfare of foster children will improve as a result of the requested injunction cannot be considered superfluous.
II. DISCUSSION
A. Legal Standard for Preliminary Injunctions
The parties do not dispute the legal standard for issuance of a preliminary injunction:
To obtain a preliminary injunction in the district court, plaintiffs [must] demonstrate (1) a strong likelihood of success on the merits, (2) the possibility of irreparable injury to plaintiffs if preliminary relief is not granted, (3) a balance of hardships favoring the plaintiffs, and (4) advancement of the public interest. . . . Alternatively, injunctive relief could be granted if the plaintiffs demonstrate[ ] either a combination of probable success on the merits and the possibility of irreparable injury or that serious questions are raised and the balance of hardships tips sharply in their favor. . . . These two alternatives represent extremes of a single continuum, rather than two separate tests. . . . As a result, the greater the relative hardship to the party seeking the preliminary injunction, the less probability of success must be established by the party. . . .
Rodde v. Bonta, 357 F.3d 988, 994 (9th Cir.2004) (citations, internal quotation marks, and alterations omitted). In addition, "[m]andatory preliminary relief, which goes well beyond simply maintaining the status quo Pendente lite, 1070 is particularly *1070 disfavored, and should not be issued unless the facts and law clearly favor the moving party." Anderson v. United States, 612 F.2d 1112, 1114 (9th Cir.1979).
B. Standing
As previously noted, Plaintiffs' substantive claims are based primarily on the Medicaid Act. The key statutory provisions at issue are 42 U.S.C. §§ 1396a(a), 1396d(a) and 1396d(r). As a threshold matter, the State Defendants contend that Plaintiffs do not have a private right of action to bring a suit under 42 U.S.C. § 1983 for violations of these provisions of the Medicaid Act.
The applicable test for standing is set forth in Blessing v. Freestone, 520 U.S. 329, 117 S.Ct. 1353, 137 L.Ed.2d 569 (1997). As stated in S.D. ex rel. Dickson v. Hood, 391 F.3d 581, 602 (5th Cir.2004),
In Blessing. . . . the Supreme Court reiterated the three factors that it has traditionally considered when determining whether a particular federal statute gives rise to a right enforceable by § 1983: (1) whether Congress intended for the provision to benefit the plaintiff; (2) whether the plaintiff can show that the right in question is not so "vague and amorphous" that its enforcement would "strain judicial competence"; and (3) whether the statute unambiguously imposes a binding obligation on the states.
In Gonzaga Univ. v. Doe, 536 U.S. 273, 122 S.Ct. 2268, 153 L.Ed.2d 309 (2002), the Supreme Court held that a former university student could not bring a § 1983 suit for alleged violations of the Family Educational Rights and Privacy Act because that statute had an "aggregate focus" and did not contain rights-creating language targeting a specific, identifiable group of individuals:
We . . . reject the notion that our cases permit anything short of an unambiguously conferred right to support a cause of action brought under § 1983. Section 1983 provides a remedy only for the deprivation of "rights, privileges, or immunities secured by the Constitution and laws" of the United

States. Accordingly, it is rights, not the broader or vaguer "benefits" or "interests," that may be enforced under the authority of that section.
Id. at 283, 122 S.Ct. 2268.
[Where a] provision focuse[s] on "the aggregate services provided by the State," rather than "the needs of any particular person," it confer[s] no individual rights and thus could not be enforced by § 1983.
Id. at 282, 122 S.Ct. 2268 (quoting Blessing, 520 U.S. at 343, 117 S.Ct. 1353) (emphasis added). Following Gonzaga, in deciding whether a statute gives rise to an enforceable right under § 1983, courts have looked to whether Congress intended that a specific, identifiable class of individuals benefit from the statute.
Some six weeks ago, the Ninth Circuit held that the main subsection of section 1396a(a) on which Plaintiffs here rely 0907 § 1396a(a)(10)[6] 0907 "creates an individual right enforceable under section 1983." Watson v. Weeks, 436 F.3d 1152, 1155 (9th Cir.2006). The decision in Watson contains a useful review of the "Medicaid Framework" 1071 and "of the applicable law for determining whether a particular federal *1071 statute can be enforced through a private right of action under section 1983." Id. at 1157-62. It is unnecessary to set forth that review here, and I will not do so. It is sufficient to note that in ruling that § 1396a(a)(10) creates a private right of action enforceable under § 1983, the Ninth Circuit "join[ed] five federal circuits that have already so held." Id. at 1159. Also, the court distinguished Sanchez v. Johnson, 416 F.3d 1051 (9th Cir.2005), the case on which the State Defendants mainly rely, by contrasting the Medicaid Act provision involved in that case (§ 1396a(a)(30)(A)) with the one involved in Watson (and here) 0907 § 1396a(a)(10)(A). Id. at 1161. In short, under Watson Plaintiffs do have standing.
C. Does the Medicaid Act Require That California Provide Wraparound Services and Therapeutic Foster Care to Plaintiffs?
1. Are They Services?
Defendants do not dispute that by voluntarily participating in Medicaid through its Medi-Cal program, California is required to "comply with certain requirements imposed by the Act and regulations promulgated by the Secretary of Health and Human Services. . . ." Wilder v. Va. Hosp. Ass'n, 496 U.S. 498, 502, 110 S.Ct. 2510, 110 L.Ed.2d 455 (1990). Nor do they dispute that the Medicaid Act requires the provision of EPSDT to Medicaid-eligible children under the age of twenty-one, 42 U.S.C. § 1396d(a)(4)(B); that EPSDT requires the State to screen eligible children "to determine the existence of certain physical or mental illnesses or conditions," 42 U.S.C. § 1396d(r)(1)(A)(ii); and that the Act requires the State "to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan." 42 U.S.C. § 1396d(r)(5).
What the State Defendants do dispute is that "wraparound services" and "therapeutic foster care" are EPSDT services and are "medically necessary." They contend that the Medicaid Act only applies to "services" and that wraparound and therapeutic foster care are not "services" per se, but rather "approaches" or "processes" or "philosophies" regarding the delivery of health care. See, e.g., Barthels Depo., Vol. 1 at 82:14-18; Grayson Depo. at 30:7-14. In a related vein, the State Defendants also complain that "Plaintiffs have not only failed to define, but have obstreperously resisted defining, what they mean by the terms `wraparound services' and `therapeutic foster care.'"
Throughout much of this litigation this Court has pressed Plaintiffs to specify, in as concrete a manner possible, the precise forms of assistance that "wraparound services" and "therapeutic foster care" entail. Plaintiffs now have done so, at least to the extent necessary to refute the State Defendants' objections that they cannot understand what such assistance consists of and should not be ordered to do something that they cannot understand.
As to "wraparound services," Plaintiffs have provided a statutory reference point.[7] Plaintiffs also have defined "wraparound" as follows:

1072

Providers of wraparound care services: (a) engage in a unique assessment and treatment planning process that is characterized by the formation of a child, *1072 family, and multi-agency team (b) marshal community and natural supports through intensive case management and (c) make available an array of therapeutic interventions, which may include behavioral support services, crisis planning and intervention, parent coaching and education, mobile therapy, and medication monitoring.

McCabe Decl., Ex. D, App. A at 1. In addition, Plaintiffs have provided a nine page chart breaking down each of the nine identified component services of wraparound services. For each component service, they presented a detailed definition of what that service entails, the qualifications of the rendering providers (e.g., "Staff with BA/BS in MH-related field or with 2 years experience in Mental Health"), and the specific provision(s) of the Medicaid Act under which, they contend, California must provide that service. Plaintiffs set forth these detailed definitions in an "Appendix A" to their answers to interrogatories.

As to "therapeutic foster care," Plaintiffs have described that component of the requested mandatory injunction as "an intensive, individualized health service provided to a child in a family setting, utilizing specially trained and intensively supervised foster parents." These programs:

(a) place a child singly, or at most in pairs, with a foster parent who is carefully selected, trained, and supervised and matched with the child's needs; (b) create, through a team approach, an individualized treatment plan that builds on the child's strengths; (c) empower the therapeutic foster parent to act as a central agent in implementing the child's treatment plan; (d) provide intensive oversight of the child's treatment, often through daily contact with the foster parent; (e) make available an array of therapeutic interventions to the child, the child's family, and the foster family (interventions may include behavioral support services for the child, crisis planning and intervention, coaching and education for the foster parent and the child's family, and medication monitoring); and (f) enable the child to successfully transition from therapeutic foster care to placement with the child's family or alternative family placement by continuing to provide therapeutic interventions.

McCabe Decl., Ex. D, App. B at 1. In addition, Plaintiffs proffered a seven page chart breaking down each of the seven component services of therapeutic foster care, the requisite qualifications of the providers, and the statutory authorization. Id. Plaintiffs specified these aspects of therapeutic foster care as "Appendix B" to their answers to certain interrogatories.[8]

Are Appendices A and B mere words that provide only an illusion of medically necessary services? Are they highfalutin sentiments devoid of practical application? Is what Justice Cardozo once wrote applicable: "We seek to find peace of mind in the word, the formula, the ritual. The hope is an illusion." Benjamin N. Cardozo, The Growth of the Law, pp. 66-67 (1924). Or do Appendices A and B merely reflect that "[t]he only tool [that] the lawyer [has] is words. We have no marvelous pills to prescribe for our patients. . . . Whether we are trying a case, writing a brief, drafting a contract, or negotiating with an adversary, words are the only things we have to work with." Charles Alan Wright, Book Review, Townes Hall Notes, Spring 1988, at 5.

1073 It is perhaps inevitable that in defining and describing these disputed means of *1073 treatment for mentally ill children ("wraparound services" and "therapeutic foster care"), Plaintiffs included imprecise terms, bordering on jargon. Nevertheless, I find that the physicians, therapists, social workers, teachers, counselors, parents and others who are necessary providers of EPSDT surely are able to convert these words into meaningful services.

And services they are. Defendants understandably prefer to characterize "wraparound" and "therapeutic foster care" as "processes" or "approaches" or "philosophies," because those words are not in the Medicaid Act 0907 only "services" are mandated.[9] But to relegate "wraparound" and "therapeutic foster care" to some realm other than "services," as the State Defendants seek to do, is akin to limiting the classification of a criminal defense attorney's "services" to only his advice and incourt representation, while excluding his necessary efforts at coordinating the professional work of others, such as an investigator, jury consultant or sentencing consultant. Often the client is assisted by a team of professionals, and a key, necessary "service" of the lawyer is to

coordinate these professionals' respective services. To extend the analogy further, a criminal defense attorney will also rely on (and help shape) the participation of the client himself in his coordinated defense. So, too, in "wraparound" a core element of that service is "family voice and choice," i.e., family participation in and contribution to the array of treatment. See Bruns Decl. ¶ 26.[10]
1074 *1074 2. Does EPSDT Require Wraparound and Therapeutic Foster Care?
The State Defendants proceed to argue that even if "wraparound" and "therapeutic foster care" are services, the Medicaid-mandated provision of EPSDT does not encompass them. Section 1396d(r) lists an array of services that states are required to provide to children under age twenty-one. Plaintiffs rely primarily on § 1396d(r)(5), a catch-all provision, which requires that states render "[s]uch other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services. . . ." The State Defendants contend that this language means that such states need only provide those services expressly listed in § 1396(d) (a).
The Court disagrees. Section 1396d(a) identifies twenty-eight different services, including diagnostic services, psychiatric services, rehabilitative services and case management services. To be sure, the statute does not mention "wraparound services" and "therapeutic foster care," but a specific service, although not expressly listed in § 1396d(a), may nevertheless fall under one of the other twenty eight categories. See, e.g., Pediatric Specialty Care, Inc. v. Ark. Dep't. of Human Servs., 293 F.3d 472, 480-481 (8th Cir. 2002) ("early intervention day treatment" required under § 1396d(a)(13) (rehabilitative services)); Collins v. Hamilton, 349 F.3d 371, 376 (7th Cir.2003) ("psychiatric residential treatment facilities" required under § 1396d(a)(16) (inpatient psychiatric hospital services)); Emily Q., 208 F.Supp.2d at 1090 ("therapeutic behavioral services" required under EPSDT). "Congress did not grant or allow states the discretion to define what types of health care and services would be provided to EPSDT children. . . ." S.D., 391 F.3d at 593. As stated in Rosie D., supra, "the only limit placed on the provision of EPSDT services is the requirement that they be `medically necessary'. . . ." Rosie D., at 25-26 (emphasis added). "[I]f a licensed clinician finds a particular service to be medically necessary to help a child improve his or her functional level, this service must be paid for by a state's Medicaid plan pursuant to the EPSDT mandate." Id.
Wraparound services has nine component services; therapeutic foster care has seven. Each component service has numerous subcomponent services. Each subcomponent may fall under any one or more of the twenty-eight different categories of § 1396d(a). The three categories Plaintiffs claim to be most frequently applicable are: "rehabilitative services," 42 U.S.C. § 1396d(a)(13); "case management services," 42 U.S.C. § 1396d(a)(19); and "personal care services," 42 U.S.C. § 1396d(a)(24). Plaintiffs' supplemental interrogatory responses described above (Appendices A and B) link, in chart form, each component of wraparound services and therapeutic foster care service to the corresponding category or categories of § 1396d(a). The declaration of Chris Koyanagi 1075 provides a similar breakdown. Koyanagi Decl. ¶ 23-31.[11] The Court finds it *1075 likely that virtually all of the corresponding categories of § 1396d(a) identified by Plaintiffs do, in fact, encompass the linkedto service.[12]
The State Defendants do not directly rebut or even challenge Ms. Koyanagi's categorizations. Instead, they merely point to a June 28, 2005 report by the federal Government Accountability Office ("G.A.O.") that proposes numerous legislative reforms to Medicaid, one of which aims to address the use of categories such as "rehabilitation services" to improperly bill the federal government for services "that are intrinsic elements of nonMedicaid programs." See Defs.' Ex. 103 at 168. Even assuming that in principle the G.A.O. report could be relevant, it is of no help to State Defendants. It does not discuss EPSDT or wraparound services and therapeutic foster care. Moreover, it confirms that "Medicaid payments will be available for appropriate rehabilitation services that are intended for the maximum reduction of physical or mental disability and measurable restoration of an individual to the best possible functional level." Id. (emphasis in original).
In short, wraparound services and therapeutic foster care fall within the EPSDT obligations of Medicaidparticipating states. This conclusion is buttressed by the fact that in other states wraparound services and therapeutic foster care programs have been funded by Medicaid. For example, Linda Huff Redman, Ph.D., the former Deputy Director of Arizona's Medicaid Program, states that Arizona uses Medicaid funding for EPSDT to

pay for almost all of the component services of therapeutic foster care 0907 the only exclusions being "room and board expenses and the one-time or occasional goods and/or services needed to support the child and their family (e.g., refrigerator, clothes)."[13] Redman Decl. ¶¶ 3, 18-26. Nineteen other states[14] also provide therapeutic foster care as a "mental health service paid for by Medicaid and billed using codes in the `Healthcare 1076 Common Procedure Coding *1076 System.'" Id. ¶ 19. Arizona also funds its wraparound services program with Medicaid dollars. Id. ¶¶ 4, 27-30. The Medicaid-covered components of Arizona's therapeutic foster care program includes "group rehabilitative treatment, individual and family therapy, substance abuse/chemical dependency therapy, basic living skills redevelopment, social skills redevelopment and crisis/behavior management." Id. ¶ 25. The Medicaid-covered components of its wraparound program include the engagement of the child and family; immediate crisis stabilization; strengths, needs and cultural discovery; formation of the child and family team; development and implementation of the behavioral health plan; on-going crisis and safety planning; tracking and adapting; and transition out of the formal wraparound program. Id. ¶ 29. Dr. Redman's detailed description of Arizona's state-wide program is corroborated and supplemented by Timothy Penrod, formerly a State of Arizona Child Protection Services Specialist and now the CEO of a firm providing those kinds of services to children and families in Arizona. Penrod Decl. ¶¶ 1-26.
Nebraska has used Medicaid funds to provide wraparound services, Koyanagi Decl. ¶ 27, although the parties debate the extent to which Medicaid dollars now contribute to that program. Koyanagi Supplemental Decl. ¶ 3b; Defs.' Ex. 107.
Pennsylvania's wraparound services are "funded by Pennsylvania's Medicaid program, as part of its EPSDT benefit." Nace Decl. ¶ 30-31.
In Milwaukee, Wisconsin, Medicaid funding is used for "Wraparound Milwaukee" to cover "case management, team meetings, mobile crisis intervention, psychiatric and psychological assessments, crisis stabilization teams, medical day treatment, medication management, in-home therapy, office-based therapy, group therapy, substance abuse treatment, and a comprehensive provider system." Kamradt Decl. ¶ 18. Only "[n]on-medically necessary services 0907 like tutors and mentors 0907 are not covered. . . ." Id.
Even the State Defendants' own expert, Mary Jean Duckett, of the United States Department of Health and Human Services, acknowledges that "[s]ome states have included in their approved state plans, coverage for services under the label of therapeutic foster care that [the federal Center for Medicare and Medicaid Services] believed to consist of component parts that are Medicaid-covered care and services within the scope of the definitions listed in 42 U.S.C. § 1396d(a)." Duckett Decl. ¶ 5.
Not only do wraparound services and therapeutic foster care fall within the scope of Medicaid-mandated ESPDT services, but they may be "medically necessary" within the meaning of the statute. The Medicaid Act does not define when a service is "medically necessary." Rather, the decision "rests with the individual recipient's physician and not with clerical personnel or government officials." Pinneke v. Preisser, 623 F.2d 546, 550 (8th Cir.1980); Weaver v. Reagen, 886 F.2d 194, 200 (8th Cir.1989) ("The Medicaid statute and regulatory scheme create a presumption in favor of the medical judgment of the attending physician in determining the medical necessity of treatment."). Plaintiffs have proffered the declarations of numerous behavioral and mental health experts who attest to the medical necessity of providing these services to foster care children with emotional disturbances. Thus, Ira Lourie, a former psychiatrist at the National Institute for Mental Health for over two decades and currently Assistant Clinical Professor of Child Psychiatry at Georgetown University School of 1077 Medicine, states that *1077 "wraparound services are medically necessary for children with serious mental health needs." Lourie Decl. ¶ 2. Dr. Lourie adds that "wraparound programs enable children with behavioral, psychiatric, or emotional impairments to function as well and as normally as possible." Lourie Decl. ¶ 13. Dr. Patricia Chamberlain, an Oregon-based psychologist who developed a therapeutic foster care program lauded by the federal government, states that "a children's mental health system that does not include Therapeutic Foster Care . . . as an available intervention is incomplete and inadequate because intense mental health interventions, provided in home-like settings are necessary for many children with serious behavioral or mental health needs." Chamberlain Decl. ¶ 3. Dr. Eric Bruns, a psychologist and Assistant Professor at the University of Washington School of Medicine, states that "[a]long with therapeutic foster care, . . . wraparound is generally cited among the most effective integrated communitybased interventions for children with emotional, behavioral, and mental

health disorders. As such, both therapeutic foster care and wraparound are integral parts of any modern children's mental health system." Bruns Decl. ¶ 3. Dr. Charles Huffine, a psychiatrist who served as President of the American Association of Community Psychiatrists, states that wraparound services "are essential mental health services and medically necessary for some children with mental health needs." Huffine Decl. ¶ 7. Dr. Robert Friedman, the Chair of the Department of Child and Family Studies at the University of South Florida, states that "[t]herapeutic foster care is an evidence-based practice, the gold standard in mental health interventions for youth. . . . [T]here are sufficient findings to consider wraparound services a research validated evidence-based practice." Friedman Decl. ¶ 4. He adds that "a functioning children's mental health system would include both therapeutic foster and wraparound care services. Both services are necessary for some children with serious emotional disturbance, many of whom are in the foster care system." Id. ¶ 5. Friedman also notes that "wraparound services and therapeutic foster care are widely thought of as essential to any modern children's mental health system. . . ." Id. ¶ 31.
The State Defendants have not presented any declarations by mental health experts contesting this evidence that wraparound services and therapeutic foster care are medically necessary services for foster care children with mental health care needs.[15]
For all the foregoing reasons, the Court concludes that Plaintiffs have demonstrated a strong likelihood of succeeding on the merits of their substantive claims concerning the Medicaid Act and EPSDT.
1078 Plaintiffs contend that the balance of hardships tips in their favor because absent an order requiring the State of *1078 California to provide wraparound services and therapeutic foster care, those foster children with mental health needs would likely face unnecessary institutionalization. The State Defendants' one paragraph opposition on this point argues (1) that Plaintiffs cannot be suffering irreparable injury given that they waited three years since initiating this suit to file the present motion and (2) that Plaintiffs have an adequate remedy via the Medicaid appeals process. As to the first argument, Plaintiffs initially focused much of their efforts and limited resources on their claims against Los Angeles County, which led to a pioneering, albeit, still problem-laden, settlement. The County agreed to ensure that members of the county wide subclass "promptly receive necessary, individualized mental health services in their home . . . or the most homelike setting appropriate to their needs; receive the care and services needed to prevent removal from their families . . .; be afforded stability in their placements . . .; and receive care and services consistent with good child welfare and mental health practice and the requirements of state and federal law." Katie A. Advisory Panel's Fifth Report to the Court, June 16, 2005, at 3. As to the remaining members of the statewide class, the unmet mental health needs and the harms of unnecessary institutionalization are no less grave now than three years ago.
Defendants' argument that the Medicaid appeals process undermines the showing of irreparable injury is also unpersuasive. "[E]xhaustion of state administrative remedies should not be required as a prerequisite to bringing an action pursuant to § 1983." Patsy v. Bd. of Regents of State of Fla., 457 U.S. 496, 516, 102 S.Ct. 2557, 73 L.Ed.2d 172 (1982).
III. CONCLUSION
The Court GRANTS Plaintiffs' motion for preliminary injunction.[16] The component services of wraparound services and therapeutic foster care identified in Plaintiffs' supplemental interrogatory responses likely fall within the EPSDT provisions of the Medicaid Act. Therefore, California must screen members of the statewide class and provide wraparound services and therapeutic foster care where medically necessary "to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services." 42 U.S.C. § 1396d(r)(5).[17]
Accordingly, during the pendency of this lawsuit, Defendant Sandra Shewry, in her official capacity as Director of the California Department of Health Services, and Defendant Dennis Boyle, in his official capacity as Director of the California Department of Social Services, as well as their respective successors in office, agents, servants, 1079 employees, and all others *1079 acting in concert with them, shall provide wraparound services and therapeutic foster care, as defined in Appendices A and B. Such forms of treatment shall be provided to class members on a consistent, statewide basis through the Medi 0907 Cal program or other means, beginning not later than 120 days

from entry of this Order. (The plan need not necessarily include all of the aspects of wraparound services and therapeutic foster care specified in Appendices A and B.) In order to effectuate this requirement, counsel for the State Defendants and for Plaintiffs shall meet and confer and develop a plan for implementing this preliminary injunction. Among other things, the plan must identify the responsibilities of the different State agencies, the need for additional providers, the eligibility criteria for wraparound services and therapeutic foster care, methods and procedures to inform class members of the availability of these services, and a timeline for accomplishing needed tasks. In negotiating the plan, counsel shall diligently and in good faith take into account and apply this Court's previous rulings and observations in this case and in Emily Q.
Furthermore, the State Defendants and Plaintiffs shall also meet and confer as to whether the Court should appoint a Special Master. (If the Court does so, the individual may well be the same person who may be appointed Special Master in Emily Q.)
Not later than 70 days from entry of this Order, the State Defendants and Plaintiffs shall file a joint status report regarding the status of an implementation plan and the possible appointment of a Special Master.
Because this action is brought by a class of indigent Plaintiffs, the Court chooses to exercise its discretion by not requiring the posting of a bond. People of Cal. ex rel. Van De Kamp v. Tahoe Reg'l Planning Agency, 766 F.2d 1319, 1325 (9th Cir.1985).
IT IS SO ORDERED.
[1] Shewry's predecessor was Diana Bonta Boyle's predecessor was Rita Saenz.
[2] Plaintiffs' FAC also named the Los Angeles County DCFS and its Director, Anita Block, as defendants (collectively, "the County Defendants"). On July 16, 2003, the Court conducted a fairness hearing on a tentative settlement agreement reached between Plaintiffs and County Defendants on behalf of a subclass of children who are in the custody of DCFS, or have been referred to or are subject to referral to DCFS. The Court approved the settlement. See Stipulated Order Re Final Approval of Class Settlement (July 16, 2003) and Stipulation Between Plaintiffs and County Defendants Regarding Definition of Class Members (Feb. 23, 2004).
Although the present motion does not involve the County Defendants directly, they have expressed their views on the issue by filing a "Statement of Position Re: Plaintiffs' Motion for Preliminary Injunction." In short, the County states that it "is committed and able to meet its obligations within the existing Medi-Cal structure but would benefit from the changes proposed by Plaintiffs. . . . Should Plaintiffs prevail . . . the County will be able to meet its obligations more easily and this will necessarily help to enure to the benefit of the children and family it serves."
[3] Defendants do not dispute that currently they are not providing these forms of assistance, as such, to members of the plaintiff class.
[4] As of July 1, 2004, over 85,000 children were in child welfare-supervised foster care in California. Pls.' Ex. 106.
[5] Because the Court need not deal directly with the claims asserted under the Americans with Disabilities Act and Rehabilitation Act, see infra, the Court does not analyze the State Defendants' arguments that the State's limited resources militate against imposing wraparound and therapeutic foster care on a statewide basis. See Olmstead v. L.C. ex. rel. Zimring, 527 U.S. 581, 603, 119 S.Ct. 2176, 144 L.Ed.2d 540 (1999). This decision concerns only the Medicaid Act, and as stated in Ark. Med. Soc'y, Inc. v. Reynolds, 6 F.3d 519, 531 (8th Cir.1993), a state "may take . . . budget factors into consideration when setting its reimbursement methodology," but it "may not ignore the Medicaid Act's requirements in order to suit budgetary needs." In any event, there is substantial evidence that wraparound services and therapeutic foster care actually save the State money, compared to alternatives involving institutionalization. See, e.g., Bruns Decl. ¶ 22(b)-(c); Kamradt Decl. ¶¶ 16-17; Chamberlain Decl. ¶ 26; Farr Decl. ¶ 20; see also Pls.' Ex. 135 at 969, Ex. 136 at 971-72, Ex. 137 at 974.
[6] The precise provision is 42 U.S.C. § 1396a(a)(10)(A)(1), which in essence provides that a Medicaid-funded "State plan for medical assistance must . . . provide for making medical assistance available" to various recipients

specified elsewhere. Those recipients include "individuals . . . under the age of 21." 42 U.S.C. § 1396d(a)(4)(B). "Medical assistance" includes payment for EPSDT. Id.
[7] It is California Welfare and Institutions Code § 18251(d), which describes "community based intervention services that emphasize the strengths of the child and family and [that] include[] the delivery of coordinated, highly individualized unconditional services to address needs and achieve positive outcomes in their lives."
[8] Henceforth, in this opinion the charts that were attached as the appendices to the McCabe Declaration shall be referred to as Appendix A and Appendix B.
[9] The State Defendants argue that "[m]ost of Plaintiffs' declarations do not state, or even suggest, that `wraparound services' or `therapeutic foster care' are Medicaid covered services as such." Opp'n at 21. Defendants then review several of the declarations submitted by Plaintiffs' experts 0907 e.g., those of Eric Bruns, Ph.D.; Ira Lourie, M.D.; Robert Friedman, Ph.D.; Patricia Chamberlain, Ph.D. With respect to each, Defendants argue that: (1) the expert does not explicitly refer to "wraparound services" and "therapeutic foster care" as "services" per se and (2) the expert has not claimed that wraparound services and therapeutic foster care are covered by Medicaid. These arguments are not persuasive.
First, that Defendants have combed through these declarations and have been able to locate instances where the terms "wraparound" or "therapeutic foster care" are found alongside the words "process," "program," or "practice" (instead of the word "service") does not mean that they are not services. Indeed, such games can be played with the opposite effect. Plaintiffs have pointed out occasions where the State has itself referred to wraparound as a "service" 0907 e.g., California's "Wrap-Around Services Pilot Project." Opp'n at 13 (emphasis added). Also, California Welfare and Institutions Code § 18250(d) 0907 a statute 0907 also refers to "Wraparound services."
Second, that Plaintiffs' medical and behavioral experts do not also opine on whether the EPSDT provisions of the Medicaid Act cover wraparound services and foster care is of no consequence. Plaintiffs rely on different experts to establish that point. See below.
[10] Defendants quote out of context and in a misleading manner this Court's observation in Emily Q. that "[t]he wraparound process is not a program or a type of service." Emily Q., 208 F.Supp.2d at 1091. What the Court actually noted in that limited portion of a 28 page opinion dealing with Therapeutic Behavioral Services ("TBS") was that "TBS is one type of a broad variety of individualized services that may be used in a `wraparound' process. The wraparound process is not a program or a type of service. [It] can include any combination of services and support." (emphasis added.) To infer from the middle sentence that something that consists of a combination of services and supports is not in itself a "service" within the meaning of the Medicaid Act makes no sense. See Farr Decl. ¶ 23 n. 1 ("[R]eferring to Wraparound as a process . . . do[es] not mean . . . that it is not a mental health service. Individual and group therapy and case management services, for instance, can all be described as processes, but they are unquestionably mental health services. The same is true for Wraparound.")
[11] Ms. Koyanagi is the Policy Director of the Washington, D.C.-based Bazelon Center for Mental Health Law, which is one of the counsel for Plaintiffs. She works with the federal Center for Medicare and Medicaid Services and the federal Substance Abuse and Mental Health Services Administration. She was the primary author of "Making Sense of Medicaid for Children with Serious Emotional Disturbance." Id. ¶ 10 and Ex. 2. That definitive study "demonstrated that wraparound and therapeutic foster care can be covered by Medicaid," id. ¶ 22, and that states "regularly" receive Medicaid funding for such services. Id. ¶ 26.
[12] For example, the first component service of wraparound services is "Engagement of the Child and Family." See Appendix A at 2. A subcomponent of that service is to "organize[ an initial meeting with the child and family [to] explain[] wraparound care services . . . and encourage[] the participation of additional family members. . . ." Id. The Court finds that this likely falls under § 1396d(a)(19) (case management services). As another example, the second component service of wraparound services is "Immediate Crisis Stabilization." Id. at 2-3. A subcomponent of that service is "to address safety issues related to medical needs, severe psychiatric symptoms, behaviors of a child that might place others in jeopardy, or issues related to a child living in an unsafe environment." Id. at 3. The Court finds that, depending on the circumstances and severity of the crisis, these

activities likely fall under § 1396d(a)(5)(A) (physician services), § 1396d(a)(2)(A) (outpatient hospital services), § 1396d(a)(9) (clinic services), § 1396d(a)(7) (home health care services), or § 1396d(a)(13) (rehabilitative services).
Each component service of therapeutic foster care similarly falls within, one or more categories of § 1396d(a). For example, "Recruitment and Matching," which includes "the recruitment of families to serve as therapeutic foster parents, and then matching those families with children in need of a therapeutic foster home," See Appendix B at 2, likely falls under § 1396d(a)(19) (case management services).
[13] These exclusions are not applicable here since Plaintiffs do not seek to compel California to provide them.
[14] Arkansas, Delaware, Florida, Georgia, Kansas, Kentucky, Michigan, Minnesota, Montana, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, and Wyoming. Id. ¶ 19 n. 2.
[15] In reference to the wraparound services provided via California's Title IV-E Waiver Child Demonstration Project, the State Defendants do contend that "a federally required independent evaluation of the project showed that the project did not demonstrate that provision of wraparound services was any more effective than traditional services." (citing Treadwell Decl. ¶ 11). This is misleading. Treadwell went on to state that "[t]he evaluation . . . concluded that one of the likely reasons that there was no statistically significant positive effect shown for the group of children receiving wraparound services was that the [participating] `counties were more successful at providing Wraparound-like services to the comparison [i.e., control] group than the evaluation was able [to] assess, resulting in similar outcomes between the groups.'" Treadwell Decl. ¶ 11.
[16] Docket No. 315.
[17] Given this conclusion, it is unnecessary to address Plaintiffs' alternative claims that they are entitled to the same relief under the Americans with Disabilities Act and the Rehabilitation Act. Similarly irrelevant is the State Defendants' contention that Title IV-E of the Social Security Act, which is the primary funding mechanism for children who have already been placed in foster care, does not permit payment for social services for the child or the child's family when the child has not yet been removed from the home. Plaintiffs do not claim that the State of California must pay for wraparound and therapeutic foster care using Title IV-E funds (although Title IV-E funds may, indeed, cover certain component services of wraparound services and therapeutic foster care). Rather, Plaintiffs claim that the Medicaid Act's independent funding provision, namely, Title XIX of the Social Security Act, will likely help cover those services. Thus, any restrictions on the use of Title IV-E funds are not relevant to Plaintiffs' Medicaid-based argument.
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 </s> Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 1 of 41 Page ID #:7878

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UNITED STATES DISTRICT COURT

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CENTRAL DISTRICT OF CALIFORNIA

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WESTERN DIVISION

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14 KATIE A., et al.,

Case No. 2:02-cv-05662 JAK (SHx)

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Plaintiffs, SPECIAL MASTER'S NOVEMBER

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v.

2014 PROGRESS REPORT ON THE IMPLEMENTATION OF THE

17 DIANA BONTA, et aI.,

KATIE A. PLAN

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Date: November 24,2014 Defendants. Time: 3:OOp.m.

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Crtrm: 750 Judge: Honorable John A. Kronstadt

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Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 2 of 41 Page ID #:7879

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TABLE OF CONTENTS

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SECTION ONE: INTRODUCTION

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5 SECTION TWO: KATIE A~ SERVICES TO SUBCLASS MEMBERS

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6

7 SECTION THREE: STATUS ON STATE ACTIVITIES FOR INCREASING

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9 SERVICES TO SUBCLASS MEMBERS IN SELECTED COUNTIES

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11 SECTION FOUR: KATIE A. STATE AND COUNTY STRUCTURES

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13 SECTION FIVE: PARTIES PLAN TO MAINTAINING COMMUNICATION

14 POST JURISDICTION

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16 SECTION SIX: THE SPECIAL MASTER'S SUMMARY AND FINDING

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18 SECTION SEVEN: THE SPECIAL MASTER'S RECOMMENDATIONS

19 TO THE COURT

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21 EXHIBITS:

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22 EXHIBIT ONE: THE SHARED MANAGEMENT STRUCTURE AND COMMUNICATION

23 PLAN

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25 EXHIBIT TWO: CALIFORNIA DEPARTMENT OF SOCIAL SERVICES AND

26 DEPARTMENT OF HEALTH CARE SERVICES DATA SHARING AGREEMENT

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Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 3 of 41 Page ID #:7880

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SECTION ONE: INTRODUCTION

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This Progress Report is submitted to the Court in accordance with the Katie A. Court's Order

5 dated October 16,2014, Court Dkt 918. Special Master had planned on distributing a draft

6 Report for the Parties review and comment on before filing the Progress Report with the Court

7 but due to time constraints the Special Master was unable to provide the Parties with a draft prior

8 to filing the Report. The timing of the receipt of the implementation updates from the State and

9 the time necessary for the Special Master to read, analyze and reasonably respond to the updates,

10 did not allow enough time to provide a draft Report for the Parties and also meet the November

11 20, 2014 filing date.

12

The views expressed in the Special Master's report on the State's progress in implementing

13 the Katie A. Implementation Plan (hereafter referred to as "the Plan") are those of the Special

14 Master only and do not necessarily represent the views of the Parties in implementing the Katie

15 A. Plan, who may provide the Court with their own written responses to this report.

16

The Special Master expects this to be his final Report to the Court on the progress of the

17 State's implementation of Katie A. The Court has indicated that the Status Conference set for

18 November 24,2014 will be the final Status Conference.

19 Purpose and Organization of this Report

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This report has two purposes: (1) update the Court on progress made in implementing the

21 Katie A. Plan since the October 16,2014 Status Conference; and (2) provide the Court with a

22 summary of Post Jurisdiction opportunities and challenges.

23

The Special Master recognizes that the Court's jurisdiction over this matter is scheduled to

24 end December 5, 2014. The current report will not attempt to review the extensive description

25 and discussion on the State's implementation ofthe Plan that were covered in previous Reports to

26

27 challenges in the State's effort to implement the Plan that were thoroughly reviewed in the

28 Special Master's, June 16,2014, Report, Court Dkt 899.

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Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 4 of 41 Page ID #:7881

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This November 2014 Report begins with the focus on the State's current progress and results

4 in implementing the Katie A. Service Delivery Action Plan. and Updated Therapeutic Foster Care

5 (TFC) Work Plan, March 4, 2014, Court Dkt 883, and with the Plaintiffs', State Defendants', and

6 Special Master's Statement ofAgreement on Selected Recommendations from the Special

7 Master's Report, Court Dkt 913, August 15,2014 and Statement ofAgreement on

8 Recommendation 1-4, October 28,2014, Court Dkt 919.

9

The report will focus primarily on those implementation activities related to promoting,

10 supporting and ensuring the delivery of Intensive Care Coordination (ICC) and Intensive Home

11 Based Services (IHBS), and Therapeutic Foster Care (TFC) (once implemented) to Katie A.

12 children, as medically necessary, which is at the heart of the Katie A. Settlement Agreement.

13 Additionally, this report will provide a review and update on the development of new State

14 structures for a Shared Management System between the State Departments of Social Services

15 (DSS) and Health Care Services (DHCS), and a State and county quality assurance and oversight

16 structure/system. As such, this report is organized into sections plus exhibits:

17

• One: Introduction

18

• Two: Katie A. Services to Subclass Members

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• Three: Status on State Activities for Increasing Services to Subclass Members in Selected

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Counties

. 21

• Four: New Katie A. State and County Structures

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• Five: Parties' Plan to Maintaining Communication Post Jurisdiction

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•. Six: The Special Master's Summary and Findings

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• Seven: The Special Master's Recommendations to the Court

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• EXHIBITS

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SECTION TWO: KATIE A. SERVICES TO SUBCLASS MEMBERS

28

There now has been over a year and half of Katie A. implementation and data collection by

29 the State and counties. The Special Master's June and September 2014 Reports provided an

30 extensive review of the data available at that time. I will not provide such an extensive review of

31 the current data but will instead provide the State's 'Initial Observation' of the counties October

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Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 5 of 41 Page ID #:7882

1 2014 Semi-Annual Progress Report and provide an update on the relationship between estimated

2 number ofpotential subclass members self-reported by the counties in their October 2014 Semi-

3 Annual Progress Report and the unduplicated count by DHCS mental health claims data of

4 subclass members actually receiving ICC and IHBS. (DHCS's October 6, 2014 Twelve Month

5 Rolling Claims Data Report Oct 2013 - Sept 2014.)

6 This section will conclude with an update that will also be provided on the status of Therapeutic

7 Foster Care (TFC) implementation.

8 California Counties October 2014 Semi-Annual Progress Report-State Report

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The State has provided the Special Master with the following' Initial Observation' dated

10 November 10,2014 of the counties October 2014 Semi-Annual Progress Report:

11 Overview

12 The Katie A settlement agreement was designed to transform the way California's child

13 welfare and mental health systems work together to meet the mental health needs of

14 children and youth involved with both systems. This transformation is being accomplished

15 across the state through the adoption of a Core Practice Model (CPM) and provision of

16 Intensive Care Coordination (ICC), Intensive Home Based Set'vices (IHBS) and Therapeutic

17 Foster Care (TFC) (once clarified by the Federal Government) to children who meet certain

18 eligibility criteria as members ofthe subclass. The state has guided and monitored

19 implementation and delivery ofthese services through a series of county semi-annual

20 progress reports, which have been used to understandfactors behind both successes and

21 challenges of implementation and what is needed to ensure continued success.

22 As the following tables demonstrate, services implementation is dramatically increasing

23 over time. The May 2014 progress reports indicated considerable increases in the numbers

24 ofsubclass members identified and provided with ICC and IHBS services (Table 1). This

25 substantial increase is likely due to the initial launch efforts and subsequent push toward

26 full implementation by counties. The Ociober 2014 progress reports show more modest
27 t;ncI"ea,") es t+lnt a+t "f e,'..(It7ec+t a "",7)~f1L;.Uf+".}f'."Vn,I"I"" l"'t".l"'rl'al H ;'1""'Ple1'"1"£ e'f'PHratl' nMVII, e',:.Jf.JfVn.I-r"/n.J t+V A VA',',',r5rVnl'IMt g /n.JUH/.Jn"razf£',f,A,,nbl'll"'YVnJ.f
28 services (Table 2),

29

30

31

5

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 6 of 41 Page ID #:7883

1

2 Key indicators ofcounty progress between the Octobe7; 2013 and May 2014 progress

3 reports.

. :/:.: ,.',.' ........ > ...........
;'; ....<. •.,. <, >kleasure·· Subclass Members Identified

."., {)¢tQber:2013 ·.. M',..a..y2014·

12,538

16,577

P...e.r,'C.:e;.nt

..D,...

if ..

/. er. en..c... e

i 32 percent

Counties Providing ICC and 16
IHBS

42

i 163 percent

Children & Youth Receiving ICC 500 Children & Youth Receiving
312 IHBS

3,969 2,862

i 694 percent i 817 percent

Children & Youth Projected/or Services by Next Report Period]

5,060

7,353

i 45 percent

4 Table 1 5 Key indicators ofcounty progress between the May and October 2014 progress reports. 2

Subclass Members Identified

16,577

Counties Providing ICC and 42
IHBS

Children & Youth Receiving ICC 3,969

Children & Youth Receiving IHBS

2,862

Children & Youth Projected/or Services by Next Report Period

7,353

6 Table 2

7

8
9 Status 0/Previously Identified Issues

19,679 50 5,800 4,006
8,553

i 19 percent i 19 percent i 46 percent i 40 percent
i 16 percent

1 The numbers shown reflect children projected to receive ICC Services. Some of those children are also projected to receive IRES. 2 Final numbers are subject to change pending receipt of all October 2014 progress reports and completion of a full review and analysis.
6

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 7 of 41 Page ID #:7884

1 The State provides assistance to counties on issues identified as a barrier to successful

2 implementation ofservices. Solutions are often developed and always implemented at the

3 local level. For example, staffing needs and concerns are common throughout the State,

4 and relate to managing turnover, the associated initial and ongoing training needs, as well

5 as efforts to increase the size oftheir local workforce. To address these needs, counties

6 report expanding the size oftheir workforce for child welfare and mental health, increasing

7 contracts with service providers, revising local staffing plans, and sharing training

8 resources across agencies as well as among neighboring counties. The State is also

9 exploring options to help address the unique needs ofsmall, rural counties.

10 An issue many counties faced in the past related to questions about information sharing

11 practices and privacy laws. Given that CDSS and DHCS do not have the authority to

12 implement a statewide solution, the State actively sought alternative ways to address these

13 concerns. Some counties have developed and implemented solutions, such as standing court

14 orders, memoranda ofunderstanding, or other agreements. In addition, the State invited

15 the California Office ofInformation Integrity (CaIOHI) to speak during one ofthe regular

16 technical assistance calls (October 8, 2014). The CalOHI has the expertise and statutory

17 authority to speakfor the State on these matters, and provided information to the counties

18 about state and federal laws, including where exceptions exist regarding disclosure

19 restrictions. Solutions are being implemented successfully in many locations across the

20 State, and this issue has subsided substantially.

21

In the May 2014 progress reports, counties voiced strong concerns regarding increased

22 administrative workload associated with completing the progress reports. In response,

23 additional funding was identified and made available for counties beginning with the

24 October 2014 report. The Governor's Budget for Fiscal Year 201412015 includes $2

25 million to cover costs associated with counties completion ofthe progress reports.

26 Initial Observations from Current Reports

27

28 trends that will continue to be areas offocus goingforward. Some ofthese issues, which are

29 described below, are discussed during technical assistance calls with individual counties. It is

30 important to note, however, that in many cases additional information fl-om counties is needed to

31 understand the issues fully.

7

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 8 of 41 Page ID #:7885

1

While additional hiring and increased staffing were reported by many medium and large

2 sized counties, many small and afew large counties continue to experience challenges in this

3 area. Several small counties report that capacity is a barrier to providing services due to a

4 shortage in staff. Rural counties in particular struggle with recruiting and retaining qualified

5 staff.

6

Data reported by some counties may have been calculated incorrectly. It appears the State's

7 methodology remains a source ofconfusion for some counties. The number ofpotential subclass

8 members, was first added to the May 2014 progress report. This is just the second report to

9 include these elements. The State's efforts to clarifY the methodology were helpful in many

10 counties. Nevertheless, some county reports have beenflaggedfor follow up to requestfurther

11 information or explanation. Questions include things such as, whether confirmed subclass

12 members are included in the number ofpotential subclass members, how children in group homes

13 are reflected, and how a county defines "unknown to the County MHP." Questions like these and

14 others occur most often for counties that did not provide any information in Column 2 oftheir

15 report, which is where the State looks to find additional information about the data.

16

Other questions related to data center on information concerning potential subclass

17 members. Enclosure 1, Part A is usedfor counties to report numbers'ofpotential subclass

18 members, which relate directly to the process counties use to screen, refer, and assess a child's

19 mental health needs, The State is gaining a better understanding ofthese processes and their

20 effectiveness. In particular, the progress reports indicate the need to examine how referrals are

21 documented and tracked across both child welfare and mental health agencies. These issues will

22 be discussed in greqter detail when a full analysis ofthe reports is complete.

23

Although data shows that the provision ofICC and IHBS continued to increase following the

24 previous reporting period, the data may not accurately reflect the number ofsubclass members

25 receiving ICC and IHB8. Some counties have indicated in their progress reports, as well as in

26 conversations with the State, that a number ofsubclass members are receiving ICC and IHBS, but

27 that the county is billing it as a different service, such as Targeted Case lvfanagement or lvfental

28 Health Services. This appears to be occurring more fi-equently with ICC than IHB8.

29 Consequently, several counties report to the State that the number ofsubclass members receiving

30 ICC and IHBS is actually higher than what appears on monthly SDMC claiming reports.

31

Based on the progress reports, as well as conversations with counties, it appears that there

8

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 9 of 41 Page ID #:7886

1 are instances where identified subclass members may not be currently receiving little or any

2 mental health services. Although the reasons for this vary by county and by individual subclass

3 member, it is an issue that remains a concern andfocus ofthe State's continued outreach with the

4 counties. Both the State and counties recognize that this issue must continue to be further

5 analyzed, addressed, and monitored until every subclass member is receiving appropriate mental

6 health services.

7 Progress

8

Any examination ofprogress must include a point ofreference. Understanding where

9 . we are requires understanding where we began; to ensure that conclusions are drawn in the

10 proper context and that next steps are appropriate and likely to produce meaningful results.

11 With this is mind, it is helpful to consider a few points ofhistory.

12

Using information fi'om the May 2014 progress reports, just one year after the CPM

13 Guide and Documentation Manual were released and the initial steps of implementation

14 taken, 42 counties reported providing ICC to 3,969 children, with some of those children

15 also receiving IHBS. The relative significance of these numbers can be understood better

16 through a review of California's earlier implementation of Wrctparound Services. These

17 two implementation efforts differ in a number of important ways, but the service models of

18 the programs themselves share several key. elements, making the comparison relevant to

19 understanding the context in which current efforts are taking place.

20

As the table below shows (Table 3), California Wraparound Services programs were

21 approved in 47 counties between 199i and 2010. 4 The number ofchildren receiving

22 Wraparound Services in 2010 was approximately 3,400. 5 When considered alongside these

23 numbers, the substantial and rapid implementation progress achieved in Katie A seems

24 clear. Put another way, it took just one year for ICC and IHBS to reach the capacity that

25 Wraparound needed 13 years to achieve.

26

27

28

3 Wraparound Services were established in California in 1997 through Senate Bill 163. 4 With the passage of Realignment 2011, counties are not required to submit Wraparound Implementation Plans to CDSS for approval. The last Implementation Plan review and approval occurred in 2010. 5 Estimate based on monthly Wraparound Count Reports submitted to CDSS by counties.
9

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 10 of 41 Page ID #:7887
1 2

Time Period Reviewed

May 2013 -Feb 2014 1997 - 2010

Total Time to Achieve Service Level

One Yea;'

13 Years

Counties Providing Services

42

47

Children Receiving Services

3,969

3,400 (estimated)

3 Table 3

4

5

The Katie A. progress is also evident by way ofinfrastructure established in many counties.

6 Several counties have created a shared management structure between child welfare and mental

7 health, which has led to better communication and increased collaboration. This shared

8 management structure includes, but is not limited to, regular leadership meetings, Memoranda of

9 Understanding, co-located staffandjointly developed policies and procedures. The

10 establishment ofsuch infrastructure has not only contributed to the success ofcurrent

11 implementation efforts, but will also ensure continued progress and sustainability goingforward.

12

Another positive sign ofsuccessful implementation is the increased use ofparent andfamily

13 partners across the state. Many counties have reported that efforts have been devoted to

14 recruiting and training parent partners. Counties also discuss the participation ofparent

15 partners in Child and Family Team meetings and the positive impact it has had on the

16 children/youth andfamilies receiving services.

17 Katie A. sCount: Estimated Potential Number ofSubclass Members, Subclass Members, and

18 Provision ofICC and IHBS to Subclass Members

19

Estimated Potential Subclass Member Size: The October 2014 Counties Semi-Annual

20 Progress Report estimated the number ofpotential subclass members at 43,112 and increase of

21 7,723, a twenty-two percent increase from the counties May 2014 Semi-Annual Progress Report.

22

DHCS Rolling Claims Report ofICC and IHBS Provided to Subclass Members: The October

23 6, 2014 DHCS Twelve Month Rolling Claims Data reported 11, 738, unduplicated subclass

24 members received one or more types ofmental health services, and increase offifteen percent

25 from September 15, 2014 claims report.

10

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 11 of 41 Page ID #:7888

1

The October 6, 2014 Claims report indicated that ofthe 11,734 subclass members who

2 received one or more types ofmental health services, 6,672 subclass members received Intensive

3 Care Coordination (ICC) and 5,531 subclass members received Intensive Home Based Services

4 (IHBS), a thirteen andfourteen percent increase respectively from September 15, 2014 claims

5 data report.

6

Highest Monthly Total ofICC and IHBS Provided to Subclass Members: The DHCS Rolling

7 Claims Data (Oct 2013- Sept 2014) also reports unduplicated monthly totals. The highest single

8 monthly total for subclass members receiving ICC was April 2014 where 2,871 received ICC and

9 for IHB8, May 2014, where 2,541 received IHBS services. The highest single monthly totalfor

10 subclass members receiving any type ofmental health services was April 2014, where a total of

11 6,350 subclass members received some form ofmental health service.

12 Therapeutic Foster Care (TFC) Implementation

13

TFC is an intensive, individualized behavioral health service through which,a Katie A.

14 subclass child or youth is placed with specially selected, trained, and closely supervised TFC

15 parents. TFC services are provided based on medical necessity criteria, in accordance with the

16 child or youth's individualized care plan. TFC is an alternative t<;> placement in congregate care

17 for intensive treatment needs and can be a treatment placement for subclass members stepping

18 down from intensive congregate care facilities, thus reducing the time in congregate care

19 placements.

20

The TFC parents, as Medi-Cal providers under clinical supervision, serve as primary

21 change agents in the therapeutic treatment process and share responsibility for implementing the

22 child or youth's care plan by working closely with themental health ICC coordinator, child

23 welfare social worker, and other members of the child and family team (CFT).

24

DHCS is continuing to seek approval ofTFC by the Centers for Medicare and Medicaid

25 Service (CMS) as a Medi-Cal covered service. DHCS provided responses to the Centers for

26 Medicare and Medicaid Services' (CMS) Request for Additional Information (RA!) by September

27 23,2014 as specified in Recommendation 2 from the Plaintiffs', State Defendants', and Special

28 Master's Statement of Agreement filed with the court on August 15, 2014.

29

The DHCS has informed the Special Master that:

30 "DHCS has had conversations on October 30, 2014, and November 6, 2014, with CMS

31 regarding the TFC State Plan Amendment (SPA) #14-011. CMS indicated that there have been

11

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 12 of 41 Page ID #:7889

1 problems with TFC SPAs in other states and that CMS is looking at TFC SPAs with a different

2 lens. CMS informed DHCS that on October 14, 2014, CMS denied the State OfMississippi's SPA

3 on TFC for comparability reasons (limiting the service to children in foster care versus all

4 eligible children). CMS understands the importance ofTFC services for California and are

5 willing to work with DHCS to determine an appropriate and approvable methodfor implementing

6 TFC. This is a normal process with how CMS and DHCS work together through SPAs..

7 CMS was going to internally research and discuss strategies and get back to DHCS. CMS must

8 either approval or deny the SPA by December 22, 2014, which is when their 90-day clock

9 ends. (IfCMS is not ready to approve the SPA by December 22, 2014, DHCS would have the

10 option to withdraw its' responses to the RAJ which would take the SPA "offthe clock" and allow

11 additional time, ifneeded This, too, is standard protocol when more time is needed to work

12 through complexities ofa SPA). CMS has not yet provided a definitive response to whether or

13 not a SPA is necessary to implement TFC. "

14

15

SECTION: THREE: STATUS ON STATE ACTIVITIES FOR

16

INCREASING SERVICES TO SUBCLASS MEMBERS IN SELECTED COUNTIES

17

According to the Statements of Agreement on Selected Recommendations, Recommendation

18 1, Increase Services to Subclass Members In Selected Under-Performing Counties, Court Dkt

19 913, August 15,2014, the Statement of Agreement on Recommendations 1, Identify Measurable

20 Growth Trends, Court Dkt 919, October 28,2014, and utilizing the overarching framework

21 established in the Service Delivery Action Plan, CrtDkt 883, March 4,2014 the State was to

22 address utilization ofICC ap.d IHBS in the twelve counties with the largest child welfare caseload,

23 as well as in the counties not yet providing services (regardless oftheir size).

24

Furthermore, the State was to begin to identify for each county: a) performance goals for

25 increasing the number of children and youth receiving ICC, IHBS, and TFC (once implemented),

26 and (b) a projected timeline for achieving these goals. These goals would be based on county-

27 specific or local conditions.

28

DSS and DHCS completed its initial round of work with eight counties on September 15,

29 2014. The results of their initial actions with the eight counties was reported in the Special

30 Master's October 2014 Report.

31

12

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 13 of 41 Page ID #:7890

1

2 Activities Oli Increasing ICC and IHBS and Identifying County Performance Goals

3

The State has provided the Special Master the following summary of the status of State's

4' activities on increasing ICC and IHBS and on identifying performance goals for increasing the

5 number of subclass members receiving ICC and IHBS and TFC (once implemented):

6

Sixteen Counties - Consistent with Recommendation 1 ofthe August 15,2014 filing of

7 Plaintiffs', State Defendants', and Special Master's Statement ofAgreement on Selected

8 Recommendations, the State has continued its work to increase the provision ofICC and IHBS to

9 subclass members (SCM) in selected lower-performing counties or counties with the largest child

10 welfare caseloads. As noted in the Special Master's September 26, 2014 report to the court, the

11 State completed this work with the first eight counties by the September 15, 2014 deadline set

12 forth in Recommendation 1. The State committed to working with the remaining sixteen counties

13 with its initial outreach to each one to be completed by October 31,2014. The State has now

14 concluded this work with all sixteen counties which included: Contra Costa, Fresno, Kern, Lake,

15 Lassen, Mariposa, Modoc, Mono, San Bernardino, San Diego, San Joaquin, San Mateo, Santa

16 Clara, Sierra, Sutter, and Yuba.

17

The State also initiated a series ofcalls, to reach out to the counties to ascertain ifany

18 specific barriers existed that prevented themfi'om accurately identifying subclass members and/or

19 prevented themfi'om delivering ICC and IHBS to subclass members. Counties were also asked

20 what actions they were taking to address those barriers. With that information, the State assessed

21 how effective each county's actions were likely to be in addressing the identified barriers. In

22 some instances, the State reached out to counties on multiple occasions to better understand their

23 issues or planned actions. The State then identified the specific actions it would take with regard

24 to these specific counties to address the identified issue or barrier, including developing general

25 timelines for resolution.

26 I~sues or Barriers Identified by the State or County

27

Most counties reported a heightened effort to ensure that children entering the child welfare

28 system, and those already in the system, are promptly screened and referredfor assessments.

29 Most ofthe larger counties reported that they had completed the development ofpolicies and

30 procedures to address screening, referral and assessment, but a few smaller counties had not yet

31 completed these tasks but were in the process ofdoing so.

13

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 14 of 41 Page ID #:7891

1

While several counties reported having sufficient capacity to serve all subclass members

2 (SCM's) either currently or within the nextfew months, others reported numbers showing that

3 there were identified SCM's not yet receiving ICC and IHBS services. Explanations for this

4 included the following: SCM's were placed in group homes for whom ICC could not be billed

5 until 30 days before discharge, SCM's were placed out ofcounty; Medi-Cal billing ofICC or

6 IHBS has been delayed or incorrectly billed as another type ofservice such as Targeted Case

7 Management. A county that reported a large proportion ofchildren placed out ofcounty stated

8 that they will be working with the placement counties to ensure that out ofcounty youth receive

9 appropriate services. Several counties pointed out that children were receiving other types of

10 services that couldproperly be viewed as ICC, such as wraparound, although not billed as such.

11 Afew counties reported methodological difficulties in reporting accurately the number of

12 children identified as SCM's or those projected to receive services; fat example, one county did

13 not understand that the number ofprojected cases should be cumulative and another county

14 corrected its report by eliminating duplicate entries which decreased its reported numbers of

15 identified SCM's.

16

Some counties reported difficulties in recruiting and retaining qualified staffand other

17 capacity issues, particularly in small, rural counties. Several counties reported a need to improve

18 coordination between local mental health and child welfare agencies and requested training to

19 assist with the development ofadministrative structures to facilitate this; however, it should be

20 noted that, at this time, none ofthe 16 counties contacted reported difficulties in sharing

21 information across agencies as creating a barrier to appropriate identification or provision of

22 services to SCM's.

23

Implementing CFT's was also an issue for some counties. Among these counties, several

24 reported a need to develop policies and procedures on CFT's and requested training. Several

25 counties are using the Safety Organized Practice approach to providing services, which provides

26 further use ofCFTs and evidenced basedpractices consistent with the Core Practice Model.

27 Pro-active County Actions

28

Counties are taking various steps to improve screening ofpotential subclass members, and

29 identification ofSCM's, which will increase the number ofchildren receiving ICC and IHBS.

30 Several counties reported screening all new cases; other counties have adopted a Quality

31 Assurance practice ofreviewing all open cases on a periodic basis to ensure that they are

14

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 15 of 41 Page ID #:7892

1 screened and referredfor assessment ifthe screening indicates it is needed. For example, one

2 county runs a monthly report ofchildren with open child welfare services who are not receiving

3 mental health services to ensure that they are screened and referred ifnecessary. Another

4 county has a special unit that works with children in group homes to ensure the availability of

5 services that align with the CPM by providing coordination ofservices, and is training providers

6 to track the proviSion ofthese services.

7

While a few counties reported some lack ofclarity around application ofthe Core Practice

8 Model, most ofthe 16 counties contacted are developing, or have developed, practices and

9 procedures to facilitate adoption ofthe model. Some counties are hiring additional staffthat will

10 focus on teaming, namely the facilitation ofthe team meetings and coordination ofservi,ces. In 11 addition, several counties report that they provide ongoing training to contract and county staff .

12 on the Core Practice Model and Katie A related intervention strategies; others have requested

13 state assistance in addressing training needs. Some counties are providing training on proper

14 billing ofservices. Where- needed, counties have been taking positive steps to ensure adequate

15 .capacity to screen andprovide services by hiring staffand expanding provider contracts. For

16 example, a larger county reporting low provision ofICC and IHBS services stated that it has

17 recently expanded its provider contracts to include ICC and IHBS, and has plans to expand them

18 once again in FY 2015-2016 to double its capacity to provide these services. Another county that

19 has reported difficulty providing CFT due to staffing shortages has co-located staffat the child

20 welfare agency, which has helped with coordination between the child welfare and mental health

21 agencies.

22 State Assessment of County Actions

23

In general, several counties have the capacity to provide ICC and IHBS to all identified

24 SCM's and are providing those services. For those not yet fully serving all SCM's, the State

25 believes that the actions the counties are taking to increase the proviSion ofICC and IHBS are

26 appropriate and effective. In some instances, the State believes that the actions counties are

27 taking could be further bolstered by training or closer monitoring.

28

With respect to the 16 counties discussed in this report, the State notes that adoption ofthe

29 Core Practice Model is increasing, through training as well as through the use ofthe Safety

30 Organized Practice model. Additionally, counties have been successful in developing strategies

31 to increase screening and assessment ofpotential subclass members for both children entering

15

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 16 of 41 Page ID #:7893

1 the child welfare system and those already in the system, and to increase the provision ofICC and

2 IHBS services. Some ofthe difficulties that appeared to be more prevalent during the initial

3 implementation efforts, such as difficulties in sharing information across agencies, are no longer

4 reported as presenting barriers to effective implementation. However, the difficulties that smaller

5 counties encounter, such as recruitment and retention ofstaffand the development of

6 administrative processes, remain present amidst their efforts to implement the Katie A. settlement

7 agreement. Nevertheless, these counties are addressing these issues or are requesting State or

8 county peer-to-peer assistance. For example, one county is considering enlisting the help ofstaff

9 ji'om neighboring counties to cover certain roles.

10 State Action

11

The State will take or has taken various actions in response to its conversations with

12 counties. In some instances, continued State monitoring is all that is required. In others, the

13 State believes that more direct State involvement would be most helpful in increasing service·

14 delivery. For example, some counties have requested training on teaming or use ofthe Core

15 Practice Model, which the State has provided and will continue to provide. The trainingfor the
"-
16 smaller counties will include examples from other small counties ofsuccessful administrative

17 practices andprocesses thatfacilitate interagency collaboration and teaming. Training will also

18 address how to adapt/leverage existing teaming processes to meet CFT requirements. In other

19 instances; the State is planning to conduct site visits to more closely monitor and assist county

20 efforts to increase the number ofSCM being served. These visits will also be used to assist the
21 counties with increasing recruitment, expanding provider contracts, and to offer other training if·

22 needed. For counties with billing issues, the state will follow up to ensure they are resolved and

23 that claims for ICC and IHBS continue to increase as expected.

24 Recommendation One

25

Since filing the October 28, 2014 Plaintiffs', State Defendants', a~d Special Master's

26 Statement ofAgreement, the State has begun the work ofimplementing Recommendation 1, in

27 which the State agreed to set peliormance goals for counties in implementing the Katie A

28 services. The State intends to fold this work into its efforts with the 24 counties. The State team

29 tasked with contacting the 24 counties (the 8 previously reported to the court in addition to the 16

30 discussed here) has begun incOlporating peliormance goals in the tools used to conduct the State

31 team's work with counties. The State team has also started instructing staffas to how to integrate

16

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 17 of 41 Page ID #:7894

1 setting ofpelj'ormance goals into conversations with counties. Leadership from each Department

2 has engaged the county associations on this topic. The State expects to begin contacting counties

3 in January 2015 to set and ensure achievement ofthe counties' respective peliormance.

4

The State has provided the Special Master the following Eight County Update:

5 Eight County Update

6 In addition to the work the State has completed with the sixteen counties, the State has continued

7 its efforts to increase the provision ofICC and IHBS with the eight counties first contacted in

8 August and September of2014. These counties were Alameda, Napa, Orange, Riverside,

9 Sacramento, San Francisco, Sonoma and Stanislaus.

10 County Barriers and County Actions

11 In general, the eight counties have continued their efforts to identify subclass members (SCM) or

12 increase service delivery to SCM's in the past several weeks. For example, two counties have

13 corrected inaccuracies in their data which will now result in more accurate reporting ofSCM's.

14 Two ofthe counties indicated that they will either begin claiming next month or, because claiming

15 issues have been resolved, expect to see billingfor ICC and IHBS increase in the coming months.

16 Yet another county has made some internal organizational changes that have improved its ability

17 to assess potential SCM's. Other work the counties committed to do is still underway or near

18 completion such as the development ofinformation sharing memoranda or Policies and

19 Procedures for Child and Family Team (CFT) meetings. One county is actively developing a

20 strategy to rectify issues it has with CFTs.

21 State Assessment and State Action

22 The State believes that the counties have been taking effective action to increase the provision of

23 ICC and IHBS services. The State is actively monitoring these counties either on a monthly or

24 quarterly basis. In some instances, the State is monitoring counties' efforts through claims data

25 on a monthly basis. Further, the State has contacted or will shortly be contacting counties

26 regarding specific issues such as the status ofa data sharing agreement or the effectiveness ofa

27 contract to do CFTtraining. The State is also preparing to meet with one county to review what

28 systemic issues may be a barrier to increasing services.

29

30

31

17

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 18 of 41 Page ID #:7895

1

2

SECTION FOUR: KATIE A. STATE AND COUNTY STRUCTURES

3

The Katie A. Settlement Agreement and subsequent implementation plan calls for the State to

4 establish an array of State-and eventually county-service system structures and processes that

5 will oversee, promote, monitor, provide quality oversight, and ensure the sustained

6 implementation of Katie A. services.

7

A number of task forces were established to make recommendations to DRCS and DSS for

8 consideration before establishing new system structures. A brief summary ofthe task force

9 charges and the status of their implementation by the State are provided below.

10 Joint Management Taskforce (JMT)

11

The purpose ofthe JMT is to make recommendations to DRCS and DSS for the

12 establishment of a Shared Management Structure (SMS) that will oversee the Katie A. initiative

13 for the long term

14

Shared Management Structure with its shared vision and mission Statement would set policy

15 and program direction, provide clear and consistent guidance, and identify outcomes and

16 accountability measures that are consistent with the Katie A. Core Practice Model (CPM). The

17 SMS would provide the framework, models, and technical assistance for county child welfare and

18 mental health agencies to consider in order to work more effectively together at the local level

19 consistent with the CPM, and also to involve families and youth in local decision making.

20 Accountability, Communication and Oversight System (ACO) Taskforce

21

The purpose of the ACO Taskforce is to make recommendations to DRCS and DSS for the

22 adoption of a statewide quantitative and qualitative data-informed system of oversight,

23 accountability, and communication. The ACO Taskforce recommendations are intended to

24 promote the development and use of the Core Practice Model, to ensure effective, quality mental

25 health services, and to efficiently monitor, measure, and evaluate access to services, service

26 delivery, and costs at the individual, program, and system levels.

27 Core Practice lVlodei (CPIvI) Fiscai Taskforce

28

The purpose of the CPM Fiscal Taskforce is to develop a strategic plan using fiscal

29 incentives and reduced administrative barriers to accomplish Statewide adoption of the Katie A.

30 Core Practice Model (CPM), deliver intensive home and community based services to subclass

31 members within the CPM framework, and reduce the use of congregate care.
--j

18

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 19 of 41 Page ID #:7896

1

2 Recommendations forwarded to DSS and DHCS

3

The Joint Management Taskforce (JMT) issued its recommendations to DSS and DHCS

4 regarding (1) Shared Management Structure; (2) Accountability, Communications and Oversight;

5 and (3) Core Practice Model fiscal strategies, Exhibit 1, on July 29,2014. The recommendations

6 included in the report address the formal requirements for establishing a Shared Management

7 Structure. Additionally, the recommendations provide a comprehensive Accountability,

8 Communications and Oversight framework that, among other things, calls for an evaluation of the

9 viability of implementing a formally coordinated System Improvement Plan (SIP)/Performance

10 Improvement Project (PIP) effort, and encourages institutionalizing quality assurance processes

11 relating to practice improvement, Core Practice Model implementation, and timely access to

12 . Intensive Care Coordination and Intensive Home Based Services.

13 DHCS and DSS Actions on JMT Recommendations

14

The State has provided the Special Master the following State response to the Joint

15 Management and Fiscal Task Force Recommendations:

16

CDSS and DHCS

17

Response to the joint Management and Fiscal Task Force Recommendations

18

Background

19

20 As a resLilt ofthe Katie A. v. Bonta Settlement Agreement and subsequent Implementation Plan,

21 the California Department ofHealth Care Services (DHCS) and the California Department of

22 Social Services (CDSS) (the State) agreed to perform a number ofactions including the

23 establishment ofa Shared Management Structure (SMS) to develop a shared vision and

24 mission statement; provide policy and program direction with clear and consistentguidance,

25 and deveiop outcome aryd accountability measures consistent with the Core Practice Model

26 (CPM).

27 To this end, the Agreement calledfor the establishment ofajoint Management Task Force

28 ljMTJ Accountability, Communications and Oversight (ACO) Task Force and a CPM Fiscal Task

29 Force. Although theACO Task Force was initially intended to be a sub-committee ofthejMT, it

19

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 20 of 41 Page ID #:7897
1 was concluded by the Parties and the Court that the membership ofthe JMT included many of 2 the same representatives who would also sit on the ACO Task Force. Therefore, members ofthe 3 JMT also serve as the ACO Task Force with the addition ofkey program and quality assurance 4 representative from the State, counties, and providers. 5 The JMT recommendations were submitted to the State on July 29,2014 while the CPM Fiscal 6 Task Force submitted its recommendations to the State in November 2013. Therefore 7 responses to both the JMT and Fiscal Task Force's recommendations are included in this 8 document. The recommendations and responses are organized into four separate sections: 9 I. Shared Governance 10 II. Policies and Procedures 11 III. Accountability, Communication and Oversight 12 IV. Fiscal Strategies 13 14 The State summarized the key components ofeach recommendation and prepared the 15 response. 16 I. Shared"Management Structurefor CDSS and DHCS 17 The JMT recommends that DHCS and CDSS adopt a shared governance model consisting ofa 18 Transformation Manager/Facilitator and two leadership teams-the Executive Team (ET) 19 and the Community Team (CT). Together, these functions will constitute the Shared 20 Management Structure (SMS). 21 Transformation Manager/Facilitator 22 The Transformation Manager/Facilitator will provide staffsupport and facilitation for both of 23 the shared management teams and report directly to the ET. This person must have the time 24 and skills to work across both departments and lived experience or substantial experience with 25 families and youth with lived experience. 26 Executive Team 27 The ET will provide leadership and decision-making in the implementation ofChild 28 Welfare/Mental Health state interagency and intra-agency collaborative policy and practice 29 consistent with the CPM. The ET will operate with direction and inputfrom the CT. Matters 30 that cannot be resolved by this team will be elevated to the Secretary ofthe Health and Human 31 Services agencyfor resolution.
20

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 21 of 41 Page ID #:7898
1 Community Team 2 ,The CTwill be comprised offamily and youth members, advocates, providers, county 3 representatives and state representatives from the executive team. The role ofthe CT is to 4 ensure that stakeholders are engaged and are equal partners in leading the collaborative 5 effort to change policy and practice. The team will provide leadership, direction, advice and 6 feedback about state policies and programs relevant to service delivery, data collection, quality 7 improvement and accountability regarding child welfare youth and families who need mental 8 health services. Both the ET and CT will meet at least monthly. 9 The JMT recommends that the SMS be assessed using a Continuous Quality Improvement (CQI) 10 approach. Both teams, together with the Transformation Manager, will need to continually 11 evaluate how the teams and teaming structure is functioning and make changes as needed to 12 ensure that goals and objectives are being accomplished, necessary work is getting done and 13 the process reflects the vision, mission and values as they are articulated. 14 FixIT Teams will be created and function when there is a need to deal with a specific issue 15 identified anywhere within the governance structure. These will be time-limited focused work 16 groups with subject matter experts. 17 State Response 18 The State agrees to adopt the JMT recommendation to establish a Shared Management 19 Structure as proposed subject to specified modifications regarding implementing the function 20 ofthe Transformation Manager/Facilitator. The ETwill provide leadership and make 21 "decisions related to the implementation ofpolicies and practices ofthe CPM and use data to 22 drive decisions and monitor service delivery fidelity. The ET will consist ofdesignees ofthe 23 CDSS and DHCS Directors who will have decision making authority and when appropriate, will 24 elevate issues to the State Directors. The designees will be expected to engage with the CT 25 soliciting advice and communicating feedback regarding various implementation areas. The 26 ETwill convene its'first meeting no later than january 31,2015 and will meet quarterly or 27 more frequently as needed. 28 The State agrees with the JMT recommendation to establish a CT that will provide input, 29 advice and feedback to the ET and State Team regarding policies and practice related to the 30 CPM and service delivery, data collection, quality improvements and accountability. The CT 31 will be comprised ofyouth, parents, providers, advocates, a local Child Welfare Services
21

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 22 of 41 Page ID #:7899
1 representative, a local Mental Health Plan representative, a County Welfare Directors 2 Association representative, a County Behavioral Health Directors Association representative, a 3 CDSS state team member and a DHCS state team member. This team will meet quarterly. 4 Pending installation o/the shared management structure, the existing State Team, comprised 5 o/representatives from CDSS and DHCS, will continue in its role to operationalize the Service 6 Delivery Action Plan (SDAP) and other work that may emerge from the leadership teams. The 7 State Team will address policy and practice areas and provide technical assistance and 8 strategies to counties and providers. The State Team will continue to meet on a bi-weekly 9 basis. A communication and feedback strategy will be developed by the State Team during the 10 transition to the SM5. 11 Regarding the JMT recommendation for a FixIT Team, the State chooses to embed the FixIT 12 Team functions within the current State Team infrastructure. The FixIT Team function will 13 operate as proposed by the JMT recommendations, convening as a time limited ad hoc 14 workgroup that will include members (internal and/or external) to address issues that require 15 special review and specific expertise. These ad hoc groups will include members ofthe State 16 Team, as well as other stakeholders. Frequency ofmeetings will depend on the issue. 17 DHCS and CDSS are in support ofthe Transformation Manager/Facilitator function. In order 18 to ensure that the roles and responsibilities ofthis function are incorporated most effectively, 19 the Departments will need to determine whether the function requires a new position or ifit 20 can be repurposed within the Departments' existing infrastructure as well as further 21 determine the duties and expectations ofthis position. 22 Current State and local infrastructures will be accessed in order to sustain the collaborative 23 environment/momentum between Mental Health and Child Welfare agencies. (See 24 Attachment A) 25 II. Policies and Procedures 26 Recommendation Summary 27 The JMT recommends that DHCS and CDSS enter into a Memoranda ofAgreement (MOA) 28 articulating the Interagency Policies and Procedures by December 1,2014, in order to better 29 coordinate child welfare and mental health systems, program, and practice efforts that will 30 serve child welfare youth with mental health needs. The MOA terms will include but not be 31 limited to agreement to 1) Aligning departmental policies and procedures; 2) Coordinating
22

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 23 of 41 Page ID #:7900
1 routine communication prior to departmental action to assure alignment ofdirection and 2 expectations; 3) Establishing joint departmental protocolsfor the production and distribution 3 ofinformation relating to and/or impacting both departments; and 4) Jointly issuing and 4 signing All County Letters and All County Information Notices when both child welfare and 5 county Mental Health Plans are or may be affected by the policy or practice. 6 State Response 7 The State adopts and agrees with the purpose ofthis recommendation and acknowledges that 8 the State will enter into a Memoranda ofAgreement (MOA) byJuly 1, 2015 instead ofthe 9 proposed December 1,2014. The MOA will include, but not be limited to items outlined in the 10 JMT recommendations (Items 1-4). 11 III. Accountability, Communication and Oversight 12 Recommendation Summary 13 The JMT recommends that the CT develop recommendations for a comprehensive CQI and 14 Accountability System that further integrates the efforts ofDHCS and CDSS such as the 15 Performance Outcomes System (POS), Continuum ofCare Reform (CCR), Case Management 16 System (CMS) and other activities.
, 17 The goal will be to include all efforts into a comprehensive CQI System for the purpose of
18 guiding the state and counties in improving performance. The CT is to provide its report to the 19 ET byJune 30,2015 for review and adoption as State policy. 20 The SMS is also recommended to convene a stakeholder meeting to obtain specific inputfor the 21 CQI System per the Settlement Agreement. 22 Prior to finalizing the overall CQI System, DHCS and CDSS will meet the commitments ofthe 23 SDAP and the ACO report (short term, mid-term and long term goals). 24 The CT will work with the State to re-establish appropriate dates and timelines for these 25 activities. Within the overall CQI System, DHCS and CDSS will develop incremental steps to 26 integrate compliance and quality review activities. Wherever possible, compliance and quality 27 improvement activities will be integrated and/or coordinated to increase efficiency and reduce 28 duplication. 29 State Response 30 The State agrees with theJMT recommendations to establish a CQ CQI and Accountability 31 System consistent with the ACO short term, medium and long term goals. The State will review
23

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 24 of 41 Page ID #:7901
1 and consider the recommendations ofthe Community Team's report due to the ET byJune 30, 2 2015. 3 The State agrees with the goal to coordinate existing State and County quality improvement 4 processes and systems. These quality improvement processes are associated with the DHCS 5 Performance Outcomes System and External Quality Review Organization, the CDSS 6 Congregate Care Reform, and the California Child and Family Services Review. The State will 7 identify areas ofnatural intersection and coordination among these systems and work towards 8 incremental integration through the use ofthe SMS. 9 The State will develop communication and input loops between counties, the families, youth, 10 providers and associations regarding the CQI using the governance structure. Putting fn place 11 an effective communication strategy is important while the State installs the governance 12 structure. With regard to the short-term, mid-term and long term goals outlined by the ACO, 13 many ofthese activities are currently being accomplished by the State Team as outlined in the 14 Service Delivery Action Plan developed on February 27,2014. Per the JMT recommendation, as 15 implementation progresses, the Servic.e Delivery Action Plan timeframes will be modified to 16 address any emerging issues and current commitments. 17 IV. Fiscal Strategies 18 Recommendation Summary 19 The JMT recommends that DHCS and CDSS develop and adopt the recommendations ofthe 20 . CPM Fiscal Task Force and collaboratively address budgeting and fiscal strategies that 21 maximize the use ofresources. 22 State Response 23 The State agrees with the recommendations ofthe CPM Fiscal Task Force and believes many 24 are either achievable within the future shared management structure or are currently ·25 underway through other initiatives. The Departments also reserve the right to revise any 26 method, process, and/or timelines associated with the recommendations.
24

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 25 of 41 Page ID #:7902

1
2 Fiscal Task Force Recommendations 3 Recommendation 1.1.1 - The California Department ofSocial Services and Department 4 ofHealth Care Services Should Work with the County Welfare Directors Association, 5 California Mental Health Directors Association (Now the California Behavioral Health 6 Directors Association), and Other Stakeholders to Develop a Plan that Invests Existing 7 Resources into the Provision ofCoordinated and Aligned Training and Coaching that 8 Assists Line Staff, Supervisors, Subcontractors, Family Members, and Other Support 9 Persons with Acquiring the Skills Needed to Implement and Sustain the Core Practice 10 Model Statewide

11

The DHCS and CDSS have already begun work to align training and coaching through

12

the child welfare statewide training system in collaboration with the California

13

Institute for Behavioral Health Solutions rCIBHS). Additional discussions have occurred

14

with other training entities including the Chadwick Center. Further alignment with

15

other stakeholders will be explored with the Community Team once developed as part

16

ofthe shared management structure.

17 Recommendation 1.2.1 - The Department ofHealth Care Services Should Publish a 18 Comprehensive EPSDT Documentation Manual Similar to the Documentation Manual 19 prepared by the California Institute for Mental Health (Now the California Institute for 20 Behavioral Health Solutions)

21

The DHCS and CDSS will work togethe.r to convene a multi-disciplinary workgroup in

22

summer of2015 to revise the current Medi-Cal Manual and Core Practice Model guide,

23

which will be more comprehensive based on lessons learnedfrom the Statewide

24

Learning Collaborative.

25 Recommendation 1.2.2 - The Department ofHealth Care Services and California 26 Department ofSocial Services Should Prepare Ciear Written Guidance for Counties and 27 Providers Regarding Proper Cost Allocation

28

The DHCS and CDSS will explore what guidance will best support counties and

29

providers regarding costs for services with the Community Team once developed as

30

part ofthe shared management structure.

25

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 26 of 41 Page ID #:7903

1 Recommendation 2.1.1 - The California Department ofSocial Services Should Consider 2 Updating Current Regulations and Payment Structures for Group Home Providers in a 3 Manner that Results in Short- Term Treatment and/or Crisis Residential Beds Being 4 Available When Needed

5

The current regulations and payment structures are currently being addressed in the

6

CDSS Continuum ofCare Reform (CCR) framework.

7 Recommendation 2.1.2 - The California Department ofSocial Services and California . 8 Department ofHealth Care Services, with Input from Stakeholders, Should Explore 9 Opportunities to Build Upon the Knowledge Gained from Prior Efforts to Shorten the 10 Length ofStay in Group Homes and Other Institutional Placements

11

This information is currently reflected in the CDSS CCR framework.

12 Recommendation 2.3.1 - The Department ofHealth Care Services Should Work 13 with County Child Welfare and Mental Health Departments to Produce an Information 14 Notice that Encourages Counties to Invest Mental Health Services Act or 1991 Realignment 15 Funds into Transition Programs Designed to Increase Placement Stability

16

The DHCS will provide technical assistance to encourage counties to invest mental health

17

funding into transition programs to support placement stability for children andyouth.

I
18 Recommendation 2.3.2 - The California Department ofSocial Services and Department

19 ofHealth Care Services, with Input from Stakeholders, Should Explore Opportunities

20 Under the Affordable Care Act to Increase Access to Mental Health Services to Increase (

21 Placement Stability

22

The CDSS and DHCS will explore these opportunities with the Community Team once

23

developed as part ofthe shared management structure.

24 Recommendation 2.4.1 - The California Department o/Social Services and the 25 . Department ofHealth Care Services, with Input from Stakeholders, Should Explore the 26 Role and Continued Viability ofInteragency Placement Committees and Propose Any 27 Necessary Statutory Amendments to Clarify Their Role

28

Child and Family Teams are built within the CCRframework. Further, CDSS and DHCS

26

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 27 of 41 Page ID #:7904

1

will examine the roles ofthe CFT and these committees with the Community Team once

2

developed as part ofthe shared management structure.

3 Recommendation 3.1.1 - The California Department ofSocial Services and the 4 Department ofHealth Care Services Should Explore with Stakeholders Opportunities for 5 County Child Welfare and Mental Health Departments to Share Resources in Providing 6 Care to Children and Youth in the Child Welfare System Who Need Mental Health 7 Treatment

8

The sharing ofresources and opportunities will be leveraged and examined within the

9

current context ofavailable resources and is currently being addressed in the CDSS CCR

10

framework.

11 Recommendation 3.1.2 - The California Department ofSocial Services and California 12 Department ofHealth Care Services Should Explore with Stakeholders Jointly Publishing 13 a Document that Describes how County Child Welfare and Mental Health Departments 14 May Negotiate Agreements to Share the Fiscal Risks and Benefits Associated with Group 15 Home Placements

16

The fiscal structure ofgroup home placements is being revised in the CDSS CCR

17

framework.

18 Recommendation 3.1.3 - The California Department ofSocial Services and Department 19 ofHealth Care Services Should Work with County Child Welfare and Mental Health 20 Departments to Determine how the Core Practice Model will Impact Workload for Child 21 Welfare Workers and Mental Health Clinicians

22

This is currently being addressed in the child welfare statewide practice model, which is

23

being developed based on the foundational work ofthe Katie A. Core Practice Model.

24

This model will support best practice for child welfare workers statewide and provide a

25

model for a family focused approach.

26 Recommendation 3.2.1 - The Department ofHealth Care Services Should Seek 27 Additional Resources to Provide Training and Technical Assistance to County Mental 28 Health Departments to Assist with Proper Documentation and Claiming for Medi-Cal 29 Specialty Mental Health Services

27

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 28 of 41 Page ID #:7905

1

The CDSS and DHCS continue to work with both statewide training systems within child

2

welfare and mental health to improve cross training and the development oftrainings

3

thatjurther address coordination ofmental health services within child welfare.

4

Additional training needs for proper documentation and claiming for Medi-Cal

5

Specialty Mental Health Services will also be addressed within this framework.

6 Recommendation 3.2.2 - The California Department ofHealth Care Services Should 7 Work with the California Mental Health Directors Association to Improve the Provider 8 Enrollment Process

9

The DHCS will work with the California Behavioral Health Directors Association on

10

improvements to the provider enrollment process, while considering the new Affordable

11

Care Act requirements to ensure program integrity.

12 Recommendation 3.3.1 - The California Department ofSocial Services and the 13 Department ofHealth Care Services Should Work with Stakeholders to Prepare for Local 14 Government Agencies and Organizations a Catalogue ofFunding Sources Which May be 15 Used to Finance the Non-Federal Share of Title XIX Services, as Well as Non-Traditional 16 Mental Health Services

17

The CDSS and DHCSwill explore the developmentofa Catalogue ofFunding Sources

18

with the Community Team once developed as part ofthe shared management structure.

19 Recommendation 3.3.2 - The California Departmeht ofSocial Services and the

20 Department ofHealth Care Services Should Continually Collaborate with County Child

21 Welfare and Mental Health Departments to Seek Federal Grants or Waivers and

22 Foundation Grants that Would Support Implementation ofthe Core Practice Model

23

The CDSS has begun this effort through the recently executed Title IV-E Waiver

24

Demonstration Project. As part ofthis project, nine county child welfare departments

25

,v,v,;L1L1L "U se r1 :L tL' e .1TV_rl:.J;' U ,1V ,..U11lA ,.,,..S ft.-.,..v. s"U",p,,p,,V ..I..fL- fL-Ilt,e H :"IL"'pLle I"l"L'e"I,LfL-,,..U,.ft.-.:.L,l...'"", V,.).F"f"-'hL e \rJnU"I e JD. Ir"\d,.C"f-H;r.... e jnVllrvn,u1e1L

26

using Safety Organized Practice elements.

27

28 Exhibit 1. The Shared Management Structure and Communication Plan
29

28

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 29 of 41 Page ID #:7906

1

2

SECTION FIVE: PARTIES PLAN TO MAINTAINING COMMUNICATION POST

3

JUEaSDICTION

4

The Parties have agreed to continue to maintain communication Post jurisdiction as described

5 in some detail in the Plaintiffs', State Defendants' and Special Master's Statement ofAgreement

6 on Recommendations 1-4, specifically Recommendation 3, October 28,2014, Court Dkt 919.

7 Accordingly, "The Parties agreed that continued dialog on improving service delivery roll-out,

8 consistent with the practice model, and avoiding future litigation would be valuable to the State,

9 counties, Medi-Cal beneficiaries, and stakeholders."

10

The State and Plaintiff s have agreed that an initial meeting should occur as soon as possible,

11 but at this time no date has been set.

12

13

SECTION SIX: SPECIAL MASTER'S SUMMARY AND FINDINGS

14

In this section I will summarize progress regarding implementation of the Settlement

15 Agreement and the Plan since th~ October 16,2014 Status Conference. I will also provide the

16 Court with a Summary Finding of selected Post Jurisdiction obligations that are essential for the

17 State to continue to implement and or to begin implementing. It is not my intention to address the

18 full array of issues or findings from previous Special Master Reports and Updates to the Court,

19 specifically the changed California Environment or Timeline Extensions. Instead, I will focus on

20 key matters I believe are central and pivotal to successful implementation into the future.

21

The Parties have consistently acknowledged that all elements of the Settlement Agreement, th~

22 Plan, Service Deli"very Action Plan and Statements of Agreement would not be fully implemented
;--r
23 during the Court's jurisdiction. Although I have disagreed with the State at times regarding

24 specific activities, deliverables and the number of subclass members who should have received

25 ICC 'and IHBS and the level of county implementation of the Core Practice Model by the end of

26 the Court's jurisdiction, I have not disagreed with the assertion that there would be a continuing

27 obligation on the State to implement Katie A.

28

I will close this section of my Report with a list of essential deliverables, actions, activities that

29 remain to be fulfilled post jurisdiction. This list is not intended to be all inclusive regarding what

30 must occur for the successful implementation of Katie A. Over time, the State will need to

31 continue to develop additional goals and new strategies in adapting to federal, state and county

29

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 30 of 41 Page ID #:7907

1 conditions.

2 I once again want to commend the effort and intention of all the Parties in advancing the Katie . ,., .) A. effort. The past three years of implementation rollout have required massive work, especially

4 on the part ofthe State departments and county agencies, along with much support, forbearance,

5 and encouragement on the part of the Plaintiffs and the parents and providers who were members

6 ofthe Negotiation Workgroup.

7 Katie A. Services to Subclass Members - State's 'Initial Observation' of the October 2014

8 Semi-Annual Progress Report and DHCS Claim Data

9

The State's Initial Observations ofthe October 2014 County Semi-Annual Progress Reports

10 highlight the overall increase in subclass members identified and provided with ICC and IHBS. It

11 compared the last two Semi-Annual Progress Reports, October 2013 and May 2014, with the

12 October 2014 Semi-Annual Progress Report, which showed modest increases. The State's

13 characterization of the modest increase as a 'shift from the initial implementation effort to

14 ongoing sustainability of services' is somewhat confusing. Perhaps it's the choice of words,

15 initial implementation vs. ongoing sustainability. From my perspective the State's current efforts

16 are more directed at assisting cOUIJ,ties in providing or increasing ICC and IHBS to subclass

17 members and not focused on sustaining the current level of service. Regardless, the State and

18 counties deserve credit for these increases, as modest as they are.

19

The State has made progress in addressing numerous barriers identified by counties that were

20 limiting their ability or capacity to provide ICC and IHBS. Counties have advised the State they

21 have been able to expand their workforce, increase contractwith service providers, revise local

22 staffing plans and shared training resources across agencies and neighboring counties. Although

23 not every county has been successful to date in addressing these issues, the smaller counties in

24 particular have unique circumstances and challenges in these areas. The State is intending to

25 make a special effort to engage and support-these counties in finding solutions.

26

Information sharing practices and privacy laws have continued to be a concern but more and

27 more counties are fmdillg successful solutions to this problem. In part, this is a result of the State

28 offering a wide range of technical assistance that included a consult with California Office of

29 Information Integrity. This issue remains and will require continued support and solution focus

30 by the State.

31

-

30

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 31 of 41 Page ID #:7908

1

2

Even though the State provided many opportunities and hours of consultation on how to

3 complete the data section of the Semi-Annual Progress Report, many counties continue to have

4 difficultly completing the Semi-Annual Progress Report due to confusion about the State's

5 methodology. Some of the data in the Report may have been calculated incorrectly. Although

6 there may be errors, I expect the number of errors to decrease over time as the counties receive

7 technical support from the State.

8

At this point in analyzing the Semi-Annual Progress Reports and DHCS Claims Data, the

9 State is gaining a better understanding of countys' screening, referral, assessment and tracking

10 process. This increased understanding will assist the State in its monitoring, and providing

11 technical assistance to the counties, likely.resulting in an increase in access and provision of ICC

12 and IHBS to subclass members. Excellent Job.

13

Some counties may be billing other mental health services instead ofICC and IHBS. This

14 has been a continuing problem since implementation. Counties appear either reluctant or unable

·15 to transition subclass members from other mental services to ICC and IHBS. The issue may

16 require special attention and action by the State in order to change this situation.

17

I found it troubling that in the 'Progress' section the State would use the time it took (thirteen

18 years) to successfully implement Wraparound, a discretionary program, in comparison to the

19 implementation of Katie A, especially ICC and IHBS, which are federal Medicaid/Medi-Cal

20 entitlements for children. I recognize it takes time to implement, but these are two very different

21 programs, with different requirement/expectation under federal law.

22 Claims Data and October 2014 Semi-Annual Progress Report - Counties and the State should

23 be commended on the continued progress in providing ICC and IHBS to an ever increasing

24 number of subclass members as reported in the October 2014 Semi-Annual Progress Report and

25 DHCS claims data. There is an additional context that should be taken into consideration and

26 factored in when examining the increase in subclass members receiving ICC and IHBS. This

27 larger context includes the 'potential/estimate nu..'TIber' of subclass members known to c:hild

28 welfare that have yet to be screened and assessed by mental health to determine subclass eligible

29 and receive ICC and IHBS

30

The best data available on Katie A. subclass members receiving intensive Katie A. services

31 comes from the Counties' Semi-Annual Progress Report and DHCS Medi-Cal claims data.

31

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 32 of 41 Page ID #:7909

1 Claims data from DHCS indicate the number of subclass members receiving ICC and IHBS as

2 medically necessary is up since my last report. That is good news.

3

There is more good news on data and its analysis. The State's capacity to exchange and

4 match DHCS and DSS data bases has recently been approved through a State Interagency

5 Agreement (IA), Exhibit 2, that authorizes the exchange and matching of confidential data

6 between DSS and DHCS. The use of the exchanged data is limited and qualified, but it will go a·

7 long way to improve the State's capacity and authority to provide oversight and coordination of

8 health care services for any child in the foster care system. It makes particular reference to

9 analyzing data regarding Katie A. and will likely become a cornerstone in the Accountability,

10 Oversight and Communication System that will be implemented under the new Shared

11 Management Structure between DSS and DHCS. This is a landmark accomplishment and should

12 be applauded.

13

I've included Table 4(below) Statewide Headcount to indicate the level of subclass members

14 receiving ICC and IHBS and Table 4.1 Statewide Headcount without Los Angeles.

15

Table 4, Katie A. Statewide Headcount, is based on two sources of information. First, it

16 incorporates county self-reported data from the October 2014 and May 2014 County Semi Annual

17 Progress Report. The self-reported information identifies potential subclass members (the high-

18 risk pool for meeting subclass criteria), along with county-identified subclass members and

19 subclass members receiving ICC and IHBS. The second source of information is from the DHCS

20 Mental Health Services Claims Data Rolling Report for the 12-month period October 2013

21 through September 2014. The information from the Claims Data Report identified the number of

22 subclass members claimed for any specialty mental health services received, along with the

23 number of subclass members who received ICC and IHBS during the reporting period.

24

25

26

27

28

29

30

31

32

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 33 of 41 Page ID #:7910

1

STATEWIDE
From Katie A. Semi-Annual Progress County Self Reports

Subclass Members Receiving Mental Health services:
OCT 2014 Self report

Subclass 12,538

Numerical Count ICC 5,800

IHBS 4,006

Potential Subclass Members (from October 2014 Semi-Annual Report): 43,112 Potential Subclass Members (from May 2014 Semi-Annual Report): 35,389

From Katie A. Mental Health Services Reports

Most recent report displayed first:

DHCS SD/MC Numerical Count Claimed

Subclass

ICC

IHBS

October 2014 (Oct 6,2014 Rolling Total)

11,734

6.672

5,531

September 2014 (Sept 15 Rolling Total)

10,221

5,911

4,699

From Oct. 2014 Semi- Annual Report and DHCS Oct. Claimed Mental Health Services

Report

Potential Subclass Self Reported

Subclass Count
Self Reported

ICC Count Self Reported

IHBS Count Self
Reported

Subclass )
Claimed
Oct 14

ICC Claimed Oct 14

IHBS Claimed Oct 14

43,112

19,679 (46%)

5,800 (13%)

4,006 (9)

11,734
(27%)

6,672
(15%)

5,531
(13%)

2 Table 4 3 4 5 6 7 8 9 10

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 34 of 41 Page ID #:7911

1 Table 4.1 (below) is the statewide Headcount, drawn from the same data sources used to produce Table 4

2 except that Los Angeles County data has been removed. Los Angeles County is operating under its own

3 County Katie A. Settlement, and was uniquely positioned to implement ICC and IHBS and began

4 implementation much earlier than the other counties. Consequently, LA County data is not

5 representative of how the rest of the state is currently performing in providing ICC and IHBS.

6

STATEWIDE w/o Los Angeles
From Katie A. Semi-Annual Progress County Self Reports

Numerical Count

Subclass Members Receiving Mental Health

Subclass

ICC

services:

OCT 2014 report

26,572

3A93

Potential Subclass Members (from Oct 2014 County Semi-Annual Report): 26,849

Potential Subclass Members (from May 2014 Semi-Annual Report): 23,626

From Katie A. Mental Health Services Reports

IHBS 1,812

Most recent report d!splayed first:
October 2014 (oct 6,2014 Rolling Total) September 2014 (Sept 15 Rolling Total)

SO/MC Numerical Count Claimed

Subclass

ICC

IHBS

8,081

3A20

2,261

6,848

2,887

1,653

From Oct. 2014 Semi- Annual Report and DHCS Oct. Claimed Mental Health Services

Report

Potential Subclass Self Reported
26,849

Subclass Count Self
Reported 11,032 (41%)

ICC Count
Self Reported
3A93 (13%)

IHBS Count
1,812 (7)

Subclass Claimed Oct. 14
8,081 (30%)

ICC Claimed Oct 14

IHBS Claimed Oct 14

3A20 (13%)

2,061 (8%)

7 Table 4.1

8

Based on the data presented above, it appears that statewide - both with and without Los

9 Angeles County data, counties are claiming some form of mental services for a less than one-third

10 (30 percent) of potential estimated subclass members. The October 2014 Self Report identified

11 41 % of the potential subclass members receiving some form of mental health service. The State

12 is continuing to review the difference between self reported data and actual claimed services and

34

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 35 of 41 Page ID #:7912

1 self reported. These differences can be often the result of timing issues, State data more often

2 than not lags behind county data or it can be a methodological issue in the data collection. The

3 State will continue to work with counties to iron out these differences or irregularities in data

4 reporting.

5

With regard to specific Katie A. ICC and IHBS intensive services, counties are claiming ICC

6 for less than one-fifth (15 percent including Los Angeles and 13 percent without Los Angeles) of

7 potential estimated subclass members, and are claiming IHBS for around one-tenth (13 percent

8 including Los Angeles and 8 percent without) of potential estimated subclass members. This is

9 an incremental increase since the Special Master October 2014 Report that addressed June 2014

10 Claims Data Report.

11

The statewide claims for IHBS, are slightly higher by 2 percent for ICC and 2 percent IHBS,

12 of potential estimated subclass m~mbers compared to the October 2014 report I made to the

13 Court, which is encouraging. The statewide numbers without including Los Angeles are up by 4

14 percent for ICC and 3 percent for IHBS of potential subclass members from my October Report.

15 This is a significant and positive change and shouldn't go unnoticed. It's the first time since

16 implementation that the State's percentage of ICC and IHBS provided to the potential subclass

17 members has exceeded Los Angeles County. There does appear to be an increase in subclass

18 members being identified by mental health but the rate at which these children are accessing ICC

19 and IHBS continues to be problematic.

20

The gap between the number of children known to county child welfare agencies who appear

21 to be subclass members (potential estimated subclass members) and the number of these children

22 that are actually becoming subclass members is unacceptable. As reported in the October 2014

23 Special Master's Report, even by adjusting the potential estimate number of subclass members by

24 one third, this continues to remain an unacceptable nun1ber of children not being able to

25 receive/access ICC and IHBS, as medically necessary, a federally entitled service.

26 Status on State Activities for Increasing Services to Subclass Members in Selected Counties

27

There is good news. Looking over the October Semi-k.lllual Progress Report WId the

28 September 2014 DHCS Claims Data Report, there continues to be an increasing number of

29 subclass members receiving ICC and IHBS. It's likely that State's efforts of outreaching to

30 counties, providing a new level of monitoring, direct engagement and the provision of technical

31 assistance for problem solving has contributed to this increase. Other factors have also

35

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 36 of 41 Page ID #:7913

1 contributed to this increase as well. This includes counties preparing for the Semi-Annual Report,

2 additional staffing at the county level and a better understanding of the implementation

3 requirements.

4

The State has adopted and is successfully putting to use a 'Problem Solving' approach as

5 they monitor and engage selected counties. This approach identifies county barriers/issues;

6 identifies actions taken by the county to resolve the issue/barriers; assesses effectiveness of

7 county actions; identifies State actions with timeframes, if necessary, with the specific intent on

8 increasing the number of subclass members receiving ICC and IHBS. This problem solving

9 approach is evident in the States Sixteen County Summary Report and in the Eight County

10 Update.

11

The State's summary on their activities for increasing services to subclass members

12 demonstrated the impact they are having by engaging counties through direct monitoring,

13 personal involvement and technical assistance. This type of ongoing vigilance and problem

14 solving intentionality during this critical phase of implementation will pay big dividends for

15 increasing the number of subclass members who receive ICC and IHBS.

16 The State's problem solving approach should becoming increasingly more efficient and effective

17 as the State gains an understanding of county operation issues, methods of identification of

18 potential subclass members, screening, referral for assessment, subclass determination and the

19 provision ofICC and IHBS.

20

The Sixteen County Summary and Eight County Update speaks for itself and it's very

21 encouraging to see the State reporting out their actions and expected increases in ICC and IHBS.

22 There are two areas of concern that have emerged in the Summary and Update. One, many

23 counties are not transitioning subclass members who are receiving 'other mental health services'

24 to ICC and IHBS. There are many possible reasons for this, but there are no 'substitutes or

25 equivalents' for ICC and IHBS. It's clearly stated in the Medi-Cal ICC and IHBS Documentation

26 Manual, subclass members are entitled to these services, as medically necessary, and should

27 receive them consistent with the Mfulual. Two, there appears in the Summary and Update no

28 acknowledgement that insufficient dollars exist to hire the staff necessary that would increase the

29 number of subclass members receiving ICC or IHBS. If conversations were occurring about

30 counties' limited capacity to hire staff due to lack of dollars I would hope that issue would surface

31 sooner than later. Perhaps as the new Shared Management Structure emerges, if money to hire

36

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 37 of 41 Page ID #:7914

1 staff arises as an issue, it will surface then.

2

The State has committed to continue to implement this approach beyond the Court's

3 jurisdiction as one of a number of strategies to begin to significantly close the gap between the

4 number of estimated potential subclass and subclass members receiving ICC and IHBS. This

5 strategy alone will not be sufficient. The additional strategy described in the Recommendation

6 One, from the Katie A. Statement of Agreement, October 28,2014, Court Dkt 919, whereby the

7 State will identify performance goals for counties, will strengthen the overall effectiveness of the

8 State increasing the number of children and youth receiving ICC, IHBS, and TFC (once

9 implemented), consistent with the CPM.

10

The State identifying county performance goals is in the early stages of implementing this

11 action identified in the October, Statement of Agreement. The Sixteen County Summary and

12 Eight County Update established a placeholder for this effort in the future, but atthis time no

13 county performance goals have been set. It's evident that the State is preparing its staff and

14 counties for this goal setting process. It's also important that the State has been providing updates

15 to their respective county associations regarding this activity, so there are no surprises. I'm

16 optimistic that this work with counties will show meaningful and timely results in increasing the

17 numbers of subclass members receiving ICC and IHBS.

18 .

The Special Master remains cautiously optimistic regarding the State's ability to keep this

19 commitment on continuing this level of review and State actions with counties where documented

20 access and under utilizations to ICC and IHBS for subclass members exist. Although there will

21 be many new and potential State priorities that could redirect staff resources away from

22 continuing the implementation of Katie A., in my conversations with State staff they continue to.

23 reflect a commitment consistent with the level of State and county engagement called for in the

24 Statement of Agreements, Service Delivery Action Plan and the objectives 6fthe Settlement

25 Agreement.

26

In closing, ICC and IHBS are Medi-Cal/Medicaid services that the subclass members are

27 entitled to under federal law, as medically necessary. Until a process is in place in all fifty-eight

28 counties to ensure future potential subclass members are screened, and assessed by mental health

29 to determine subclass eligibility and subclass members receive ICC and IHBS, the State should

30 not reduce is efforts in implementation of Katie A.

31

37

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 38 of 41 Page ID #:7915

1 TFC Implementation

2

As described earlier in this report, the State is working with CMS to secure approval of TFC.

3 The Special Master remains optimistic that the State will secure eMS's approval to add TFC as a

4 Medi-Cal covered service. There will be significant work that remains once CMS's approval is

5 received in order to bring TFC online statewide. To avoid unnecessary delays in implementation

6 it will be important that the State develop an updated work plan with timelines, to the extent

7 possible, running concurrently with CMS review, that addresses specific implementation

8 deliverables required for a successful statewide launch of TFC. Key deliverables will be

9 identified in the Post Jurisdiction - Unfinished Implementation section below

10 State and County Structures: Implementation of a Shared Management Structure,

11 Accountability, Communication and Oversight System and Core Practice Model Fiscal

12 Strategies

13

As discussed earlier, the State has acted on the JMT/ACO recommendations. The Special,

14 Master wants to acknowledge the State for adopting the majority, if not all, of JMT/ACO

15 recommendations. The operationalization, over the next six-eight months, of what has been

16 adopted by DHCS and DSS will determine how effective the Shared Management Structure and

17 Accountability, Oversight and Communication implementation will actually be. There remains a

18 lot of decisions that need to be made, work processes to be developed and recommendations made

19 and acted on. I have identified a number of key action items in the Unfinished Implementation

20 Finding. I remain encouraged.

21 Post Jurisdiction - Unfinished Implementation Finding

22

The Special Master finds there remains significant unfinished and or yet to be implemented

23 activities/deliverables from the Settlement Agreement, Court Dkt 779, Implementation Plan,

24 Court Dkt 819-1, Service Delivery Action Plan, Court Dkt 883, Therapeutic Foster Care Work

25 Plan Update, Court Dkt 883, Statement ofAgreement on Selected Recommendations, Court Dkt

26 913, August 15,2014 and Plaintiffs' and State Defendants', and Special Master's Statementof

27 Agreement on Recommendation 1-4, October 28, 2014, Court Dkt 919. As intended, the

28 implementation of Katie A. will continue past the Court's jurisdiction. As discussed earlier I will

29 not list out all the activities the State will continue to undertake, instead my finding shall identify

30 . key activities or deliverables the State should begin implementing or continue implementing.

31

• Executive Team: Implement and operationalize the Shared Management Structure as

38

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 39 of 41 Page ID #:7916

1

approved by DSS and DHCS. This includes convening the Executive Team meeting no

2

later than January 15,2015 and meet more frequently if issues arise, but to meet at least

3

quarterly.

4

• Community Team: Implement and operationalize the Community Team component of

5

the Shared Management Structure as approved by DSS and DHCS and meet on a quarterly

6

basis.

7

• Transformational Manager: Finalize decisionltimeline on hiring or contracting for the

8

Transformation Manager/Facilitator function as part of the Shared Management Structure.

9

• Departmental Policies and Procedures: Develop and finalize, as part ofthe Shared

10

. Management Structure, a Memoranda of Agreement 0 between DSS and DHCS in order

11

to better coordinate child welfare and mental health efforts to serve child welfare youth

12

with mental health needs consistent with the activities and goals identified in the JMT

13

recommendations i.e., operationalizing the coordination of routine communication, joint

14

protocols for issuing and signing All County Letters and All County Information Notices.

15

• Accountability, Communication and Oversight System: As a component of the Shared

16

Management Structure, DSS and DHCS Executive Team convene and charter the

17

Community Team to develop recommendations for a comprehensive Continuous Quality

18

Improvement (CQI) and Accountability as identified in the approved Shared Management

19

Structure. Guided by the work of the JMT recommendations the Community Team make

20

a recommendation by June 30, 2015 to the Executive Team for consideration and adopting

21

as State policy.

22

e Fiscal Strategies: Executive Team develop and implement the DSS and DHCS approved

23

Fiscal Strategies Recommendations 1.1.1-3.3.2, with particular emphasis on 1.1.1 as it

24

pertains to aligning resources for training, coaching of individual to acquire the skills

25

needed to implement and sustain the Core Practice Model Statewide and 1.2.1, DHCS

26

publishing a comprehensive EPSDT Documentation Manual.

27

• Service Delivery Action Plan and Statement Of Agreements:

28

a. Continue and/or implement the Action Plan steps the State departments will take

29

to monitor the counties' progress in providing ICC and IHBS; improve performance

30

of those counties that are not making sufficient progress in providing ICC and

31

IHBS; transition subclass members who are currently receiving intensive mental

39

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 40 of 41 Page ID #:7917

1

health services into ICC and IHBS and complete development of outcomes and

2

accountability measures and quality controls systems consistent with the Core

3

Practice Model.

4

b. DSS and DHCS continue its intentional focus and activities as specified in

5

Recommendation 1, Statement of Agreement on Selected Recommendations, Court

6

Dkt 913, for increasing ICC and IHBS, and TFC (once implemented) to subclass

7

members in the twelve counties with the largest child welfare caseload, as well as in

8

counties not yet providing services.

9

c. Implement actions/activities identified in Recommendation 1, Statement

10

of Agreement on Selected Recommendations, Court Dkt 919 to identify for each

11

county: a)performance goals for increasing the number of children and youth

12

receiving ICC, IHBS and TFC (once implemented), and (b) a projected timeline for

13

achieving these goals. These goals will be based on county-specific or local

)

14

conditions.

15

d. Continue and implement actions/activities identified in Recommendation 2,

16

Statement of Agreement on Selected Recommendations, Court Dkt 919, continue

17

Counties' Semi-Annual Progress Reports.

18

• TFC Implementation: Implement TFC as a Medi-Cal service. Continue to pursue

19

CMS' s approval, and in order to promote a timely implementation of TFC. Pending

20

CMS's approval, DHCS, and DSS and other stakeholders concurrently begin to address

21

additional key TFC implementation areas that were identified in the TFC Work Plan

22

Update. Potential areas include documentation requirements/progress notes, medical

23

necessity/service criteria, service lockouts, and the development of separate but

24

complementary provisional/draft foster care and mental health per diem rates or additional

25

areas that have arisen since the February 2014 Work Plan Update was submitted to the

26

Court.

27

28

29

30

.31

40

Case 2:02-cv-05662-JAK-SHX Document 923 Filed 11/20/14 Page 41 of 41 Page ID #:7918

1 SECTION SEVEN: SPECIAL MASTER'S RECOMMENDATIONS TO THE COURT

2

The Special Master makes no recommendations as the Court is expected to terminate its

3 .jurisdiction over this matter on December 5, 2014.

4

5

In closing, if as expected the November 24,2014 Status Conference turns out to be the last time I

6 will address the Court, I would like to thank the Court for affording me the privilege of serving as

7 Special Master for the Katie A. case. It has been one of the most rewarding assignments of my

8 career. To Judge Matz and Judge Kronstandt, the Katie A. children and families thank you for your

9 dedication and perseverance. I can't say enough about the appreciation and gratitude I have for all

10 those involved in the negotiation of the settlement agreement, the development of the implementation

11 plan and monitoring its implementation. I would also like to extend a very special thank you to both

12 Pruiies, counsel and program staff, for their patience, professionalism and passion for ensuring foster.

13 children and their families receive the services they need and are entitled to. I am proud of the

14 accomplishments made by the Parties as reflected in the implementation of the Plan. I wish the State

15 and Plaintiffs only the best as they continue to advance the implementation of Katie A. after

16. termination of the Court's Jurisdiction.

17

18 Dated: November 20,2014

19

Respectfully Submitted

20

21

22 23

24

Richard Saletta, LCSW

25

Special Master

26

27

28

29

30

41

 </s> Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 1 of 24

1

2

3

4

5

6

7

8

UNITED STATES DISTRICT COURT

9

CENTRAL DISTRICT OF CALIFORNIA

10

II KATIE A eta!.,

12

Plaintiffs,

13

v.

14 DIANA BONTA,

15

Defendants.

CASE NO. CV 02-5662 AHM (SHx) ORDER ON PLAINTIFFS' RENEWED MOTION FOR A PRELIMINARY INJUNCTION

16

17

I.

18

INTRODUCTION

19 A. Ninth Circuit Ruling

20

The Ninth Circuit ruled that this Court "applied an erroneous legal standard

21 in concluding that the EPSDT provisions require the State to provide wraparound

22 and TFC. The district court mistakenly assumed that if all the components of

23 wraparound and TFC fall within categories listed in§ 1396d(a), and that

24 wraparound and TFC can be deemed health care 'services' in themselves, then the

25 package of components must be offered in the form of wraparound or TFC."

26 Katie A., ex ref. Ludin v. Los Angeles County, 481 F.3d 1150, 1157 (9th Cir.

27 2007).

28

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 2 of 24

1

The Ninth Circuit stated that this Court "did not explore the possibility that

2 the State might only have an obligation to fund the component services of

3 wraparound and TFC, rather than to offer the coordinated complex of services in a

4 single package" and concluded that "the EPSDT provisions require only that the

5 individual services listed in§ 1396d(a) be provided, without specifying that they

6 be provided in any particular form." !d. at 1157, 1158. The Ninth Circuit

7 therefore concluded that this Court "should have examined whether all required

8 component services under§ 1396d(a) were already being supplied. If all

9 mandated services under§ 1396d(a) are being supplied effectively, the State is not

10 obliged to go further and package the services as wraparound and TFC." !d. at

11 1158. The Ninth Circuit also noted that"[w]hile the states must live up to their

12 obligations to provide all EPSDT services, the statute and regulations afford them

13 discretion as to how to do so. There is nothing in the EPSDT statutory provisions

14 or regulations that indicates that the state must generally design its Medicaid

15 system to fund 'packages' ofEPSDT services." !d. at 1159.1

16

The Ninth Circuit instructed this Court to employ the following approach

17 on remand:

18

The court should have first determined whether the State is meeting

19

its legal obligation under the EPSDT provisions to provide all

20

individual health services that fall under the categories listed in §

21

1396d(a). Then, if it found that the State is failing to provide the

22

individual health services effectively, the court should have

23

determined whether the failure could only be remedied by ordering

24

the State to fund the individual services as a single "bundle." Rather

25

26 1 At footnote 15 of its opinion the Ninth Circuit stated, "It is possible that if the

27 State fails adequately to provide the component services, and the effectiveness of

28

those services requires their coordinated delivery, it may be appropriate to require the State to provide services packaged together in a particular form, such as

wraparound or TFC."

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 3 of 24

1

than applying a legal rule that requires the State always to fund a

2

coordinated bundle of services if the individual components fall

3

under§ 1396d(a), the court should have applied a legal rule that

4

would allow the State to exercise its discretion as to how to meet its

5

EPSDT obligation effectively to provide all the component services

6

that fall under§ 1396d(a). On remand, the district court should

7

analyze plaintiffs' likelihood of success on their Medicaid Act claims

8

in this manner.

9 !d. at 1160. Moreover, the Ninth Circuit noted,

10

[O]n remand, in order to comply with Rule 52(a) and to facilitate

II

appellate review, the district court should first make separate

12

determinations as to (1) whether each component service of

13

wraparound and TFC falls under a particular provision of§ 1396d(a),

14

and (2) whether defendants have effectively provided each mandated

15

component service, before applying the standard discussed above to

16

determine whether the State should be required to provide the

17

required services in another manner which will render such services

18

effective, or proceed directly to wraparound and TFC.

19 !d. at 1162-63.

20 B. Status Upon Remand

21

The parties are familiar with the voluminous papers that were filed after

22 plaintiffs moved anew for a preliminary injunction. Although the Court was

23 prepared to assess their positions in the manner required by the Ninth Circuit, the

24 parties' respective memoranda and evidence did little to focus the analysis beyond

25 what had been presented and argued back in 2006. For that reason, the Court

26 issued separate orders on August 12, 2008 and August 13, 2008 directing the

27 parties to address several specific questions at the August 14, 2008 hearing

28 ("Hearing"). Among these questions were the following:

3

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 4 of 24

1

• Question. (a) This Court did not deal with billing in its Order. (433

2

F.Supp.2d 1065.) Yet the Ninth Circuit ruled that the Court erred because,

3

as the Ninth Circuit put it,

4

5

The Court did not explore the possibility that the State might only

6

have an obligation to fund the component services ofwraparound

7

and TFC, rather than to offer the coordinated complex ofservices in

8

a single package.

9

10

... [D}efendants had stated in their opposition to Plaintiffs' motion

11

for a preliminary injunction that 'Medi-Cal already covers the

12

services that Plaintiffs are entitled to under Medicaid and that

13

PlaintiffS were seeking a bundled rate.' There was also evidence in

14

the record that Medi-Cal currently reimburses providers for at least

15

some components ofwraparound and TFC. Therefore the court

16

should have examined whether all required component services

17

under§ 1396d(a) were already being supplied."

18

481 F. 3d at 1158 (emphasis added). Does this quote and the passage cited

19

below from 481 F. 3d at 1161 suggest that the Ninth Circuit conflated the

20

question ofthe required delivery ofservices with the different (albeit

21

related) question ofbillingfor services?

22

(b) Given that both sides agree that at least many ofthe component

23

aspects ofwraparound and TFC are required under§ 1396d(a), is the real

24

dispute about how providers will bill/or services they render? Are

25

Defendants opposing this motion because they do not want to reimburse

26

providers for wraparound or TFC services that are billed as such--i.e.,

27

described and labeled as wraparound or TFC? Ifthat is the crux of

28

Defendants' concern, then is whether someone who is a coordinator or

4

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 5 of 24

1

integrator ofcomponent services, such as a "wraparound coordinator, "

2

eligible for Medicaidfunding an example ofthe issue? (See App. A to

3

5/12/06 Addendum to Order Granting Plaintiffs' Motion for Preliminary

4

Injunction, p.2.) How about a "wraparoundfacilitator"? A TFC

5

"coordinator"? Ifthat is the key concern, would Plaintiffs agree that

6

persons who coordinate the delivery ofthose services could not billfor

7

wraparound or TFC-- "as such"?

8

• Question. The Ninth Circuit directed .this Court to determine whether

9

"the State is failing to provide the individual health services effectively"

10

before determining whether any failure to do so "could only be remedied by

11

ordering the State to fund the individual services as a single 'bundle. "'

12

(481 F. 3d at 1161) (emphasis added). How is the Court to evaluate the

13

effectiveness ofthe delivery ofthose components ofwraparound and TFC

14

that even Plaintiffs acknowledge are being provided? What is the key

15

evidence on which each side relies for its position as to effectiveness vel

16

non?

17

• Question. See n.15 to the Ninth Circuit's opinion (481 F.3d at

18

1157): Assuming the State does adequately provide the component services

19

required by EPSDT, do Plaintiffs contend that "the effectiveness ofthose

20

services requires their coordinated delivery . .. "? Plaintiffs repeatedly

21

insist that "Plaintiffs do not contend that California must provide

22

wraparound services (or TFC) as a single bundled service under Medi-

23

Cal. " [Reply Brief 8: 16-18}. (What do Plaintiffs mean by the phrase

24

"single bundled service"?) How do Plaintiffs reconcile that assertion with

25

their many other implicit, and sometimes explicit, contentions to the effect

26

that all the components ofboth wraparound and TFC must be provided as

27

if in a package? For example, Plaintiffs state "... [A]ll the components of

28

wraparound services and TFC in Appendices A and B are necessary and ..

5

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 6 of 24

1

. they all must be provided in a coordinatedfashion to be effective .... "

2

[Opening Memo. 18:6-8]. Similarly, Plaintiffs assert that "[T}o be

3

effective TFC 'must be provided as an integrated service, ' which means that

4

the 'components are interrelated and must be coordinated.'" Id., 21:2-4.

5 The parties' responses to these questions, their arguments at the August 14, 2008

6 hearing on plaintiffs' Renewed Motion for a Preliminary Injunction and the papers

7 they filed afterward have prompted the Court to step back and look at the

8 proverbial "big picture." In some respects it is a disappointing picture indeed.

9

This case involves complex statutes and regulations; innovative strategies

10 for dealing with mental illness and behavioral problems afflicting children and

11 adolescents; the challenge of coordinating the efforts of such disparate Medicaid

12 providers as physicians, social workers, lawyers, teachers, family members and

13 foster parents, all of whom serve or treat those children; foster care systems

14 throughout the state that are beleaguered on many fronts; and the ever-present

15 (and growing) gap between the legal responsibilities of governments and their

16 capacity to discharge those costly responsibilities. Moreover, both sides are

17 forced to navigate through a bureaucratic maze: three different governmental

18 systems - - federal, state and local - - with their own sets oflaws, regulations and

19 procedures. (Medicaid is a federal program. Medi-Cal is a state program, but it is

20 administered by and dependent on California's 58 counties.) Moreover, each

21 governmental system wishes to limit the amount of money it has to spend.2

22

The parties ostensibly share the basic objective of seeing to it that the right

23 of these children to receive services mandated by Medicaid and Medi-Cal is fully

24 enforced. Moreover, they now appear to be in agreement about certain issues

25 they previously treated as in conflict. Yet, as the Court noted at the hearing,

26

27 2 To deal with severe fiscal and budgetary constraints, the State Defendants attempt

28

to enforce complicated reporting, billing and reimbursement requirements by imposing rigorous audit procedures.

6

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 7 of 24

1 despite the huge costs in time, money and resources that litigation exacts, both

2 sides seem more intent on vindicating their respective contentions than on

3 pursuing promising opportunities to narrow their differences and even reach an

4 agreement, especially as to wraparound.

5

So what, really, is the problem? There are actually two problems. First,

6 there is genuine, but somewhat misplaced, confusion as to whether certain

7 components of wraparound and TFC qualify as required EPSDT services.

8 Second, and more importantly, it now is clear that the main practical barrier is

9 determining how providers may and should bill for those services.

1 o

In 2006, after much prodding, plaintiffs finally described just what

11 wraparound and TFC consist of. Since then, however, they have had difficulty

12 demonstrating clearly that the State Defendants are not providing those services.

13 Indeed, plaintiffs now acknowledge that in several respects at least some of these 14 services are being provided, albeit not necessarily as part of Medi-Cal. The State

15 Defendants, for their part, claim to provide all required EPSDT services to

16 members of the plaintiff class. Yet in opposing plaintiffs' efforts to obtain

17 wraparound and TFC under EPSDT as a matter of right, State Defendants still

18 cling unreasonably to a semantical mantra dependent on an unnecessary

19 technicality- i.e., they are not required to provide wraparound and TFC "as such."

20 This position fails to recognize not only the broad scope ofEPSDT, but the

21 essence ofboth wraparound and TFC.

22

And yet, there is a reasonable basis to find that the parties can reach

23 agreement on many issues. Their respective responses to the Court's pre-hearing

24 written questions, their concessions at the hearing, and their post-hearing

25 submissions collectively provide a promising basis to do so, as the following

26 summary demonstrates.

27

28

7

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 8 of 24

I C. Framework for Negotiations

2

1. Answers to Court's Pre-bearing Questionnaires

3

At page 5 of plaintiffs' August 20, 2008 written response to this Court's

4 Question 15, plaintiffs acknowledged that "the SB-163 wraparound programs and

5 the pilot program in Marin County [are] currently providing wraparound

6 programs" but that "whether they are providing all of the components of

7 wraparound services ... in a coordinated fashion"-- is unclear.3 "However,

8 plaintiffs suspect that many children enrolled in these programs are receiving all

9 the components of wraparound services and in a coordinated fashion."

10

2. Representations at Hearing

II

(a) State Defendants' Representations. State Defendants' counsel

12 represented that as to wraparound "California is already covering those things

13 ["Immediate Crisis Stabilization" and "Engagement of Child/Family"] if they are

14 billed under Case Management and Rehabilitative options." [Transcript, p.15.]

15

• It appears from the gist of other statements made by State

16 Defendants' counsel that California's position is that other components of

17 wraparound services that were listed on Dr. Redman's Table (attached hereto as

18 Exhibit A), also are covered. See, e.g., Transcript p.53:

19

wrapar"oIunntdersmersvoicfetsh,eadneyltihvienrgytohfatseinrvvioclevsetshiamt mweed'rieatceaslltianl:giilization

20

andbringing the _people together to work with this child specifically and planning and providing the services, those services are already

21

being covered under the Medicaid Act called Case Management and

Rehabilitative Services.

22

Specifically for Rehabilitative Services - excuse me, one second.

23

I'll add that, in addition any one of those components that cover

24

improving or restoring a beneficiary's dailx living skills, social and leisure skills, support resources or education shall be covered under the Medicaid

25

Act and IS already being covered ....

26

27
28 3 Plaintiffs also emphasize that the SB-163 programs are in place on only some 40 counties.

8

Ca e 2:02-cv-05662-AHM-SH Document 629 Filed.09/22/2008 Page 9 of 24

I 2

hoafvtheocsSoevocehartoeedwgtoehvreieemrs,tuhwnoedseedrocCocmaospveoeMrnetahnnetasmgaearmendebnrwot kialenlndcodRnoetwihnanubeioftopthtcieooynv,feawrlltehiennmotot.

one only

3 4 5

iowCtp'aests'irqoeeunMissBtaeaieynnciiananthgtugeoesrtmesehesMeetncissnhta,.gamRrwttehseeadlfhatomansrvhagaeneul'lacslgtioshcevtoh.sesarCIereftaiaoynstoieght,ueMtwrablasiekltnlsawatiageitlbseul.omncudoBetevnuerettvrRaheineert,hyareawRobietenihlhdeiCoatrabasctliitiloaofivtotnaeert,raniIoiniatntd.,hink

(Emphasis added.)

6

• State Defendants' counsel also confirmed that "[i]fwork is

7 performed that consists of 'engagement of child slash [sic] family,' the state

8 agrees that falls within the Medicaid statute and the Medi-Cal program ...." Id.,

9 p.56. Indeed, counsel volunteered that "all of the things listed here [Exhibit A, the

10 Table of Contents for Redman Declaration] can fall under Case Management or

11
Rehabilitative Services ...." Id. at 58.

12
(b) Plaintiffs' Representations.

13

• Counsel for plaintiffs, in turn, reiterated that 39-40 counties in

14 California do provide "wraparound," albeit not as a Medi-Cal program and not

15 "effectively" (in his opinion) because not as an entitlement for all eligible

16
children.

17

• In addition, plaintiffs' counsel concluded his remarks with this

18
observation:

19 20
21
22 23

pattthharreaealktptce'tasohdrveeIbaefdyebrwietocnodaeugntcbasoeryboeaneuMrcwglceiheoehddtrvee,imrecterwhaaewaihyddtieb,cuaheaalnlnrdmiendseuirtnltocehMehdtetaceyemyordasomiar-raenCpendoaaadnlltlshenocoenuontrrtgsseirtcepatoehntrfeseetlwsgdyleiore,nnafitetnpehmsnagegdrtnohoatuetunohtntCestadhordaesuerveelrCiristveoiinfucgrets i-bno-ttoahntrhdeeca1idpsvsieiusneitnosgfapesxrtoaovcitwalyhearwsthtaohbewoiruoteunhldtoiwtbleetmheneeytnittclioesud-lad-nabdinledllaiwgneidbhidlaietvlyievcner'rittgtehrooinasee

24

services.

25 !d. at 81. (Emphasis added.)
26

27

28

9

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 10 of 24

1

3. Post-hearing Filings4

2

(a) Plaintiffs

3

Plaintiffs filed several exhibits. The Court compiled a Table of Contents of

4 those items. It is attached hereto as Exhibit B.5 Exhibit 184, the DMH Letter No.

5 06-05 (July 24, 2006) appears to be the key one. The letter lists and describes in

6 detail those wraparound components initially listed by plaintiffs that are

7 reimbursable under Medi-Cal. 6 The DMH circulated that letter as a means of

8 implementing the now-vacated Preliminary Injunction that this Court issued on

9 March 14, 2006.

10

(b) Defendants

11

• Rita McCabe, currently the Chief of the Medi-Cal Mental Health Policy

12 Branch and other Health Care Benefits of the California Department of Mental

13 Health ("DMH"), is a dedicated, hard-working, official who has been required to

14 devote long, difficult hours to addressing issues in this case and the related Emily

15 Q litigation. On August 20, 2008, State Defendants filed her declaration in
16 support of their Supplemental Brief. Among other things, Ms. McCabe explained 17 in detail the basis for a revealing chart (attached hereto as Exhibit C) that 18 constitutes page three of the Defendants' Supplemental Brief. Ms. McCabe

19 represented that of the nine components of wraparound defined by plaintiffs' 20 expert, Dr. Redman, four are authorized outright by Medi-Cal and the remaining

21
22 4 The Court takes judicial notice of all the documents that both sides filed, except as to disputed declarations. But even those declarations are nevertheless relevant
23 and admissible for purposes of this order. 24 5 In the future, all parties shall attach a Table ofContents to exhibits and declarations 25 they file, which thus far have been unusually voluminous.
26 6 This Court finds that those components are Medi-Cal eligible, notwithstanding 27 Deputy Attorney General Goldsmith's remarks at the most recent deposition ofRita 28 McCabe.

10

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 11 of 24

1 five could be authorized, under certain circumstances, which she helpfully

2 described.

3

• State Defendants later filed a series of documents described in the

4 attached Exhibit D, a Table of Contents the Court also compiled. State

5 Defendants included the declaration of Bradley Norman, which identifies 6 individuals and programs that currently provide guidance as to "Medi-Cal billing" 7 for eligible wraparound services. (See Norman Dec!.,, 6, 10.) In addition, State

8 Defendants filed the declaration of Curtis Yukoi, which contains "Program Code 9 Descriptions" that provide guidance on how to claim Medi-Cal funds. Moreover,

1o they filed the Declaration of Gary Renslo, who reveals that as recently as July

11 2008 the DMH completed and posted on its website a Medi-Cal Billing Manual.

12

The Court is distinctly unimpressed with plaintiffs' negative approach in

13 their September 4, 2008 opposition to the State Defendants' submission of this 14 evidence, and the Court overrules their objection to the late filing of those

15 documents. It is disappointing that plaintiffs utterly ignored the Court's explicit 16 invitation at the Hearing to not only look for, but exploit, the many promising

17 areas of agreement that emerged at the Hearing. Particularly disturbing is 18 plaintiffs' complaint in their footnote 4 that the State Defendants changed their

19 position as to which components of wraparound services are covered by MediCal. 20 The change in the State Defendants' position went a considerable distance toward

21 accepting plaintiffs' contentions. Plaintiffs could have figuratively declared

22 partial victory. Instead, they complained that State Defendants did not explain

23 why they changed their position. Plaintiffs also cavalierly pooh-poohed the

24 potential benefit of the California Institute for Mental Health ("CIMH") EPSDT 25 Chart Documentation Manual and they flatly ignored the potential benefit from

26 the technical assistance that EMQ provides to California counties having SB 163

27 programs. Also regrettable is plaintiffs' failure to see the opening that the DMH 28 letter No. 06-05 provides. Finally, while the DMH Billing Manual attached to Mr.

11

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 12 of 24

Renslo's declaration may not answer all of plaintiffs' questions, it is a very recent

2 document that should have prompted plaintiffs to reevaluate their position.

3

n

4

MANDATED NEGOTIATIONS: WRAPAROUND

5

The foregoing summary confirms that at least as to wraparound what is

6 urgently needed - - and clearly feasible - - is a good faith joint effort by the parties

7 to develop letters and notices that the State Defendants will disseminate to all of

8 the County Mental Health Plans ("MHPs"), and to as many eligible recipients (or

9 their individual and institutional representatives) as possible. Such negotiations

10 will surely assist the parties in reducing or eliminating the confusion about

II wraparound's Medicare/Medi-Cal status. They likely also will reduce or eliminate

12 the concern ofMHPs, providers and recipients as to whether such services will be

13 reimbursed. The Court ORDERS the parties to undertake that effort promptly.

14 The letter and notices that the parties shall develop shall list specifically, and in

15 plain language, the components of wraparound defined by Dr. Redman that are

16 covered by Medi-Cal, and it should explain how these services properly may be

17 characterized and billed. In conducting these negotiations, the parties shall make

18 maximum use of the offers, assurances and materials identified above.

19

The parties shall file a status report on their negotiations by not later than

20 October 29, 2008. If at any point before then or by then they conclude that their

21 efforts can be assisted by the Court, they are welcome to request such assistance.

22

III.

23

PRELIMINARY OBSERVATIONS

24

RE WRAPAROUND COORDINATION

25

The Court may ultimately have to determine the second prong that the

26 Ninth Circuit referred to as important for appellate review-- i.e., whether

27 providing the components of wraparound separately is "effective" or whether

28 instead delivery of those services must be coordinated to satisfy the EPSDT

12

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 13 of 24

1 requirements. Because the State Defendants have (to their credit) re-evaluated

2 their position as to which components of wraparound fall within EPSDT, if they

3 request the opportunity to respond to the following preliminary observations --

4 they are not final findings -- the Court will allow them to do so, after the parties

5 report to the Court about their negotiations and the Court makes its findings as to

6 the first prong (i.e., which components fall within EPSDT).

7

Under one statute, wraparound services are comprehensive and holistic

8 services that should be provided in a coordinated fashion. See, e.g., California

9 Welfare and Institutions Code § 18251 (d), defining wraparound services as

10 "community-based intervention services that emphasize the strengths of the child

11 and family and includes the delivery of coordinated, highly individualized

12 unconditional serviCes to address needs and achieve positive outcomes in their

13 lives." Cal. Welf. & Inst. § 18251(d) (emphasis added).

14

As seen in the following evidence, there is clear support for the conclusion

15 that wraparound services must be coordinated to be effective.7 For example, the

16 first component of wraparound services is "Engagement of the Child and Family."

17 See App. A at 2. Bruce Kamradt, the Director of Wraparound Milwaukee, states

18 that "one cannot provide necessary services for the child without engaging the

19 family" because a "basic precept of wraparound services ... is that a child is a

20 member of [a] family" and that the family must become "an active participant in

21 determining the child's strengths and needs, developing a plan to meet the child's

22 needs and helping to marshal the services to meet those needs." Supp. Kamradt

23 Dec!. 14. See also Penrod Dec!. 123 (Child family team "acts as the 'glue' to

24 coordinating the implementation of all the components of wraparound services,

25

26 7 The evidence was encompassed in Plaintiffs' Proposed Findings of Fact and

27 Conclusions of Law. See e.g., 11 31-32. The Court invited State Defendants to

28

challenge the accuracy ofand factual basis for those citations, and State Defendants pointed to no errors.

13

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 14 of 24

1 and the team itself functions as a mode of treatment."). "It makes absolutely no

2 sense to form a child and family team but not have this team intimately involved

3 in and responsible for planning for any mental or behavioral crisis of the child,

4 gathering information as to the child's strengths and needs, developing a plan to

5 deliver necessary services to the child through both formal and natural supports,

6 tracking the success of this plan and making necessary adjustments, and ultimately

7 planning for the child's transition away from wraparound. services." Further Farr

8 Dec!.~ 9. See also Supp. Penrod Dec!.~ 22 ("By coordinated, I mean that the

9 components of wraparound services are interrelated and interconnected. For

10 example, the child and family must be engaged through the child's treatment and

11 involved in forming the child and family team; the child and family team must be

12 involved in developing and implementing the treatment and crisis plans; and the

13 goals determined by the child and family team must drive the treatment and

14 ultimately the transition from wraparound services."). See also Penrod Dec!.~ 24

15 ("Disconnected efforts often led to less-effective outcomes. Instead, [Arizona]

16 found that the best way to ensure that the services a child received from a provider

17 were effective was to have the child and family team work together with the

18 provider and coordinate the child's care from the provider."); accord, Supp.

19 Friedman Dec!.~ 18 (Providers in Nebraska of multi-systemic therapy ("MST"), a

20 treatment for children with anti-social behavior, originally provided services

21 independent of the wraparound team only to find that the children were not having

22 the expected positive outcomes. Once the MST providers were integrated into the

23 wraparound team, the children's mental health improved.)

24

Members of the statewide class are often involved with more than one state

25 system (i.e., welfare, mental health, probation) and they often receive care from

26 more than one provider. Rauso Dec!.~ 12; Supp. Farr. Dec!.~ 10. Thus, it is

27 critical that all those caregivers work together to meet the child's needs. Supp.

28 Kamradt Dec!.~ 8. Otherwise, there is a risk of"disjointed or competing

14

Ca 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 15 of 24

I assignments or orders from different providers or systems [that] may make it

2 virtually impossible for the child and family to accomplish them all, thereby

3 setting the child and family up for failure." Rauso Dec!.~ 12. Thus, absent

4 coordination, providers may be working in opposite directions as to whether to

5 keep a child in the home or allow him to remain in public school. Supp. Kamradt

6 Dec!.~ 8; Supp. Huffine Dec!.~ 19 ("[C]hild and family are pulled in a variety of

7 directions by different obligations and approaches and there is a replication of

8 efforts by different child-serving agencies.")

9

Moreover, wraparound is considered an "evidence-based practice" and "the

10 gold standard" in the mental health field, because the treatments have resulted

II from randomized clinical trials. See Chamberlain Dec!.~ 14; Second Supp.

12 Chamberlain Dec!.~ 15; Friedman Dec!.~~ 19-21; Supp. Friedman Dec!.~ 12;

13 Supp. Bruns Dec!. ~~ 20, 30. "As a general proposition regarding evidence-based

14 practices, there is no evidence, and no reason to believe, that the intervention will

15 lead to the positive results that have been proven if you vary the method of

16 providing it from the way it was designed, developed and researched." Supp.

17 Friedman Dec!.~ 13; accord, Supp. Huffine Dec!.~ 14; Second Supp.

18 Chamberlain Dec!.~ 16.

19

Thus, given that wraparound was researched and developed with specific

20 components, the evidence shows that modifying or omitting any of these

21 components lessens the effectiveness of the services. See, e.g., Supp. Bruns Dec!.

22 ~~ 21-24 ("There must be adherence to the fully specified practice for its benefits

23 to be conferred ... One cannot take out any of the components and expect

24 successful outcomes for children."). One wraparound provider in Sacramento

25 states that "even if a case manager is attentive, engaged and thoughtful, that

26 arrangement is not an adequate substitute for a functioning child and family

27 team." Further Farr Dec!.~ 3. See also Supp. Bruns Dec!.~ 18 (noting that

28 research has found better outcomes through the "provision of services through a

15

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 16 of 24

1 treatment team"). Two studies by Dr. Eric Bruns further show that "the more that

2 the wraparound provider adhered to the core components," the "better the

3 outcomes would be for children and their families." Supp. Bruns Dec!.~~ 28-29.

4 See also Supp. Friedman Dec!.~ 18 (A multi-site Department of Defense

5 wraparound project did not provide all the components and did not coordinate the

6 components that were provided; as a result, there were not statistically significant

7 differences between children in the program and those receiving traditional mental

8 health services.)

9

IV.

10

THERAPEUTIC FOSTER CARE

11

The Court finds that the parties are further along in narrowing their

12 differences as to wraparound than they are as to "TFC." Moreover, there is a

13 complication as to TFC: will the moratorium on the Centers for Medicare and 14 Medicaid Services ("CMS") regulations expire on April!, 2009?8 Because the

15 wraparound negotiations mandated by the preceding section ofthis order may

16 entail various problems in their own right, it would be imprudent to require the

17 parties simultaneously to embark on the same path as to TFC. Accordingly, at

18

19

20

21

22

23 8 On June 30, 2008, President Bush signed into law Public Law 110-252 (H.R.

2642), Supplemental Appropriations Act of 2008. Section 7001 (a) of that law: (1) 24 extended the existing moratorium on the CMS regulations regarding rehabilitative

25 services until April!, 2009 (Section 7001 (a)(2)); (2) imposed a new moratorium on

26

the CMS regulations regarding case management services until April 1, 2009 (Section 700l(a)(3)(B)); and (3) prohibited the U.S. Department of Health and

27 Human Services from taking "any action" to impose restrictions related to any ofthe

28 regulations that are subject to these moratoria (Section 700l(a)(3)(A)).

16

Cas 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 17 of 24

1 this time the Court intends to take the preliminary injunction motion as to TFC 2 under submission.

3

4

IT IS SO ORDERED.

5
6 DATED:
7

9/22/08

A.Ho~nrt'"'~~----~--~
United States District Judge

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

17

Table with Selected States' Coverage of Components ofWraparound Services and Therapeutic Foster Care
Table of Contents

Table Sections

Page

tr:1
-~
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;.-3
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it
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"«>'.".a.' ·~"
~"2105/07

Appendix A: Components of Wraparound Services

Engagement of Child/Family...................................................... 3

Immediate Crisis Stabilization................................................... . 7
Ongoing Crisis and Safety Planning.............................................. 10 Strengths and Needs Assessment............ :..... ;............................ .. 14

Wraparound Team Formation...................................................... 18..

Wraparound Service Plan Development. ......................................... 22

Wraparound Services Plan Implementation.................................... . 27

Tracking and Adapting the Wraparound Servic_e Plan....................... .. 32

Transition........................................: ..................................... 36

~ ...._~"t.~~

'"''

'"

·~

Appendix B: Components of Therapeutic.Fo~~r Care.

i

'

.1,

-<-··-

Therapeutic Foster Care.................... ,,,_, ....~:. ."::: ....•:.'.... :.·.. ~:... :......_: 41- -

Recruiting and Matching....................... :... - ... :............ ,., ........... 42
Foster Parent Training........................................... :.................. 43 Development of Treatment Plan............. ,..... , .............................. 47 Tracking and Adapting the Treatment Plan.................................... . 51 Plan l!nplementation................... _. ............................................ 54 Family Treatment................................................................... 57 Transition........................................................................ :.. .. 60

Sour.ces ...............,. . :............... ·..... · ·· ··· ··· ··· · ··· ·· ·· ···· ·· ·· ·· ···· · ··· ··:· ··· ·· · 63

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2

Case 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 19 of 24

Plaintiffs' Submission of Additional Documents (filed 8/20/08) Katie A. et al v. Bonta et al (CV 02-05662)

Ex. 181: Ex. 182: Ex. 183: Ex. 184: Ex. 185: Ex. 186: Ex. 187: Ex. 188:
Ex. 189:

California Dept. of Mental Health ("DMH") Letter No. 040-4 Re: EPSDT Services Notices at Time of Admission (dated 2/19/04)
DMH Letter No. 99-03 Re: EPSDT Services Notices at Time of Admission (dated 7/23/99)
DMH Letter No. 01-01 Re: One to One Mental Health Services (dated 5/4/01)
DMH Letter No. 06-05 Re: Implementation of the Preliminazy Injunction in Katie A. (dated 7/24/06)
Standard Contract Between DMH and the County Mental Health Plans
Introduction. TOC. and Sections 2. 3 and 10 of the manual for providers from the Fresno Mental Health Plans
A Guide to Procedure Codes for Claiming Mental Health Services from the LA County Dept. of Mental Health (dated 4/12/07)
Short-Doyle/Medi-Cal Organizational Provider's Manual for Specialty Mental Health Services under the Rehabilitation Option and Targeted Case Management Services by the LA County Dept. of Mental Health (updated April2007)
Checklists developed by the County of San Diego for billing various mental health services

EXHIBITB

Attorneys for Defendants

10

11

IN THE UNITED STATES DISTRICT COURT

12

FOR THE CENTRAL DISTRICT OF CALIFORNIA

. 13

14 15 16 17 18

KfJaDnGtirnahneiA.icd,rexdloolinTbtivtubdyafIhigsnnEdrMa;heouBnAJnauihAdrcl.dgio,lhsNtyhwbDhanEyaehrnoe.olneT;laxoLudrnAtCrgundfoeNh.rdesn,tiDxihehJbnbtniory;GseofdhrhManuAniManeegsRAlnxdohfiYdtRcnoththh;YRfrEearHiorooe.eB,tlEbnnuh.bL,eedgNeyxrbrhuRtstyadhYniendr, . similarly situated,

19

Plaintiffs,

20

v.

21 22
23
24 25 26

DDACCStCSD1hEIAOeNHhteeAhpRipEUGILlrNaLaVdNoNEorrADrtuIZstLeTmCmgR,nBAEYhEeDeESOnanSnD1NgnitNCtr;0edEeoo0lAATOcPefFf,~tNsNAUniSao;nDeCmIRNrocTDacoToliTFAluiliuflatyYrsAVhntleiBhS;vtlMcSSEyeOeeLteeoN,rIDCrOCvrLrvvTiaeKSioYciclpcOfei,eAefasCDsoFs;rN,;atriRamnrlGLnieiIfeOaEcTdontLSAroDtnErooiSaofesf

27

Defendants.

28

CV-02-05662 ARM (SHx)

SRSCUTEOASPUPPTROLETEND'MSSEEEFAENTUNTOGDAUTALSHTNBETR14SI,E' 2F00IN8.

ORDER

.

Hearing: Time:

Under Submission Under Submission

Courtroom: 14 Judge: Hon. A

Howard Matz

EXHIBITC-1

.,.?•i,c'.•+:,•·,··"'"''~l.·,. ·.'·. <)3y .this pleading State Defendants submit their supplemental brief in response

3 to the order of the Court issued on August 14, 2008 as follows:

4
5

1) ctihDoneveAeTcrlpaaepbrdealebntiydooinfMxCsAeeodtntaiitcnneadgnitdTfs/ohMarettrehtaadJwc?ih-.heCeuedattilhctopeFrrRootghesrdteeamrcmoaC.mna'srpeodanesecnllaitsrsateotidfowinn{raAEpxpahprioebnuidnt idAxa)Bsalroiesfted

6
7
8

2) (RfAaleelldthteWeacrb,li,tarhareianngtdui1olMa3nt9eis6odta(n1atc1i)ane(ltag.c).w,T)shhtuheecathdht eesacreslttashCrefaaorsteireotihMns tssahhoneomacugehledaSmrtaaealcnstteote,lreecixsvltipeinlcliasc"iandoloftschweuerhmvaietcnestse",rvic·es ·

"document."

9

State Defendants provide the chart below to address the Court's directive for a

10
·n

"yes" or "no" answer. Please note, State Defendants have provided "yes" or "no" answers where possible.. However, because there are components listed in

12 Appendix A and B that do not lend themselves to yes or no answers because the

13 components are only covered by Medicaid/Medi-Cal with additional

14 qualifications, State Defendants have identified these components as a "maybe."

15 All references are supported l)y explanations in the attached declaration of Rita

16 McCabe. (Exhibit B.)

17 Ill

18 Ill

19

20

21

22

23

24

25

26
27

28

EXHIBITC-2

2

Filed 09/22/2008 Page 22 of 24

2 Is component covered? Appendix A:

3 Components of

4 Wraparound Services

5 Yes

Engagement of

6

Child/Family

7 Yes

Immediate Crisis

8

Stabilization

9 Yes

Ongoing Crisis and

10 11 Yes

Safety Planning Strengths and Ne.eds

12

13 Maybe with additional

14 qualifications 15 Maybe with additional
qualifications 16 Maybe with additional 17 qualifications

18

with additional

19

20

21

Team Formation
Service Plan Development Ser-vices Plan
Tracking and Adapting the Service Plan Transition

of Contents
Declaration of Rita McCabe£1 Page (p.) 6, paragraph (par.) I. P. 7, par. 2.
P.8, par. 3.
Id. at par. 4.
P. 9, par. 5.
Id. at par. 6.
P.IO,par. 7.
P. 11, par. 8.
Id. at par. 9.

22

23

24

25

26
27

l. Please description of the

note that the word "wraparound" has component, per the Court's directive.

been

deleted

from

the

·

28

2. Rita McCabe's Declaration explains the coverage of the components as indicated in this

conditions chart.

of

Medicaid/Medi-Cal's

EXHIBITC-3

3

Filed 09!22f2Q08... . E;;~ge 23 of. 24

AppendixB:

Authority in

4

Components of

Declaration of Rita

5

Therapeutic Foster

McCabe·

6

Care

7 No
8 No
9· No 10 Maybe with additional

Therapeutic Foster Care Recruiting and Matching Foster Parent Training Development of

P. 12,par. I.

P. 13, PilL 2.

Id.

3.

Id. at par. 4.

11 qualifications

... TreatmentPlan

12 Maybe with additional 13 qualifications
Maybe with additional 14

Tracking and Adapting
.~
the Treatment Plan
Plan Implementation.

Id. at par. 5. P. 14, par. 6.

15

16

Family Treatment

Id. at par. 7.

17

Transition

P. 15, par. 8.

18

19

20

As for the second directive relating to a State level "documents," State

21 Defendants include the pertinent text of Title 9 California Code of Regulations

22 which describes theMedi-Calcriteria. (McCabe's Dec!.) Also, State Defendants

23 have included a copy of relevant portions of California's State Plan, effective

24 July I, 1993 with information from Richard Hildebrand. The State Plan describes

25 the services provided under the medi-Cal Specialty Mental Health Services

26 Program. (Richard Hildebrand at par. 3, 4.)

27

Finally, the State Defendants would like to reiterate its position that

28 Plaintiffs' Motion for Preliminary Injunction should be denied because Plaintiffs

EXHIBITC-4

Case 2:02-cv-05662-AHM-SH Document 629 Filed 09/22/2008 Page 24 of 24

Defendants' Further Submission of Supplemental Information (filed 8/27/08) Katie A. eta! v. Bonta eta! (CV 02-05662)

Ex. A:

EPSDT Chart Documentation Manual published by California Institute ofMental Health (p.1-89)

Ex. B:

Norman Decl. (p.90-93)
Ex. 1: Norman CV (p.95)
Ex. 2: Rodriguez CV (p.97) Ex. 3: DMH Letter No. 06-05 Re Implementation of the Preliminary Injunction in Katie A. (p.99-1 07) Ex. 4: "Progress Note Quick Notation" (p.l 09-113)

Ex.l:

Yokoi Decl. (p. 4-6)
Ex. A: Program Code Descriptions (p.S-103)

Ex. 2:

Renslo Decl. (p. 105) Ex. A: Mental Health Medi-Cal Billing Manual (p. 109-156)

EXHIBITD

 </s> 1 ROBERT D. NEWMAN, SBN 86534 KIMBERLY LEWIS, SBN 144879
2 RICHARD A. ROTHSCHILD, SBN 067356 WESTERN CENTER ON LAW
3 AND POVERTY 3701 Wilshire Boulevard, Suite 208
4 Los Angeles, California 90010 Telephone: (213) 487-7211
5 Facsimile: (213) 487-0242

6 KIRK A. HORNBECK, SBN 241708 MATTHEW BENEDETTO, SBN 252379
7 HELLER EHRMAN LLP 333 S. Hope Street, 39th Floor
8 Los Angeles, California 90071-3043 Telephone: (213) 689-0200
9 Facsimile: (213) 614-1868

10 Attorneys for Plaintiffs 11 [Additional Counsel Listed on Next Page]

12

UNITED STATES DISTRICT COURT

13

CENTRAL DISTRICT OF CALIFORNIA

14 KATIE A., by and through her next

15

friend Michael Ludin; MARY B., by and through her next friend Robert Jacobs;

16

JANET C., by and through her next friend Dolores Johnson; HENRY D., by

17

and through his next friend Gillian Brown; AND GARY E., by and through

18

his next friend Michael Ludin; individually and on behalf of others

19 similarly situated,

Plaintiffs,

20 v.

21 DIANA BONTÁ, Director of California Department of Health Services; LOS

22 ANGELES COUNTY; LOS ANGELES

23

COUNTY DEPARTMENT OF CHILDREN AND FAMILY

24

SERVICES; ANITA BOCK, Director of the Los Angeles County Department of

25 Children and Family Services; RITA

SAENZ, Director of the California

26 Department of Social Services, and

27

DOES 1 through 100, inclusive, Defendants.

28

Case No.: CV-02-05662-AHM (SHx)
PLAINTIFFS’ PROPOSED FINDINGS OF FACT AND CONCLUSIONS OF LAW RE MOTION FOR PRELIMINARY INJUNCTION The Hon. A. Howard Matz Courtroom: 14

Proposed Findings of Fact and Conclusions of Law

1

MARK D. ROSENBAUM, SBN 59940

MELINDA BIRD, SBN 102236

2

AMERICAN CIVIL LIBERTIES UNION

OF SOUTHERN CALIFORNIA

3

1616 Beverly Boulevard

Los Angeles, California 90026

4

Telephone: (213) 977-9500

Facsimile: (213) 250-3919

5

MARILYN HOLLE, SBN 61530

6

PROTECTION & ADVOCACY, INC.

3580 Wilshire Boulevard, Suite 902

7

Los Angeles, California 90010

Telephone: (213) 427-8747

8

Facsimile: (213) 427-8767

9

JOHN O’TOOLE, SBN 62327

PATRICK GARDNER, SBN 208119

10

LEECIA WELCH, SBN 208741

NATIONAL CENTER FOR YOUTH LAW

11

405 14th Street, 15th Floor

Oakland, California 94612

12

Telephone: (510) 835-8098

13

Facsimile: (510) 835-8099

14

IRA BURNIM (pro hac vice) ALISON BARKOFF (pro hac vice)

15

BAZELON CENTER FOR MENTAL HEALTH LAW

16

1101 Fifteenth Street, NW, Suite 1212 Washington, DC 20006

17

Telephone: (202) 467-5730 Facsimile: (202) 223-0409

18

Additional Counsel listed on caption page

19

20

21

22

23

24

25

26

27

28

Proposed Findings of Fact and Conclusions of Law

1

PROCEDURAL HISTORY

2

1. Currently before the Court is Plaintiffs’ motion for a preliminary

3 injunction. Plaintiffs’ motion, like their previous motion, is based on the Medicaid

4 Act, the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act.

5 In their motion, Plaintiffs seek a mandatory preliminary injunction to require State

6 Defendants – Sandra Shewry, current Director of the California Department of

7 Health Care Services (DHCS) and John Wagner, current Director of the Department

8 of Social Services (DSS) – to provide wraparound services and therapeutic foster

9 care (TFC) to members of the class for whom these services are medically

necessary. Plaintiffs’ Memorandum of Points and Authorities in Support of Motion

10

for Preliminary Injunction (Feb. 2, 2008) (Pls. Mem. of P&A), at 1.

11

2. On March 14, 2006, the Court granted an earlier motion for preliminary

12 injunction seeking similar relief. Katie A. v. Bonta, 433 F. Supp. 2d 1065 (C.D. Cal.

13 2006). The Court’s order was based on the Medicaid Act, and the Court did not

14 decide Plaintiffs’ claim under the Americans with Disabilities Act. Id. at 1069 n.5,

15 1078 at n.17. That order was appealed, and the U.S. Court of Appeals for the Ninth

16 Circuit reversed and remanded the order. Katie A. ex rel Ludin v. Los Angeles

17 County, 481 F.3d 1150 (9th Cir. 2007). With respect to Plaintiffs’ Medicaid claim,

18 the Ninth Circuit directed this Court to address three discrete issues on remand.

19 Katie A., 481 F.3d at 1163.

20

3. According to the Ninth Circuit’s decision, this Court should first

21 address whether each component of wraparound services and TFC falls under the
22 categories of services listed in 42 U.S.C. § 1396d(a). Katie A., 481 F.3d at 1163.
23 The Court should next address whether Defendants have effectively provided each 24 mandated component service. Id. If they have not, the Court should decide 25 “whether the State should be required to provide the required services in another 26 manner which will render such services effective, or proceed directly to wraparound 27 and TFC.” Id.
/ / / 28

1
Proposed Findings of Fact and Conclusions of Law

1

2

FINDINGS OF FACT

3

State Defendants

4

4. The term “Defendants,” when used herein, refers to Ms. Shewry,

5 DHCS’ current Director, and Mr. Wagner, DSS’ current Director. DHCS, which

6 was previously known as the California Department of Health Services, is the state
7 agency responsible for supervising the administration and operation of the Medi-Cal 8 program. Katie A., 481 F.3d at 1152; Emily Q. v. Bonta, 208 F. Supp. 1078, 1088 9 (C.D. Cal. 2001).
5. DHCS has entered into an interagency contract so that the California 10
Department of Mental Health (DMH) has assumed responsibility for supervising the 11 administration of mental health services to Medi-Cal recipients and other indigent 12 persons. Emily Q., 208 F. Supp. 2d at 1089. On a county level, the Mental Health 13 Plans (MHPs) are responsible for providing mental health services to Medi-Cal
14 recipients. Id.

15

6. DSS is the state agency with supervisory responsibility over the

16 administration of foster care and child welfare services in California. Welf. & Inst.

17 Code § 10600; see also Katie A., 481 F.3d at 1152 n.2. DSS plays a significant role

18 in determining whether class members receive needed mental health services. Katie

19 A., 481 F.3d at 1163 and n.22 (DSS “has the power to affect foster care children’s

20 receipt of mental health services” and acts “in active concert with DHS with regard

21 to the class members’ receipt of health care through MediCal”; internal quotations

22 omitted).

23

Plaintiff Class

24

7. As this Court previously found, “[a]t stake in this lawsuit is the health

25 of thousands of children in California who are already in, or are likely soon to wind

26 up in, foster care.” Katie A., 433 F. Supp. 2d at 1069.

27

8. There are approximately 78,000 children in child welfare-supervised

foster care in California. Needell, et al., Child Welfare Supervised Foster Care

28

2
Proposed Findings of Fact and Conclusions of Law

1 Highlights from CWS/CMS, Further Newman Declaration (Decl.), Exhibit (Exh.)

2 168 at 1061; Freitas Decl., 544-45 at ¶ 7, Exh. 3 at 618. Thousands of additional

3 children receive child welfare services in their own homes. In Los Angeles County

4 alone, 23,000 children were in out-of home (foster) care, while another 17,000

5 children were receiving child welfare services from the County’s Department of

6 Children and Family Services (DCFS) but had not been removed from their homes.

7 Findings of Fact and Conclusions of Law re Settlement Agreement between

8 Plaintiffs and County dated November 20, 2006 (Findings) at ¶¶ 17, 23, 52.

9

9. Approximately 50 to 80 percent of children in or at risk of foster care

placement require mental health services. See, e.g., California Little Hoover

10

Commission, Young Hearts and Minds: Making a Commitment to Children’s

11 Mental Health (Oct. 2001) (Young Hearts), Exh. 101 at 134; California Mental

12 Health Planning Council, California Mental Health Master Plan: A Vision for

13 California (March 2003), Exh. 132 at 946. According to Defendants’ own expert,

14 Dr. John Landsverk, the research literature “suggests that between one-half and

15 three-fourths of the children entering foster care exhibit behavior or social

16 competency problems that warrant mental health care” and “[t]here is also evidence

17 that this high rate of need may be anticipated as well for children who are served by

18 child welfare while remaining in their biological homes.” Landsverk Decl., 391-92

19 at ¶ 4; accord California Health and Human Services, Exh. 133 at 963-64 (study

20 finding that 84% of a sample of 213 foster children had developmental, emotional,

21 and/or behavioral problems).

22

10. By definition, the Plaintiff class consists of children who require mental

23 health treatment. The certified class is children in California who (a) are in foster

24 care or at imminent risk of foster care placement; and (b) have a mental illness or
25 condition that has been documented or, had an assessment already been conducted, 26 would have been documented; and (c) who need individualized mental health 27 services, including but not limited to professionally acceptable assessments,
behavioral support and case management services, family support, crisis support, 28

3
Proposed Findings of Fact and Conclusions of Law

1 therapeutic foster care and other necessary services in the home or in a home-like

2 setting, to treat or ameliorate their illness or condition. Order dated June 18, 2003,

3 at 21-22.

4

11. Plaintiffs are substantially limited in major life activities, such as caring

5 for themselves, interacting with others and learning. See, e.g., Smith Decl., 30-34 at

6 ¶¶ 4, 8, 11, 12; Truesdale Decl., 48-51 at ¶¶ 3, 4, 7-10; Frakes Decl, at ¶ 8.1

7

12. Almost 100 percent of class members in foster care are eligible for

8 Medicaid. Hatekayama Deposition (Depo.) at 47:18-48:4.2 In addition, a large

9 number of children at risk of foster care placement are eligible for Medicaid under

the other mandatory Medicaid categories listed in 42 U.S.C. § 1396a(a)(10)(A)(i),

10

including Social Security Income (SSI) recipients and children in families with

11 limited income. Accord Emily Q., 208 F. Supp. 2d at 1088 (“States are required to

12 provide Medicaid coverage to all individuals and groups designated in 42 U.S.C. §

13 1396a(a)(10)(A)(i). These groups include low income families with children, as

14 described in Section 1931 of the Social Security Act.”).

15

13. The Plaintiff class has “‘complex needs’” and “’are particularly

16 vulnerable.’” Katie A., 433 F. Supp. 2d at 1068 (quoting Rosie D. v. Romney, 410 F.

17 Supp. 2d 18, 23-24 (D.Mass. 2006)). The medical needs of the Plaintiff class

18 “‘frequently extend across a spectrum of service providers and state agencies.’”

19 Katie A., 433 F.Supp.2dd at 1068 (quoting Rosie D., 410 F. Supp. 2d at 23-24).

20 Three critical state agencies are DHCS, DMH and DSS.

21

14. Members of the Plaintiff class are caught up in a system that “has been

22 widely acknowledged to be failing.” Katie A., 433 F. Supp. 2d at 1069. In past

23 years, California has ranked last among the 50 states on average Medicaid

24

25 1 Plaintiffs have submitted some declarations and exhibits in support of this motion

26

that had been filed in support of the prior preliminary injunction. Those earlier declarations generally did not include Bates Stamp numbers for citation purposes.

27 2 Children in foster care receiving federal assistance under Title IV-E of the Social

28

Security Act are eligible for Medicaid. 42 U.S.C. § 1396a(a)(10)(A)(i)(I); see also Katie A., 481 F.3d at 1154 n.9.

4
Proposed Findings of Fact and Conclusions of Law

1 expenditures on foster children. U.S. Department of Health and Human Services,

2 Office of the Assistant Secretary for Planning and Evaluation, Health Conditions,
3 Utilization and Expenditures of Children in Foster Care (September 2000), Exh.
4 121 at 595 and 600. California’s Little Hoover Commission has found that “[m]ore 5 than 50,000 children in the foster care system who may need mental health services 6 do not get them.” Young Hearts, Exh. 101 at 87. A DMH official admits that they 7 “are unable to provide adequate services to all foster children.” Neilsen Depo. at 8 112:12-113:9. An official with Los Angeles County likewise admits that only a 9 fraction of foster children in the County who need mental health services are getting
them. Hatekayama Depo. at 125:19-126:15, 160:10-162:14. 10
15. Thousands of foster children in California, including members of the 11 Plaintiff class, have been placed in group homes. Further Newman Decl., Exh. 168 12 at 1061 (estimating almost 6500 children in foster care in group homes). A 13 significant percentage of these foster children, perhaps more than 50%, are in high 14 level group homes, namely Rate Classification Level (RCL) facilities of 12 and 15 above.3 See Katie A. Advisory Panel, Third Panel Report to the Court (hereafter 16 Third Panel Report), Exh. 140 at 998 (nearly 60% of foster children in Los Angeles
17 County in RCL facilities are in RCL facilities of 12 and above). As of November
18 2005, Los Angeles County alone had 1,832 foster children in group homes, with

19 more than half of them in RCL 12 facilities and above. Findings at ¶ 38. Thousands

20 more foster children in California are placed outside the state. DSS, Child Welfare

21 Services/Case Management System: Total Children in Supervised Out of Home

22 Placements by Placement - June 2003, Exh. 112 at 444 (estimating 2900 foster

23 children placed out of state).

24

16. The “delivery of treatment” is not “the primary purpose of group homes

25

26 3 Group homes in California are classified into RCLs of 1-14, using a point system
27 designed to reflect the level of care and services they provide. DSS, Reexamination 28 of the Role of Group Care in a Family-Based System of Care, Exh. 103 at 282.

5
Proposed Findings of Fact and Conclusions of Law

1 for foster children.” Barthels Depo. (Vol. 1) at 81:3-22. Defendants’ own expert

2 reports that the “benefit of care in group and institutional settings is not well

3 substantiated and may even be deleterious due to close association with deviant
4 peers, the risk of contagion, loss of contact with family and peers, and other
5 factors.” Landsverk Decl., 391-92 at ¶ 4, Exh. 2 at 420. A top state DMH official 6 agrees that that residential care is not an “evidence-based” practice. Neilsen Depo. 7 at 187:9-18. To the contrary, “the evidence is negative, mixed, or shows no effect 8 for institutionally-based interventions – in hospital, residential or group home 9 settings.” California Institute of Mental Health Report, Exh. 104 at 361; see also
Bruns Decl., at ¶ 15 (“near absence of outcome data” to support residential 10
treatment and psychiatric hospitalization). “Children in group care almost certainly 11 … experience fewer interpersonal experiences that support their well-being, 12 including the chance to develop [a] close relationship with a significant individual 13 who will make a lasting, legal commitment to them.” Richard P. Barth, Institutions 14 vs. Foster Homes: The Empirical Base for the Second Century of Debate (2002), 15 Exh. 129 at 791; see also Farr Decl., at ¶ 22 (“severe risks associated with
16 residential treatment”). Group homes can also be dangerous. See, e.g., Centobie

17 Decl., at ¶ 8 (Kayla beaten by older girls in a residential placement); Supplemental

18 (Supp.) Beckman Decl., 9 at ¶ 14 (Cherise placed in a group home that is a “known

19 recruiting grounds for pimps”); Worth Decl., 26-27 at ¶¶ 26-27 (Christine’s

20 behaviors got worse, not better, when placed in a group home, as she “has learned

21 all kinds of bad behavior from other kids in the group homes,” such as how to cut

22 her wrists).

23

17. Foster children with significant mental health needs, including

24 members of Plaintiff class, often experience multiple placements and placement
25 disruptions because they are not provided with the mental health services they need. 26 See, e.g., Rauso Decl., 72-73 at ¶¶ 18-19 (group of 43 foster children averaged 27 nearly seven placements per child in less than three years); Worth Decl., 22-26 at ¶¶
16-20 and 25 (Since being placed in foster care in 2004, Christine has been in more 28

6
Proposed Findings of Fact and Conclusions of Law

1 than eight placements and is currently living in an RCL: 12 group home three hours

2 away from her home); Centobie Decl., at ¶¶ 1, 2, 8 (In 18 months in Merced

3 County’s foster care system, Kayla was shunted through 9 different residential
4 placements and 11 psychiatric hospitalizations); see also Magnatta Decl., at ¶¶ 1, 4,
5 23; Frakes Decl., at ¶¶ 2, 3, 5, 10-23; Brumbach Decl., at ¶¶ 4, 12, 17, 21. DSS has 6 acknowledged that “many children have been caught in a revolving door of 7 inappropriate placements,” adding that the “typical child in group care has 8 experienced an average of five different placements before being put in a group 9 setting.” DSS, Reexamination of the Role of Group Care in a Family-Based System
of Care, Exh. 103 at 263 and 281. In the twelve-month period ending March 31, 10
2007, 44% of the children in foster care in California had experienced three or more 11 placements during their current episode and 14.3% of them had experienced six or 12 more placements. Freitas Decl., 544-45 at ¶ 7, Exh. 3 at 619. Multiple placements 13 can subject foster children to the “trauma of repeated abandonment,” so that they 14 “come to expect they will fail and often give up trying to succeed.” Burgess Decl., 15 at ¶¶ 8, 13; accord Beckman Supp. Decl., 9 at ¶ 16 (shuttling Cherise in and out of
16 seven or more placements, including foster homes, group homes and psychiatric

17 hospitals “has aggravated her feelings of depression, abandonment and uncertainty

18 about the future”); Dembrowsky Decl., at ¶ 12 (for child who went through 15

19 placements in three years, the “only constants in Bobby’s life since entering foster

20 care has been that his mental disabilities will cause him to act out and he will be

21 moved to another placement to repeat the cycle somewhere else”).

22

18. Many foster children, including members of Plaintiff class, eventually

23 end up in the delinquency system because a lack of appropriate mental health

24 services. See, e.g., Children with Behavioral Problems: High Incidence of Failed
25 Placements, Exh. 127 at 762; GAO, Child Welfare and Juvenile Justice: Federal 26 Agencies Could Play a Stronger Role in Helping States Reduce the Number of 27 Children Placed Solely to Obtain Mental Health Services” (April 2003), Exh. 131 at
863; Centobie Decl., at ¶¶ 6, 8, 15, 17, 22, 33, 37 (Despite history and diagnosis of 28

7
Proposed Findings of Fact and Conclusions of Law

1 serious mental disorders, Kayla’s mother was told by the local child welfare agency

2 that “the only way Kayla would get the services she needed was through the

3 probation department,” and Kayla ended up in jail).

4

Definition of Wraparound Services and TFC

5

19. Wraparound services are defined in Welfare and Institutions Code §

6 18251(d) as “community-based intervention services that emphasize the strengths of
7 the child and family and includes the delivery of coordinated, highly individualized 8 unconditional services to address the needs and achieve positive outcomes in their 9 lives.” Providers of wraparound care services: (a) engage in a unique assessment
and treatment planning process that is characterized by the formation of a child, 10
family, and multi-agency treatment, (b) marshal community and natural supports 11 through intensive case management, and (c) make available an array of therapeutic 12 interventions, which may include behavioral support services, crisis planning and 13 intervention, parent coaching and education, mobile therapy, and medication
14 monitoring. Katie A., 481 F.3d at 1153 n.5; Katie A., 433 F. Supp. 2d at 1071-72;

15 McCabe Decl., Ex. D, Appendix A (Appendix A); Supp. Bruns Decl., 212 at ¶ 16;

16 Supp. Friedman Decl., 318 at ¶ 10; Supp. Huffine Decl., 382 at ¶ 10.

17

20. Wraparound services are comprised of the following nine component

18 services and activities: engagement of the child and family; immediate crisis

19 stabilization; strength and needs assessment; wraparound service plan development;

20 wraparound service plan implementation; ongoing crisis and safety planning;

21 tracking and adapting the wraparound service plan; and transition. Katie A., 481

22 F.3d at 1153; Katie A., 433 F. Supp. 2d at 1072; Appendix A; Supp. Bruns Dec.,

23 212 at ¶ 16; Supp. Friedman Decl., 318 at ¶ 10; Supp. Huffine Decl., 382 at ¶ 10.

24

21. TFC is an intensive, individualized mental health service provided to a

25 child in a family setting, utilizing specially trained and intensely supervised foster

26 parents. Therapeutic foster programs (a) place a child singly, or at most in pairs,

27 with a foster parent who is carefully selected, trained, and supervised and matched with the child’s needs; (b) create, through a team approach, an individualized
28

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Proposed Findings of Fact and Conclusions of Law

1 treatment plan that builds on the child’s strengths; (c) empower the therapeutic

2 foster parent to act as a central agent in implementing the child’s treatment plan; (d)

3 provide intensive oversight of the child’s treatment, often through daily contact with

4 the foster parent; (e) make available an array of therapeutic interventions to the

5 child, the child’s family, and the foster family (interventions may include behavioral

6 support services for the child, crisis planning and intervention, coaching and

7 education for the foster parent and the child’s family, mobile therapy for the child

8 and the child’s family, and medication monitoring); and (f) enable the child to

9 successfully transition from therapeutic foster care to placement with the child’s family or an alternative family by continuing to provide therapeutic interventions.
10 Katie A., 481 F.3d at 1153 n.6; Katie A., 433 F. Supp. 2d at 1072; McCabe Decl.,
11 Ex. D, Appendix B (Appendix B); Supp. Friedman Decl., 318 at ¶ 10; Supp. Huffine

12 Decl., 382 at ¶ 12; Second Supp. Chamberlain Decl., 279 at ¶ 11.

13

22. TFC is comprised of the following seven component services and

14 activities: recruitment and matching; therapeutic foster parent training; development

15 of a treatment plan; tracking and adapting the treatment plan; plan implementation –

16 individual child treatment; plan implementation – family treatment; and transition.

17 Katie A., 481 F.3d at 1153; Katie A., 433 F. Supp. 2d at 1072; Appendix B; Supp.

18 Friedman Decl., 318 at ¶ 10; Supp. Huffine Decl., 382 at ¶ 12; Second Supp.

19 Chamberlain Decl., 279 at ¶ 11.

20

23. Wraparound services and TFC are mental health services appropriate

21 for children both in and outside of the foster care system. The services are the same

22 regardless of whether the child is involved in the foster care system. Second Supp.

23 Redman Decl., 492-509 at ¶ 22; accord Knisley Decl., 654 -55 at ¶ 17.

24

Evidence of Medicaid Coverage of the Components of Wraparound Services

25

and TFC

26

24. Plaintiffs have presented persuasive evidence from leading national

27 experts that each component of wraparound services and TFC can be covered under one or more provisions of 42 U.S.C. § 1396d(a) and is already covered by other
28

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Proposed Findings of Fact and Conclusions of Law

1 states’ Medicaid programs. The Court finds both credible and persuasive the

2 declaration of Dr. Redman and her accompanying table, which demonstrate how the

3 activities and services that are the components of wraparound services and TFC in
4 Appendices A and B are available under other states’ Medicaid programs. Second
5 Supp. Redman Decl., 482-83 at ¶ 12 and Exh. 7 at 548-618. The declarations of Ms. 6 Knisley, Ms. Koyanagi, and Mr. Westmoreland corroborate that the components of 7 wraparound services and TFC are covered by Medicaid and that the activities that 8 comprise these components have been covered by other states’ Medicaid programs 9 with CMS’ approval. Westmoreland Decl., 767-71 at ¶¶ 2, 10, 12-14; Knisley
Decl., 646-54 at ¶¶ 3, 15, 16; Koyanagi Decl., at ¶¶ 3, 22, 25, 26, 28, 29, 30. 10
25. “[O]ther states fund wraparound and TFC programs under Medicaid.” 11 Katie A., 481 F.3d at 1156; accord Katie A., 433 F. Supp. 2d at 1076-77 (discussing 12 other states’ Medicaid programs’ coverage of wraparound services, including 13 Arizona, Wisconsin, and Pennsylvania for wraparound services, and 19 states’ 14 coverage of TFC); see also Second Supp. Redman Decl., 482-83 at ¶ 12 and Exh. 7 15 at 548-618; Knisley Decl., 653-54 at ¶ 16; Penrod Decl., 414-17 at ¶ 4, 8-13;
16 Koyanagi Decl., at ¶ 22.

17

Evidence That Wraparound Services and TFC Are Effective Treatments and

18

Are Medically Necessary for Children with Significant Emotional,

19

Behavioral, and Mental Health Needs

20

26. Wraparound services and TFC are effective treatments for children in

21 the class, including those with serious mental health, emotional, or behavioral needs.
22 See, e.g., Supp. Supp. Friedman Decl., 316-20 at ¶¶ 5, 8-12 (wraparound services
23 and TFC); Supp. Bruns Decl., 209-21 at ¶¶ 7-8, 11-12, 20, 30-31 (same); Supp. 24 Huffine Decl., 380-82 at ¶¶ 5, 8, 9, 11 (same); Chamberlain Decl., at ¶ 3 (TFC); 25 Second Supp. Chamberlain Decl., 279-80 at ¶ 12 (TFC); Katie A., 433 F. Supp. 2d 26 at 1078 (citing Lourie Decl., at ¶¶ 2, 13; Chamberlain Decl., at ¶ 3; Bruns Decl., at ¶ 27 3; Huffine Decl., at ¶ 7; Friedman Decl., at ¶¶ 4-5, 31).
27. The “gold standard” of efficacy in the mental health field is an 28

10
Proposed Findings of Fact and Conclusions of Law

1 “evidence-based practice” where there have been randomized clinical trials of a

2 treatment. Chamberlain Decl., at ¶ 14; Second Supp. Chamberlain Decl., 282 at ¶

3 15; see also Friedman Decl., at ¶¶ 19-21; Supp. Friedman Decl., 318-20 at ¶ 11;

4 accord Landsverk Decl., 392-93 at ¶ 7. TFC and, more recently, wraparound

5 services are both considered “evidence-based practices.” Supp. Friedman Decl., 320

6 at ¶ 12 (wraparound services and TFC); Supp. Bruns Decl., 215-21 at ¶¶ 20, 30

7 (same); Supp. Huffine Decl., 381-82 at ¶¶ 9, 11 (same); Second Supp. Chamberlain

8 Decl., 282 at ¶ 15 (TFC).

9

28. Defendants acknowledge that wraparound and TFC are among the

“successful practices and approaches to effectuate child and family well-being.”

10

State Defendants’ Opposition to Plaintiffs’ Motion for Preliminary Injunction

11 (Defs.’ Opp.) at 21.

12

29. The provision of wraparound services and TFC is medically necessary

13 for a large number of children in the class, including those with serious mental

14 health, emotional or behavioral needs. Supp. Friedman Decl., 316-20 at ¶¶ 5, 8-12

15 (wraparound services and TFC); Supp. Huffine Decl., 380-82 at ¶¶ 5, 8, 9, 11

16 (same); Supp. Bruns Decl., 209-22 at ¶¶ 7-8, 11-12, 20, 30-31 (same); Chamberlain

17 Decl., at ¶ 3 (TFC); Second Supp. Chamberlain Decl., 279-80 at ¶ 12 (same); accord

18 Katie A., 433 F. Supp. 2d at 1076 (citing Laurie Decl., ¶¶ 2, 13; Chamberlain Decl.,

19 ¶ 3; Bruns Decl., ¶ 3; Huffine Decl., ¶ 7; Friedman Decl, ¶¶ 4, 31).

20

30. Defendants do not dispute Plaintiffs’ evidence of medical necessity, as

21 was true when Plaintiffs filed their earlier motion, Katie A., 433 F. Supp. 2d at 1076-

22 77.

23

Evidence that Defendants Are Not Effectively Providing the Components of

24

Wraparound Services and TFC

25

31. All of the components of wraparound services and TFC must be

26 provided in a coordinated fashion to be effective and to ensure that class members

27 receive medically necessary services. See, e.g., Supp. Bruns Decl., 209-22 at ¶¶ 810, 16, 24, 31, 33 (discussing research showing that “to achieve these positive
28

11
Proposed Findings of Fact and Conclusions of Law

1 outcomes” that are possible from wraparound services and TFC “all of the

2 components. . .must be provided and they must be provided in a coordinated

3 fashion”); Supp. Huffine Decl., 380-88 at ¶¶ 6, 7, 10-12, 15, 21 (“in order to get the
4 results that are possible from wraparound services and therapeutic foster care, these
5 services must be provided as they were designed (that is, with all of the components 6 being provided in a coordinated fashion)” and discussing research supporting that 7 opinion); Supp. Friedman Decl., 316-25 at ¶¶ 6, 7, 10, 14-16, 19 (“[t]here is no 8 evidence to suggest, and no reason to believe, that wraparound services or 9 therapeutic foster care will have the positive outcomes expected without providing
all of the components and doing so in a coordinated fashion as they have been 10
designed, developed and researched” and discussing research supporting that 11 opinion); Second Supp. Chamberlain Decl., 279-86 at ¶¶ 9-11, 17, 18, 23 (“To meet 12 the mental health needs of children for whom therapeutic foster care is necessary, all 13 of the components of therapeutic foster care must be provided and they must be 14 provided in a coordinated fashion as they are with MTFC.”); accord Supp. Kamradt 15 Decl., 368-72 at ¶¶ 3, 8, 9, 11; Supp. Penrod Decl., 414-27 at ¶¶ 4, 6, 7, 19, 22, 26-
16 29; Rauso Decl., 68-70 at ¶¶ 5, 12.; Bhattacharya Decl., 199 at ¶ 9; Berrick Decl.,

17 147-59 at ¶¶ 4, 28, 41; Champion Decl., 163-66 at ¶¶ 10, 17; Further Farr Decl.,

18 147-59 at ¶¶ 2-9.

19

32. Defendants have not identified any specific component or components

20 of wraparound services or of TFC that they contend are being effectively provided.

21 Nor have Defendants offered evidence that they are effectively providing any

22 specific component or components of wraparound services and TFC.

23

33. In discovery, Defendants asserted that none of the components of

24 wraparound services and TFC are covered under the Medi-Cal program. DHCS’
25 Director has stated in her interrogatory responses that “[n]one of the components of 26 wraparound services set forth in Appendix A” and “[n]one of the components of 27 TFC set forth in Appendix B” are “covered as such by the Medi-Cal program.”
Further Newman Decl., 833-34 at ¶ 4; Exh. 164 at 874-75. Rita McCabe testified on 28

12
Proposed Findings of Fact and Conclusions of Law

1 behalf of California’s DMH at a deposition last October that the Medi-Cal program

2 should not be reimbursing providers for any of the components of wraparound

3 services listed in Appendix A or any of the components of TFC listed in Appendix
4 B. Further Newman Decl., Exh. 167 at 964-1029. In a letter dated February 14,
5 2008, Defendants’ counsel represented that “there is no one to testify” on 6 Defendants’ behalf as to whether the Medi-Cal program was effectively providing 7 any of the mandated components of wraparound services and TFC. Supp. Newman 8 Decl., 1104 at ¶ 7, Exh. 176 at 1296 (February 14, 2008 Letter from Karen 9 Ackerson-Brazille).
34. Wraparound services and TFC are available to class members only at 10
the counties’ discretion. For example, Alameda County discontinued its successful 11 wraparound program. Berrick Decl., 150-55 at ¶¶ 14-18, 27. For counties that do 12 provide wraparound services, it is undisputed that the counties have complete 13 discretion on the number of wraparound “slots” they wish to provide. Treadwell 14 Depo. at 21:22-22:1, 31:21-25, 102:20-23. There is no requirement that a county 15 provide wraparound services to all children in the target population for whom these
16 services would be medically necessary or otherwise appropriate. Id. at 27:1-28:10,

17 38:20-39:1.

18

35. In existing wraparound programs, eligibility is limited to foster children

19 residing in or at risk of being placed in RCL facilities of 10 or above. Grayson

20 Depo. at 38:14-39:16; Treadwell Depo. at 22:7-10. Counties do not provide

21 wraparound services to all children in the target population for whom such services

22 would be appropriate. Id. at 9:1-10:25, 13:3-13, 40:15-20.

23

36. The current availability of wraparound services and TFC falls far short

24 of class members’ need for these services. See, e.g., Huffine Decl., at ¶¶ 38-43
25 (giving a “conservative estimate” that wraparound services are medically necessary 26 for 15-20% of children in California’s foster care system); Supp. Huffine Decl., 383 27 at ¶ 13 (TFC is medically necessary for children in or at risk of placement in group
homes, RTCs, or psychiatric hospitals for whom receiving wraparound services in 28

13
Proposed Findings of Fact and Conclusions of Law

1 their own home or in an alternative home is not possible or is insufficient);

2 Chamberlain Decl., at ¶ 24 (“The research shows that MTFC is both appropriate and

3 necessary for many children who are eligible for substitute care (i.e., kids being sent

4 to residential or group homes) because of severe emotional, behavioral, or

5 psychiatric impairments”)); Findings at ¶¶ 32 and 39 (more than half the foster

6 children in RCL facilities of 12 and above could be served in family settings). Only
7 about 2,500 children received wraparound services in California in June 2007. 8 Further Newman Decl., Exh. 165 at 916-925. From January through March 2007, 9 312 children were placed in Intensive Treatment Foster Care (ITFC), the most
common form of TFC in California. Further Newman Decl., Exh. 169 at 106210
1074. See also Katie A., 481 F.3d at 1153 and 1156-57 (Ninth Circuit affirmed prior 11 findings of irreparable harm where this Court cited the “undisputed evidence that 12 wraparound and TFC are medically necessary for children with serious mental 13 health needs” and “described the potential for irreparable harm to plaintiffs in the
14 form of unnecessary institutionalization and unmet mental health needs”).

15

37. Plaintiffs have provided persuasive evidence that Defendants are not

16 effectively providing the components of wraparound services and TFC.

17

Providing Wraparound Services and TFC Will Not Create Significant

18

Additional Costs for California or Compel Cutbacks to Other Medicaid

19

Recipients

20

38. County after county has found that wraparound services are cheaper

21 than the care now being provided class members. See, e.g., DSS, Foster Care Rates
22 Group Home Facility Listing, Exh. 123 at 610 (monthly payments per child are
23 $5,613 for a RCL 12 facility and $6,371 for a RCL 14 facility); Rauso Decl., 73-74 24 at ¶20 (preliminary estimates by Los Angeles County indicate wraparound services 25 has saved the County more than $55,000 per child in placement costs alone); SB 26 163 Wraparound Final Evaluation, Mono County, Exh. 135 and 969 (average child 27 in wraparound program costs less than half the costs of keeping the youth in a RCL
14 facility); Mendocino County’s SB 163 Children’s Wraparound Services Pilot 28

14
Proposed Findings of Fact and Conclusions of Law

1 Project Final Report, Exh. 163 at 971 (wraparound services about a third less

2 expensive than cost of out of home placement and specialty mental health services);

3 Report to the Legislature on Humboldt County’s Wraparound Services Program,
4 Exh. 137 at 974 (cost of serving child with wraparound services almost one-third
5 less expensive than serving a child without wraparound services); Farr Decl., at ¶ 20 6 (Sacramento County has saved approximately $6 million in foster care funding with 7 wraparound services); see also Kamradt Decl., at ¶¶ 16-17 (serving a child through 8 the Wraparound Milwaukee program cost less than half as much as placing the child 9 in a Residential Treatment Center (RTC)).
39. TFC is also cheaper than the care now provided to class members. See, 10
e.g., Champion Decl., 164-65 at ¶ 15 ($2,000 per month to therapeutic foster parents 11 for each child placed in their homes, which is far less than the “alternative high level 12 residential placements with costs beginning at more than $5,600 per month”); 13 Chamberlain Decl., at ¶ 26 (discussing study finding taxpayer savings from MTFC 14 program); Supp. Chamberlain Decl., at ¶ 6 (discussing cost savings from providing 15 TFC to child in lieu of placing in a RTC); Richard P. Barth, Institutions vs. Foster
16 Home: The Empirical Base for the Second Century of Debate (2002), Exh. 129 at

17 792 (“The costs of institutional care far exceed those for foster care or treatment

18 foster care. The difference in monthly cost can be. . .2 to 3 times as high as

19 treatment foster care”).

20

40. Local juvenile detention facilities spend approximately $3,500 to house

21 a child for the average 27-day stay and the California Youth Authority spends

22 $3,100 just to house a child. Young Hearts and Minds, Exh. 101 at 91.

23

41. The evidence does not support any contention by Defendants that

24 providing wraparound services and TFC would create significant costs that would

25 compel cutbacks to other Medi-Cal recipients.

26

Evidence that State Defendants Are Unnecessarily Institutionalizing Class

27

Members

42. By failing to provide wraparound services and TFC to class members,

28

15
Proposed Findings of Fact and Conclusions of Law

1 Defendants are unnecessarily institutionalizing individuals with mental disabilities

2 in congregate care, emergency psychiatric wards, psychiatric hospitals and juvenile

3 detention facilities. See, e.g., Supp. Bruns Decl., 209-210 at ¶¶ 8-9; Supp. Friedman

4 Decl., 316 at ¶ 5; Kamradt Decl., at ¶¶ 1, 3, 11-15, 19; Rauso Decl., 71-72 at ¶¶ 14-

5 18; Farr Decl., at ¶¶ 2, 7-13; Findings of Fact and Conclusions of Law re Settlement

6 Agreement between Plaintiffs and County dated November 20, 2006, at ¶¶ 32 and

7 39 (more than half the foster children in RCL facilities of 12 and above could be

8 served in family settings); see also Champion Decl., at ¶¶ 6, 7, 12; Letter dated

9 January 31, 2003, from Bradford R. Luz, Director of Butte County Department of Behavioral Health, Exh. 117 at 579-80; Treadwell Depo. at 126:11-18; Neilsen
10 Depo. at 158:4-159:18; Lourie Decl., at ¶¶ 4-11, 13. Chamberlain Decl., at ¶¶ 1, 2,
11 13-17; Watrous Decl., at ¶¶ 5-7; Berrick Decl., 157-58 at ¶¶ 34-37; Grealish Decl.,

12 at ¶¶ 1-4, 31.

13

43. There is no evidence that children would object to receiving

14 wraparound services or TFC rather than being institutionalized. Available evidence

15 is to the contrary. See, e.g., Smith Decl., 29-36 at ¶¶ 3, 4, 15 and 17; Further Farr

16 Decl., 119-33 at ¶¶ 12-60.

17

CONCLUSIONS OF LAW

18

Plaintiffs Have Met the Standard for a Mandatory Preliminary Injunction

19

44. Plaintiffs seeking a preliminary injunction must show either (1) a

20 combination of probable success on the merits and the possibility of irreparable

21 injury, or (2) that serious questions are raised and the balance of hardships tips

22 sharply in their favor. Katie A., 481 F.3d at 1156; Katie A., 1069. In cases where

23 plaintiffs seek mandatory preliminary relief, plaintiffs must show that the facts and

24 law clearly favor the moving party. Katie A., 481 F.3d at 1156; Stanley v.

25 University of Southern California, 13 F.3d 1313, 1320 (9th Cir. 1994); Katie A., 433

26 F. Supp. 2d at 1070.

27

45. Plaintiffs suffer an array of injuries from Defendants’ failure to meet

their mental health needs, including unnecessary institutionalization, emotional 28

16
Proposed Findings of Fact and Conclusions of Law

1 injuries from multiple failed placements, and abuse in group homes. See supra at ¶¶

2 13-18. The harms Plaintiffs face are imminent, grave, and irreparable. Katie A.,

3 481 F.3d at 1156. See Beltran v. Meyers, 677 F.2d 1317, 1322 (9th Cir. 1982)

4 (irreparable injury occurs when State denies “needed medical care” to Medicaid

5 recipients). Plaintiffs will continue to face these harms without the preliminary

6 injunction. Katie A., 481 F.3d at 1156-57.

7

46. This Court rejects Defendants’ arguments that Plaintiffs have not

8 shown irreparable harm because they waited three years before filing the prior

9 preliminary injunction motion and eight months after the Ninth Circuit’s remand to file this new motion for preliminary injunction. As this Court previously found,
10 Plaintiffs “initially focused much of their efforts and limited resources on their
11 claims against Los Angeles County,” and these efforts resulted in a “pioneering,

12 albeit still problem-laden, settlement” in which the County agreed to make a number

13 of important commitments for the care of members of the countywide class. Katie

14 A., 433 F. Supp. 2d at 1078. Defendants’ argument regarding the timing of this

15 motion is similarly unavailing, given the five months of discovery preceding this

16 motion and Defendants’ request for an additional two months to file their

17 opposition. “The unmet mental health needs and harms of unnecessary

18 institutionalization” to the Plaintiff class “are no less grave now” than when this

19 lawsuit was filed. Id.

20

47. This Court also rejects Defendants’ argument that Plaintiffs have not

21 been irreparably harmed because they have an adequate remedy through the

22 Medicaid appeals process. As this Court previously found, “exhaustion of state

23 administrative remedies should not be required as a prerequisite to bringing an

24 action pursuant to § 1983.” Katie A., 433 F. Supp. 2d at 1078 (citing Patsy v. Board

25 of Regents of State of Fla., 457 U.S. 496, 516, 102 S.Ct. 2557, 73 L.Ed. 2d 172

26 (1982)).

27

48. “The public interest is a factor to be strongly considered” in granting a

preliminary injunction. Lopez, 713 F.2d at 1437. A “government must be

28

17
Proposed Findings of Fact and Conclusions of Law

1 concerned not only with the public fisc but also with the public weal.” Id. Here, it is

2 in the public interest to ensure that the Plaintiff class, foster children who are both

3 poor and disabled, get the mental health services they need. Providing wraparound

4 services and TFC will also likely save the public money. See supra at ¶¶ 38-40.

5

49. The balance of hardships clearly tips in Plaintiffs’ favor.

6

50. The facts and law in this case clearly favor the Plaintiffs on their

7 Medicaid claim and their ADA claim, as set forth below.

8

Plaintiffs’ Claims under the Medicaid Act

9

51. As this Court previously ruled, Plaintiffs have a private right of action

against Defendants under 42 U.S.C. § 1983 for their violations of the Medicaid Act,

10

including 42 U.S.C. §§ 1396a(a), 1396d(a), and 1396d(r). Katie A., 433 F. Supp. 2d

11 at 1070 (citing Watson v. Weeks, 436 F.3d 1152, 1155 (9th Cir. 2006) (noting that

12 “[i]n ruling that § 1396a(a)(10) creates a private right of action enforceable under §

13 1983, the Ninth Circuit joined five federal circuits that have already held so”;

14 internal quotation marks omitted); accord Katie A., 481 F.3d at 1162.

15

52. When a state chooses to participate in the Medicaid program, the state

16 must comply with the Medicaid Act and its implementing regulations. Katie A., 481

17 F.3d at 1154; Katie A., 433 F. Supp. 2d at 1071.

18

53. The Medicaid Act requires that each state provide for making medical

19 assistance available, including “early and periodic screening, diagnostic, and

20 treatment services ... for individuals who are eligible under the plan and are under

21 the age of 21, ” 42 U.S.C. § 1396d(a)(4) (EPSDT).

22

54. 42 U.S.C. § 1396d(r)(5) defines these services to include “[s]uch other

23 necessary health care, diagnostic services, treatment, and other measures described

24 in subsection (a) of this section to correct or ameliorate defects and physical and
25 mental illnesses and conditions discovered by the screening services, whether or not 26 such services are covered under the State plan.” Under § 1396d(r)(5), states must 27 cover every type of health care or service necessary for EPSDT corrective or
ameliorative purposes that is allowable under § 1396d(a). Katie A., 481 F.3d at 28

18
Proposed Findings of Fact and Conclusions of Law

1 1154, 1158.

2

55. 42 U.S.C. § 1396d(a) contains a list of 28 categories of care or service.

3 Katie A., 481 F.3d at 1154. The 1396d(a) categories are fairly general. Katie A.,

4 481 F.3d at 1154.

5

56. A service need not be expressly listed in § 1396d(a) to be covered.

6 Katie A., 483 F.3d at 1158; Second Supp. Redman Decl., 480 at ¶ 8 ; Knisley Decl.,

7 651-52 at ¶ 13; Westmoreland Decl., 773 at ¶ 18.

8

57. States must provide all of the services listed in § 1396d(a) to eligible

9 children when such services are found to be medically necessary. Katie A., 481 F.3d

at 1154; Defs.’ Opp. at 5.

10

58. California is required to provide EPSDT services to eligible children

11 under the age of 21. Katie A., 481 F.3d at 1154.

12

59. California must provide covered services to class members rather than

13 simply make such services available. Katie A., 481 F.3d at 1162, citing 42 U.S.C. §

14 1396a(a)(43).

15

Plaintiffs Prevail on the Three Issues Identified by the Ninth Circuit

16

60. All the components of wraparound services and TFC fall within the 28

17 categories of services under § 1396d(a). See, e.g., Second Supp. Redman Decl.,

18 478-483 at ¶¶ 5, 11, 12, and Exh. 7 at 548-618; Westmoreland Decl., 767-71 at ¶¶

19 2, 10, 12-14; Knisley Decl., 646-54 at ¶¶ 3, 15, 16; Koyanagi Decl., at ¶¶ 3, 22, 25,

20 26, 28, 29, 30.

21

61. The category of services known as rehabilitative services covers “other

22 diagnostic, screening, preventive, and rehabilitative services, including any medical

23 or remedial services (provided in a facility, a home, or other setting)” when those

24 services “are recommended by a physician or other licensed practitioner . . . for the
25 maximum reduction of physical or mental disability and restoration of an individual 26 to the best possible functional level.” 42 U.S.C. § 1396d(a)(13). This includes: 27 diagnosis, assessment, treatment planning and coordinating the delivery of
rehabilitative services; crisis services; family psychoeducation to enlist a person’s 28

19
Proposed Findings of Fact and Conclusions of Law

1 family in addressing and managing the person’s mental illness; peer support and

2 counseling; basic life skills and social skills training and support; medication

3 education and management; and illness and disability management. U.S.

4 Department of Health and Human Services, Centers for Medicare & Medicaid

5 Services, A Primer on How to Use Medicaid to Assist Persons Who are Homeless to

6 Access Medical, Behavioral Health and Support Services (January 2007), at 58-59

7 (Second Supp. Redman Decl., Exh. 6 at 546-47); Second Supp. Redman Decl., 488-

8 90 at ¶ 19; accord Knisley Decl., 651-55 at ¶¶ 13, 16, 17; McCabe Decl., 64-65 at ¶

9 9 (coverage under rehabilitative services includes assistance to individuals with “functional skills, daily living skills, social and leisure skills, grooming and personal
10 hygiene skills, meal preparation skills, support resources, and medication
11 management”).

12

62. The case management category of services covers “services which will

13 assist individuals eligible . . . in gaining access to needed medical, social,

14 educational, and other services.” 42 U.S.C. § 1396n(g)(2). This includes:

15 assessments to determine service needs, which can involve “[g]athering information

16 from other sources such as family members, medical providers, social workers, and

17 educators”; development of a specific care plan with the active participation of the

18 eligible individual and others and that, among other things, “specifies the goals and

19 actions to address” the various services needed by the eligible individual; referral

20 and related activities to help an individual obtain needed services; and monitoring

21 and follow-up activities. P.L. 109-171, § 6052(a)(2) (Feb. 8, 2006), codified at 42
22 U.S.C. § 1396n(g)(2)(A)(ii); Second Supp. Redman Decl., 484-85 at ¶ 14; Knisley
23 Decl, 656-57 at ¶ 18; accord McCabe Decl., 65-67 at ¶¶ 11, 13A (case management 24 services “may include, but are not limited to, communication, coordination, and 25 referral; monitoring service delivery to ensure beneficiary access to service;” 26 assessments; service plan development and periodic review; linkage and 27 consultation; assistance in accessing services; and crisis planning).
63. 42 U.S.C. § 1396d(a)(9) covers “clinic services furnished by or under 28

20
Proposed Findings of Fact and Conclusions of Law

1 the direction of a physician, without regard to whether the clinic itself is

2 administered by a physician, including such services furnished outside the clinic by

3 clinic personnel to an eligible individual who does not reside in a permanent

4 dwelling or does not have a fixed home or mailing address.”

5

64. 42 U.S.C. § 1396d(a)(6) covers “any other type of remedial care

6 recognized under State law, furnished by licensed practitioners within the scope of

7 their practice as defined by State law.”

8

65. All the components of wraparound services and TFC fall within the

9 §1396d(a) categories of rehabilitative services, §1396d(a)(13), case management services, § 1396d(a)(13), clinic services, § 1396d(a)(9), and/or any other type of
10 remedial care recognized under State law, furnished by licensed practitioners within
11 the scope of their practice as defined by State law,” § 1396d(a)(6). Second Supp.

12 Redman Decl., 481-82 at ¶ 10; Koyanagi Decl., at ¶ 25, 28-30; Knisley Decl., 653 at

13 ¶ 15; Westmoreland Decl., 770 at ¶ 12.

14

66. With regard to the nine components of wraparound services, the Court

15 finds that these components fall under the following categories of services under §

16 1396d(a):

17

A. “Engagement of the child and family” – rehabilitative services and case

18

management services. Koyanagi Decl., at ¶ 28(a); Second Supp.

19

Redman Decl., 491-92 at ¶ 21.

20

B. “Immediate crisis stabilization” – rehabilitative services. Koyanagi

21

Decl., at ¶ 28(b); Second Supp. Redman Decl., 492-509 at ¶ 22(b)(i).

22

C. “Strengths and needs assessment” – rehabilitative services and case

23

management services. Koyanagi Decl., at ¶ 28(c); Second Supp.

24

Redman Decl., 483-85 at ¶¶ 13, 14; see also id., 486-91 at ¶¶ 16, 20.

25

D. “Wraparound team formation” – rehabilitative services and case

26

management services. Koyanagi Decl., at ¶ 28(d); see also Second

27

Supp. Redman Decl., 486-91 at ¶¶ 16, 20.

E. “Wraparound plan development” – rehabilitative services and case

28

21
Proposed Findings of Fact and Conclusions of Law

1

management services. Koyanagi Decl., at ¶ 28(e); Second Supp.

2

Redman Decl., 483-509 at ¶¶ 13, 14, 22(a)(i).

3

F. “Wraparound service plan implementation” – rehabilitative services

4

and, depending on the nature of the services in the plan, possibly other

5

§ 1396d(a) categories, including case management services. Koyanagi

6

Decl, at ¶ 28(f).

7

G. “Ongoing safety and crisis planning” – rehabilitative services and clinic

8

services. Koyanagi Decl., at ¶ 28(g); Second Supp. Redman Decl.,

9

492-509 at ¶ 22(b)(i).

H. “Tracking and adapting the wraparound service plan– rehabilitative

10

services and case management services. Koyanagi Decl., at ¶ 28(h);

11

Second Supp. Redman Decl., 486-91 at ¶¶ 16, 20.

12

I. “Transition” – rehabilitative services. Koyanagi Decl., at ¶ 28(i);

13

Second Supp. Redman Decl., 510-11 at ¶ 23(b).

14

67. With regard to the seven components of TFC, the Court finds that these

15 components fall under the following categories of services under § 1396d(a):

16

A. “Recruiting and matching” – rehabilitative services and case

17

management services, when done on behalf of a particular child.4

18

Koyanagi Decl., at ¶ 30(a); Second Supp. Redman Decl., 492-509 at ¶

19

22(b)(ii).

20

B. “Therapeutic foster parent training” – rehabilitative services and case

21

management services, when done on behalf of a particular child.5

22

Koyanagi Decl., at ¶ 30(b); Second Supp. Redman Decl., 492-509 at ¶

23

22(b)(iii).

24

25 4 When not done on behalf of a particular child, this component is covered as an

26

administrative expense built into the provider reimbursement rate. Second Supp. Redman Decl., 492-509 at ¶ 22(b)(ii).

27 5 When not done on behalf of a particular child, this component is covered as an

28

administrative expense built into the provider reimbursement rate. Second Supp. Redman Decl., 492-509 at ¶ 22(b)(iii).

22
Proposed Findings of Fact and Conclusions of Law

1

C. “Development of treatment plan – rehabilitative services and case

2

management services. Koyanagi Decl, at ¶ 30(c); Second Supp.

3

Redman Decl., 492-509 at ¶ 22(a)(i).

4

D. “Tracking and adapting the treatment plan” – rehabilitative services

5

and case management services. Koyanagi Decl., at ¶ 30(d); Second

6

Supp. Redman Decl., 492-509 at ¶ 22(a)(ii).

7

E. “Plan implementation – individual child treatment” – rehabilitative

8

services and, depending on the nature of the services in the plan,

9

possibly other § 1396d(a) categories, including case management

services. Koyanagi Decl., at ¶ 30(e).

10

F. “Plan implementation – family treatment” – rehabilitative services and

11

clinic services. Koyanagi Decl., at ¶ 30(f); Second Supp. Redman

12

Decl., 491-92 at ¶ 21.

13

G. “Transition” – rehabilitative services and case management services.

14

Koyanagi Decl., at ¶ 30(g); Second Supp. Redman Decl., 492-509 at ¶

15

22(a)(iii).

16

68. While Defendants do not expressly concede that any particular

17 component of wraparound services is covered by Medicaid, they state that “[i]f the

18 medical necessity criteria is met and the services are properly described, the service

19 activities under the process called wraparound could be Medicaid covered services

20 under 42 U.S.C. § 1396d(a)(19) and covered pursuant to 42 U.S.C. § 1396d(a)(13)

21 as other diagnostic, screening, preventative and rehabilitative services. Defs.’ Opp.

22 at 7; see also McCabe Decl., 64 at ¶ 8 (same).

23

69. Defendants argue that the new case management regulations prohibit

24 coverage of TFC under this category of services.6 Even if the components of TFC

25

26 6 Recently proposed legislation would, however, put a moratorium until April 9,

27 2009 on enforcement of the case management regulations as well as the

28

rehabilitative service regulations and other regulations proposed by CMS. See H.R. 5613, The Protecting the Medicaid Safety Net Act of 2008.

23
Proposed Findings of Fact and Conclusions of Law

1 do not fall within the category of case management services, they fall within other

2 categories of services in § 1396d(a), including rehabilitative services. See, e.g.,

3 Koyanagi Decl. at ¶ 28 (stating that TFC “is a mental health service that is

4 commonly billed under the Medicaid Rehabilitation category” and describing how

5 each component can be covered as a rehabilitative service); accord Appendix B.

6 See also supra at ¶ 65. Moreover, the case management regulations do not prohibit
7 covering the components of TFC – when TFC is provided as a mental health 8 intervention – under a state’s Medicaid program. Second Supp. Redman Decl., 4929 509 at ¶ 22. The case management regulations “do[] not in any way, compromise a
Medicaid recipients’ eligibility for medically necessary services . . ., including 10
medically necessary case management (and targeted case management) services that 11 are not used to administer other programs.” 72 Fed. Reg. 68077, 68088 (Dec. 4, 12 2007). When TFC is provided as a mental health intervention, the components of 13 TFC that fall within the definition of case management services are “not used to
14 administer other [non-health care] programs.” Second Supp. Redman Decl., 492-509

15 at ¶ 22.

16

70. Defendants are not effectively providing the components of

17 wraparound services and TFC to class members. See supra at ¶¶ 31-37. There is

18 ample evidence that the State does not cover the components of wraparound services

19 and TFC under its Medicaid program. Additionally, the evidence is clear that the

20 State does not consider class members to have an entitlement, under Medicaid or

21 otherwise, to receive the components of wraparound services and TFC or to receive

22 them in a coordinated fashion. The result is that class members are denied

23 medically necessary mental health services.

24

71. Defendants have not demonstrated that providing the components of

25 wraparound services and TFC in a manner other than the comprehensive and

26 coordinated fashion set forth by Plaintiffs is effective or that an alternative approach

27 would meet the medical needs of class members. Plaintiffs’ evidence clearly demonstrates that to be effective, Defendants must provide all of the components of
28

24
Proposed Findings of Fact and Conclusions of Law

1 wraparound services and TFC in a coordinated fashion to class members for whom

2 they are medically necessary. See supra at ¶ 31.

3

72. Plaintiffs have not requested, and Defendants need not provide,

4 wraparound services and TFC as bundled services for billing purposes.

5

Plaintiffs Have Proven Their ADA and Rehabilitation Act Claims

6

73. Plaintiffs and members of the class are entitled to relief under Title II of

7 the ADA, § 12102(2), and Section 504 of the Rehabilitation Act, 29 U.S.C. § 794.7

8

74. Class members are persons with disabilities under the ADA. See 42

9 U.S.C. § 12102(2) (disability includes mental impairment that substantially limits

one or more major life activities); see supra at ¶ ¶ 10-11.

10

75. Defendants Shewry and Wagner are appropriate defendants under the

11 ADA. Miranda B. v. Kitzhaber, 328 F.3d 1181, 1187-89 (9th Cir. 2003).

12

76. The regulations implementing Title II mandate that public entities

13 administer their services to individuals with disabilities in the “most integrated

14 setting appropriate” to their needs [28 C.F.R. § 35.130(d)], which means “a setting

15 that enables individuals with disabilities to interact with non-disabled persons to the

16 fullest extent possible.” 28 C.F.R. pt. 35, App. A, p. 543 (2004).

17

77. In Olmstead v. L.C., 527 U.S. 581, 119 S.Ct. 2176, 144 L.Ed.2d 540

18 (1999), the Supreme Court held that the ADA prohibits unnecessary

19 institutionalization of individuals with disabilities. Id. at 587; see also ARC of

20 Washington State Inc. v. Braddock, 427 F.3d 615, 618 (9th Cir. 2005)(“states are

21 required to provide care in integrated environments for as many disabled persons as
22 is reasonably feasible, so long as such an environment is appropriate to their mental
23 health needs”). States are required to transfer individuals with disabilities from 24 institutional to integrated community settings if: (1) the individual is appropriate for 25 community placement, (2) the individual does not oppose such a placement, and (3) 26 the community placement could be reasonably accommodated. Olmstead, 527 U.S.

27

28

7 The analysis of the ADA applies equally to Section 504. See Miranda B. v. Kitzhaber, 328 F.3d 1181, 1188 (9th Cir. 2003).

25
Proposed Findings of Fact and Conclusions of Law

1 at 587, 607.

2

78. Plaintiffs have proven that wraparound services and TFC will prevent

3 the unnecessary institutionalization of class members. See supra at ¶ 42. The Ninth

4 Circuit affirmed this Court’s prior finding that Plaintiffs “would face unnecessary

5 institutionalization without the preliminary injunction.” Katie A., 481 F.3d at 1156.

6

79. Plaintiffs have proven that class members’ community placement can

7 be reasonably accommodated and that it would not be a fundamental alteration to

8 transfer class members to, or maintain them in, community settings. See supra at ¶¶ 9 38-41.
80. Defendants bear the burden of establishing a fundamental alteration 10 defense. Townsend v. Quasim, 328 F.3d 511, 520 (9th Cir. 2003). Defendants 11 fundamental alteration defense is based on two arguments: that wraparound and

12 TFC are not covered by Medicaid and that Plaintiffs seek unreasonably to impose

13 “one approach to delivering mental health service on all children in all counties.”

14 Defs.’ Opp. at 23, 24-25. However, Plaintiffs have proven that the components of

15 wraparound services and TFC are covered by Medicaid. See supra at ¶¶ 65-68.

16 Moreover, Plaintiffs do not seek a “one size fits all” approach and they have never

17 sought to preclude the State or counties from providing services other than

18 wraparound services or TFC to class members. This lawsuit seeks wraparound

19 services and TFC only for those members of the class for whom these services are

20 medically necessary. See Pls.’ Reply Mem. of P&A, at 2. That does not constitute a

21 fundamental alteration within the meaning of the ADA.

22

81. Defendants have failed to demonstrate that, taking into account the cost

23 of providing the services, the needs of others with disabilities, and the resources

24 available to the state, it would be a fundamental alteration to furnish community

25 services to the Plaintiffs. See Olmstead, Townsend v. Quasim, 328 F.3d 5111 (9th

26 Cir. 2003).

27

This Court Will Grant Plaintiffs’ Preliminary Injunction

82. Plaintiffs have met the standard for the granting of a mandatory 28

26
Proposed Findings of Fact and Conclusions of Law

1 preliminary injunction. See supra at ¶¶ 44-50. Accordingly, this Court will grant a

2 preliminary injunction directing Defendants to make wraparound services and TFC

3 available to all class members on a consistent statewide basis through the Medi-Cal

4 program or other means. The Defendants should be given 60 days to develop a plan

5 and another 60 days to provide the actual services. Defendants’ counsel shall meet

6 and confer with Plaintiffs’ counsel to develop a plan for implementing this
7 preliminary injunction. See Katie A., 433 F. Supp. 2d at 1079. The plan must 8 identify, among other things, the responsibilities of the different State agencies, the 9 need for additional providers, the eligibility criteria for wraparound services and
TFC, methods and procedures to inform class members of the availability of these 10
services, and a timeline for accomplishing needed tasks. Id. With regard to 11 developing this implementation plan, the parties shall submit joint progress reports 12 to the Court every two weeks. These progress reports shall reflect any issues where 13 the parties have reached agreement on particular issues as of that date (e.g., the
14 eligibility criteria for wraparound services) and any issues where the parties have

15 been unable to reach agreement and so the Court will have to resolve this particular

16 dispute over implementation.

17

83. The injunction will issue against both Defendants in their official

18 capacities as the current Directors of DHCS and DSS. Concerted action by both

19 Departments is needed to ensure class members receive needed mental health

20 services. Katie A., 481 F.3d at 1162. The actions of the child welfare system

21 heavily influence whether class members receive needed mental health services. Id.

22

84. The Court will not require the posting of a bond. See People of State

23 of Cal. ex rel. Van De Kamp v. Tahoe Regional Planning Agency, 766 F.2d 1319,

24 1325-26 (9th Cir. 1985); Orantes-Hernandez v. Smith, 541 F. Supp. 351, 385 n.42

25 (C.D. Cal. 1982); accord Katie A., 433 F. Supp. 2d at 1079.

26

85. All of the foregoing constitutes the Court’s findings of fact and

27 conclusions of law. To the extent that the factual recitals also constitute legal

28

27
Proposed Findings of Fact and Conclusions of Law

 </s> SETILEMENT AGREEMENT

Background

I. Plaintiffs brought this lawsuit entitled Katie A. et a!. v. Diana Bonta et a!. (the "Katie A.

Litigation"), filed July 18, 2002, case no. 02-05662, seeking certification of a class and

declaratory and injunctive relief against Diana Bonta, Director of California Depatiment of Health

Services; Rita Saenz, Director of the California Depatiment of Social Services, (hereinafter

collectively referred to as "the State" or "State Defendants") and against Los Angeles County; Los

Angeles County Depatiment of Children and Family Services ("DCFS"); Anita Bock, Director of

the Los Angeles County Department of Children and Family Services (hereinafter collectively

referred to as "the County" or "County Defendants") and Does I through I 00, inclusive.

2.

Plaintiffs filed the First Amended Complaint on December 20, 2002. The First Amended

Complaint is the operative pleading in this action.

3. On June 18, 2003, this case was cetiified as a class action for purposes of all causes of

action in Plaintiffs' First Amended Complaint against the State Defendants on behalf of a class of

children in California who:

(a) Are in foster care or are at imminent risk of foster care placement, and

(b) Have a mental illness or condition that has been documented or, had an assessment

already been conducted, would have been documented, and

(c) Who need individualized mental health services, including but not limited to

professionally acceptable assessments, behavioral suppoti and case management services, family

support, crisis support, therapeutic foster care, and other medically necessmy services in the home

or in a home-like setting, to treat or ameliorate their illness or condition.

Page I

For the purposes of this case, "imminent risk of foster care placement" means that within the last 180 days a child has been participating in voluntmy family maintenance services or voluntary family reunification placements and/or has been the subject of either a telephone call to the Child Protective Services hotline or some other documented communication made to a local Child Protective Services agency regarding suspicions of abuse, neglect or abandonment. 4. Members of the class include children living with their parents or relatives or in any of a variety of placements, such as group homes or foster homes. 5. Plaintiffs entered into a settlement agreement (hereinafter "County Settlement") with County Defendants regarding all claims in the First Amended Complaint, which County Settlement was approved by the Comt on July 16, 2003. 6. On March 14, 2006, the District Court granted Plaintiffs' motion for preliminary injunction in this case. Katie A. v. Bonta, 433 F.Supp.2d 1065 (C.D.Cal. 2006). On March 23, 2007, the Ninth Circuit Comt of Appeals vacated the preliminmy injunction and remanded for fmther proceedings consistent with its opinion. Katie A. ex rei Ludin v. Los Angeles County, 481 F.3d 1150 (91h Cir. 2007). 7. California Department of Health Care Services (DHCS) is the successor in interest to California Department of Health Services, Toby Douglas is the successor-in-interest to Diana Bonta as Director ofDHCS, and Will Lightbourne is the successor-in-interest to Rita Saenz as the Director of the California Department of Social Services (CDSS) and both have assumed the roles and are substituted in their respective official capacities as State Defendants herein by operation oflaw.
Page 2

8. The State Defendants deny all wrongdoing alleged in this action and deny any liability whatsoever to Plaintiffs and the Plaintiff Class. 9. State Defendants assert that they have meritorious defenses which they have asserted in this action, and assett that they have entered into this Settlement Agreement ("Agreement") with the accompanying proposed Stipulated Judgment (a copy of which is attached hereto, marked as Appendix "A" and incorporated herein by reference) solely for the purpose of settling and compromising the claims of the Plaintiffs, in order to avoid the expense and diversion of its personnel caused by protracted litigation, and to terminate the claims asserted against State Defendants. 10. The Court appointed a Special Master on April 3, 2009, to facilitate the parties' efforts to reach agreement on the legal issues and/or narrow the differences between the parties in the case. The patties, along with a small group of other interested and significant stakeholders (hereafter "negotiation workgroup") engaged in a lengthy and intensive negotiation process over a year and a half, under the direction of the Special Master, utilizing an interest based decision making process, which required consensus of the negotiation workgroup in order to make recommendations. 11. The best interests of the class will be substantially advanced by the settlement of the Katie A. litigation based on the commitments reflected in this Agreement, rather than by a trial on the merits. 12.. In consideration of the covenants and undettakings set fmth herein and intending to be legally bound thereby, it is stipulated and agreed by the Plaintiffs and the State Defendants, represented by their undersigned counsel, that all of Plaintiffs' claims for relief against the State Defendants which were assetted in the Complaint filed on July 18, 2002, or First Amended
Page 3

Complaint filed on December 20 2002, including any claims against employees and officers of State Defendants, shall be resolved on the following terms as set fmth in this Agreement: I. Jurisdiction and Authority of the Court. 13. The United States District Comt has jurisdiction over the claims against all Defendants pursuant to 28 U.S.C. §§ 1331, 1343 and 1367. Venue is proper in the Central District of California pursuant to 28 U.S.C. § 1391(b). 14. After notice of and an opportunity to comment on this Agreement has been provided to the Plaintiff class and others thereby affected, the Comt shall determine whether to approve this Agreement as being a fair, reasonable and adequate settlement of the Katie A. Litigation and to enter the accompanying Stipulated Judgment. Except as otherwise noted, the terms of this Agreement shall not take effect until the Court issues its order approving this Agreement. 15. This Agreement settles all claims against the State Defendants in this lawsuit. 16. State Defendants agree that this Agreement is binding on the California Department of Mental Health ("CDMH"), a non-patty to the Agreement. 17. The patties to this Agreement acknowledge that notice of, and an opportunity to comment on, this Agreement must be provided to the Plaintiff class and others thereby affected. Immediately following the execution of the Agreement, the patties shall jointly develop the content of the written notice to be given to the Plaintiff class, as well as negotiate the terms of how notice shall be given to the Plaintiff class. 18. Promptly upon execution of this Agreement and completion of the activities described in Paragraph 17 above, Plaintiffs shall apply to the Court by application and/or motion for
Page4

preliminary approval of the Agreement, Plaintiffs shall apply to the Court for entry of an order substantially in the following form:
(a) Giving its preliminary approval of the Agreement (which includes the Stipulated Judgment) as being fair, reasonable and adequate as to members of the Class;
(b) Approving the proposed procedures for giving notice to members of the Class of the Agreement; and
(c) Scheduling a fairness hearing as to whether the Agreement should be finally approved as fair, reasonable and adequate as to members of the Class and the Stipulated Judgment should be entered. II. Objectives and Specific Agreements. 19. The objectives of this Agreement are to:
(a) Facilitate the provision of an array of services delivered in a coordinated, comprehensive, community-based fashion that combines service access, planning, delivery, and transition into a coherent and all-inclusive approach;
(b) Suppmt the development and delivery of a service structure and a fiscal system that supports a core practices and services model, as described in (a),
(c) Suppmt an effective and sustainable solution that will involve standards and methods to achieve quality-based oversight, along with training and education that suppmt the practice and fiscal models;
(d) Address the need for cettain class members with more intensive needs (hereinafter referred to as "Subclass members") to receive medically necessary mental health services in their own home, a family setting or the most homelike setting appropriate to their needs, in order to facilitate reunification, and to meet their Page 5

needs for safety, permanence, and well-being.
(1) Subclass Members are children and youth who are full-scope Medi-Cal eligible, meet medical necessity, have an open child welfare services case, and meet either of the following criteria:
A. Child is currently in or being considered for: Wraparound, therapeutic foster care or other intensive services, therapeutic behavioral services, specialized care rate due to behavioral health needs or crisis stabilization/intervention; or
B. Child is currently in or being considered for a group home (RCL 10 or above), a psychiatric hospital or 24 hour mental health treatment facility, or has experienced his/her 3'd or more placements within 24 months due to behavioral health needs.
20. To fulfill the above objectives, the State Defendants agree to the following:
(a) CDMH1 and CDHCS will develop and disseminate a Medi-Cal Specialty Mental Health documentation manual (hereinafter "Documentation Manual") that will inform and instruct providers on:
(1) two arrays of services, Intensive Care Coordination (ICC), as defined in
1 Because of the possible restructuring of CDMH, at this time the parties are uncertain as to whether CDMH will be the State agency responsible for performing the obligations assigned to CDMH pursuant to this Agreement. State Defendants agree that the State will perform CDMH's obligations under this Agreement.
Page 6

Appendix "E", and Intensive Home Based Services (IHBS), as defined in Appendix "D", to be provided to the subclass, as described in Paragraph 19 (d)(l) of this Agreement; (2) Therapeutic Foster Care (TFC), as defined in Katie A. v. Bonta, 433 F.Supp.2d 1065, 1072 (C.D.Cal. 2006), e.g., Multidimensional Treatment Foster Care (MTFC), Intensive Treatment Foster Care (ITFC). A. CDMH, CDSS and DHCS, in collaboration with the negotiation workgroup,
including consultants, if needed, will determine: I. To what extent the activities and/or components of TFC services are covered under the Medicaid Act, including EPSDT, 42 U.S.C. § 1396 et seq., and its implementing regulations, and 2. To what extent the activities and/or components are covered under the Califomia Medicaid State Plan; 3. To what extent, if any, the State Plan needs to be amended to cover TFC services that are covered under the Medicaid Act but are not covered in the State Plan.
(b)(I) The Documentation Manual will describe how ICC and IHBS should be provided consistent with the Core Practice Model Principles and Components (hereinafter referred to as the "Core Practice Model"), as defined in Appendix "B", using a Child and Family Team, as defined in Appendix "C".
(b)(2) The Documentation Manual will be developed by the State Defendants in collaboration with the negotiation work group, and other stakeholders upon
Page 7

agreement by the patiies. Chapters of this manual may include, but would not be limited to:
• Description of the eligible class • How to refer a child for IHBS/ICC, and TFC services • General description of Medi-Cal reimbursable service
activities that can comprise the IHBS/ICC arrays of services, and TFC services • Authorization/utilization • Claiming • General description of other non-Medi-Cal reimbursable service activities that can be pati of the IHBS/ICC models or arrays of services, and TFC services • Billing Rules and Requirements • Documentation Requirements • Examples of Forms • Where to call for additional information (b)(3) CDMH and CDSS will post the draft Documentation Manual on their Internet sites for a thirty-day public comment period. CDMH and CDSS will post a final copy of the Documentation Manual on the Internet sites of CDMH and DHCS. (c) DHCS will draft and submit amendments to the definitions of Targeted Case Management (TCM) services and Rehabilitation services in the California's State
Page 8

Medicaid Plan through State Plan Amendments, consistent with the Core Practice Model and ICC and IHBS and the Mercer Consulting Repmt, Katie A. Phase I and II Analysis, dated October 6, 20 I0. (d) CDMH and CDSS will establish a shared management structure to develop a shared vision and mission statement, policy and program direction, clear and consistent guidance, and outcomes and accountability measures consistent with the Core Practice Model (Appendix "B"). To this end, in consultation with the negotiation workgroup, CDSS and CDMH will develop a Core Practice Model Guide and establish a joint management task force with representatives from each depattment and representatives from youth, parent pattnet', county and provider groups. CMHDA and CWDA will be consulted on membership of the group and requested to join the task force. The work of the joint management task force will be focused on the goal of creating joint program management system. The Task force will consider and repott within 12 months after execution of this Agreement on the proposed methods for doing this including: (1) Establishment of the shared management structure between CDMH and
CDSS through legislation, and/or regulation, or other means to atiiculate a shared set of goals, vision and mission statements. Policies and procedures should be prepared and revised jointly as needed to ensure a shared practice is consistent and duplication is avoided, and provide a process for quickly resolving conflicts; (2) Building upon existing relationships with all state agencies that serve foster youth with mental health needs including the State Department of
Page 9

Education, the California Department of Dmg and Alcohol, and the California Depatiment of Correction and Rehabilitation to coordinate information and services in a manner consistent with the Core Practice Model. Existing venues for developing relationships already exist with State Interagency Team, Child Welfare Council, local blue ribbon commissions, etc.; (3) Creating a cross-system process and procedures to suppoti and manage the shared responsibility between CDMH and CDSS for delivering services to foster youth that is consistent with the Core Practice Model at the county/local level; (4) Developing and providing models for local agencies to consider in order to work more effectively together, including, for example, integration of departments or services, specific coordination management models that oversee the departments, and/or Memoranda of Understandings (MOUs) for specific collaboration. (e) CDSS and CDMH, in consultation with the joint management task force, will develop and endorse practice tools, training curriculum, practice improvement protocols, and quality control systems to suppmi the shared Core Practice Model in order to support service integration and/or coordination for mental health services for class members; (f) CDSS and CDMH will develop cross system training curriculum and educational materials for child welfare and mental health staff. (I) CDSS will initiate a request to the Statewide Training and Education
Page 10

Committee (STEC) to develop a process and timeline for curriculum development. (2) The educational materials are intended to be used by counties and providers to explain the system to children and families including a joint DSS/DMH tool kit for the Child and Family Teams. (3) The curriculum shall develop and promote structured oppmtunities for teaming at all levels such as Team Decision Making meetings, Child and Family Teams, Interagency Operations Networks, Interagency Placement Review Teams, Departmental Leadership Team meetings, etc. (g) CDSS, CDMH and DHCS will clarify and provide guidance on state and federal laws as needed to implement this Agreement so that counties and providers can understand and consistently apply them. Proposed methods may include, but are not limited to: (1) Providing ongoing technical assistance to include manuals, policy-
guidance, education and training, program development and fidelity to program principles to suppmt the Core Practice Model; (2) Ensuring audit compliance units follow the billing and documentation guidelines developed by the state depattments in order to ensure appropriate and consistent audit standards are being utilized to review provider billing claims; (3) Encouraging local policy and regulatory discretion/variations to be consistent with the Core Practice Model. (h) Seeking to improve methods and adequacy of data collection, matching, and
Page 11

sharing to suppmt the Core Practice Model at the state, county, and provider levels, CDSS and CDMH will develop a proposal to incotporate into the implementation plan to produce and post data including relevant claims infmmation for the class. Proposed methods may include: (1) Improving data exchange and matching among CDSS and CDMH and
other state and local depmtments; (2) Developing and disseminating a clear policy on information
sharing/privacy issues between child welfare and mental health and other service pattners; (3) Using existing data collection and existing baseline and perfmmance benchmarks to the greatest extent feasible; (4) Determining what will be measured that reflects intended outcomes. Use the measured outcomes to evaluate progress on implementing the Core Practice Model and access to intensive home-based mental health services and intensive care coordination for mental health services. Relevant data may include: A. Clinical status data, including assessments of symptoms, risks, functioning, strengths, and other information on how the class member is doing in his or her life; B. Utilization data, including disposition infmmation such as aftercare from hospitals and group homes, etc. C. Treatment facility data that reflect what is happening within the episode of
Page 12

treatment. Monitoring the degree to which CFT and intensive home-based mental health services, and intensive care coordination for mental health services are provided and the extent to which they are provided within the Core Practice Model; (i) A process shall be developed to identify class members in order to link them firmly to services.
G) DHCS, CDSS and CDMH will establish a Data and Quality Task Force and produce a report with recommended actions and timelines to:
(I) Establish a method to track the use ofiCC and IHBS services arrays and TFC for subclass members.
(2) Utilize the Extemal Quality Review and Califomia Child and Family Services Review (C-CFRS) requirements to develop a plan for the collection of data and information about children in the class who receive mental health services.
(3) Collect data elements in DHCS, CDSS and CDMH data systems specific to the class (and subclass) in order to evaluate utilization (pattems, type, frequency, intensity of services) and timely access to care.
(4) Facilitate a stakeholder meeting to solicit ideas from stakeholders and counties about what data conceming the class the departments should routinely produce and post. Establish a procedure and timeline to produce and post data that is
Page 13

useful to Counties, stakeholders and State depmtments in addressing the needs of children in the class.
(5) All reports and timelines will be posted on the CDMH and CDSS websites.
(k) Models
(I) The State Departments, in consultation with the Negotiations Workgroup, will conduct a statewide readiness assessment of counties to develop and model child welfare and mental health service delivery systems that can be successful in implementing the Core Practice Model (CPM).
(2) The readiness assessment team will be informed by California Mental Health Directors' Association (CMHDA), California Welfare Directors Association (CWDA), providers, family members, and youth serving organizations.
(3) The readiness assessment will specifically focus on: A. the strength of the connectivity and collaboration between child welfare and mental health to administer an atl'ay of services to suppott IHBS, and ICC and TFC; B. the ability to transfer lessons learned to other programs and counties. Existing monitoring tools utilized by the State will be used to identify the counties; and C. whether the counties have or can build a system that delivers services to scale county-wide.
(4) At least one large, medium and small county will be selected by the State for this purpose to suppott intensive training and systems development for the CPM.
Page 14

(5) The selected counties will be used to test strategies for providing mental health services according to the CPM. Second, the sites may serve as the first phase of the statewide effott to deliver services according to the CPM, in accordance with the Implementation Plan.
(6) Selected model counties will receive training, technical assistance and other supportive incentives from the State for their strategies to test the CPM.
(7) Modeling is intended to facilitate adoption of the CPM Model and is not intended to inhibit provision of IlffiS, ICC, TFC and the Core Practice Model in counties other than the model counties.
(I) The implementation plan will address how the CPM and IHBS/ICC and TFC will be brought to scale statewide. (m) The State Departments, in consultation with the Negotiations Workgroup and fiscal and technical consultant experts, will establish a CPM Fiscal Task Force.
(I) The CPM Fiscal Task Force will focus on do-able, achievable, and fiscally sound incentives to deliver IHBS, ICC, and TFC within the Core Practice Model framework and reduce use of group homes and other institutional placements.
(2) The CPM Fiscal Task Force will develop a strategic plan or proposal that: A. I. Evaluates ways to support counties to implement the IHBS and ICC for the sub-class of children, including improving cash flow to counties that serve youth pursuant to the CPM and improving eligibility reliability for providers and counties; and 2. Secure alternative resources for services or state/county EPSDT match. B. Explores methods and options for reducing reliance on out-of-home Page 15

placements, including: l. Using group homes primarily for short-term crisis stabilization; 2. Establishing pilot programs that demonstrate the effectiveness of alternatives to group homes for very high needs and/or very highrisk youth; 3. Developing funding models or resources that facilitate the transformation of existing group home beds to intensive homebased services; 4. Enabling transition services in the community to be provided to group home residents to facilitate discharge; 5. Reconfiguring multi-agency mental health screening committees to provide for timely access to mental health services and suppmts consistent with the Core Practice Model and to reduce use of, or reliance on, out-of-home care
(3) The parties will incorporate the CPM Fiscal Task Force's plan or proposal into the Implementation Plan to the fullest extent practicable consistent with the time available. III. Implementation Plan 21. The patties agree to develop a specific Implementation Plan to fulfill the obligations of this Agreement. The parties will begin to develop the Implementation Plan once the Coutt gives its preliminary approval of the Settlement Agreement and will complete the Implementation Plan within six months after the Coutt gives its final approval of the Settlement Agreement. The Implementation Plan shall be developed with the assistance of the Special Master, as needed, and
Page 16

shall address all of the following: specific steps, deliverables, and a timeline for implementation. It is understood and agreed by the parties that the implementation timeline will include activities or deliverables that may be completed, or ongoing, after the end of coutt jurisdiction. IV. Special Master's Role. 22. The patties agree that the appointment of Richard Saletta as Special Master shall continue and be extended for thirty-six months after court approval of the Settlement Agreement. In the event that Mr. Saletta cannot continue to serve in this capacity for the duration of the Agreement, Plaintiffs and the State Defendants shall attempt to determine a mutually agreeable candidate to be his replacement, subject to Court approval. If Plaintiffs and State Defendants cannot agree upon a mutually agreeable replacement to Mr. Saletta, the patties shall each propose a candidate for the Coutt's consideration and appointment. 23. The Special Master may communicate freely with each of the parties or their counsel. The Special Master may hire consultants, as needed, to assist the Special Master and patties in carrying out any duties under this Agreement, if the patties agree. 24. State Defendants shall pay the reasonable costs of the services of the Special Master and any consultants the Special Master and/or the parties agree are necessary to hire. 25. The Special Master shall:
(a) advise and assist the patties in the development of an Implementation Plan pursuant to Paragraph 21; and, if they are unable to reach agreement, shall make recommendations with accompanying findings of fact to the Court; and
(b) determine whether the Implementation Plan is reasonably calculated to ensure that State Defendants meets the terms of the Agreement and objectives set forth in Paragraph 19. Page 17

26. The Special Master shall make regular written reports to the parties and the Court regarding the status of State Defendants' progress in meeting the obligations and commitments under the Implementation Plan. The Special Master shall prepare reports on a 120-day basis during the first year of the Agreement, every six months during subsequent years, and one last report no later than 30 days prior to the expiration of the District Court's jurisdiction over this lawsuit. 27. Thirty days prior to filing each such written report, the Special Master shall provide a draft of the repott to counsel for State Defendants and Plaintiffs. If requested by either State Defendants or Plaintiffs, the Special Master may, in his discretion, convene a meeting with counsel for State Defendants and Plaintiffs, as well as appropriate State officials, to give the parties an opportunity to discuss the Special master's tentative findings and conclusions. 28. The Special Master shall file the final repotts with the Court and provide copies to each patty to the lawsuit. Any party to this Agreement may prepare and file with the Comt a response to the Special Master's status report pursuant to FRCP Rule 53(f). A copy of any responsive repotts filed by the patties to this Agreement must be served upon counsel of record for all other parties to this lawsuit on the date of the filing of the responsive repott with the Coutt. 29. The patties acknowledge that a purpose of this Agreement is to avoid further litigation and disputes between the parties. V. Duration of the time period to satisfY the terms of the Agreement and Judgment. 30. The Comt will retain jurisdiction over this lawsuit until 36 months after comt approval of the Settlement Agreement, at which time the Court's jurisdiction will expire. The patties agree that this expiration of jurisdiction shall not be extended, for any reason, beyond the 36-month
Page 18

period following approval of the Settlement Agreement. The parties also agree that no provision of the Settlement Agreement will be enforceable beyond the 36-month period following approval of the Settlement Agreement, and the pmiies will not seek to enforce any provision of the Settlement Agreement beyond the 36-month period following approval of the Settlement Agreement. VI. Nullification of the Agreement. 31. If, for any reason, the Couti does not approve this Agreement and the Stipulated Judgment as a fair, reasonable, and adequate settlement of the Katie A. Litigation as between the Plaintiffs and State Defendants, or if an order approving this Agreement and the entry of the Stipulated Judgment is not upheld on appeal, if any, this Agreement shall be null and void. VII. No Admission of Liability 32. The State Defendants expressly deny each and all of the claims and contentions alleged against it by the Plaintiffs in this action. This Agreement, anything contained herein, and any negotiations or proceedings hereunder shall not be construed as or deemed to be an admission, presumption, evidence of, or concession by State Defendants of the truth of any fact alleged or the validity of any claim which has or could have been asse1ied in this action, or of the deficiency of any defense which has or could have been asserted in this action or of any wrongdoing or liability whatsoever. 33. This Agreement, the fact of its existence, and any term hereof shall not be construed as an admission by State Defendants or used as evidence against State Defendants in any civil, criminal, or administrative action or proceeding except as described below. Any rep01is, recommendations or findings by the Special Master also shall not be construed as an admission by
Page 19

the State Defendants or used as evidence against State Defendants in any civil, criminal, or administrative action or proceeding except as described below. 34. This Agreement, the fact of its existence, and any term hereof shall be admissible in evidence in any proceedings in the instant lawsuit. Any repotis, recommendations or findings by the Special Master also shall be admissible in any proceedings in the instant lawsuit and shall be considered prima facie evidence of the conclusions contained therein. VIII. Dispute Resolution Process 35. Before filing any motion to enforce the terms of this Agreement, counsel for the moving pmiy shall contact counsel for the opposing party to discuss thoroughly, preferably in person, the substance of the contemplated motion and any potential resolution. If the parties mutually consent, they may seek to mediate the dispute with the Special Master or any other mutually acceptable mediator. If the dispute cannot be resolved with the assistance of a mediator, then such motion to enforce shall not be filed until thirty (30) days after the patiies have conferred to discuss the motion unless either patiy is threatened with irreparable harm, in which case the motion can be filed in a shorter period of time. IX. Attorneys' Fees. 36. The State Defendants agree to pay to plaintiffs' counsel a total of $3.75 million as an allinclusive attorneys' fees sum. The patiies agree that this amount is meant to cover all of plaintiffs' claims for past attorneys' fees and costs, any future attorneys' fees and costs during the implementation period and period of couti jurisdiction, and any and all claims by any of plaintiffs' counsel, including but not limited to, claims by or on behalf of, Heller Ehrman and/or its successors.
Page 20

37. The patties agree that starting 1 day after the comt enters its final order approving this settlement following the fairness hearing, interest shall accme at the legal rate of seven percent per annum on any outstanding balance of the amount listed in paragraph 36. X. Other Provisions. 38. The patties agree to use their best effmts to carry out the terms of the Agreement. At no time shall any of the patties or their counsel seek to solicit or otherwise advise Class members to submit objections to the Agreement or to appeal from the order giving final approval to the Agreement and entry of the proposed Stipulated Judgment. 39. This Agreement and the proposed Stipulated Judgment contain all the terms and conditions agreed upon by the parties hereto, and no oral agreement entered into at any time nor any written agreement entered into prior to the execution of this Agreement regarding the subject matter of this proceeding shall be deemed to exist, or to bind the parties hereto, or to vary the terms and conditions contained herein. 40. Both patties to this Agreement have pmticipated in its drafting and, consequently, any ambiguity shall not be construed for or against either party. 41. Each of the undersigned attorneys represents that he or she has been duly authorized to enter into this Agreement. 42. This Agreement may only be amended, modified, or supplemented by an agreement in writing signed by both the State Defendants and the Plaintiffs' counsel and approved by the Comt. 43. The patties recognize and acknowledge that this Agreement and the proposed Stipulated Judgment must be approved by the Court pursuant to paragraph 14 above. The patties agree to cooperate in good faith in the creation of all papers submitted to the Court to secure such
Page 21

approval. In the event. that the Court does not approve this Agreement and the Stipulated

Judgment or the OJ'der approving this Agreement and entry of the Stipulated Judgment is reversed

on appeal, the pm1ies shall make good faith effo11s to modify the Agreement so as to gain judicial

approval.

44. Notice, when due to Plaintiffs or State Defendants, shall be given by delivering' it, in

person or by United States certified first class mail to the parties' counsel of record in this

litigation.

\

45. This Agreement shall inure to the benefit of and be binding upon the legal representatives

and any successor· of Plaintiffs and the State Defendants, including CDMH.

46. This Agreement may be executed in counteJ'P,arts, each of which will be deemed to be an

ol'iginal and all ofwhich taken together shall constitute a single instrument. This Agreement may

be executed by signature via facsimile transmission or electronic mail which shall be deemed the

·same as an original signature.

On behalfof State Defendants,

On Behalf of Plaintiffs,

byk~~£·~gby ~-il~~

Ernest Ma11inez, Deput):t,"ttomey Gener Califomia Department f Justice

Robert D. Newman Westem Center on Law & Poverty

by ' -~~J~

Kimberly Lewis National Health Law Program

by~..,...,.--=--:-------~ Patrick Gardner National Center for Youth Law

Page22
l

approval. In the event that the Court does not approve this Agreement and the Stipulated Judgment or the order approving this Agreement and entry of the Stipulated Judgment is reversed on appeal, the parties shall make good faith efforts to modifY the Agreement so as to gain judicial approval. 44. Notice, when due to Plaintiffs or State Defendants, shall be given by delivering it, in person or by United States certified first class mail to the parties' counsel of record in this litigation. 45. This Agreement shall inure to the benefit of and be binding upon the legal representatives and any successor of Plaintiffs and the State Defendants, including CDMH. 46. This Agreement may be executed in counterparts, each of which will be deemed to be an original and all of which taken together shall constitute a single instrument. This Agreement may be executed by signature via facsimile transmission or electronic mail which shall be deemed the same as an original signature.

On behalf of State Defendants,

On Behalf of Plaintiffs,

by
Ernest Martinez, Deputy Attorney General California Department of Justice

by
Robert D. Newman Western Center on Law & Poverty

by~~~--~------------­
Kimberly Lewis National! th Law Program

a ne National Center for Youth Law

Page 22

()
'i
by
by ~M~e~li~n~da-B~ir~d----------------Disability Rights Califomia
by~~--~-------------­
Mark Rosenbaum ACLU of Southern California

J. '...

-' ' ', • •

' t-

Page 23

by -~-c-----------lra Burnim
by~ Bazelon Center for Mental Health Law Melinda Bird Disability Rights California by
_ _ _ _ _ __ _ ~N~la~rk~R-os_e_n~ba_t_tn_l ACLU ofSouthem Califomia
Page 23

by -c---cc----cc-----------~ Ira Burnim Bazelon Center for lvlcntal Health Law
by~~~~--·----­ Melinda Bird Disability Rights California
byJil\!1f~kJRAoLSeJ~u~U~,b '"--.. ~..._
ACLU of Southern California
P~ge 23

APPENDIX "A"

IN THE UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA
WESTERN DIVISION

KATIE A. etc., et al,

Case No. CV-02-05662 AHM (SHx)

Plaintiffs, [PROPOSED] STIPULATED

JUDGMENT~URSUANTTO

v.

CLASS ACTION SETTLEMENT

AGREEMENT

DIANA BONTA, etc., et al,

[Federal Rules of Civil Procedure, Rule 23, subd. (e)]

Defendants.

Date: Time: Ctiroom:
Judge

, 2011 a.m.
14
Hon. A. Howard Matz

Plaintiffs and Defendants, the Director of the California Depatiment of Health Care Services (CDHCS), the Director of the California Department of Social Services (CDSS), as well as non-patiy (Real Party in Interest) the Director of the California Department of Mental Health (CDMH) (collectively "State Defendants") have entered into a settlement agreement for resolution of this class action matter. Defendant Los Angeles County previously entered into a settlement agreement with plaintiffs which this comi approved and entered judgment pursuant thereto on

Page 24

Plaintiffs and the State Defendants (the Parties) have submitted the proposed

Settlement Agreement to the Court for final approval pursuant to, and in

compliance with Federal Rules of Civil Procedure, Rule 23, subdivision (e).

The Court found that the Parties gave notice of the proposed Settlement

Agreement to the Plaintiff class and others thereby affected in a reasonable manner.

Fed. R. Civ. P. 23(e)(l). On

, 2011, the Court conducted a

fairness hearing pursuant to Fed.R. Civ. P. 23(e)(2), affording the parties and all

other interested persons the opp01iunity to be heard in supp01i of and in opposition

to the proposed settlement agreement. After reviewing and considering the papers

filed in support of the settlement agreement, the evidence, argument, comments and

objections submitted at the fairness hearing, the Comi has made a finding that the

settlement agreement is fair, reasonable and adequate to bind class members.

The Comi having fully considered the matter and good cause appearing ,

hereby ORDERS, ADJUDGES AND DECREES as follows:

1. The Court has jurisdiction over the claims for injunctive and declaratory

relief against State Defendants pursuant to 28 U.S.C. §§ 1331, 1343 and 1367.

Venue is proper in the Central District of California pursuant to 28 U.S.C. §

1391(b).

2. This case has been certified as a class action for purposes of all claims

against State Defendants on behalf of a class of children in California who:

(a) Are in foster care or are at imminent risk of foster care placement,

and

(b) Have a mental illness or condition that has been documented or, had

an assessment already been conducted, would have been documented, and

Page 25

(c) Who need individualized mental health services, including but not limited to professionally acceptable assessments, behavioral supp01i and case management services, family supp01i, crisis supp01i, therapeutic foster care, and other medically necessary services in the home or in a home-like setting, to treat or ameliorate their illness or condition."
For the purposes of this case, "imminent risk of foster care placement" means that within the last 180 days a child has been participating in voluntary family maintenance services or voluntary family reunification placements and/or has been the subject of either a telephone call to the Child Protective Services hotline or some other documented communication made to a local Child Protective Services agency regarding suspicions of abuse, neglect or abandonment.
3. Judgment is entered pursuant to the terms of the Settlement Agreement incorporated herein, as though fully set forth, and attached as Exhibit A to this Judgment.
4. The Couti orders the patties to the Settlement Agreement to perform all oftheir obligations thereunder.
5. The Couti will retain jurisdiction over this lawsuit until36 months after court approval of the Settlement Agreement, at which time the Couti's jurisdiction will expire. Pursuant to Paragraph 30 of the Settlement Agreement, this expiration ofjurisdiction shall not be extended, for any reason, beyond the 36-month period following approval of the Settlement Agreement.
6. Pursuant to Paragraph 15 ofthe Settlement Agreement, the Settlement Agreement settles all claims against the State Defendants in this lawsuit.
Page 26

7. The Court finds that no just reason exists for delay in entering this Judgment pursuant to the Settlement Agreement. Accordingly, the Clerk is hereby directed to enter his Final Judgment.
8. This Judgment is binding against State Defendants, their successors in office, CDHCS, CDSS, CDMH2, the respective officers, agents and employees of these state agencies.
9. The Court will subsequently dismiss this lawsuit against the State Defendants in accordance with the terms ofthe Settlement Agreement.

Dated _ _ _ _, 2011

A. Howard Matz United States District Judge

2 2 Because of the possible restructuring of CDMH, at this time it is uncertain as to whether CDMH will be the State agency responsible for performing the obligations assigned to CDMH pursuant to this Agreement. State Defendants agree that the State will perform CD~viH's obligations under this Agreement.
Page 27

APPENDIX "B"
Core Practice Model
The Core Practice Model, which would be utilized by all agencies or individuals who serve class members and their families, adheres to a prescribed set of family centered values and principles that are driven by a definable process. The Core Practice Model values and principles are summarized as follows:
• Services are needs-driven, strengths-based, and family-focused from the first conversation with or about the family.
• Services are individualized and tailored to the strengths and needs of each child and family.
• Services are delivered through a multi-agency collaborative approach that is grounded in a strong community base.
• Family voice, choice, and preference are assured throughout the process. • Services incorporate a blend of formal and infmmal resources designed to assist families
with successful transitions that ensure long-term success. • Services are culturally competent and respectful of the culture of the children and their
families. • Services and supports are provided in the child and family's community. • Children are first and foremost protected from abuse and neglect and maintained safely in
their own homes. • Children have permanency and stability in their living situations.
In order to benefit from the full array of services they need, at whatever level appropriate and necessary to meet their needs, class members will be best served through five key practice components that are organized and delivered in the context of an overall child and family plan. These five components include the following:
• Engagement: Engaging families is the foundation to building trusting and mutually
beneficial relationships between family members, team members, and service providers. Agencies involved with the child and family work to reach agreement about services, safety, well-being (meeting attachment and other developmental needs, health, education, and mental health), and permanency.
• Assessing: Information gathering and assessing needs is the practice of gathering and
evaluating information about the child and family, which includes gathering and assessing strengths as well as assessing the underlying needs. Assessing also includes determining the capability, willingness, and availability of resources for achieving safety, permanence, and well-being of children.
• Service Planning and Implementation: Service planning is the practice of tailoring
suppotts and services unique to each child and family to address unmet needs. The plan specifies the goals, roles, strategies, resources, and timeframes for coordinated implementation of suppotts and services for the child, family, and caregivers.
Page 28

• Monitoring and Adapting; Monitoring and adapting is the practice of evaluating the effectiveness of the plan, assessing circumstances and resources, and reworking the plan as needed. The team is responsible for reassessing the needs, applying knowledge gained through ongoing assessments, and adapting the plan in a timely manner.
• Transition: The successful transition away from formal supports can occur when informal supports are in place and providing the support and activities needed to ensure long-term stability.
Child and Family Team: The Work Group has also reached consensus that a subset of Katie A class members need a more intensive approach and service delivery to address their array of needs and strengths, and that this subset would best be served through a formally organized Child and Family Team. In those instances where intensive or complex needs are identified, a formal Child and Family Team would be created to serve as the primary vehicle delivering services in accord with the Core Practice Model in order to bring significant individual team members together to help the family develop a plan of care that addresses their needs and strengths. The principle role of the Child and Family team would be as follows:
• The Child and Family Team (CFT) assembles as a group of caring individuals to work with and suppmt the child and family and, in addition to the various agency and provider staff involved in service delivery to the family, includes at a minimum a facilitator and a family support partner or family specialist for youth.
• Team facilitation can be done by a mental health provider, social worker, or probation officer. The facilitator maintains a committed team and is qualified with the necessary skills to bring resources to the table in suppo1t of the child and family.
• An effective CFT continues the process of engagement with the family and or caregivers about their strengths and needs, ensures services are well coordinated, and provides a process for transparent communication.
Page 29

APPENDIX "C"
The Child And Family Team Child and Family Team: The Work Group has also reached consensus that a subset of Katie A class members need a more intensive approach and service delivery to address their array of needs and strengths, and that this subset would best be served through a formally organized Child and Family Team, In those instances where intensive or complex needs are identified, a formal Child and Family Team would be created to serve as the primary vehicle delivering services in accord with the Core Practice Model in order to bring significant individual team members together to help the family develop a plan of care that addresses their needs and strengths. The principle role of the Child and Family team would be as follows:
• The Child and Family Team (CFT) assembles as a group of caring individuals to work with and support the child and family and, in addition to the various agency and provider staff involved in service delivery to the family, includes at a minimum a facilitator and a family suppmt pattner or family specialist for youth.
• Team facilitation can be done by a mental health provider, social worker, or probation officer. The facilitator maintains a committed team and is qualified with the necessary skills to bring resources to the table in suppmt of the child and family.
• An effective CFT continues the process of engagement with the family and or caregivers about their strengths and needs, ensures services are well coordinated, and provides a process for transparent communication.
Page 30

APPENDIX "D"
Intensive Home-Based Mental Health Services
Intensive Home-Based Services (IHBS) are individualized, strength-based interventions designed to ameliorate mental health conditions that interfere with a child's functioning. Interventions are aimed at helping the child build skills necessary for successful functioning in the home and community and improving the child's family's ability to help the youth successfully function in the home and community. IHBS are delivered according to an individualized treatment plan developed by a care planning team (see Intensive Care Coordination). The care planning team develops goals and objectives for all life domains in which the child's mental health condition produces impaired functioning, including family life, community life, education, vocation, and independent living, and identifies the specific interventions that will be implemented to meet those goals and objectives. The goals and objectives should seek to maximize the child's ability to live and patticipate in the community and to function independently, including through building social, communication, behavioral, and basic living skills. Providers of intensive home-based services should engage the child in community activities where the child has an oppottunity to work towards identified goals and objectives in a natural setting. Phone contact and consultation may be provided as patt of the service. IHBS includes, but is not limited to:
• Educating the child's family about, and training the family in managing, the child's disorder;
• Medically necessary skill-based remediation of behaviors, including developing and implementing a behavioral plan with positive behavioral supports and modeling for the child's family and others how to implement behavioral strategies;
• Improving self-care, including by addressing behaviors and social skills deficits that interfere with daily living tasks and with avoiding exploitation by others;
• Improving self-management of symptoms, including assisting with self-administration of medications;
• Improving social decorum, including by addressing social skills deficits and anger management;
• Suppotting the development and maintenance of social suppott networks and the use of community resources;
• Suppotting employment objectives, by identifying and addressing behaviors that interfere with seeking and maintaining a job;
• Suppmting educational objectives, through identifying and addressing behaviors that interfere with succeeding in an academic program in the community; and
• Suppotting independent living objectives, by identifying and addressing behaviors that interfere with seeking and maintaining housing and living independently.
IHBS are highly effective in preventing a child being removed from home (biological, foster, or adoptive) through admission to an inpatient hospital, residential treatment facility or other residential treatment setting.
Page 31

Settings: IHBS may be provided in any setting where the child is naturally located, including the
home (biological, foster or adoptive), schools, recreational settings, child care centers, and other
community settings. Availability: IBHS are available wherever and whenever needed, including in evenings and on weekends. Providers: IHBS are typically provided by paraprofessionals under
clinical supervision. Peers, including parent partners, may provide IHBS. More complex cases may require service delivery by a clinician rather than a paraprofessional.
Page 32

APPENDIX "E"
Intensive Care Coordination
Intensive Care Coordination (ICC) is a service that is responsible for facilitating assessment, care platming and coordination of services, including urgent services [for children! youth who meet the
Katie A. class criteria].
Intensive Care Coordination (ICC) provides: • A single point of accountability for ensuring that medically necessary services are accessed, coordinated, and delivered in a strength-based, individualized, family/youthdriven, and culturally, and linguistically relevant manner; • Services and supports that are guided by the needs of the youth; • Facilitation of a collaborative relationship among a youth, his/her family and involved child-serving systems; • Support the parent/caregiver in meeting their youth's needs; • A care planning process ensures that a care coordinator organizes and matches care across providers and child serving systems to allow the youth to be served in their home community; and • Facilitated development of the Child and Family Planning Team (CFT).3
ICC service components consists of"
Assessment: The CFT completes a strength-based, needs driven, comprehensive assessment to organize and guide the development of an Individual Care Plan (ICP) and a risk management/safety plan. The assessment process determines the needs of the youth for any medical, educational, social, mental health, or other services. ICC may also include the platming and coordination of urgent needs before the comprehensive assessment is completed. The initial assessment will be reviewed as necessary, but at least every 90 days. Planning: Development of an Individual Care Plan: Using the information collected through an assessment, the care coordinator convenes and facilitates the CFT meetings and the CFT develops a child- and family-centered Individual Care Plan (ICP) that specifies the goals and actions to address the medical, educational, social, mental health, or other services needed by the youth and family. The care coordinator works directly with the youth, the family and others significant to the child to identify strengths imd needs of the youth and family, and to develop a plan for meeting those needs and goals. Referral, monitoring and related activities:
• works directly with the youth and family to implement elements of the ICP; • prepares, monitors, and modifies the ICP in conceit with the CFT; to determine whether
services are being provided in accordance with the ICP; whether services in the ICP are adequate; and whether these are changes in the needs or status of the youth and if so, adjusting the plan of care as necessary, in concert with the CFT;
3 The CFT includes, as appropriate, both formal supports, such as the care coordinator, providers, case managers from child~serving agencies, and natural supports, such as family members, neighbors, friends, and clergy.
Page 33

• will identity, actively assist the youth and family to obtain and monitor the delivery of available services including medical, educational, mental health, social, therapeutic, or other services.
Transition: • develops with the CFT a transition plan when the youth has achieved goals of the ICP; and • collaborates with the other service providers and agencies on the behalf of the youth and family.
Settings ICC may be provided to children living and receiving services in the community (including in TFC) as well as to children who are currently in a hospital, group home, or other congregate or institutional placement as part of discharge planning.
Page 34

 </s> JUL-26-2006 16:27 From:US COURT OF APPEALS

To:2134278767

UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT

FI-LED
JUL 26 2006
~HY ~ G~TTERSOh,CLERK
U.S. COURT OF APPEALS

KATIE A., by & through her next friend
Michael Ludin; et a1.,
Plaintiffs - Appellees,
v.

No. 06-55559
D.C. No. CV-02-05662..AHM Central District of Califomia, Los Angeles

LOS ANGELES COUNTY; et al.~

ORDER

Defendants,

and

RITA SAENZ, Director ofCA Dept of
Social Services; et al.,

Defendants - Appellants.

Before: B. FLETCHER and THOMAS, Circuit Judges.
Tb... J.s l·.S a pre.r1m·mary m· J·unctm· n appea1.
Appellants' motion for a stay pending appeal of the Horder granting plaintiffs' motion for preliminary injunction, and addendum thereto, and a]] subsequent orders affecting defendants- appellants" is denied.
The previously established briefing schedule remains in effect. The
provisions ofNinth Circuit Rule 31-2.2(a) shalJ not apply to this appeal. Any motions to extend time to file the brief:.;; will be strongly disfavored.

JUL-26-2006 16:28 From:US COURT OF APPEALS

To:2134278767

06-55559
The court sua sponte expedites the hearing of this preliminary injunction appeal.
The Clerk shall calendar this appeal during the month of October 2006 in
Pasadena, California.

S:\MOA1"1'\f'anelord\7.06\dt\06·55559.VII"Pd

2

 </s> CASE NO.: 06-55559 _______________________________
IN THE UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
KATIE A., by and through her next friend Michael Ludin; MARY B., by and through her next friend Robert Jacobs; JANET C., by and through her next friend Dolores Johnson; HENRY D., by and through his next friend Gillian Brown; AND
GARY E., by and through his next friend Michael Ludin, individually and on behalf of all others similarly situated,
Plaintiffs-Appellees,
v.
DIANA BONTÁ, Director of California Department of Health Services; LOS ANGELES COUNTY; LOS ANGELES COUNTY DEPARTMENT OF
CHILDREN AND FAMILY SERVICES; ANITA BOCK, Director of the Los Angeles County Department of Children and Family Services; RITA SAENZ, Director of the California Department of Social Services, and Does 1 through 100,
inclusive,
Defendants-Appellants. _____________________________________
APPELLEES’ BRIEF _____________________________________
APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA U.S.D.C. No. CV-02-05662-AHM THE HONORABLE A. HOWARD MATZ
ROBERT D. NEWMAN, ESQ. KIMBERLY LEWIS, ESQ. Western Center for Law and Poverty 3701 Wilshire Boulevard, #208 Los Angeles, CA 90010-2809 (213) 487-7211 Attorneys for Plaintiffs-Appellees Additional counsel listed on inside cover

MARK D. ROSENBAUM, ESQ. American Civil Liberties Union of Southern California 1616 Beverly Boulevard Los Angeles, CA 90026-5752 (213) 977-9500 (213) 4278767 – Fax
RON PETERSON, ESQ. Heller Ehrman LLP 333 South Hope Street Suite 3900 Los Angeles, CA 90071-3043 (213) 689-0200 (213) 614-1868
MELINDA BIRD, ESQ. MARILYN HOLLE, ESQ. Protection & Advocacy, Inc. 3580 Wilshire Boulevard, #902 Los Angeles, CA 90010 (213) 427-8747 (213) 427-8767

IRA BURNIM, ESQ. ALISON BARKOFF, ESQ. Bazelon Center for Mental Health Law 1101 Fifteenth Street, NW, #1212 Washington, D.C. 20006 (202) 467-5730 (202) 223-0409
JOHN F. O’TOOLE, ESQ. PATRICK GARDNER, ESQ. LEECIA WELCH, ESQ. National Center for Youth Law 405 14th Street, 15th Floor Oakland, CA 94612-2701 (510) 835-8098 (510) 835-8099 - Fax

2

TABLE OF CONTENTS

Page

INTRODUCTION AND SUMMARY OF ARGUMENT ........................................1
STATEMENT OF JURISDICTION..........................................................................5
STATEMENT OF ISSUES .......................................................................................5
STATEMENT OF THE CASE..................................................................................6
STATEMENT OF FACTS ........................................................................................8
A. The Majority of Foster Children Have Significant Mental Health Needs. ............................................................................8
B. The Medi-Cal Program Has Failed to Meet the Mental Health Needs of Many Foster Children. ...............................................9
C. Through Wraparound, Foster Children Can Avoid Group Homes and Multiple Placements. ............................................14
D. Fewer Than Half of California’s Counties Even Offer Wraparound, and Even These Fail To Serve All Those In Need. ...............................................................................................17
E. Medi-Cal Policies Significantly Limit Access to Wraparound. ........................................................................................19
F. TFC Is Another Medically Necessary Mental Health Service for Many Foster Children.......................................................22
G. TFC Is Not Available on a Consistent Statewide Basis When Children Need It. ......................................................................24
STANDARD OF APPELLATE REVIEW..............................................................25
ARGUMENT ...........................................................................................................27
I. THE DISTRICT COURT APPLIED THE CORRECT STANDARDS FOR GRANTING A MANDATORY PRELIMINARY INJUNCTION. ..................................................................27
II. THE DISTRICT COURT’S FINDINGS OF FACT AND CONCLUSIONS OF LAW WERE SUFFICIENTLY COMPREHENSIVE TO PROVIDE A BASIS FOR ITS DECISION.....................................................................................................28

- i -

TABLE OF CONTENTS (CONTINUED)

Page

A. The Preliminary Injunction Should Be Affirmed Unless it is Not Possible for this Court to Have a Full Understanding of the Relevant Issues Without Additional Findings by the District Court...........................................28
B. The District Court Made the Necessary Findings that Members of the Plaintiff Class Are Entitled to Receive Wraparound Services and TFC under the EPSDT Statutes. ...............................................................................................29
C. The District Court Correctly Found that Plaintiffs Have a Strong Likelihood of Success on Their EPSDT Claims..................................................................................................33
D. For the Other Factors Governing a Mandatory Preliminary Injunction, the District Court Made All the Requisite Findings or Alternatively the Findings Are Sufficiently Comprehensive and There Is No Genuine Dispute about the Omitted Findings. ..................................................37
III. NONE OF THE FINDINGS OF FACT BY THE COURT BELOW ARE CLEARLY ERRONEOUS. ..................................................44
IV. THE DISTRICT COURT CORRECTLY APPLIED THE LAW IN GRANTING THE PRELIMINARY INJUNCTION................................................................................................51
V. THE ORDER GRANTING THE PRELIMINARY INJUNCTION MOTION COMPLIES WITH RULE 65. ............................56
VI. DEFENDANTS’ MISCELLANEOUS OBJECTIONS TO THE PROCEEDINGS BELOW ARE DEVOID OF MERIT. .....................57
CONCLUSION ........................................................................................................59
STATEMENT OF RELATED CASES ...................................................................60
REQUEST FOR ORAL ARGUMENT ...................................................................61
CERTIFICATE OF COMPLIANCE.......................................................................62

- ii -

TABLE OF AUTHORITIES
Page
CASES
Acosta-Huerta v. Estelle, 7 F.3d 139 (9th Cir. 1992)....................................................................................59
Alexander v. Choate, 469 U.S. 287 (1985) .............................................................................................53
Anderson v. United States, 612 F.2d 1112 (9th Cir. 1979) .............................................................................27
Beltran v. Meyers, 677 F.2d 1317 (9th Cir. 1982) .............................................................................38
Class Plaintiffs v. City of Seattle, 955 F.2d 1268 (9th Cir. 1992) .............................................................................52
Cupolo v. Bay Area Rapid Transit, 5 F.Supp. 2d 1078 (N.D. Cal. 1997) ....................................................................27
D.A.R.E. America v. Rolling Stone Magazine, 270 F.3d 793 (9th Cir. 2001)................................................................................59
Dahl v. HEM Pharm. Corp., 7 F.3d 1399 (9th Cir. 1993)..................................................................................27
Demery v. Arpaio, 378 F.3d 1020 (9th Cir. 2004) .............................................................................26
Earth Island Inst. v. U.S. Forest Serv., 442 F.3d 1147 (9th Cir. 2006) .............................................................................26
Emily Q. v. Bontá, 208 F. Supp. 2d 1078 (C.D. Cal. 2001) ............................................ 10, 13, 52, 53
Federal Trade Comm’n v. Enforma Natural Prods., Inc., 362 F.3d 1204 (9th Cir. 2004) .............................................................................29
Firebaugh Canal Co. v. U.S., 203 F.3d 568 (9th Cir. 2000)................................................................................28
Gregorio T. v. Wilson, 59 F.3d 1002 (9th Cir. 1995)................................................................................26
- iii -

TABLE OF AUTHORITIES (CONTINUED)

Page

Harris v. Board of Supervisors, Los Angeles County, 366 F.3d 754 (9th Cir. 2004)................................................................................26
Heckler v. Lopez, 463 U.S. 1328 (1983) ...........................................................................................43
Husan v. Olympic Airways, 316 F.3d 829 (9th Cir. 2002)................................................................................45
Lewis v. Casey, 518 U.S. 343 (1996) .............................................................................................27
LGS Architects, Inc. v. Concordia Homes of Nevada, 434 F3d 1150 (9th Cir. 2006)..............................................................................33
Lopez v. Heckler, 713 F.2d 1432 (9th Cir. 1983) ...................................................................... 43, 44
McMillan v. McCrimon, 807 F. Supp. 475 (C.D. Ill. 1992) ........................................................................38
Memorial Hosp. v. Maricopa County, 415 U.S. 250 (1974) .............................................................................................38
Patsy v. Board of Regents of State of Fla., 457 U.S. 496 (1982) .............................................................................................39
Pinneke v. Preisser, 623 F.2d 546 (8th Cir. 1980)................................................................................35
Regal Knitwear Co. v. NLRB, 324 U.S. 9 (1945) .................................................................................................52
Rizzo v. Goode, 423 U.S. 362 (1975) .............................................................................................27
Rodde v. Bontá, 357 F.3d 988 (9th Cir. 2004)................................................................... 37, 38, 43
Rosen v. Siegel, 106 F.3d 28 (2nd Cir. 1997).................................................................................33
Rosie D v. Swift, 310 F.3d 230 (1st Cir. 2002) ................................................................................30

- iv -

TABLE OF AUTHORITIES (CONTINUED)

Page

San Lazaro Ass’n, Inc. v. Connell, 286 F.3d 1088 (9th Cir. 2002) .............................................................................10
S.D. ex rel Dickson v. Hood, 391 F.3d 581 (5th Cir. 2004)................................................................................54
Southwest Voter Registration Educ. Project v. Shelley, 344 F.3d 914 (9th Cir. 2003)................................................................................25
Spradlin v. Lear Siegler Management Services Co., Inc., 926 F.2d 865 (9th Cir. 1991)................................................................................58
Townsend v. Quasim, 328 F.3d 511 (9th Cir. 2003)................................................................................53
United Food & Commercial Workers Union, Local 1099 v. Southwest Ohio Regional Transit Authority, 163 F.3d 341 (6th Cir. 1998)......................................................................... 27, 28
Vance v. American Hawaii Cruises, Inc., 789 F.2d 790 (9th Cir. 1986)................................................................................29
Walczak v. EPL Prolong, Inc., 198 F.3d 725 (9th Cir. 1999)......................................................................... 25, 26
Weaver v. Reagen, 886 F.2d 194 (8th Cir. 1989)................................................................................35
Wilder v. Virginia Hosp. Ass’n, 496 U.S. 498 (1990) .............................................................................................30
Wyandotte Nation v. Sebelius, 443 F.3d 1247 (10th Cir. 2006) ...........................................................................27
STATUTES
29 U.S.C. §794.........................................................................................................53
29 U.S.C. §12132.....................................................................................................53
42 U.S.C. §1396.........................................................................................................9
42 U.S.C. §1396a(a).................................................................................................55
42 U.S.C. §1396a(a)(10)(A)(i).................................................................................53

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TABLE OF AUTHORITIES (CONTINUED)

Page

42 U.S.C. §1396a(a)(10)(A)(i)(I)...............................................................................9 42 U.S.C. §1396a(A)(10)(A)(i)(II) ............................................................................9 42 U.S.C. §1396a(A)(10)(A)(ii) ................................................................................9 42 U.S.C. §1396a(a)(10)(A)(i)(III)..........................................................................55 42 U.S.C. §1396d(a) ........................................................................................ passim 42 U.S.C. §1396d(a)(1)............................................................................................49 42 U.S.C. §1396d(a)(1)-(27)....................................................................................48 42 U.S.C. §1396d(a)(4)(B) ......................................................................................55 42 U.S.C. §1396d(a)(11)..........................................................................................49 42 U.S.C. §1396d(a)(13)..........................................................................................33 42 U.S.C. §1396d(a)(19)............................................................................. 33, 34, 54 42 U.S.C. §1396d(a)(24)..........................................................................................33 42 U.S.C. §1396d(r).......................................................................................... 31, 56 42 U.S.C. §1396d(r)(1)(A)(ii)..................................................................................30 42 U.S.C. §1396d(r)(5) ............................................................................... 30, 31, 53 42 U.S.C. §1396n(g)(2) .................................................................................... 34, 54 42 U.S.C. §1396n(g)(4)(A)......................................................................................54 Senate Bill No. 163,
Stats. 1997, Ch. 795, §§1-10..................................................................................3 Welfare and Institutions Code §18250 ....................................................................48 Welfare & Institutions Code §18358.15(a)(1)-(5)...................................................24 RULES Fed.R.Civ.P. 52(a)......................................................................................... 4, 28, 32 Fed.R.Civ.P. 65 ..........................................................................................................5

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TABLE OF AUTHORITIES (CONTINUED)

Page

Fed.R.Civ.P. 65(d) ...................................................................................... 52, 56, 57
Fed.R.Civ.P. 78 ........................................................................................................58 REGULATIONS
42 C.F.R. §440.130(d) .............................................................................................34 OTHER AUTHORITIES
State Medicaid Manual, §5110 (April 1990)...............................................................................................34
Webster’s Ninth New Collegiate Dictionary (Merriam Webster 1991)................................................................................48, 49

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INTRODUCTION AND SUMMARY OF ARGUMENT The district court granted a preliminary injunction in this case because thousands of foster children in California are not provided necessary mental health services and thus are needlessly placed in locked hospital wards, other institutional facilities or large group homes. Yet many of these children could remain in their own homes and communities if only they received two mental health services they are entitled to receive under the Early and Periodic Screening, Diagnosis and Treatment (“EPSDT”) provisions of the Medicaid Act. Wraparound services and therapeutic foster care (“TFC”) are “among the most effective integrated community-based interventions for children with emotional, behavioral, and mental health disorders.” Bruns Declaration (“Decl.”), Excerpts of Record (“ER”) 6207, ¶3. Indeed, California’s leading mental health research institute has identified wraparound services and TFC as the “[o]nly two intervention models [that] have demonstrated effectiveness in the treatment of foster children.”1 Defendants – Directors of the California Department of Health Services and Department of Social Services – have appealed the preliminary injunction which requires California to provide wraparound services and TFC to eligible foster children. Appellants’ Opening Brief (“AOB”) distinguishes itself for what it does 1 California Institute for Mental Health, Evidence-Based Practices in Mental Health Services for Foster Youth (March 2002) (“CIMH Report”), ER 4813, 481820.
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not say. Defendants make no claim to be meeting the mental health needs of most, some or even a few foster children in California. Forgotten by Defendants are the tens of thousands of abused and neglected children within governmental custody, children such as “Charlie,” an emotionally disturbed eight-year old subjected to prenatal drug exposure and early parental abuse. Lowe Decl., ER 6809. A courtappointed expert had recommended wraparound services and TFC for Charlie so that this boy could eventually be placed with his loving and committed grandmother. Id., ER 6811-12, ¶¶3-5. However, because wraparound services and TFC were not available in his county, Charlie only deteriorated in foster care, “bounc[ing] from placement to placement for the next four years,” each more restrictive and costly, only to end up in Metropolitan State Hospital, which even State officials describe as the “end of the line.” Id., ER 6089-90, ¶¶8-11; Barthels Deposition (“Depo.”), ER 8492.
Defendants do not contest most of the material facts which justify issuance of the preliminary injunction. They do not, for example, dispute that: the majority of foster children in California have unmet mental health needs; thousands of foster children are placed in group homes; and the treatment of foster children in group homes is both ineffective and expensive. There also is little, if any, dispute that:
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● wraparound services and TFC are medically necessary for many foster children with mental health needs, ● wraparound services and TFC prevent the unnecessary institutionalization of these children and youth; and ● both these mental health services are cost effective. Whereas several other states’ Medicaid programs cover wraparound services and TFC for children and youth under the age of 21, California’s Medicaid program (known as Medi-Cal) does not. Why not? In the face of all these undisputed facts, Defendants profess ignorance of what Plaintiffs and Appellees (“Plaintiffs”) mean by wraparound services even though the California Legislature adopted a law in 1997 to encourage counties to provide wraparound services to children at risk of placement in high-level group homes. Senate Bill No. 163, Stats. 1997, Ch. 795, §§1-10. Defendants similarly claim they don’t know what TFC is even though 19 other state Medicaid programs provide TFC. Order Granting Plaintiffs’ Motion for Preliminary Injunction (“Order”), ER 14684. In one breath, Defendants argue that Medicaid does not cover most components of wraparound services and TFC, but in the next breath they argue that many of these components are already covered by Medi-Cal. Defendants show little respect for the district court (Honorable A. Howard Matz), describing the Order as “rambling and disjointed,” “replete with platitudes
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and significant inaccuracies and omissions.” AOB 37. Contrary to Defendants’ unfounded beliefs, the court below applied the proper standards for granting a mandatory preliminary injunction. Meanwhile, Defendants are unable to demonstrate that any of the lower court’s findings of fact was clearly erroneous or that the court applied any erroneous legal standards.
Defendants’ principal argument in this appeal is procedural: the Order does not comply in every respect with the requirements of Rule 52(a). The Order contains all the mandatory findings of fact and conclusions of law that Medicaideligible members of the Plaintiff class are entitled to receive wraparound services and TFC from the Medi-Cal program pursuant to the EPSDT provisions. The district court also made the requisite findings that these children with intense mental health needs would suffer irreparable harm from the continuing denial of the two medically necessary services and that the balance of hardships sharply favors the Plaintiffs. Even assuming arguendo that the Order does not fully comply with Rule 52(a), the findings of fact and conclusions of law are sufficiently comprehensive to provide a basis for the district court’s decision and there are no genuine disputes about the omitted findings.
The facts and law clearly favor Plaintiffs on their Medicaid claim. To prevent the illegal and unnecessary suffering of thousands of foster children, the district court granted a mandatory preliminary injunction. The lower court did not
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abuse its discretion. This Court should affirm the preliminary injunction in all respects.
STATEMENT OF JURISDICTION Plaintiffs agree with Defendants’ Statement of Jurisdiction.
STATEMENT OF ISSUES 1. Did the district court apply the correct standards for issuing a mandatory preliminary injunction? 2. Did the order granting the preliminary injunction contain the requisite findings of fact and conclusions of law, or at the very least, are the findings of fact and conclusions of law sufficiently comprehensive to provide a basis for the district court’s decision and are there any genuine disputes about the omitted findings? 3. Are the challenged findings of fact by the district court clearly erroneous? 4. Did the district court apply erroneous legal standards in granting the preliminary injunction motion? 5. Is the preliminary injunction sufficiently specific to comply with the requirements of Rule 65?
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STATEMENT OF THE CASE As Defendants have devoted nearly half their brief to the procedural history of this lawsuit [AOB 6-30], Plaintiffs will only amplify on a few matters. Plaintiffs “are five troubled children with unmet mental health needs.” Order, ER 14670. When this lawsuit was filed, Plaintiff Katie A. had been in foster care since she was age four and had been subjected to 37-out-of-home placements during the preceding ten years. Complaint, ER 5-6. Another Plaintiff, Mary B., was a 16year-old, legally blind girl who had been in 28 placements during her three years in foster care. Id., ER 6-7. Besides Defendants, the other defendants were Los Angeles County, its Department of Children and Family Services (“DCFS”), and Anita Bock, then DCFS’ Director (“County Defendants”). Complaint, ER 10. Plaintiffs subsequently reached a settlement with the County Defendants and, following a fairness hearing on July 16, 2003, the district court approved the proposed settlement on behalf of a Countywide subclass. ER 221-247, 854-859. Meanwhile, the district court granted Plaintiffs’ motion for class certification on behalf of “[c]hildren in California who (a) are in foster care or are at imminent risk of foster care placement; and (b) have a mental illness or condition that has been documented or, had an assessment already been conducted, would have been documented; and (c) who need individualized mental health services. . . .” Order
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re Class Certification, ER 511-532. The district court specified what was meant by “imminent risk of foster care placement” in the class definition. Id., ER 532. Defendants appealed the class certification order, and this Court denied the appeal on July 24, 2003.
Plaintiffs filed their preliminary injunction motion on September 9, 2005. ER 4443-4445. Although Defendants mostly discuss the declaration of Chris Koyanagi [AOB 16-17], Plaintiffs filed 37 declarations, 43 exhibits and excerpts from 8 depositions in support of their motion. ER 4486-7304.
The district court did not rule on the preliminary injunction motion at the October 31 hearing. ER 13499. During the hearing, counsel for Defendants said that the “real issue here is whether wraparound and therapeutic foster care [are] Medicaid covered services.” ER 13518. At the hearing’s conclusion, the trial court said that “I will just take the matter under submission.” ER 13519. The accompanying minute order likewise said that the motion was “under submission.” ER 13418. The district court did, however, invite the parties to submit a document, not more than three pages in length, “identifying the most important exhibits, declarations and depositions upon which they rely.” Id. Both sides filed such submissions on November 7, 2005. ER 13419-25, 13480-83.
Four months later, the district court granted the preliminary injunction motion. Order, ER 14670-90. The Order gave Defendants 120 days to provide
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wraparound services and TFC to class members on a consistent, statewide basis through the Medi-Cal program or other means. Id., 14689-90.
Defendants thereafter filed motions for reconsideration, correction and/or
clarification and for stay of the Order pending a hearing on the other two motions.
ER 14726-14760. The district court denied all three motions [ER 15004-05], but
issued an Addendum to its Order addressing the twelve questions for which
Defendants had sought correction and/or clarification. ER 15311-40. STATEMENT OF FACTS
A. The Majority of Foster Children Have Significant Mental Health Needs.
As of July 1, 2004, 85,268 children were in child welfare-supervised foster care in California.2 California’s Little Hoover Commission, a “watchdog” agency
created by the state legislature, has stated that nearly 70% of California foster children will experience a mental health problem.3 The California Health and
Human Services (“CHHS”) Agency has given even higher estimates, citing one
study which found that 84% of a sample of 213 foster children had developmental, emotional, and/or behavioral problems.4
2 B. Needell, et al., 1998-2004 July 1 Caseload Children in Child Welfare Supervised Foster Care by Placement Type in California, ER 4888-4889. 3 Young Hearts & Minds: Making a Commitment to Children’s Mental Health (October 2001) (hereafter “Young Hearts”), ER 4624. 4 CHHS Foster Care Slide Presentation, ER 5463-64. See also Code Blue: Health Services for Children in Foster Care (March 1998), ER 4944 (50 to 60% of foster
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The California Institute for Mental Health (“CIMH”) has summarized the
reasons why foster children are at risk: first, their entry into the child welfare
system resulted from a family breakdown due to abuse, neglect, or both; second,
the children suffer disruptions in their relationships when they are separated from
family, friends and teachers to enter foster care; third, children who suffer the
chronic stresses of living in poverty are over-represented in the child welfare
system; and fourth, the “foster care experience itself may actually exacerbate
emotional and behavioral problems” since multiple placements are common and the length of placement is often indeterminate.5
B. The Medi-Cal Program Has Failed to Meet the Mental Health Needs of Many Foster Children.
Nearly all foster children are eligible to receive medical services, including mental health services, from Medi-Cal.6 Order, ER 14671. Medicaid is a joint
federal and state program designed to provide medical and remedial services to low-income people. 42 U.S.C §1396 et seq.7 The Department of Health Services
(“DHS”) is the single state agency responsible for supervising the administration
children in California have “moderate to severe mental health problems”). 5 CIMH Report, ER 4826. 6 Foster children are automatically eligible for Medicaid if they receive Title IV-E foster care assistance. 42 U.S.C. §1396a(a)(10)(A)(i)(I). Other foster care children can still qualify for Medicaid through one of the other mandatory eligibility categories, such as receiving supplemental security income [id., §1396a(A)(10)(A)(i)(II)], or one of the optional categories, such as being “medically needy” [id., §1396a(A)(10)(A)(ii)]. 7 Hereafter, all statutory references are to Title 42 unless indicated otherwise.
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and operation of Medi-Cal. San Lazaro Ass’n, Inc. v. Connell, 286 F.3d 1088, 1091 (9th Cir. 2002). DHS has, however, entered into an interagency contract so that the Department of Mental Health (“DMH”) supervises the administration of mental health services to Medi-Cal recipients and other indigent persons. Emily Q. v. Bontá, 208 F. Supp. 2d 1078, 1089 (C.D. Cal. 2001). On a county level, the Mental Health Plans are responsible for providing mental health services to MediCal recipients. Id.
In past years California has ranked last among the 50 states on average Medicaid expenditures on foster children.8 The Little Hoover Commission has warned that “[m]ore than 50,000 children in the foster care system who may need mental health services do not get them.”9 A DMH official confirms that “we are unable to provide adequate services to all foster kids.” Neilsen Depo., ER 10147-48. An official with Los Angeles County admits that only 14% of the foster children in that County are receiving mental health services whereas “research tells us . . . that anywhere between 40 and 80 percent of the kids in foster care would need mental health services.” Hatekayama Depo., ER 9644-45, 9679-81.
8 U.S. Department of Health and Human Services, Health Conditions, Utilization and Expenditures of Children in Foster Care (September 2005), ER 5090 and 5095. 9 Young Hearts, ER 4577; see also Little Hoover Commission, Still in Our Hands: A Review of Efforts to Reform Foster Care in California (February 2003) (hereafter “Still in Our Hands”), ER 4540.
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The experiences of many class members reflect these profound problems in the foster care and mental health systems. One mother describes in excruciatingly painful detail the experiences of her 15-year old daughter, Kayla. Centobie Decl., ER 6278-86, ¶¶1-39. During 18 months in Merced County’s foster care system, Kayla was shunted through 9 different residential placements and 11 psychiatric hospitalizations, including a group home in Redding, which was six hours away from her mother. Id., ER 6278, 6280, ¶¶1, 2. Rather than helping Kayla, each new placement contributed to her distress: in one she was beaten by older girls and in another she ran away and was raped while she wandered the streets. Id., ER 6280-81, ¶¶8, 13. She continually attempted suicide and cut her arms with a knife and a razor. Id., ER 6279-82, ¶¶6, 8, 15 and 22. Despite a diagnosis of severe depression and other serious mental disorders, the local child welfare agency eventually told Kayla’s mother that “there was nothing they could do for” her daughter and that “the only way Kayla would get the services she needed was through the probation department.” Id., ER 6279-82, 6284, ¶¶6, 8, 15, 17, 22, 33. Kayla ended up in jail. Id., ER 6285, ¶37.
Kayla’s story is all too typical. A minimum of 9,000 foster children are placed in group homes each year.10 A significant percentage of these foster children, perhaps more than 50%, are in high level group homes, namely Rate 10 DSS, Reexamination of the Role of Group Care in a Family-Based System of Care (June 2001), ER 4766 and 4769 (60% of 15,000 children).
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Classification Level (“RCL”) facilities of 12 and above.11 As of February 2004,
Los Angeles County alone had 2,160 foster children in group homes, including 405
children under age 12 and a “shocking” 122 children ages 8 and below.12 Another
2900 foster children in California are placed outside the state.13
By all accounts, the “delivery of treatment” is not “the primary purpose of
group homes for foster children.” Barthels Depo., ER 8456. A top DMH official
admits that residential care is not an “evidence-based” practice with the exception
of TFC. Neilsen Depo., ER 10222. On the contrary, “the evidence is negative,
mixed, or shows no effect for institutionally-based interventions – in hospital,
residential or group home settings”14 “Children in group care almost certainly also
experience fewer interpersonal experiences that support their well-being, including
the chance to develop [a] close relationship with a significant individual who will
make a lasting, legal commitment to them.”15
11 Group homes in California are classified into RCLs of 1-14, using a point system designed to reflect the level of care and services they provide. DSS, Reexamination of the Role of Group Care in a Family-Based System of Care, ER 4772. Katie A. Advisory Panel, Third Panel Report to the Court (hereafter “Third Panel Report), ER 5498 (nearly 60% of foster children in Los Angeles County in RCL facilities are in RCL facilities of 12 and above) 12 Third Panel Report, ER 5498-5500. 13 DSS, Child Welfare Services/Case Management System: Total Children in Supervised Out of Home Placements by Placement - June 2003, ER 4939. 14 CIMH Report, ER 4851; see also Bruns Decl., ER 6210, ¶15 (“near absence of outcome data” to support residential treatment and psychiatric hospitalization). 15 Richard P. Barth, Institutions vs. Foster Homes: The Empirical Base for the Second Century of Debate (February 2002), ER 5291; see also Farr Decl., ER
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The Department of Social Services (“DSS”), which is responsible for
administering the foster care system, has acknowledged that “many children have
been caught in a revolving door of inappropriate placements.”16 DMH recently
conducted a series of case reviews which confirmed how foster children have
experienced multiple group home placements and repeated hospitalizations.17
When children do not receive appropriate mental health services at home, crises
and hospitalization are inevitable.18
Kayla’s eventual involvement in the delinquency system is all too common.
The Children’s Services Inspector General for Los Angeles County warned that a
“disproportionate number of Juvenile Court actions are presently being filed based
upon the failure of relative placements resulting from a child’s behavioral
problems.”19 San Diego County estimated that in one year alone 200 children
were placed in the juvenile justice system to obtain mental health services.20 Thus,
6432-33, ¶22 (“severe risks associated with residential treatment”). 16 DSS, Reexamination of the Role of Group Care in a Family-Based System of Care, ER 4771. 17 These case reviews were part of DMH’s Focused Reviews of the services provided to class members in Emily Q. v. Bontá. See, e.g., San Bernardino Review, cases 5, 7, 8, ER 6123-24, 6127-30; Yolo County Review, ER 6090-91. 18 See, e.g., Decls. of Beckman, ER 5996-97, ¶¶6, 9; Brumbach, ER 6200-01, ¶9; Lowe., ER 6809, ¶2. 19 Children with Behavioral Problems: High Incidence of Failed Relative Placements, ER 5257. 20 GAO, Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services” (April 2003), ER 5363.
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the Little Hoover Commission found that some “children in California have needs beyond the capacity of existing treatment programs” and are “sent to out-of-state programs;” others “end up in the juvenile justice system . . . on the streets, or cycling through inappropriate programs.”21
C. Through Wraparound, Foster Children Can Avoid Group Homes and Multiple Placements.
Wraparound services are individualized, community-based services and supports that are provided to children with mental health needs as an alternative to removing them from their homes and communities and placing them in restrictive institutional settings. Grealish Decl., ER 6501-05, ¶¶21, 25, 27. A panel of nationwide experts has agreed that the core elements of wraparound services are that they be “family-driven, team-based, collaborative, community-based, culturally competent, individualized, strength based, natural support focused, unconditional, and outcome based.” Bruns Decl., ER 6213, 6215-16, ¶¶22 and 33. 22 DSS has given much the same description of the core elements of wraparound.23
21 Young Hearts, ER 4629. 22 See also CIMH Report, ER 4835 (giving similar description of wraparound). Explanations of these terms, such as “strength based” and culturally competent” can be found in “Wraparound Principles.” Bruns Decl., ER 6215-16, ¶33, and ER 6238-45. 23 DSS’ All-County Information Notice No. I-28-99 (April 7, 1999), ER 4497.
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DMH has identified wraparound as one of the measures that has “been working to improve services/supports to our foster care populations and their families.”24 DSS officials believe that wraparound programs have enabled foster children to live at home or in a home-like setting. Grayson Depo., ER 9266-67.
Wraparound is one of the few mental health interventions for which there is “strong” evidence of efficacy, with significant expert support and many scholarly articles describing its benefits.25 For example, in one of the first programs, Wraparound Milwaukee, the level of dysfunction and impairment significantly decreased for children and youth during their enrollment according to three nationally accepted research instruments on child behavior, while simultaneously, the cost of serving these children declined by one-third. Decls of Kamradt, ER 6600-01, ¶15; Bruns, ER 6212-13, ¶22. One wraparound provider in Sacramento County has attained the following results with children whom the County describes as the “most challenging to the system of care”: the percentage of children living in RCL facilities of 12 and above has declined from 45% at the time of admission to 11% at time of discharge; 89% are attending school four or five days a week; and 74% of the children are discharged to family settings. Farr Decl., ER 6419-20,
24 DMH, “Talking Points, Responses to Little Hoover Commission Report,” ER 4745-49. See also DMH Chapter 26.5 1997 Out-Of-Home Care Report, ER 4925 (wraparound services are among the “intensive efforts [that] are critical to the successful treatment of youth” with severe emotional disturbances). 25 CIMH Report, ER 4834, 4850; Bruns Decl., ER 6212-14, ¶¶21-29; Friedman Decl., ER 6455-59, ¶¶19-29.
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6429-3, ¶¶7-8, 15.26 Moreover, the United States Surgeon General has repeatedly
recognized wraparound services as a promising practice for children with mental health needs and their families. Bruns Decl., ER 6212, ¶21.27 In comparison,
institutional treatments, such as in-patient hospitalization and residential treatment
centers, have few proven long-term benefits to children and have almost no
outcome data to support their effectiveness. Friedman Decl., ER 6459, ¶30; Bruns
Decl, ER 6210, ¶15.
Statistics do not tell the whole story. With wraparound services, one teenage
boy in Alameda County progressed from living in a foster home, wetting his bed,
fighting and having difficulties in school to living again with his mother and
planning to attend a local community college followed by a four-year school.
Charles-Heathers Decl., ER 6310-12, ¶18. A fifteen-year old boy in Sacramento
County who was severely depressed and enrolled in a school for severely
emotionally disturbed children made such incredible improvements with
wraparound services that he transferred to a large mainstream school where he was
26 Sacramento County compiled additional data on the outcomes after discharge of children who Child Protective Services (“CPS”) had referred for wraparound services versus children who CPS had referred for the usual services. Farr Decl., ER 6429, 6431, ¶¶14, 19. The County found, among other things that, 52% of the children in wraparound services were no longer in CPS versus 29% of the control group; and only 9% of wraparound youth were still in CPS and living in RCL of 12 and above versus 25% of the control group. Id., ER 6431, ¶19. 27 See also Friedman Decl., ER 6455-59, ¶19-30 (discussing development of evidence base for wraparound services).
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an honor roll student and captain of a championship bowling team, and
subsequently became a student at a local community college. Farr Decl., ER
6427-29, ¶13. These stories are typical of the result of quality wraparound services.28
D. Fewer Than Half of California’s Counties Even Offer Wraparound, and Even These Fail To Serve All Those In Need.
Despite its remarkable effectiveness, wraparound had been implemented in
only 24 out of 58 counties in California as of February 2004 and only through two
pilot programs initiated by DSS. Treadwell Depo., ER 10855, 10857-58,
10909-27. One is a state-only funded program created by Senate Bill No. (“SB”)
163, while the other is a special foster care demonstration program with the federal government known as the IV-E waiver. Treadwell Depo., ER 10855-57.29 Each
county can choose whether it wants to provide wraparound services to foster
28 See, e.g., Dennis Decl., ER 6397-98, ¶21 (with wraparound services, older teenager who had been suicidal and struggling with substance abuse and who had a borderline personality disorder went on to graduate from college and receive a Masters of Social Work). 29 Funding for the two programs is quite different: SB 163 – 40% from the state and 60% from the counties; Title IV-E waiver – 50% from the federal government with approximately 20% from the state and 30% from the counties. Treadwell Depo., ER 10884-85. There are, however, more limitations on the Title IV-E waiver programs in that a county must divide children into an experimental and control groups, must measure certain outcomes, and must attempt to be “cost neutral.” Id., ER 10943-49. Children in the control group are precluded from receiving wraparound services. Id., ER 10875.
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children through these pilot programs. Grayson Depo., ER 9327-28. For more than a year, admissions to the Title IV-E wraparound have been frozen.30
It is bad enough that wraparound services essentially are “an elective service to be offered at the discretion of each county.” Burgess Decl., ER 6266, ¶11. To make matters worse, eligibility for wraparound services is limited to foster children who are currently residing in or at risk of being placed in RCL facilities of 10 or above for the SB 163 counties and RCL facilities of 12 or above for the Title IV-E waiver counties. Grayson Depo., ER 9258-59; Treadwell Depo., ER 10862.
There is no requirement that a county provide wraparound services to all children in the target population for whom these services would be medically necessary or otherwise appropriate. Treadwell Depo., ER 10867-68, 10878-79. On the contrary, counties have complete discretion on the number of wraparound “slots” they wish to provide. Id., ER 10861-62, 10871, 10942. Hence, the DSS official who is responsible for all of California’s wraparound programs admitted that the participating counties were not even providing wraparound to all children in the target population for whom such services would be appropriate. Id., ER 10849-50, 10853, 10880.
The 24 participating counties combined had the capacity to provide wraparound services to slightly more than 1500 children as of February 2004. Id.,
30 Notice from Patricia Aguiar, ER 4902-03 (no new children as of June 30, 2004). - 18 -

ER 10909-27. Plaintiffs’ declarations documented the great need for and limited access to wraparound around the state.31 DMH itself recently concluded that
providing only 30 wraparound slots in a county with more than 6000 clients under age 21 was “insufficient given the number of potential eligibles.”32
Los Angeles County is a case in point. Long after entering into the
settlement agreement in this case, this County only had the capacity to provide
wraparound services to 466 children and their families and, as a consequence,
“many class members that need Wraparound support cannot access it,” and the
“quality of Wraparound services is not adequate to meet the needs” of the Countywide class.33 One County official has testified that Los Angeles County should
have “1500 or more slots in wraparound” given the need. Hatekayama Depo., ER
9661-62. DSS has given even higher estimates – Los Angeles County should
expand capacity to “address the needs of the more than 3,000 children who are eligible” for the Title IV-E wraparound program.34
31 See, e.g., Crary Decl., ER 6318-21, ¶¶3-10 (“Wraparound services would accelerate . . . return home” of a boy, age 16, and would transition the return to a “less restrictive setting” for three other children, ages 5, 7 and 8, but such services have been denied because all these children receive federal foster care funds); Waxler Decl., ER 7302-03, ¶¶3-5 (“In January 2005, the court ordered Wraparound services for James, and his social worker referred James to Wraparound,” but, as of June 2005, Los Angeles County had still not provided such services to this 17-year old boy in foster care). 32 San Bernardino Review, ER 6106-07, 6109. 33 Third Panel Report, ER 5484, 5525. 34 Letter dated March 28, 2003, from Sylvia Pizzini, ER 4892.
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E. Medi-Cal Policies Significantly Limit Access to Wraparound.
DHS and DMH have not taken any steps to ensure that wraparound is
available to all foster children on Medi-Cal, and have erected multiple barriers to
its use. DMH officials state that their agency does not provide a wraparound
program. Neilsen Depo., ER 10178. While Medi-Cal can cover some components
of wraparound, agency staff did not know precisely what could be covered or whether these components include all services that a child may need.35 One
indication that wraparound is not covered is the absence of a billing code for providers to claim Medi-Cal reimbursement. 36 Health procedure billing codes in use across the nation include “Community Wraparound Services,”37 but these
codes are not covered by the Medi-Cal program. Barthels Depo., ER 8715-16.
In the counties which have chosen to offer wraparound services, providers
can attempt to bill portions of their services to Medi-Cal, but they risk not being
paid “even though these services are medically necessary and appropriate for the
children.” Charles-Heathers Decl., ER 6314. Auditors recently issued 19
35 Barthels Depo., ER 8457, 8463-64, 8647, 8729-30, 8739-40, 8752-53, 8757-59. 36 Wraparound services are identified by name and code on the Medi-Cal fee schedule, but are clearly designated as “inactive” and therefore inaccessible; this is but one of a number of barriers to effective provision of wraparound services identified by plaintiffs experts in the Medi-Cal regulations. Nace Decl., ER 684748, ¶35. 37 The primary coding system for health insurance billing is called Health Care Procedures Coding System (“HCPCS”). Barthels Depo., ER 8668-69. HCPCS has a number of codes whereby mental health providers can bill for wraparound services, such as H2021 and H2022.
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disallowances to Lincoln Child Center, which will cost that wraparound provider
hundreds of thousands of dollars. Id. As this provider explained, the auditors “did
not appreciate the acuity of the mental health needs of our children” or “the
importance of starting with a high level of services and then reducing the level of
services to ensure that the child does not experience another failure.” Id.
Aside from the risks, billing Medi-Cal for the components of wraparound on a piecemeal basis is quite difficult. 38 DMH has permitted each county to set its
own claims policies, procedures, contracts and practices regarding the extent of
Medi-Cal reimbursement for different components of wraparound services.
Barthels Depo., ER 8661-62. This creates an administrative nightmare for
providers which attempt to serve children in different counties. Watrous Decl., ER
7201-03. It also means that the availability of federal Medicaid reimbursement differs markedly from county to county.39 In turn, the state’s failure to maximize
38 “[O]nly the most sophisticated and dedicated behavioral health specialists, who are familiar and experienced with each of the programs and their specific administrative and eligibility requirements can attempt to create a patchwork quilt of various funding streams to address as much of the needs of the children as possible.” Nace Decl., ER 6846-47, ¶33. For anyone else “trying to gain access to effective medically necessary wraparound services, these barriers are most likely completely insurmountable.” Id. 39 For example, one wraparound provider in Alameda County bills less than 40% of all costs to Medi-Cal program, whereas another provider in Sacramento County bills approximately 65% of all costs to the Medi-Cal program. Charles-Heathers Decl., ER 6313, ¶20; see also Burgess Decl., ER 6266, ¶10.
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federal matching funds also prevents service expansion.40 In sum, California’s “myriad [of] categorical programs, policy statements, and fee schedule categories” has “resulted in a situation in which access to medically necessary wraparound services is inhibited rather than promoted.” Nace Decl., ER 6846, ¶33.
F. TFC Is Another Medically Necessary Mental Health Service for Many Foster Children.
Therapeutic foster care41 has been described as a “service for children with serious behavioral and emotional needs who cannot be cared for in their own homes.” Friedman Decl., ER 6456, ¶25. Like wraparound services, TFC “is a flexible intervention approach that emphasizes building upon positive family strengths, and provides crisis intervention, family counseling, assistance with child management and skills to enhance family functioning, and provides access to other community support programs.” Id., ER 6456-57, ¶ 26. TFC is an alternative to group and residential care, institutionalization and incarceration, and “is widely considered to be the least restrictive and most integrating form of out-of-home placement for children with severe emotional and behavioral disorders.” Chamberlain Decl., ER 6291, ¶9. TFC is provided by foster parents who are specially trained to work with children with mental health needs; these foster parents are an integral part of implementing a child’s treatment plan and the child
40 Katie A. Advisory Panel, Fifth Panel Report to the Court (hereafter “Fifth Panel Report”), ER 5547-48. 41 TFC is also called treatment foster care or specialized foster care.
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and foster parents are given ongoing supervision and support in these efforts. Id., ER 6292-96, ¶12.
By all accounts, TFC is one of the very few mental health interventions for which there is a strong evidence of effectiveness. Id., ER 6300, ¶26; Neilsen Depo., ER 10222; CIMH Report, ER 4813-14, 4836-38. Based upon the results of a number of studies, 42 the Surgeon General found that youth in TFC “showed more improvements in behavior and lower rates of reinstitutionalization and the costs were lower than those in other settings.”43 Other improved outcomes for children receiving TFC include decreased arrests, days incarcerated, violent offenses, hard drug use, and running away. Chamberlain Decl., ER 6297-98, ¶18. In addition, TFC has been found to lead to thousands of dollars of savings per child through decreased hospitalization costs and savings to other systems, including the criminal justice system. Suppl. Chamberlain Decl., ER 15104, ¶6. TFC is the best and sometimes only appropriate option for many class members who cannot function in large congregate facilities such as group homes, often because they do
42 Chamberlain Decl., ER 6288-89, ¶¶1, 3 (one form of TFC, known as multisystemic therapeutic foster care or “MTFC”, has been the subject of extensive evaluation, including eight randomized experimental clinical trials, and, based on research and program evaluation); Watrous Decl., ER 7199-7200, ¶¶5-6 (new MTFC program in San Diego County documented a nearly 200% decrease in aggregate negative behaviors). 43 Mental Health, A Report of the Surgeon General, ER 4886.
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not have the skills to interact with peers, especially those who also have mental health and behavior problems.44
G. TFC Is Not Available on a Consistent Statewide Basis When Children Need It.
Medi-Cal does not cover TFC. Barthels Depo., ER 8475. Although there are standardized national codes for billing TFC on a daily and monthly basis,45 Medi-Cal does not include either code. Barthels Depo, ER 8714-15. Medi-Cal also does not cover many components of TFC. Id., ER 8766, 8768-70, 8773, 8775-76.
Twenty of the 58 California counties offer a service called Intensive Treatment Foster Care (“ITFC)” for children who might otherwise go into “highend group care.” Dupay Depo., ER 9123. By state statute, ITFC programs are required to provide a wide range of services to “emotionally disturbed children in certified family homes,” including “individualized needs and services plans, “education and mental health services, ” and “therapeutic after-school programs.” Welf. & Inst. Code §18358.15(a)(1)-(5). However, the state officials most knowledgeable about the ITFC programs did not know what services are actually available or whether those services differ from those in other forms of foster care.46
44 See, e.g., Dennis Decl., ER 6391, ¶5; Dembrowsky Decl., ER 6330-31, ¶16. 45 Redman Decl., ER 6978, ¶¶19, 20 and ER 7153, 7157. 46 Markell Depo., ER 9945-46; see also Dupay Depo., ER 9108-09, 9111-12 (State only reimburses for “board and care services,” which pays for food, clothing,
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Only 500 children up to age 19 were served through ITFC during the quarter October -December 2002.47 Several factors have kept ITFC participation low. The regulations regarding the ITFC program are so restrictive that few providers are willing to participate. Hatekayama Depo., ER 9612-13 (no LA providers were interested in ITFC). In addition, the State reimburses ITFC at a rate significantly lower than the rates for comparable group home care in RCL facilities of 12 or 14.48
STANDARD OF APPELLATE REVIEW
Plaintiffs generally agree with Defendants’ discussion of the standards of appellate review. AOB 35-36. This Court’s review of a decision regarding a preliminary injunction “is limited and deferential.” Southwest Voter Registration Educ. Project v. Shelley, 344 F.3d 914, 918 (9th Cir. 2003)(en banc). “Review of an order granting or denying a preliminary injunction is much more limited than review of an order involving a permanent injunction, where all conclusions of law
utilities, and housing). 47 DSS, Intensive Treatment Foster Care Program: Quarterly Statistical Report, ER 5466. 48 Dupay Depo., ER 9113-15. The maximum ITFC rate of $4476 per month is also significantly less than the $5613 per month for a RCL 12 group home and $6371 for a RCL 14 facility. Compare DSS, Intensive Treatment Foster Care Programs, Authorized Rates (August 5, 2005), ER 5097-98, with DSS, Foster Care Rates Group Home Facility Listing (August 5, 2005), ER 5099, 5105.
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are freely reviewable.” Walczak v. EPL Prolong, Inc., 198 F.3d 725, 730 (9th Cir. 1999).
The abuse of discretion standard applies; an order will be reversed only if a district court bases its decision on either an erroneous legal standard or clearly erroneous findings of fact. Id. This Court “‘typically will not reach the merits of a case when reviewing a preliminary injunction. . . . As long as the district got the law right, it will not be reversed simply because the appellate court would have arrived at a different result if it had applied the law to the facts of the case.’” Earth Island Inst. v. U.S. Forest Serv., 442 F.3d 1147, 1156 (9th Cir. 2006) (citation omitted).
Defendants contend that injunctions against state agencies are subject to a “more exacting standard” of appellate review. AOB 36. Yet this Court has repeatedly affirmed preliminary injunctions against both state and local agencies. See, e.g., Gregorio T. v. Wilson, 59 F.3d 1002 (9th Cir. 1995) (Governor and other State officers enjoined from implementing various sections of Proposition 187); Demery v. Arpaio, 378 F.3d 1020 (9th Cir. 2004) (county sheriff enjoined from using a world-wide web camera in jail); Harris v. Board of Supervisors, Los Angeles County, 366 F.3d 754 (9th Cir. 2004) (county officials enjoined from closing rehabilitation hospital and eliminating 100 beds at another county hospital).
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Applying the appropriate standards of appellate review, the Court should affirm the preliminary injunction in this case.
ARGUMENT I. THE DISTRICT COURT APPLIED THE CORRECT
STANDARDS FOR GRANTING A MANDATORY PRELIMINARY INJUNCTION. Defendants discuss in great detail the standards for issuance of a preliminary injunction in this case.49 AOB 31-34. The district court adhered to these standards. Order, ER 14674. As the lower court observed, mandatory preliminary injunctions are “particularly disfavored, and should not be issued unless the facts and law clearly favor the moving party.” Id., citing Anderson v. United States, 612 F.2d 1112, 1114 (9th Cir. 1979). Courts have, however, granted such relief in appropriate circumstances. See, e.g., Dahl v. HEM Pharm. Corp., 7 F.3d 1399, 1401-05 (9th Cir. 1993) (drug company required to provide experimental new medication to patients with chronic fatigue syndrome); Cupolo v. Bay Area Rapid Transit, 5 F.Supp. 2d 1078, 1080-86 (N.D. Cal. 1997) (BART ordered to improve and repair its elevators to make them accessible to individuals with mobility
49 This case should be contrasted with many of Defendants’ citations, where there was not widespread violation of the law by governmental officials. See, e.g., Rizzo v. Goode, 423 U.S. 362, 375-76 (1975); Lewis v. Casey, 518 U.S. 343, 356 (1996).
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disabilities).50 Moreover, “[g]overnment inaction despite a statutory mandate may support a mandatory injunction issued by the court.” Firebaugh Canal Co. v. U.S., 203 F.3d 568, 577 (9th Cir. 2000).
A mandatory preliminary injunction is appropriate in this case. Both the facts and the law clearly favor Plaintiffs. The district court also was confronted with Defendants’ inaction despite the mandates of federal law.
II. THE DISTRICT COURT’S FINDINGS OF FACT AND CONCLUSIONS OF LAW WERE SUFFICIENTLY COMPREHENSIVE TO PROVIDE A BASIS FOR ITS DECISION.
In this appeal, Defendants spend little time discussing the facts or the law. Instead, they advance a hyper-technical argument that the district court failed to make the requisite findings of fact and conclusions of law to justify the preliminary injunction. AOB 36-40. Yet the 21- page Order contains the necessary findings of fact and conclusions of law, which are sufficiently comprehensive to provide a basis for the district court’s decision.
50 See also Wyandotte Nation v. Sebelius, 443 F.3d 1247, 1255-57 (10th Cir. 2006)(preliminary injunction mandated that state return proceeds, files and equipment seized in earlier raid on casino); United Food & Commercial Workers Union, Local 1099 v. Southwest Ohio Regional Transit Authority, 163 F.3d 341, 347, 364 (6th Cir. 1998) (preliminary injunction forced state agency to accept union’s advertisement on its buses).
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A. The Preliminary Injunction Should Be Affirmed Unless it is Not Possible for this Court to Have a Full Understanding of the Relevant Issues Without Additional Findings by the District Court.
Under Rule 52(a), a district court must set forth findings of fact and conclusions of law to support an order granting an interlocutory injunction. Fed.R.Civ.P. 52(a). One purpose behind Rule 52(a) is to assist the appellate court to understand the basis for the trial court’s decision. Vance v. American Hawaii Cruises, Inc., 789 F.2d 790, 792 (9th Cir. 1986).
Defendants never discuss the consequences when a district court does not make adequate findings of fact and conclusion of law. A “[f]ailure to comply with Rule 52(a) does not require reversal unless a full understanding of the question by the appellate court is not possible without the aid of separate findings.” Vance, 789 F.2d at 792; accord Federal Trade Comm’n v. Enforma Natural Prods., Inc., 362 F.3d 1204, 1212 (9th Cir. 2004). This Court may still affirm a preliminary injunction “if the findings are sufficiently comprehensive and pertinent to the issues to provide a basis for decision or if there can be no genuine dispute about the omitted findings.” Federal Trade Comm’n, 362 F.3d at 1212.
B. The District Court Made the Necessary Findings that Members of the Plaintiff Class Are Entitled to Receive Wraparound Services and TFC under the EPSDT Statutes.
According to Defendants, the findings “necessary to support the mandatory preliminary injunction” in this case would include that the Medi-Cal program
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“does not cover” wraparound services and TFC and that these two mental health services “are Medicaid-covered services.” AOB 38. The district court made findings on both those issues.
As for the first issue, the district court found that “Defendants do not dispute that currently they are not providing these forms of assistance, as such, to members of the plaintiff class.” Order, ER 14672 n.3. Defendants do not quarrel with this finding. On the contrary, they openly acknowledge that wraparound services and TFC are “not covered as such under the Medi-Cal program.” AOB 41.
As for the second issue, the district court began its analysis by summarizing a series of “undisputed” points regarding the State’s legal obligations as to the Medi-Cal program. By “voluntarily participating in Medicaid through its MediCal program, California is required to ‘comply with certain requirements imposed by the Act and regulations promulgated by the Secretary of Health and Human Services.” Order, ER 14676, citing Wilder v. Virginia Hosp. Ass’n, 496 U.S. 498, 502 (1990). The Medicaid Act “requires the provision of EPSDT to Medicaideligible children under the age of twenty-one.” Order, ER 14677. “EPSDT requires the State to screen eligible children ‘to determine the existence of certain physical or mental illnesses or conditions.’” Id., citing §1396d(r)(1)(A)(ii). EPSDT also “requires the State ‘to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or
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not such services are covered under the State plan.’” Order, ER 14677, citing §1396d(r)(5).51
The Order later discussed how “Section 1396d(r) lists an array of services that states are required to provide children under age twenty-one.” ER 14681.
Plaintiffs rely primarily on §1396d(r)(5), a catch-all provision, which requires that states render “[s]uch other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section. . . .” Id. The Order noted that subsection (a) “identifies twenty-eight different services, including diagnostic services, psychiatric services, rehabilitative services and case management services.” Id. Referring to Plaintiffs’ proposed definitions of the two mental health services at issue, the court below found that “[w]raparound services has nine component services” and TFC “has seven” component services. Order, ER 14682. “Each component service has numerous subcomponent services,” which “may fall under any one or more of the twenty-eight different categories of §1396d(a).” Id. The district court found “it likely that virtually all of the corresponding categories
51 Prior to 1989, state EPSDT programs were only required to pay for medically necessary treatment for hearing, vision, and dental problems. Cf. Rosie D v. Swift, 310 F.3d 230, 232 (1st Cir. 2002). With the amendments in 1989, states are required “to provide Medicaid coverage for any service ‘identified as medically necessary through the EPSDT program.’” Id.
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of §1396d(a) identified by Plaintiffs do, in fact, encompass the linked-to-service” of wraparound services and TFC. Order, ER 14682-83.
Defendants criticize the district court for not providing “any analysis of why the components of ‘wraparound services’ and ‘therapeutic foster care’ listed in Appendices A and B are Medicaid-covered services under 42 U.S.C. §1396d(a).” AOB 39. The criticism is totally unwarranted. The lower court discussed how Appendices A and B “link, in chart form, each component of wraparound services and therapeutic foster care service to the corresponding category or categories of §1396d(a)” and that the declaration of Chris Koyanagi provided “a similar breakdown.” Order, ER 14682.
Next, Defendants fault the district court for not making “factual finding[s]” as to whether each component of these two mental health services is currently “covered by Medi-Cal.” AOB 39. What would be the point of such findings? Defendants concede that wraparound services or TFC “are not covered as such under the Medi-Cal program.” AOB 41. It is irrelevant that some, but not all the essential components may be covered. Under Defendants’ strained reasoning, the Medi-Cal program would not have to cover the second half of an operation for brain cancer so long as it covered the first half. Moreover, Defendants never specify which of the nine components of wraparound services and seven
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components of TFC are supposedly covered by the current Medi-Cal program so as
to merit a finding by the district court.
Not surprisingly, Defendants are unable to cite any authorities to support
their belief that Rule 52(a) requires findings of fact at such a minute level of detail.52 Nor do Defendants marshal any factual or legal arguments to refute the
findings that all the components of wraparound services and TFC qualify as
rehabilitation services, case management services, personal care service or other
categories of §1396d(a), as discussed in the following section.
C. The District Court Correctly Found that Plaintiffs Have a Strong Likelihood of Success on Their EPSDT Claims.
Defendants object that the district court did not make an express
“determination that the law and the facts clearly favored Plaintiffs on the merits,
which is required for a mandatory preliminary injunction.” AOB 44. The district
court “conclude[d] that Plaintiffs have demonstrated a strong likelihood of
succeeding on the merits of their substantive claims.” Order, ER 14687.
Nonetheless, Defendants argue that that “there is no legal analysis whatsoever as to
why [the services in Appendices A and B] are Medicaid-covered services.” AOB
52 The instant case should be contrasted with the citations by Defendants. AOB 3637. See, e.g., LGS Architects, Inc. v. Concordia Homes of Nevada, 434 F3d 1150, 1155 (9th Cir. 2006) (district court’s “only explanation” for denying a preliminary injunction “was the statement that it did not consider” plaintiff “to have a likelihood of success on the merits”); and Rosen v. Siegel, 106 F.3d 28, 32 (2nd Cir. 1997) (“complete dearth of findings of fact and conclusion of law to support its injunction”).
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39. In fact, the district court analyzed both the federal law and its application in other states in reaching its conclusion.
First, the district court noted that Plaintiffs relied on several categories of services in federal law, including “‘rehabilitative services,” §1396d(a)(13), ”case management services,” §1396d(a)(19), and “personal care services,” §1396d(a)(24). Order, ER 14682. Federal law defines these services broadly. Rehabilitative services include “any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law.” 42 C.F.R. §440.130(d). Case management consists of services to “assist individuals under the [Medicaid] plan in gaining access to needed medical, social, educational, and other services.” §§1396d(a)(19), 1396n(g)(2). The district court ruled that “virtually all of the corresponding categories of §1396d(a) identified by Plaintiffs do, in fact, encompass the linked-to service.” Order, ER 14683.
The court below concluded that wraparound services and TFC “fall within the EPSDT obligations of Medicaid-participating states,” and that this “conclusion is buttressed by the fact” that these two services have been funded by Medicaid in other states. Order, ER 14684.
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The district court also addressed the issue of medical necessity. The Health Care Financing Administration (“HCFA”)53 State Medicaid Manual advises states that they must provide “any service which [they] are permitted to cover under Medicaid” so long as it meets the EPSDT medical necessity definition. State Medicaid Manual, §5110 (April 1990). As one high ranking DHS official admitted, “[s]tates must provide all needed services whether the service is covered by the state’s state plan or whether the provider type is normally enrolled in the Medicaid program.”54
The court below correctly observed that the Medicaid Act does not itself define when a service is “medically necessary.” Order, ER 14685-86. “Rather, the decision ‘rests with the individual recipient’s physician and not with clerical personnel or government officials.” Id., ER 14686, citing Pinneke v. Preisser, 623 F.2d 546, 550 (8th Cir. 1980), and Weaver v. Reagen, 886 F.2d 194, 200 (8th Cir. 1989).
The district court found that both wraparound services and TFC are medically necessary for members of the Plaintiff class. Order, ER 14686-87. In this regard, the district court pointed to “the declarations of numerous behavioral
53 HCFA has since changed its name to the Centers for Medicare and Medicaid Services (“CMS”). 54 E-mail message from Stan Rosenstein (February 23, 2003), ER 5193.
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and mental health experts who attest to the medical necessity of providing these services to foster care children with emotional disturbances.” Id.55
Dr. Lourie, for instance, has been a practicing psychiatrist for over 30 years
with a specialty in children and adolescents and is the former Director of the Child
and Adolescent Service System Program at the National Institute of Mental Health.
Lourie Decl., ER 6788-89, ¶¶1, 4, 5. Based on his many years of studying
children’s mental health interventions, Dr. Lourie stated that “wraparound services
are medically necessary for children with serious mental health needs.” Order, ER
14686.
Similarly, Dr. Patricia Chamberlain, a national expert in TFC, opined that a
children’s mental health system without TFC “as an available intervention is
incomplete and inadequate because intense mental health interventions, provided
in home-like settings are necessary for many children with serious behavioral or
55 According to three nationally accepted research instruments – the Child Adolescent Functional Assessment Scale (“CAFAS”), the Child Behavior Checklist, and the Youth Self Report – the level of dysfunction and impairment significantly decreased for children and youth during their enrollment in Wraparound Milwaukee. Kamradt Decl., ER 6600-01, ¶15; see also Farr Decl., ER 6419, ¶8 (for youth enrolled in Wraparound Sacramento, “[o]verall levels of behavioral dysfunction, as assessed by clinical measures, significantly decreased from admission to discharge”). MTFC, in turn, “is widely accepted as an evidence-based practice for controlling and allaying delinquency and anti-social behavior caused by psychological, behavioral, or emotional impairments.” Chamberlain Decl., ER 6288-89, 6297, ¶¶1, 3, 16.
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mental health needs. Id. See also Friedman Decl., ER 6459, ¶ 30 (TFC is “widely thought of as essential to any modern children’s mental health system”).
The district court also considered the lack of evidence from Defendants on the medical necessity issue. “Defendants have not presented any declarations by mental health experts contesting this evidence that wraparound services and therapeutic foster care are medically necessary services for foster care children with mental health care needs.” Order, ER 14754.56 It is worth noting that Defendants have not contested the medical necessity of these two mental health services on this appeal.
District Judge Matz is an experienced judge who understood that Plaintiffs were seeking a “mandatory preliminary injunction” and the stringent standards for granting such an injunction. Order, ER 14672 and 14674. That Judge Matz may not have used the exact words for granting a mandatory preliminary injunction is of little consequence. The Order contains all the requisite findings of fact and conclusions of law to establish the merits of Plaintiffs’ Medicaid claim. Hence, the district court did not abuse its discretion in issuing a mandatory preliminary injunction that California provide both wraparound services and TFC to Medicaid-
56 On the contrary, one of the Defendants’ own declarants, Greg Rose, singled out TFC for praise as an “evidence based practice.” Rose Decl., ER 11453-55, ¶¶1-5, and ER 11467-87.
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eligible members of the Plaintiff class when those services are medically necessary.
D. For the Other Factors Governing a Mandatory Preliminary Injunction, the District Court Made All the Requisite Findings or Alternatively the Findings Are Sufficiently Comprehensive and There Is No Genuine Dispute about the Omitted Findings.
Defendants assert without further discussion that the court below “made no actual findings as to the other factors governing preliminary injunctive relief.” AOB 39. The other factors are the possibility of irreparable injury to Plaintiffs if preliminary relief is not granted, whether the balance of hardships favors the plaintiffs, and the public interest. Order, ER 14674, citing Rodde v. Bontá, 357 F.3d 988, 994 (9th Cir. 2004). The district court made sufficient findings on these points to support its decision.
As discussed previously, the district court found that wraparound services and TFC are medically necessary services for foster children with mental health needs. Order, ER 14685-87. Generally, in Medicaid cases, “[t]he nature of [plaintiffs] claim – a claim against the state for medical services – makes it impossible to say that any remedy at law could compensate them.” McMillan v. McCrimon, 807 F. Supp. 475, 479 (C.D. Ill. 1992). A sufficient showing of irreparable injury is made when a state may deny “needed medical care” to Medicaid recipients. Beltran v. Meyers, 677 F.2d 1317, 1322 (9th Cir. 1982); see also Rodde, 357 F.3d at 999 (irreparable harm “includes delayed and/or complete
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lack of necessary treatment, and increased pain and medical complications”). The Supreme Court has stated that “[t]o allow a serious illness to be untreated until it requires emergency hospitalization is to subject the sufferer to the danger of a substantial and irrevocable deterioration in his health.” Memorial Hosp. v. Maricopa County, 415 U.S. 250, 261 (1974). “The denial of medical care is all the more cruel in this context, falling as it does on indigents who are often without the means to obtain alternative treatment.” Id.
The Order fully addressed Defendants’ two arguments regarding irreparable harm. As to their first argument that Plaintiffs waited three years to bring the preliminary injunction motion, the district court found that Plaintiffs had “initially focused much of their efforts and limited resources on their claims against Los Angeles County” and that these efforts had resulted in a “pioneering, albeit still problem-laden, settlement” in which the County had agreed to make a number of important commitments for the care of members of the countywide subclass. Order, ER 14688. For the “remaining members of the statewide class, the unmet mental health needs and the harms of unnecessary institutionalization are no less grave now than three years ago.” Id.
The district court found equally “unpersuasive” Defendants’ second argument that Plaintiffs have an adequate remedy through the Medicaid appeals process. Id. “‘[E]xhaustion of state administrative remedies should not be
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required as a prerequisite to bringing an action pursuant to §1983.’” Id., citing Patsy v. Board of Regents of State of Fla., 457 U.S. 496, 516 (1982).
The district court did not make additional findings about the irreparable harm to class members because this issue was not in serious dispute. As the court itself noted, Defendants’ “opposition on this point” consisted of just “one paragraph.” Order, ER 14688, referring to Defendants’ Opposition to Plaintiffs’ Motion for Preliminary Injunction, ER 7457.
Above and beyond the trial court’s findings, Plaintiffs presented extensive evidence that the Medi-Cal program was not currently meeting the mental health needs of foster children in California and that the denial of wraparound services and TFC was inflicting immediate irreparable harm on these children. For example, Dusty is a class member in Humboldt County, a “smart young man who is capable of going to college and making something of his life, if given wraparound or therapeutic foster care services.” Magnatta Decl., ER 6717-18, 6824-25, ¶¶1, 4, 23. When, however, Dusty did not receive the wraparound services he “desperately needed,” this 15-year old boy was eventually removed from the home of a caring foster parent and placed in a high-level group home in another county. Id., ER 6822-24, ¶¶17, 19-22.57 As a Butte County official
57 See also Bialik Decl., ER 6000-05, ¶¶3, 4, 14, 16, 20 and 21(foster youth who “enjoys reading, math, and sports” and “wants to go to college” became “increasingly depressed and desperate” when Contra Costa County refused to
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warned, the “consequences of youth needing mental health services and not
receiving them are great.”58 Six youths committed suicides in that county alone
during one year.59
Turning to the balance of hardships, the district court found that “there is
substantial evidence that wraparound services and therapeutic foster care actually
save the State money, compared to alternatives involving institutionalization.”
Order, ER 14673 n. 5 (citing four expert declarations and three exhibits).
Ample evidence supported this finding. The cost of institutional care often
exceeds $100,000 per year.60 The State’s monthly foster care payments per child
are $5613 for a RCL 12 facility and $6371 for a RCL 14 facility.61 On top of these
expenses, the monthly costs of providing mental health services are approximately
move him into a foster home with therapeutic foster care and so he is “currently detained in Juvenile Hall”); Frakes Decl., ER 6440-48, ¶¶2, 3, 5, 10-23 (class member who has a “quick wit,” “is very good at arts and crafts,” and was at least “fully capable” at one time “of performing at grade level in school,” was unable to receive a majority of the wraparound services that the county had promised and so his difficult behaviors escalated to the point that his foster mother eventually had to ask for his removal from her home). 58 Letter dated July 13, 2000, from Michael W. Clarke, Assistant Director of Butte County Department of Behavioral Health, ER 5076-77. 59 Id. 60 One county official estimated that the costs of group home placement was “approximately $100,000 per youth per year” and that did not include “the nonpublic school costs, the medication costs, or the mental health costs usually associated with group home placements.” Letter from Assistant Director of Butte County Department of Behavioral Health, July 13, 2000, ER 5076-77. 61 DSS, Foster Care Rates Group Home Facility Listing, ER 5105.
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$3600 for a child in an RCL facility of 12 and $4800 for a child in an RCL facility of 14. Hatekayama Depo., ER 9656.62
Although the costs vary, county after county has found that wraparound
services and TFC are cheaper than group home care. It costs Mono County
approximately $167,800 per year to keep one youth in a RCL 14 facility, while the
average child in the wraparound program costs $4638 per month (or $56,196 per year).63 In Mendocino County, the monthly cost of out of home placement and
specialty mental health services averaged $9495 per child, whereas providing wraparound services averaged $6065 per child.64 For Humboldt County, the
average monthly cost was $3334 for a child without wraparound services versus $2438 for a child with wraparound services.65
Just as in the proceedings below, Defendants present virtually no factual or
legal argument to counter Plaintiffs’ powerful showing that class members are
suffering immediate, irreparable harm from the denial of wraparound services and
62 Another type of locked ground home, “Community Treatment Facilities,” can cost $9,000 to $20,000 per month per child. DMH, Status of the Implementation of the Community Treatment Facilities (April 2001), ER 4912. If a foster child ends ups in the delinquency system, incarceration alone can cost more than $3000 per month. Young Hearts, ER 4581. 63 SB 163 Wraparound Final Evaluation, Mono County, ER 5469. 64 Mendocino County’s SB 163 Children's Wraparound Services Pilot Project Final Report, ER 5471. 65 Report to the Legislature on Humboldt County’s Wraparound Services Program, ER 5474.
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TFC and that the balance of hardships tips totally in Plaintiffs’ favor. The silence of Defendants on these two factors speaks volumes.
In another case involving low-income people with disabilities, this Court stated:
[T]he physical and emotional suffering shown by plaintiffs in the record before us is far more compelling than the possibility of some administrative inconvenience or monetary loss to the government. . . Faced with such a conflict between the financial concerns and preventable human suffering, we have little difficulty concluding that the balance of hardships tips decidedly in plaintiffs’ favor. Lopez v. Heckler, 713 F.2d 1432, 1437 (9th Cir.), rev’d in part on other grounds, Heckler v. Lopez, 463 U.S. 1328 (1983). In Lopez, 713 F.2d at 1436-37, this Court refused to stay a preliminary injunction even though it cost the federal government more than $20 million per month in 1980, a figure that would be much higher in current dollars. More recently, this Court in Rodde, 357 F.3d at 999, affirmed a preliminary injunction despite Los Angeles County’s estimates that it would be losing $58 million annually. Thus, even if Defendants might lose some money from the granting of the preliminary injunction in this case, such financial losses still pale by comparison to the preventable human suffering that class members will endure if the preliminary injunction had been denied.
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The last factor in granting or denying a preliminary injunction is the public interest. This Court cautioned years ago that the “government must be concerned not only with the public fisc but also with the public weal,” adding that “[o]ur society as a whole suffers when we neglect the poor, the hungry, the disabled, or when we deprive them of their rights or privileges.” Lopez, 713 F.2d at 1437. From the standpoint of society, it would be “tragic” if “poor, elderly, disabled people” were “wrongfully deprived of essential benefits for any period of time.” Id. “It would be unfortunate, but far less harmful to society, were the government to succeed in overturning the preliminary injunction but be unable to recoup all or portion of the funds.” Id. at 1437-38.
The reasoning of Lopez applies equally to the case at bar. The district court observed that “at stake in this lawsuit is the health of thousands of children in California who are already in, or are likely soon to wind up in, foster care,” and that “‘[c]hildren with serious emotional disabilities are among the most fragile members of our society’” whose “‘medical needs frequently extend across a spectrum of service providers and state agencies.’” Order, ER 14672 (citation omitted). The court below found that “[i]n California, the foster care system has been widely acknowledged to be failing” [id. at 14673], a finding which Defendants do not dispute in this appeal.
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It is in the public interest to protect the legal rights of foster children who are both poor and disabled, since it would be tragic to wrongfully deprive them of necessary mental health services for any period of time. Significantly, Defendants have presented no argument to the contrary. In sum, this Court should affirm the preliminary injunction regardless of any alleged deficiencies in the findings by the court below.
III. NONE OF THE FINDINGS OF FACT BY THE COURT BELOW ARE CLEARLY ERRONEOUS.
While Defendants insist that there are no “explicit findings of fact” in the Order [AOB 38-39], they nonetheless argue that some “implicit factual findings” in the Order are clearly erroneous. Id. at 40-43. Findings of fact “are reviewed for clear error.” Id. at 35. “Clear error review is deferential to the district court, requiring a ‘definite and firm conviction that a mistake has been made.’” Husan v. Olympic Airways, 316 F.3d 829, 835 (9th Cir. 2002)(citation omitted). “Thus, if the district court’s findings are plausible in light of the record viewed in its entirety, the appellate court cannot reverse even if it is convinced it would have found differently.” Id. None of the district court’s findings of fact are clearly erroneous.
Defendants initially attack the Order for saying that “‘Defendants do not dispute that currently they are not providing these forms of assistance, as such, to members of the plaintiff class.’” AOB 40-41, citing Order, ER 14672 n.3. But
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Defendants then admit in the next sentence that “‘[w]raparound services’ and ‘therapeutic foster care’ are not Medicaid-covered services as such and are therefore not covered as such under the Medi-Cal program.’” AOB 41. Where is the error by the court below? Defendants baldly assert that “all required Medicaidcovered services are covered as EPSDT services under the Medi-Cal program.” AOB 41. Apparently, they have forgotten the undisputed fact that Medi-Cal does not cover either wraparound services or TFC.
Defendants make much of one sentence in the Order that “Defendants do not directly rebut or even challenge [Ms. Koyanagi’s] categorizations” of these two mental health services. AOB 41, citing Order, ER 14683. According to Defendants, the declaration of Rita McCabe “directly rebuts and challenges” how the components of wraparound services and TFC fall within the different categories of services under §1396d(a). AOB 41. In fact, Ms. McCabe begrudgingly acknowledged that Medicaid could cover six and possibly seven of the nine components of wraparound services [McCabe Decl., ER 12458-59, 12462-70, ¶¶12, 13, 22, 26, 30-35] and four of the seven components of TFC [id., ER 12470-74, ¶¶36-43]. More fundamentally, the trial court acted well within its discretion in not giving any credence to Ms. McCabe’s unfounded assertions that the remaining components of wraparound services and TFC are not covered Medicaid services. This DMH official has no demonstrated expertise regarding
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wraparound services and TFC. Ms. McCabe also did not corroborate her conclusory statements with citations to any written communications from the federal government or any reports on other state Medicaid programs. Nor did this witness offer any explanation as to why the Medicaid programs in several states cover wraparound services and TFC.
Defendants next fault the Order for mischaracterizing their “contentions with respect to Medicaid-covered services” under §1396d(a). AOB 41. The Order attributed to them the contention that “states need only provide those services expressly listed in §1396(d)(a).” Order, ER 14681. While Defendants did make such contentions in the court below [ER 7453, 7445], the description of a party’s legal contentions is not a finding of fact. In any event, Defendants now agree with the lower court that Medicaid covered services for EPSDT beneficiaries are not limited to those services listed expressly by name in §1396d(a). AOB 42.
Leaving no stone unturned, Defendants challenge the district court’s finding that “in other states wraparound services and therapeutic foster care programs have been funded by Medicaid.” AOB 42, quoting Order, ER 14684. The Order found that wraparound services were covered by Medicaid programs in four other states and that TFC was covered by Medicaid programs in 19 other states. Order, ER 14684-85.
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While Defendants protest that the “Order completely ignores” their evidence about other states’ Medicaid programs [AOB 42], their evidence consisted of quibbles about two states, Arizona and Nebraska. There was no dispute that the remaining two states covered wraparound services and that 19 states covered TFC. Moreover, the district court was presented with evidence from the former Deputy Director of Arizona’s Medicaid Program, corroborated by a wraparound provider in Arizona, that Arizona’s Medicaid program covers both TFC and wraparound services for Medicaid beneficiaries. Redman Decl., ER 6978-81, ¶¶19-30; Supp. Redman Decl., ER 13198-99, ¶¶3-6; Penrod Decl., ER 6864-67, ¶¶14-19, 26. As for Nebraska, that state previously had a Medicaid managed care plan – approved by CMS – that covered wraparound services as a bundled package of services. Supp. Koyanagi Decl., ER 13125-26, ¶3.b. Although Nebraska subsequently changed its managed care contract, the fact remains that CMS had given its approval to placing these wraparound services on Nebraska’s “Medicaid menu.” Id. There was no clear error in this finding either.
According to Defendants, another “clearly erroneous” finding of fact by the district court is that wraparound services and TFC “are services.” AOB 42, citing Order, ER 14676-80. The Medicaid Act covers both services and care. §1396d(a)(1)-(27). Defendants maintain that “wraparound” and TFC “are processes or approaches and are not Medicaid-covered services as such.” AOB 42.
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They are just playing semantic games. Defendants themselves refer to California’s existing wraparound program as the “Wrap-Around Services Pilot Project.” AOB 45 (italics added); see also Order, ER 14680 at n. 9. For purposes of that pilot project, Welfare and Institutions Code §18250 supplies a definition of “wraparound services.” As for TFC, its very name is therapeutic foster care.
Defendants never explain exactly what they mean by a “process” or an “approach.” One definition of “process” is “a series of actions or operations conducing to an end.” Webster’s Ninth New Collegiate Dictionary (Merriam Webster 1991) at 937. Under this definition, all different types of medical treatment – a series of actions or operations designed to improve a patient’s condition – are “processes.” No one disputes that these “processes” are Medicaidcovered services. See, e.g., §1396d(a)(1)(inpatient hospital services) and §1396d(a)(11)(physical therapy). By the same token, an “approach” has been defined as “the taking of preliminary steps towards a particular purpose” or “a particular manner of taking such steps.” Webster’s Ninth New Collegiate Dictionary at 98. Under this definition, all different types of medical treatment could also be described as “approaches,” which once again are Medicaid-covered services.
Discharge planning, service plan development, cognitive behavioral therapy, assertive community treatment and other mental health services can all be
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described as processes or approaches. Supp. Koyanagi Decl., ER 13128, ¶9. All these mental health services are covered by Medicaid. Id. Indeed, Defendants’ principal witness, Rita McCabe, has stated that “[a]ssessment is a ‘mental health service’ under Medi-Cal Specialty Mental Health Services” [McCabe Decl., ER 12475, ¶45], and yet she has also stated that “[a]ssessment is frequently described in the health care industry as the process of gathering information for the purpose of making a decision.” Id., ER 12970, ¶21 (italics added). As one wraparound provider explained:
[R]eferring to Wraparound as a process . . . do[es] not mean . . . that it is not a mental health service. Individual and group therapy and case management services, for instance, can all be described as processes, but they are unquestionably mental health services. The same is true for Wraparound. Order, ER 14681 n. 10, quoting Farr Decl., ER 6433, ¶23 n. 1. Defendants have not cited any law or case that draws the distinction they do between care and services versus processes and approaches. In short, there was no clear error in the lower court’s finding that wraparound services and TFC are services. For their last argument about the findings of facts, Defendants protest that “[m]ost of Plaintiffs’ declarations do not state, or even suggest, that ‘wraparound
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services’ or ‘therapeutic foster care’ are Medicaid-covered services as such.” AOB 43. This argument misses the mark. As the district court noted, Plaintiffs relied on “different experts” to establish that wraparound services and TFC are Medicaid covered services. Order, ER 14680 at n. 9. In their discussion of the findings of facts, Defendants say nothing about the declarations from Chris Koyanagi, Timothy Penrod, Linda Redman and Bruce Kamradt even though these witnesses all discussed how other states’ Medicaid programs cover wraparound services and TFC. See, e.g., Redman Decl., ER 6978-81, ¶¶19-29 (describing experiences in Arizona and other states). Nor do Defendants mention the declaration that they had obtained from Mary Jean Duckett, wherein this CMS official acknowledged that “[s]ome states have included in their approved state plans, coverage for services under the label of therapeutic foster care that CMS believed to consist of component parts that are Medicaid-covered care and services” and that “some of the component parts included in plaintiffs’ conception of ‘wraparound services’ may be covered by Medicaid.” Duckett Decl., ER 11445-46, ¶¶4, 5. Consistent with Ms. Duckett’s declaration, Ms. Koyanagi reported that “nearly half of the states’ Medicaid programs cover TFC and several states’ Medicaid programs cover wraparound services.” Koyanagi Decl., ER 6645, 6652-53, 6657-58, ¶¶3, 27 and 29. Thus, there was ample evidence to support the district court’s finding that wraparound services and TFC are Medicaid covered services.
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IV. THE DISTRICT COURT CORRECTLY APPLIED THE LAW IN GRANTING THE PRELIMINARY INJUNCTION.
With this appeal, Defendants are just as unsuccessful in challenging the district court’s conclusions of law as they are in challenging its findings of fact. AOB 44-47. The lower court applied the correct standards of law.
Defendants contend that the court below “failed to employ the appropriate legal standards governing the issuance of the mandatory preliminary injunction” against them. AOB 44. Yet Defendants then reverse themselves and concede that the “Order sets forth the legal standard for issuance of a preliminary injunction and the legal standard governing the issuance of a mandatory preliminary injunction.” Id. The Order does set forth the correct legal standards. Order, ER 14674.
Defendants next argue that “there is no legal basis whatsoever for enjoining DSS” because “DHS has not delegated any authority to DSS to administer the Medi-Cal program.” AOB 38, 44. Delegation is not the proper test for the scope of an injunction. Under Fed.R.Civ.P. 65(d), an injunction binds “the parties to the action” as well as “their officers, agents, servants, employees and attorneys” plus “those persons in active concert or participation with them who receive actual notice of the order.” This rule “‘is derived from the common law doctrine that a decree of injunction not only binds the parties, but also those identified with them in interest, in privity with them, represented by them or subject to their control.’”
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Class Plaintiffs v. City of Seattle, 955 F.2d 1268, 1280 (9th Cir. 1992), quoting Regal Knitwear Co. v. NLRB, 324 U.S. 9, 14 (1945).
Here, because DHS decides how to operate the Medi-Cal program, DSS “must comply with any decision of DHS,” and is “subject to the ‘control’ of DHS in the administration of Medicaid.” Emily Q., 208 F.Supp. at 1093. DSS already oversees a number of wraparound programs in California. The Order ensures that DHS’ decisions about EPSDT funding will be implemented in those programs as well as those administered by DMH. Moreover, because DSS has supervisory responsibilities for foster children throughout California, it also acts in concert with DHS in providing (or denying) wraparound to class members. And the due process concerns that arise when an injunction binds a non-party do not apply here, since DSS already is a party. Compare Emily Q., 208 F.Supp. at 1093 (order bound agencies which were non-parties).
The Order mostly discussed the merits of Plaintiffs’ Medicaid claims. ER 14676-88. Defendants can find no fault in the district court’s legal analysis of the Medicaid Act and its EPSDT provisions. AOB 44-47. Instead, they cite Alexander v. Choate, 469 U.S. 287, 303 (1985), and Townsend v. Quasim, 328 F.3d 511, 518 (9th Cir. 2003), for the proposition that “Medicaid programs do not guarantee that each recipient will receive that level of health care precisely tailored to his or her particular needs.” AOB 46-47. Both those cases do not apply here.
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Alexander involved claims under §504 of the Rehabilitation Act, 29 U.S.C. §794; Townsend involved claims under the Americans with Disabilities Act, 29 U.S.C. §12132. In contrast, this lawsuit presents claims under the EPSDT statutes, which provide, in pertinent part, that a state must furnish “[s]uch other necessary health care, diagnostic services, treatment, and other measures” to “correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.” §§1396a(a)(10)(A)(i), 1396d(r)(5). As one court explained, states have a “mandatory duty” to “provide EPSDT-eligible children with all the health care, services, treatments and other measures described in § 1396d(a) of the [Medicaid] Act, when necessary to correct health problems. . . .” S.D. ex rel Dickson v. Hood, 391 F.3d 581, 589-90 (5th Cir. 2004).
Citing the Deficit Reduction Act of 2005 (“DRA”), Defendants stress that “Medicaid does not cover case management services covered by a third party.” AOB 46. DRA did not, however, change the law on which either Plaintiffs’ preliminary injunction motion or the Order is based. Defendants concede that DRA merely “codified” “CMS’ longstanding interpretation” of the requirements for case management in §§1396d(a)(19) and 1396n(g)(2). AOB 46. DRA permits federal financial participation for case management services and targeted case management services whenever “there are no other third parties liable to pay for
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such services. . . .” §1396n(g)(4)(A). But this has always been the case as Plaintiffs’ experts previously testified. Exhibit 2 to Supplemental Decl. of Chris Koyanagi, ER 13158 (“[P]ayment [for case management] may not be made for services for which another payer is liable”).
The gravamen of this lawsuit is that Medicaid-eligible members of the class are entitled to receive wraparound services and TFC from Medi-Cal when those services are medically necessary. That statutory entitlement does not suddenly disappear because some California counties have exercised their discretion to provide wraparound services to some class members. Both Appendix A (definition of wraparound services) and Appendix B (definition of TFC) do not contemplate that any type of case management services will be provided when a third party is otherwise liable to pay for these services. Hence, the enactment of DRA was no reason for the Court to issue a different ruling on the preliminary injunction motion.
Finally, Defendants argue that the district court committed “legal error” by ordering them “to provide screening and services to all class members.” AOB 47. The Order is not that sweeping. It only states that “California must screen members of the statewide class and provide wraparound services and therapeutic foster care where medically necessary ‘to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening
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services.’” Order, ER 14689, quoting §1396d(r)(5). Defendants nevertheless insist that the “Medicaid statute only requires availability of ‘medical assistance’ and not the provision of services.” AOB 47. Yet the very Medicaid provisions cited by Defendants – §§1396a(a) and 1396d(a) – make clear that “medical assistance” includes the provision of services. A state must provide “for making medical assistance available, including at least the care and services listed in . . . §1396d(a)” to eligible children. §1396a(a)(10)(A)(i)(III) (emphasis added). “Medical assistance” is defined as payment for the more than a dozen specific “care and services” listed in that section, including EPSDT “services.” §1396d(a)(4)(B). EPSDT services are, in turn, defined to include several “items and services,” such as “screening services,” “vision services,” “hearing services,” and any other necessary care, service, treatment or other measure identified in subsection (a). §1396d(r). Thus, the requirement that Defendants provide screening and services to class members is completely consistent with the Medicaid statutes.
V. THE ORDER GRANTING THE PRELIMINARY INJUNCTION MOTION COMPLIES WITH RULE 65.
In conclusory fashion, Defendants contend that the Order “fails dismally” to comply with Rule 65(d) since it “is profoundly unclear” as to what they are required to do. AOB 47. Not true.
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The Order specifies that Defendants shall provide wraparound services and
TFC, “as defined in Appendices A and B” to “class members on a consistent,
statewide basis through the Medi-Cal program or other means beginning not later than 120 days from entry of the Order.” ER 14689-90.66 The Order also directed
the parties to develop a plan for implementing the preliminary injunction and that
this plan must, among other things, “identify the responsibilities of the different
State agencies, the need for additional providers, the eligibility criteria for
wraparound services and therapeutic foster care, methods and procedures to inform
class members of the availability of these services, and a timeline for
accomplishing needed tasks.” Id. at 1460.
Every order granting an injunction “shall be specific in terms” and “shall
describe in reasonable detail” the acts to be performed. Fed.R.Civ.P. 65(d). The
Order in this case meets these requirements.
VI. DEFENDANTS’ MISCELLANEOUS OBJECTIONS TO THE PROCEEDINGS BELOW ARE DEVOID OF MERIT.
Scattered throughout Appellants’ Opening Brief are their miscellaneous
grievances with the proceedings below. At one point, Defendants contend that
66 The district court indicated that the Order “should not be construed to mean that every component and/or subcomponent of wraparound services and TFC, as described in Appendices A and B, must be funded, monitored, reported on, etc.” Addendum, ER 15315. In doing this, the district court tried to give Defendants some flexibility in administering the Medi-Cal program, but Defendants then criticize the lower court for not complying with Rule 65. AOB 47. Damned if you, damned if you don’t.
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“Plaintiffs have obstreperously resisted defining what they mean by the terms ‘wraparound services’ and therapeutic [foster] care.” 67 AOB 3. In fact, Plaintiffs’ supplemental responses to interrogatories included a one-page definition of wraparound services followed by an eight-page chart that breaks wraparound services into nine different components and, for each such component, provides a definition, a listing of the rendering providers and a listing of the relevant federal statutory authorization. Goldsmith Decl., ER 12535-36, ¶20; ER 12627-36. Plaintiffs’ supplemental responses similarly included a one-page definition of TFC followed by a seven-page chart setting forth the different components of TFC, the definition of these components, as well as the corresponding list of rendering providers and statutory authorization for these components. Id., ER 12637-44. The district court adopted these detailed responses as Appendices A and B to the Addendum to the Order. ER 1530-38.
Another grievance of Defendants is that the district court supposedly did not hold a “hearing on the merits” of Plaintiffs’ preliminary injunction motion. AOB 20, 24. On closer inspection, Defendants’ complaint is that they did not have much of an opportunity to present oral argument at the October 31 hearing. A district court may, however, determine motions without oral hearing upon brief written 67 Defendants did not even ask Plaintiffs for definitions of these terms until April 28, 2004. Supplemental Decl. of Robert D. Newman, ER 13191, ¶2. Plaintiff Henry D. served timely responses to the relevant interrogatories on May 28, 2004. Id., ¶3.
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statement of reasons in support and opposition. Fed.R.Civ.P. 78. See, e.g., Spradlin v. Lear Siegler Management Services Co., Inc., 926 F.2d 865, 869 (9th Cir. 1991) (appellant failed to demonstrate that he was prejudiced by being denied opportunity to present oral argument since ‘[a]rgument by counsel serves only to elucidate the legal principles and their application to the facts at hand; it cannot create the factual predicate”). Here, Defendants have made no showing of any prejudice because they were not allowed to present a more extensive oral argument regarding the preliminary injunction motion.
Defendants make passing references to California’s Mental Health Waiver, Plaintiffs’ alleged noncompliance with an April 19, 2005, discovery order, the district court’s discovery rulings and, the denial of a joinder motion. AOB 47. “A ‘bare assertion’ of an issue ‘does not preserve a claim, particularly when, as here, a host of other issues are presented for review.’” D.A.R.E. America v. Rolling Stone Magazine, 270 F.3d 793, 793 (9th Cir. 2001) (citation omitted). “‘Issues raised in brief which are not supported by argument are deemed abandoned.’” AcostaHuerta v. Estelle, 7 F.3d 139, 144 (9th Cir. 1992)(citation omitted). Defendants have advanced no arguments regarding any of these issues. They are all waived.
CONCLUSION For the foregoing reasons, the Court should affirm the Order granting the preliminary injunction motion in its entirety.
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Dated: August 10, 2006

Respectfully submitted,
By Robert D. Newman Attorney for Plaintiffs/Appellees

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STATEMENT OF RELATED CASES Emily Q., et al. v. Sandra Shrewy, Case Nos. 06-55339 and 06-55489, is a related case to the instant case in that it too is before District Judge Matz and it involves the obligations of California’s Medicaid program to provide a medically necessary, mental health service – therapeutic behavioral services – to a statewide class of Medicaid eligible beneficiaries (albeit a different class than the class in Katie A.). Plaintiffs agree with Defendants that Emily Q. is not related to the instant appeal.
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REQUEST FOR ORAL ARGUMENT Plaintiffs hereby request that this appeal be set for oral argument.

Dated: August 10, 2006

Respectfully submitted,

By Robert D. Newman Attorney for Plaintiffs/Appellees

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CERTIFICATE OF COMPLIANCE Pursuant to Federal Rule of Appellate Procedure 32(a)(7)(C) and Ninth Circuit Rule 32-1, I certify that this Brief of Plaintiff-Appellees complies with the type-volume limitation of Fed. R. App. P. 32(a)(7)(B) because this brief contains 13,941 words, excluding the parts of the brief exempted by Fed. R. App. P. 32(a)(7)(B)(iii).

I further certify that this brief complies with the typeface requirements of Fed. R. App. P. 32(a)(5) and the type style requirements of Fed. R. App. P. 32(a)(6) because this brief has been prepared using Times New Roman 14-point font, a proportionately spaced typeface.

Dated: August 10, 2006

Respectfully submitted,

By Robert D. Newman Attorney for Plaintiffs/Appellees

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SERVICE LIST

BILL LOCKYER Attorney General of the State of California JOHN H. SANDERS Lead Supervising Deputy Attorney General RICHARD T. WALDOW Supervising Deputy Attorney General SANDRA L. GOLDSMITH Deputy Attorney General KAREN ACKERSON-BRAZILLE Deputy Attorneys General 300 South Spring Street, #1702 Los Angeles, CA 90013-2501 (213) 897-2439 (213) 897-2805 - Fax

Attorneys for State Defendants, DIANA BONTÁ, Director of California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

RAYMOND G. FORTNER JR. County Counsel ANDREW W. OWENS Assistant County Counsel BRANDON T. NICHOLS Deputy County Counsel Hall of Administration, Room 602 500 West Temple Street Los Angeles, CA 90012 (213) 974-1938 (213) 687-4745 - Fax

Attorneys for Los Angeles County Defendants

ATTORNEYS FOR PLAINTIFFS

ROBERT D. NEWMAN, ESQ. KIMBERLY LEWIS, ESQ. Western Center for Law and Poverty 3701 Wilshire Boulevard, #208 Los Angeles, CA 90010-2809 (213) 487-7211 (213) 487-0242 - Fax RON PETERSON, ESQ. Heller Ehrman LLP 333 South Hope Street, Suite 3900 Los Angeles, CA 90071-3043 (213) 689-0200 (213) 614-1868 MARK D. ROSENBAUM, ESQ. American Civil Liberties Union of Southern California 1616 Beverly Boulevard Los Angeles, CA 90026-5752 (213) 977-9500 (213) 4278767 - Fax MELINDA BIRD, ESQ. MARILYN HOLLE, ESQ. Protection & Advocacy, Inc. 3580 Wilshire Boulevard, #902 Los Angeles, CA 90010 (213) 427-8747

(213) 427-8767 IRA BURNIM, ESQ. ALISON BARKOFF, ESQ. Bazelon Center for Mental Health Law 1101 Fifteenth Street, NW, #1212 Washington, D.C. 20006 (202) 467-5730 (202) 223-0409 JOHN F. O’TOOLE, ESQ. PATRICK GARDNER, ESQ. LEECIA WELCH, ESQ. National Center for Youth Law 405 14th Street, 15th Floor Oakland, CA 94612-2701 (510) 835-8098 (510) 835-8099 - Fax
384783v1

2

LA 407330 v1

 </s> • Appeal No. 06-55559
•
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
•

Diana Bonta, et al., Petitioner,
v.
Katie A., et al., Respondent.
•
ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA THE HONORABLE A. HOWARD MATZ
CASE No. CV-02-05662 BRIEF OF AMICI CURIAE IN SUPPORT OF AN AFFIRMANCE

•

O'MELVENY & MYERS LLP

MICHAEL M. MADDIGAN

KAREN R. GROWDON

ANASTASIA M. SMITH

400 SOUTH HOPE STREET

Los ANGELES, CA 90071

TELEPHONE: (213) 430-6000

FACSIMILE: (213) 430-6407

Attorneys for Amici Curiae American Academy ofChild and Adolescent Psychiatry, American

•

Academy ofPediatrics, California District IX, California Alliance ofChild and Family Services, California Adolescent Health Collaborative, California Association ofSocial

Rehabilitation Agencies, California Nurses Association, California Public Health

Association-H. California School Nurses' Organization, California Teachers' Association,

Children's Advocacy Institute, Children's Law Center ofLos Angeles, Federation ofFamilies

for Children's Mental Health, National Alliance for the Mentally Ill, National Association of

Social Workers, National Council on Community Behavioral Health, National Mental Health

Association, and the Southern California Public Health Association

•

CORPORATE DISCLOSURE STATEMENT REQUIRED BY FEDERAL

•

RULE OF APPELLATE PROCEDURE 26.1

The undersigned counsel states that:

•

American Academy of Child and Adolescent Psychiatry ("AACAP") is a

Delaware corporation, with no parent or subsidiary, and that no publicly held

company owns I0% or more of AACAP's stock.

American Academy of Pediatrics, California District IX (AAP-CA), is an

•

Illinois corporation, with no parent or subsidiary, and that no publicly held

company owns 10% or more of AAP-CA's stock.

•

California Alliance of Child and Family Services ("CACFS") is a California

corporation, with no parent or subsidiary, and that no publicly held company owns

10% or more ofCACFS's stock.

California Association of Social Rehabilitation Agencies ("CASRA") is a

California corporation, with no parent or subsidiary, and that no publicly held company owns 10% or more of CASRA' s stock.

California Nurses' Association ("CNA") is a California corporation, with no parent or subsidiary, and that no publicly held company owns I0% or more of

CNA's stock.

California Public Health Association-N ("CPHA-N") is a California

corporation, with no parent or subsidiary, and that no publicly held company owns

•

10% or more ofCPHA-N's stock.

•

California School Nurses' Organization ("CSNO") is a California

corporation, with no parent or subsidiary, and that no publicly held company owns

•

10% or more ofCSNO's stock.

California Teachers' Association ("CTA") is a California corporation, with

no parent or subsidiary, and that no publicly held company owns l 0% or more of

CTA's stock.

Children's Advocacy Institute is owned by the University of San Diego t
("USD"); USD is a California corporation, with no parent or subsidiary, and no
publicly held company owns 10% or more ofUSD's stock.

Children's Law Center of Los Angeles ("CLCLA") is a California corporation, with no parent or subsidiary, and that no publicly held company owns 10% or more of CLCLA 's stock.

Federation of Families for Children's Mental Health ("FFCMH") is a Virginia corporation, with no parent or subsidiary, and that no publicly held company owns 10% or more ofFFCMH's stock.

National Alliance for the Mentally Ill ("NAMI") is a Virginia corporation, with no parent or subsidiary, and that no publicly held company owns 10% or more ofNAMI's stock.

National Association of Social Workers ("NASW") is a Delaware

•

corporation, with no parent or subsidiary, and that no publicly held company owns

I

10% or more ofNASW's stock.

National Mental Health Association ("NMHA") is a New York corporation,

1

with no parent or subsidiary, and that no publicly held company owns 10% or more

ofNMHA's stock.

Respectfully submitted August 10, 2006.

•

MICHAEL M. MADDIGAN

KAREN R. GROWDON

ANASTASIA M. SMITH

JAMES KIDDER

BRANDlE ODGERS

GARYHO

liLLIAN ALLEN

O'MELVENY & MYERS LLP

Attorneys for Amici Curiae

LA2:807973.1

•

•

TABLE OF CONTENTS

Page

I. INTEREST OF THE AMICI CURIAE ................................................................... !

•

II. SUMMARY OF ARGUMENT ...............................................................................3

III. ARGUMENT ...........................................................................................................6

A. Wraparound Services and Therapeutic Foster Care Are Two of the Most Effective Therapies for Children With Serious Mental Health Problems .......................................................................................................6

1. Wraparound .......................................................................................6

2. Therapeutic Foster Care ................................................................... l 0

t

B. California And Other States Have Implemented Wraparound And TFC Services With Great Successes .......................................................... .15

I. Wraparound ..................................................................................... 15

2. Therapeutic Foster Care ................................................................... 19

C. California Has Recognized The Benefits of These Therapies and Implemented Legislation to Provide Them ................................................20

D. Implementing Wraparound and TFC Would Save California Millions ofDollars ......................................................................................22

t

E. Wraparound and TFC Services Are Only Available to California

Children in Foster Care On A Limited and Ad Hoc Basis .........................27

F. The Experience of Other States Shows That Federal Funding Is Clearly Available for Wraparound and TFC ..............................................28

IV. CONCLUSION ...................................................................................................... 29

•

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•

TABLE OF AUTHORITIES

Page

•

Katie A. v. Bonta,

CASES

No. CV02-5662 AHM (Mar. 14, 2006) ....................................................................... 13

OTHER AUTHORITIES

California Institute for Mental Health, Evidence-Based Practices in Mental Health Services For Foster Youth (March 2002) ................................................ passim

Code Blue: Health Services for Children in Foster Care (December 1998)..................... .4

Department of Mental Health, Out-Of-Home Care Report, Chapter 26.5 (1997) ........................................................................................................................... 10

t

Department of Mental Health, Talking Points, Responses to Little Hoover

Commission Report...................................................................................................... ! 0

Department of Social Services, Reexamination ofthe Role ofGroup Care in a Family-Based System ofCare .................................................................................. 16

E. Bruns, et al., Ten Principles ofthe Wraparound Process (2004) ..................................8

J. Takayama, et al., Children in foster care in the state of Washington: health care utilization and expenditures. JAMA. 1994; 27l:l850-1855 ..................... .4

Little Hoover Commission, Still in Our Hands: A Review ofEfforts to Reform Foster Care in California (February 2003) ......................................................3

Little Hoover Commission, Young Hearts & Minds: Making a Commitment to Children's Mental Health (October 2001) ............................................... 3, 4, 22, 23

M. Simms, eta!., Health Care Needs of Children in the Foster Care System, PEDIATRICS. 2000; 106; 909-918 .................................................................... .4

Mental Health: A Report ofthe Surgeon General (1999) .............................. 10, 13, 14, 22

N. Halfon, et a!., Children in foster care in California; an examination of Medicaid reimbursed health services utilization. PEDIATRICS. 1992; 89:1230-1237 ................................................................................................................ .4

Plumas County, SB 163 Final Evaluation Report (March 17, 2004) ...............................24

R. Hahn, et al., The Effectiveness Of Therapeutic Foster Care for the Prevention of Violcmce, American Journal of Preventive Medicine (2005) at 79 .................................................................................................................. 13

LA2:800022.7

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•

I. INTEREST OF THE AMICI CURIAE

•

Amici Curiae American Academy of Child and Adolescent Psychiatry,

American Academy of Pediatrics, California District IX, California Alliance of

I

Child and Family Services, California Adolescent Health Collaborative, California

Association of Social Rehabilitation Agencies, California Nurses Association,

California Public Health Association-N, California School Nurses' Organization,

California Teachers' Association, Children's Advocacy Institute, Children's Law

•

Center of Los Angeles, Federation of Families for Children's Mental Health,

National Alliance for the Mentally Ill, National Association of Social Workers,

National Council on Community Behavioral Health, National Mental Health

Association, and the Southern California Public Health Association (collectively

the "amici") respectfully submit this memorandum in support of affirmance of the

March 14, 2006 ruling by the Honorable A. Howard Matz of the United States

District Court for the Central District of California issuing a preliminary injunction in this action. 1

The amici collectively include many of the foremost authorities on children's mental health issues in the United States. They include professionals who treat children with serious mental health needs, parents and family members of such children, teachers, and others who have considerable expertise with respect

1 A brief description of each amicus organization is included herein as Exh. A.

•

to the needs of such children. Many of them have considerable experience in

•

providing mental healthcare services to foster children in a community-based

environment. As a result of this expertise and experience, amici are uniquely

•

positioned to speak to the need for, and effectiveness of, wraparound services and

therapeutic foster care.

For the reasons that follow, the amici believe that wraparound services and therapeutic foster care are medically necessary therapies that should be covered by California's Medi-Cal system. Such coverage is the only way to ensure that the thousands of children in the California foster care system with mental health needs are afforded the critical mental health care to which they are entitled, and the opportunity to live healthy and productive lives.

- 2-

•

II. SUMMARY OF ARGUMENT

•

Every year, more than 40,000 children are placed into the California foster

care system.2 All too often, California inflicts further harm by failing to provide

•

these children with necessary education and healthcare services.3 Even though an

estimated 70% of these children experience mental health disorders while

dependents of the state, the California Department of Mental Health has

nevertheless admitted that many of them are not receiving the care they need.4 As

a result, foster care all too often becomes "a heartless limbo" resulting in myriad

•

"childhoods squandered by an unaccountable bureaucracy."5 Unfortunately, the

very system established to help these children heal their childhood scars often ends

•

up inflicting additional trauma. 6

Mental health problems in children are extremely debilitating. Anxiety

disorders, attention deficit and behavioral disorders, development disorders, and

2 Little Hoover Commission, Still in Our Hands: A Review ofEfforts to Reform Foster Care in California (February 2003)(hereafter "Still in Our Hands"), Excerpts of Record ("ER") 04538.
3 !d.
4 Little Hoover Commission, Young Hearts & Minds: Making a Commitment to Children's Mental Health (October 2001 )(hereafter" Young Hearts"), ER 04624; see also California Health and Human Services Foster Care Slide Presentation, ER 05463-05464 (finding that 84% of a sample of 213 foster care children had mental health issues.)
5 Still in Our Hands, ER 04538.
6 !d.

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I

mood disorders affect the daily lives of children.7 Children in foster care are

I

significantly more likely to have a mental health disorder than their peers; 1988

data revealed that foster care children constituted 4% of children enrolled in

I

MediCal, but 55% of all visits to psychologists and 45% of MediCal-paid

psychiatrist visits.8 The California Institute for Mental Health estimates that "the

incidence of emotional, behavioral and developmental problems, among children

in foster care is three to six times greater than children in the community."9 The

consequences of untreated mental disorders for these vulnerable children are dire-
I
unnecessary suffering, multiple failed placements, unnecessary institutionalization,

juvenile delinquency, and even suicide. 10

I

7 Young Hearts, ER 04611.

8 M. Simms, eta!., Health Care Needs ofChildren in the Foster Care System,

PEDIATRICS. 2000; 106; 909-918 (hereafter "Simms (2000)"), Exh. B at 913 citing

I

N. Halfon, et al., Children in foster care in California; an examination ofMedicaid

reimbursed health services utilization. PEDIATRICS. 1992; 89:1230-123 7. Another

study analyzing Washington State Medicaid data from 1990 compared children in

Washington's foster care program with children receiving Aid to Families With

Dependent Children (AFDC); 25% of foster care children utilized mental health

services compared to 3% of AFDC children. !d. citing J. Takayama, eta!.,

Children in foster care in the state of Washington: health care utilization and

expenditures. JAMA. 1994; 271:1850-1855.

9 California Institute for Mental Health, Evidence-Based Practices in Mental Health Services For Foster Youth (March 2002)(hereafter "CIMH Report"), ER 04813. See !d., ER 04832 ("[California] foster children were twenty times more likely to use outpatient services and nine time more likely to be hospitalized for mental health problems than MediCal children not in foster care.")

10 !d., ER 04826-04831; Simms (2000), Exh. Bat 912. See, e.g., Code Blue: Health Services for Children in Foster Care (December 1998), ER 04943 (noting

-4-

I

California, however, has failed to satisfY its obligation to provide these

1

children with medically necessary mental health services. Although a few

California counties have enacted wraparound services ("Wraparound") and

therapeutic foster care ("TFC") with great medical and financial success, neither of

these services is accessible to the majority of California's foster children. Even

when and where these services are provided, only a fraction of the eligible children

actually receive them, and often not until after their mental health issues have

escalated far beyond the point where Wraparound and TFC first became medically

necessary.

On March 14, 2006, the Honorable A. Howard Matz ofthe United States

t

District Court for the Central District of California issued a preliminary injunction

in this action, requiring the Directors of the California Department of Heath

Services (hereafter "DHS") and the California Department of Social Services

(hereafter "DSS")(collectively "State Defendants") to provide Wraparound and

TFC to eligible foster children in California within 120 days. The amici seek to

aid the Court in evaluating this appeal by illuminating: (1) the clinical

effectiveness of Wraparound and TFC services; (2) the positive and cost-effective

experience California and other states have had with both services; (3) California's

that "[a]s wards of the state, children in foster care depend on government services for medical treatment").

-5-

•

recognition of the benefits of Wraparound and TFC services; and (4) despite this

•

recognition, California's failure to consistently provide these services to the foster

care children enrolled in MediCal.

•

III. ARGUMENT

A. Wraparound Services and Therapeutic Foster Care Are Two of

the Most Effective Therapies for Children With Serious Mental

Health Problems.

•

According to the California Institute for Mental Health, Wraparound and

TFC are the "only two intervention models that have demonstrated effectiveness for the treatment of foster care children." 11 Furthermore, research has shown that

Wraparound and TFC are the only interventions which may be beneficial to "foster

children who are disruptive, aggressive, and defiant and who experience unstable placements." 12 Although not every foster child is in need of these services, the

State must comply with its obligation to the multitude of children for whom these

services are medically necessary.

I. Wraparound Wraparound services are individualized, community-based services provided

to children with mental health needs as an alternative to removal from their homes

and communities and placement into more restrictive institutional settings such as

hospitalization or incarceration. Grealish Declaration ("Dec!."), ER 06501-06505,

11 CIMH Report, ER 04834. 12 !d., ER 04818.

-6-

I

~~ 21, 25, 27. A panel of nationwide experts has agreed that the core elements of

1

Wraparound services are that they be "family-driven, team-based, collaborative,

community-based, culturally competent, individualized, strength-based, natural-

support focused, unconditional, and outcome based." Bruns Decl., ER 06213, ER 06215, ~~22, 33. 13 Indeed, Defendant DSS defines Wraparound similarly. 14

These terms are key to Wraparound's effectiveness. For example,

"community-based" means that "services should be provided in the local

community or rural area where the child and his/her family live" and that

"[r]estrictive or institutional care should be accessed for brief stabilization only."

Dennis Dec!., ER 06396, ~ 19(b). There is a lot of evidence supporting the

superior outcomes of community-based treatment as compared to restrictive

placements. Bruns Decl., ER 06213, ~ 25. "Individualized' services are "based on

specific needs of the child and/or family, and not on a particular categorical

intervention model," and include both traditional services, such as therapy, tailored

to the child and family's needs, as well as non-traditional services, such as using

staff to provide services in the family home. Dennis Decl., ER 06396-06397, ~

13 See also CIMH Report, ER 04835 (providing a similar description of Wraparound).
14 DSS All-County Information Notice No. 1-28-99 (April 7, 1999), ER 04497 ("Wraparound is a family-centered, strengths-based, needs-driven planning process for creating individualized services and supports for children, youth, and their families that facilitate access to normalized and inclusive community options, activities and opportunities.").

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I

19(g). "Family driven" or what one expert calls "family choice and voice" means

I

that, "[f]rom a clinically therapeutic standpoint, the research shows that voice and

choice matters. One study showed that when therapists direct treatment, without

•

family alliance, the results are poorer than where there is family buy-in on the

treatment goals." Bruns Dec!., ER 06214, ~ 26; see also id., ER 06213-06214, ~~

23-28 (definitions of other terms). The principle of"strength-based' services

necessitates that "the positive aspects of the child, family and community must be

considered and be an integral part of treatment planning and service delivery."

Dennis Dec!., ER 06396, ~ 19(d). As a last example, the critical "unconditional"

element means "the team agrees to never deny services because of extreme

severity or disability, to change services as needs of the child and family change,

and to never reject the child or family from services." Id., ER 06396, ~19(c). 15

Wraparound has received widespread recognition as an effective therapy for

children with serious mental health needs. See, e.g., Bruns Dec!., ER 06207, ~ 3

("[W]raparound is generally cited among the most effective integrated community-

based interventions for children with emotional, behavioral, and mental health

disorders."); Friedman Dec!., ER 06451, ~ 4 (stating that Wraparound is "a

'

research validated evidence-based practice"); Grayson Deposition ("Dep."), ER

15 See E. Bruns, eta!., Ten Principles ofthe Wraparound Process (2004) (attached to Bruns Dec!.) for a discussion of many of these terms.

-8-

09645, p. 125:20-23 (noting that the Department of Social Services considers

Wraparound to be an evidence-based practice). The Surgeon General shares this

perspective, and has specifically cited Wraparound Services as a promising

practice on more than one occasion. See, e.g., Bruns Dec!., ER 06212, ~ 21. As

such, wraparound must be an integral part of"any modern children's mental health

system." Bruns Dec!., ER 06207, ~ 3.

Where Wraparound has been implemented, the results have been "extremely

encouraging." Bruns Dec!., ER 06212, ~ 21. As compared to "treatment-as-usual"

programs such as group care, psychiatric hospitalization, and incarceration,

Wraparound results in "greater declines in behavioral problems, greater increases

in functioning, higher stability in residential placements, and an increased

likelihood of permanent placement." Bruns Dec!., ER 06121, ~ 22(a). One study

II

found that children receiving Wraparound "were significantly less likely to change

placements," had lower rates of delinquency, and displayed fewer externalizing

behaviors. 16 Moreover, older youths who received Wraparound were significantly

more likely to be in permanent family settings or living on their own, rather than

continuing to bounce around the system. 17 Just as importantly, the positive results

II

continue after treatment ceased. During the post-intervention period, children with

16 CIMH Report, ER 04836. 17 !d.

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•

histories of incarceration and running away display significant declines in these

•

self-destructive behaviors when compared to their peers who received standard

practi•Ce servi.ces. 18

•

The State of California has repeatedly recognized the efficacy of

Wraparound. The Department of Mental Health heralds the service as one

"working to improve services/supports to our foster care populations and their families." 19 Similarly, DSS officials credit Wraparound with enabling foster

children to live at home or in a home-like setting. Grayson Dep., ER 09266-

•

09267, pp. 46:20-47:5.

2. Therapeutic Foster Care20 TFC is considered the least restrictive form of out-of-home placement for

children with severe emotional disorders. 21 The service is provided by foster

18 Jd.
19 Department of Mental Health, Talking Points, Responses to Little Hoover Commission Report, ER 04745-04749. See also Department ofMental Health, Out-OfHome Care Report, Chapter 26.5 (1997), ER 04925 (wraparound services are among the "intensive efforts [that] are critical to the successful treatment of youth" with severe emotional disturbances and "help to minimize the need for future" out-of-home care and institutional care.)
20 TFC is also called treatment foster care, specialized foster care, multidimensional therapeutic foster care, or multi-systemic therapeutic foster care.
21 Mental Health: A Report ofthe Surgeon General (1999)(hereafter "1999 Surgeon General Report"), ER 04885. See also Chamberlain Dec!., ER 06291, ~ 9 (TFC "is widely considered to be the least restrictive and most integrating form of out-of-home placement for children with severe emotional and behavioral disorders.")

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•

parents who are specially trained to work with children with mental health needs;

t

these foster parents are an integral part of implementing a child's treatment plan

and the child and foster parents are given ongoing supervision and support.

•

Chamberlain Dec!., ER 6292, ER 6294, ~~ 12(b), 12(d). Although TFC programs

vary, common features include specially trained foster parents, foster homes that

only take one child at a time, small and manageable caseloads for agency

supervisors, higher stipends for therapeutic foster parents, extensive supervision

and support during placement, continual contact with case managers and/or care

•

coordinators, and the utilization oftraditional mental health services on an as

needed basis?2

TFC is sometimes the only option for youth unable to function in other

facilities, such as group homes, due to mental health and behavioral problems, or

simply a lack a skills to interact with peers. See, e.g., Dennis Dec!., ER 06391, ~5;

Dembrowsky Dec!., ER 6330-6331, ~ 16. Among other benefits, TFC provides

crisis intervention, family counseling, access to other community support

programs, assistance with child management, and skills to enhance family

functioning. Friedman Dec!., ER 06456-06458, ~ 26, 28; Grealish Dec!., 06494-

06495, ~~ 3-4. Additionally, TFC also improves the rate of foster parent retention

22 Jd.

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•

by increasing competency and decreasing stress among the foster parents.23

•

TFC has been called the "gold standard" of mental health intervention

programs for children. Friedman Dec!., ER 06450-06451, ~ 4. Like Wraparound,

TFC is also an extremely effective treatment for children with mental health needs,

and it is widely considered to be an "evidence-based practice." 24 !d., ER 06450-

06451, ~ 4; see also Neilsen Dep., ER 05871, p. 187:9-18 (noting that TFC is

widely considered an evidence-based practice); Chamberlain Dec!., ER 06297, ~

16 (stating that Multidimensional Therapeutic Foster Care is widely accepted as an

evidence-based practice for controlling and allaying delinquency and anti-social

behavior caused by the psychological, behavioral, or emotional impairments).

Experts agree that TFC is a critical mental health service for youth. In the

opinion of one national expert, any "children's mental health system that does not

include [TFC] as an available intervention is incomplete and inadequate."

Chamberlain Dec!., ER 06289, ~ 3. See also Grealish Dec!., ER 06506, ~ 34 (TFC

23 !d.
24 There are numerous references throughout the literature establishing an "evidence-based practice" as the highest standard in mental health clinical research. To be considered an "evidence-based practice" by the National Institute of Mental Health, a therapy must have: "( 1) at least two control designs or a large series of single-case design studies; (2) a minimum of two investigators; (3) use of a treatment manual; (4) uniform therapist training and adherence; (5) true clinical samples of youth; (6) tests of clinical significance of outcomes applied; (7) both functioning and symptom outcomes reviewed; and (8) long-term outcomes beyond termination." CIMH Report, ER 04833.

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•

is "a necessary component of a children's mental health system"); Friedman Dec!.,

t

ER 06459, ~ 31 (TFC is "widely thought of as essential to any modem children's

mental health system.") According to Dr. Chamberlain, a psychologist who developed a TFC program "lauded by the federal government," providing

treatment in "home-like settings" is "necessary for many children with serious behavioral or mental health needs." I d.; Order Granting Pis.' Mot. for Prelim. Inj., Katie A. v. Bonta, No. CV02-5662 AHM (Mar. 14, 2006), ER 14686.

Several studies have demonstrated the effectiveness ofTFC in treating mental health issues in children. For example, a study that focused on youth with histories of chronic delinquency found that TFC youths were incarcerated less frequently and for fewer days that those in group care.25 The youth in TFC were 44% less likely to be incarcerated after two years as compared to their counterparts who were not receiving these treatments.26 Another study of children who had been previously hospitalized for mental health disorders found that the children who received TFC showed more behavioral improvement and lower rates of reinstitutionalization than their peers who were placed in other out-of-hospital

25 1999 Surgeon General Report, ER 04886.
26 Although the TFC group was diverted from correctional institutions to foster care (and the control group was already in group care-type arrangements), the two groups had similar criminal backgrounds before the study; 69% of the TFC youth had prior felony charges, compared with 63% of the youth in group care. See R. Hahn, eta!., The Effectiveness Of Therapeutic Foster Care for the Prevention of Violence, American Journal of Preventive Medicine (2005) at 79.

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settings, such as residential treatment homes or group care.27 Additionally, a study

•

comparing children in TFC to children in standard foster care over a two-year

period found that the TFC children were less likely to run away or be incarcerated,

•

and generally showed greater emotional and behavioral adjustment.28

Perhaps most telling, however, was a study by the National Institute of

Mental Health where delinquent boys aged 14 to I 7 were randomly assigned to either TFC or group care.Z9 One year after the children left their placements, 41%

of the TFC boys had no criminal referrals, compared with only 7% of the group care youth.30 After two years had elapsed, the results were even more dramatic; a

significantly greater number of the TFC children worked in legal jobs, reported no

use of drugs, had a positive relationship with their parents, and had abstained from unprotected sex.31 In evaluating the National Institute study, the 1999 Surgeon

General's Report noted that children in TFC "showed significantly fewer criminal

referrals, returned to live with relatives more often, ran away less often, and were

confined to detention or training schools less often."32

27 1999 Surgeon General Report, ER 04886. 28 !d. 29 !d. See also CIMH Report, ER 04837. 30 !d. 31 !d. 32 !d.

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B. California And Other States Have Implemented Wraparound

And TFC Services With Great Successes.

•

l. Wraparound

California's Wraparound services have been overwhelmingly successful

t

where given an opportunity. In particular, trials in California counties

implementing Wraparound have consistently produced positive outcomes. Among

other benefits, these services have resulted in increased permanency and stability

of placements, as well as a corresponding decrease in disruptive behavior,

•

hospitalizations, and anxious/depressed behavior among foster children.33

For example, while the breadth of these programs in Los Angeles county has

been limited, the results thus far have been overwhelmingly positive. Of the

twelve Los Angeles children who had graduated from Wraparound programs as of

August of2005, only one had re-entered foster care within the following year. 34

Furthermore, when compared to children who did not receive Wraparound

services, the graduates of Wraparound were significantly less likely to re-enter the

purview of the Department of Children and Family Services.35

33 Letter from Sylvia Pizzini, Deputy Director, Children and Family Services Division, Department of Social Services to Dr. Susan Orr, Ph.D., Associate Commissioner, Children's Bureau, Administration for Children, Youth and Families dated March 28, 2003 (hereafter "DSS Title IV-E Waiver Letter"), ER 04893, ER 04899. See also Grayson Dep., ER 09266-09267, pp. 46:20-47:15.
34 Katie A. Advisory Panel, Fifth Report to the Court (August 16, 2005) (hereafter "Fifth Panel Report"), ER 05534.
35 !d. See also Katie A. Advisory Panel, Third Report to the Court (September 7,

'

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I

In Sacramento County, Wraparound programs reported positive outcomes for

1

the youth involved, and also resulted in a cost savings to the county. Farr Dec!.,

ER 06417, ~ 2. One Sacramento study of foster children found that those who

•

were receiving Wraparound services were less likely to be incarcerated than those

who were not given the opportunity to benefit from these programs. Schroeder

Dec!., ER 07188, ~ 23. The results were so remarkable that the Board of

Supervisors voted to expand eligibility for Wraparound to all children who are

placed in Rate Classification Level ("RCL")36 facilities of level 10 and above,

t

rather than limiting it to those children who had a RCL classification of 12 or

higher. !d.

Mono County also reported positive results.37 Mono County's 2004

Wraparound Report concluded that its Wraparound program improved emotional

and behavioral adjustments and prevented placement into more restrictive environments.38 The report specifically told the story of one child who was failing

2004) (hereafter "Third Panel Report"), ER 05525.
36 Group homes in California are classified into RCLs of 1 to 14, using a point system designed to reflect the level of care and services they provide. Department of Social Services, Reexamination ofthe Role ofGroup Care in a Family-Based System ofCare, ER 04772.
37 Letter from Ann Gimbel, Ph.D., Program Chief, Mono County Mental Health to Greg Rose, Bureau Chief, Resources Development and Training Support, DSS dated April 7, 2004 (hereafter "Mono County 2004 Wraparound Report"), ER 05467.
38 !d., ER 05469.

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•

in school and had also been caught shoplifting.39 After receiving Wraparound

•

services for 12 months, the boy was able to tum his life around, staying out of

trouble with the law and also earning passing grades in school.40

•

Youth in Butte County also benefited from Wraparound services, achieving

an 81% success rate during 2004.41 Wraparound services reduced the average time

Butte County children spend in foster care and group home placements, reunified

children with their families more quickly, and reduced the suicide rate among children receiving these services.42

Mendocino County also reaped tremendous benefits from its Wraparound

services. The county reported overwhelming success in keeping "at-risk" children

out of residential placement and bringing other children home from residential treatment.43 The county also found that Wraparound services improved a child's

39 !d., ER 05468.
40 !d.
41 Letter from Patricia S. Cragar, Director, Butte County Department of Employment and Social Services to Greg Rose, Bureau Chief, Resources Development and Training Support, DSS (hereafter "Butte County 2004 Wraparound Report"), ER 05476.
42 !d. See also Letter from Michael W. Clarke, Ph.D., Assistant Director, Butte County Department of Behavioral Health to Jake Donovan, Technical Assistance Liaison, California Department of Mental Health dated July 13, 2000, ER 05076 ("During the past ten years there have been no suicides involving children or youth under our care").
43 Mendocino County Children's System of Care, SB 163 Wraparound Services Pilot Project Final Report (hereafter "Mendocino County Wraparound Report"),

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•

family functioning, social performance, emotional and behavioral adjustments,

•

school attendance, and academic performance.44

Other states have discovered similar results with the implementation of

•

Wraparound services. Arizona provides Wraparound to all children with serious

mental health needs who are Medicaid-eligible (which includes virtually all

children in its state foster care system). Penrod Dec!., ER 06877-06878,,20.
• Furthermore, the state is now making Wraparound available to all Medicaid-

eligible children who are enrolled in the behavioral health system. /d., ER 06877-

06878,, 20. Arizona cites many reasons for extending eligibility for Wraparound,

including its effectiveness in improving children's well-being, as well as

significant family satisfaction with the services. /d. Arizona's experience shows

that, over time, Wraparound services strengthen a child's family-based support

system and decrease his/her reliance on behavioral health services. /d., ER 06879,

Similarly, Wraparound Milwaukee began in 1995 and has since effectively served many children and families. Kamradt Dec!., ER 06568-06599, ,, 11-12. Wraparound Milwaukee has returned more than 80% of the children in residential treatment centers to their homes or communities, where they typically resumed
ER 05470. 44 /d., ER 05472.

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I

their education. Jd., ER 06599, ~ 12. Some of those children with severe mental

1

health needs subsequently attended colleges or trade schools, while others

successfully obtained work upon turning age 18. Jd. Follow-up data also indicates

that recidivism rates for those children decreased while they were receiving
I
Wraparound services and remained reduced through one- and three-year follow-

ups. Jd. Only a small percentage of Wraparound Milwaukee participants returned

to residential treatment centers or psychiatric hospitals. !d.

2. Therapeutic Foster Care California providers ofTFC have had similar positive results. One provider,

Walden Family Services ("Walden") has been providing a multi-dimensional

treatment foster care service since January 2004. Watrous Dec!., ER 07199, ~ 5.

Since implementing TFC with an initial group often children, Walden noticed

several mental health symptom and treatment improvements, such as a staggering

decrease in negative behaviors such as fighting, property destruction, stealing, and

the use of obscene language. !d., ER 07199-07200, ~6. The provider also noted

increased stability in educational and residential placements - from 1.6 to fewer

than 0.1 changes per year in educational placements, and from 2.2 residential

transfers per year to fewer than 0.25. Jd., ER 07200, ~7. Significantly, no child

receiving Walden's TFC service has been discharged to a higher RCL level of

care, despite the fact that half of the participants were referrals from RCL 12 group

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homes that would have been placed in more restrictive settings. !d.

•

Another provider from Humboldt County, and a foster parent, explains the

dramatic difference access to TFC can make in a child's life:

Being a therapeutic foster parent is a full-time job ...These children need constant supervision, and work best with a very structured schedule.
...When kids with high needs are placed in foster homes that are not equipped to deal with their issues, almost without fail the placements are unsuccessful within a few weeks. As a result, a high needs kid will never spend enough time in one home to stabilize, and instead [will] bounce from home to home, losing self-confidence with each move and becoming less and less willing to attach to their foster parents .
...the TFC program and wraparound services give foster parents the training and support to cope with a child's behavioral issues, which means that a child will not quickly fall out of a placement. A TFC home has the opportunity to actually implement a service plan for their foster children and see it develop.
. ..TFC kids also get a chance to observe healthy family relationships, possibly for the first time in their lives.
Nunn Dec!., ER 06866-06869,,,19,21,23-24,26.

C. California Has Recognized The Benefits of These Therapies and Implemented Legislation to Provide Them.
Wraparound services in California have been funded primarily through a

state-funded program created by Senate Bill ("SB") 163 and through a joint State and federal pilot program in five counties known as the Title IV-E Waiver.

Burgess Dec!., ER 06265-06266, ,, 9-10. Governor Pete Wilson signed SB 163 in

1998, expanding Wraparound from a pilot project in Santa Clara county to a five-

-20-

•

year and state-wide Wraparound pilot for foster care children in RCL facilities of

•

12 and higher. Two subsequent legislative measures, Assembly Bill ("AB") 2706

and 429, expanded Wraparound in California by allowing children in RCL

•

facilities of 10 and higher to access Wraparound services, and removing the five-

year limitation on the program.

Certain California counties also implemented Wraparound services through

the Title IV-E waiver. The Title IV-E waiver is a "federal demonstration project that permits states to use their IV-E funds for services instead of using IV-E funds for board and care." Treadwell Dep., ER 05906, p. 17:3 - 6. Title IV-E itself is a

federal funding program providing entitlements to children in foster care. Id., ER

t

05905-05906, pp. 16:25 - 17:1. There were five "waiver counties" in 2004:

Alameda, Los Angeles, Sacramento, Humboldt, and San Luis Obispo. Id., ER

05906-05907, pp. 17:13- 15, 18:23-25.

Interestingly, the State Defendants have historically been proponents of the

benefits of Wraparound and TFC, often advocating for an expansion of the services

under the state and federal funding programs. In 2003, in advocating for a fiveyear extension of the Title IV-E waiver, for example, DSS heralded several

benefits of Wraparound, including: (1) a decrease in placement disruptions, (2)

increased movement towards permanent arrangements, (3) a decrease in

hospitalizations, and (4) a decrease in anxious and/or depressed behavior in the

- 21 -

•

studied youth.45 DSS also emphasized the successes the "waiver counties" had

t

experienced with Wraparound.46

D. Implementing Wraparound and TFC Would Save California Millions of Dollars.

•

The State of California will save a substantial amount of money by providing

quality Wraparound and TFC services to all eligible children for whom they are

medically necessary. In the short term, both Wraparound and TFC are generally

considered to be cheaper than more restrictive placements such as

institutionalization or incarceration. Kamradt Dec!., ER 06594-06595, ,; 3

(providing Wraparound and TFC to children with serious mental health needs

"yields much better outcomes in terms of the child's development and stability in

•

the community and costs approximately half as much as placing these same

children in residential treatment centers or a fraction of the cost of psychiatric hospitals.").47 For example, as noted by the Surgeon General, TFC services are

inexpensive to start because of the few requirements for facilities or salaried staf·r.4s

The benefits are even greater in the long term, as the children who pass
45 DSS Title IV-E Waiver Letter, ER 04893. 46 !d., ER 04899-04900. 47 See also 1999 Surgeon General Report, ER 04885 (TFC and Wraparound tend to be cheaper to implement than many alternative and more restrictive treatments); see also Young Hearts, ER 04581, ER 04632. 48 1999 Surgeon General Report, ER 04885.

-22-

•

through these programs will mature into productive adults with a decreased

•

likelihood of becoming homeless, institutionalized, incarcerated, or otherwise

dependent on long-term social services.49 The result will be a significant reduction

•

of the financial burden that the State would otherwise incur from having to support

and incarcerate another generation of adults who have been failed by a system

charged with protecting them.

Wraparound and TFC services cost less than the more restrictive programs,

such as residential treatment, state hospitals, and the juvenile justice system, all of

•

which are extremely expensive to administer in California. For example,

residential treatment facilities strain the state budget to the annual tune of $780

million. State hospitals consume another $48 million in annual taxpayer revenue.5°

California juvenile detention facilities spend approximately $130 per day to house

the 11,529 children who are in these facilities at any given time, resulting in a

staggering

yearly

cost of approximately

$547

million.

1 5

With

a

monthly

tab

of

$3, 100 in housing costs and an additional $1,750 in treatment costs for each of the

7,200 youth whom it serves, the additional financial burden resulting from

operating the California Youth Authority is in the neighborhood of $419 million

49 See infra at Sections A- B. 50 Young Hearts, ER 04632. ,"] !d. , ER 04581, 04632.

- 23-

I

annually.52 The resulting total yearly expenditure for these highly restrictive

1

settings alone is in excess of $1.7 billion.

The California counties that do provide Wraparound and TFC have already

begun to realize cost savings as a result of these services. Sacramento County, for
I
instance, was able to save approximately six million dollars in foster care funding

over the course of a six months Title IV-E waiver project. Farr Dec!., ER 06430-

06432, ~~ 17-20. Mendocino County found that Wraparound services saved

approximately $3,400 each month, per child.53 Plumus County saved $105,812 in

t

one year by keeping just eight children at home and providing Wraparound

services

rather

than

sending

them

to

out-of-home

placements.

4 5

In 2002, Butte

County was able to save $1,601 per family, per month, by providing Wraparound

services instead ofthe usual placements; in 2003, this number increased to $1,988

per month, presumably the result of the program's becoming more cost efficient

over

time.

5 5

Ex.

139 at 000978.

Mono County also reaped the benefits of

Wraparound services, realizing an annual savings of $110,000 per child when

compared to placement in a level 14 facility, and another $1,400 annually per child

'"2 !d., ER 04581.

53 Mendocino County Wraparound Report, ER 05471.

•

54 Plumas County, SB 163 Final Evaluation Report (March 17, 2004), ER 05475 . 55 Butte County 2004 Wraparound Report, ER 05478.

-24-

•

when compared to a Ievell! placement.56 Humboldt County saved almost $1,100

•

per month, per child, and found that these savings increased over time once the

children

and

their

families

became

stable.

7 5

•

Arizona has also discovered that Wraparound cuts costs by keeping children

out of expensive residential treatments. In at least one case, Arizona saved over a

million dollars by using Wraparound services to successfully treat a child who

would have otherwise required expensive out of home care. Penrod Dec!., ER

06878, ~ 21. Impressive savings have been achieved in similar cases. !d., ER

06878-06879, ~~ 22-23.

Wraparound Milwaukee's extraordinary success has also been cost efficient

•

as Wraparound services have proven to be much less expensive than residential

treatment center placements. In 2004, the monthly cost of placement in a

Milwaukee residential treatment center was approximately $7,400 per child; that

figure became $8000 to $10,000 per month once the costs of case management,

child welfare services and other necessary expenses were added. Kamradt Dec!.,

ER 0660 I,~ 16. In contrast, the monthly cost of Wraparound Milwaukee services

was approximately $3,900 per child in 2004; this figure covered all services for the

56 Mono County 2004 Wraparound Report, ER 05469.
57 Humboldt County Department of Health and Human Services, Report to the Legislature on Humboldt County's Wraparound Services Program (April I, 2004), ER 05474.

- 25 -

I

child, including foster care or group care, mental health services, and social or

1

other support services. !d., ER 06601, ~ 17.

TFC services have also been proven to be cost-effective in several other

I

states, including Oregon and Oklahoma. TFC services are billed at a rate of only

$2,387.20 per month in Oregon, where non-profit organizations have partnered

with state and local agencies to provide MTFC. Redman Dec!., ER 06980, ~ 26;

Chamberlain Dec!., ER 06289-06290, ~~5-6. Oregon's MTFC program was

recently evaluated by the Washington State Public Policy Group ("WSPPG") and it

ranked first among all evaluated juvenile justice programs in providing cost-

savings to the taxpayer. Chamberlain Dec!., ER 6300, ~ 26. WSPPG's report

found:

Overall taxpayers gain approximately $12,836 in subsequent criminal justice cost savings for each program participant. Adding the benefits that accrue to crime victims increases the expected net present value to $87,622 per participant, which is equivalent to a benefit-to-cost ration of $43.70 for every dollar spent. Id.

Oklahoma's experience provides additional evidence ofTFC's cost-

effectiveness. TFC is billed in Oklahoma at a rate of$49.27 per day, or $1478.10

for a 30-day month. Redman Dec!., ER 06980, ~ 25. This rate is astoundingly low

considering that it covers the behavioral management services provided by foster

parents, as well as additional therapy services provided to the individual child and

his/her family. !d.

- 26-

•

The long term outlook is even brighter. By implementing Wraparound

1

services and TFC, the State will be able to avoid the enormous costs that result

from the need to support or incarcerate these children during their adult lives.

Perhaps most important is a potential that is priceless - the opportunity these

children will have to lead healthy, productive, adult lives.

E. Wraparound and TFC Services Are Only Available to California Children in Foster Care On A Limited and Ad Hoc Basis.
Most foster children who need help do not have access to these proven and

remarkable services. Wraparound is "an elective service to be offered at the

discretion of each county" in California. Burgess Dec!., ER 06266, ~ 11.

Wraparound is only provided to California foster care children on an ad hoc basis,

as each county can choose whether it wants to provide Wraparound services

through one of two pilot programs- the state-funded SB 163, and the federally-

funded Title IV-E waiver demonstration program. Grayson Dep., ER 09327-

09328, pp. 107:24-1 08:24; Burgess Dec!., ER 06266, ~ 11; Treadwell Dep., ER

05904-05906, pp. 15:17-17:15. Unfortunately, only 24 out of 58 counties in

California provided Wraparound services as of February 2004. Treadwell Dep.,

ER 05904, ER 05906, ER 05925-05943, pp. 15:20-23, 17:13-18:5, 69:20-87:17.

Even among the participating counties, Wraparound is only provided to a

fraction of the eligible foster care children. Eligibility for Wraparound in

California is currently limited to foster children who are residing in or at risk of

-27-

•

being placed in RCL facilities of I0 or above for SB 163 counties, and RCL

•

facilities of 12 or above for Title IV-E waiver counties. Grayson Dep., ER 09258-

09259, pp. 38: 14-39:16; Treadwell Dep., ER 05910, p. 22:7-10. Counties wanting

•

to provide Wraparound to children in lower RCL placements, like Marin County,

must do so outside the parameters of SB 163. Treadwell Dep., ER 05923-05924,

pp. 48:11-49:15.

Additionally, counties have complete discretion concerning the number of

Wraparound "slots" that they wish to provide. Treadwell Dep., ER 05909, ER

•

05915, ER 05948, pp. 21 :22-22:1, 31:21-25, 102:20-23. Counties are not required

to provide Wraparound to all children in the target population for whom such

services would be medically necessary or otherwise appropriate. Id., ER 05901,

ER 05903, ER 05913, ER 05918-05919, ER 05920, pp. 9:1-10:25, 13:3-13,27:1-

28:10, 38:20-39:1, 40:15-20. Counties are not even required to serve a minimum

percentage of children in their target population. !d., ER 05912, p. 24:10-13. As

of February 2004, the 24 participating counties only had the combined capacity to

provide services to approximately 1,500 children - a mere fraction of the children

for whom these services are medically necessary. Jd., ER 05925-05943, pp. 69:20-

87:17.

F. The Experience of Other States Shows That Federal Funding Is Clearly Available for Wraparound and TFC.
I
Besides providing evidence on effectiveness and cost-savings, the

-28-

•

experiences of other states clearly demonstrate that both TFC and Wraparound are

•

eligible to be funded by Medicaid. Several states use their Medicaid programs to

cover Wraparound, and nearly half of the states use Medicaid funds to cover TFC.

1

Koyanagi Dec!., ER 06645,,; 3. For example, Arizona covers its Wraparound and

TFC services as "medically necessary" EPSDT services. Penrod Dec!., ER 06872,

•

,; 3; Redman Dec!., ER 06973, ER 06977-06978, ,;,; 3, 18. Similarly, Oregon and

Oklahoma also bill Medicaid for the TFC services they provide. Redman Dec!.,

ER 06978, ER 06980, ,1,; 19-20, 25-26; Chamberlain Dec!., ER 06300, ,!27. Thus,

•

there can be no question that Medicaid can be used to fund these services.

IV. CONCLUSION

t

For the reasons stated, amici curiae urge the Court to affirm the Order

granting appellees' motion for preliminary injunction in its entirety.

Dated: August 10, 2006

MICHAEL M. MADDIGAN KAREN R. GROWDON ANASTASIA M. SMITH JAMES KIDDER BRANDlE ODGERS GARYHO liLLIAN ALLEN O'MELVENY & MYERS LLP

Attorneys for Amici Curiae - 29-

EXHIBIT A

•

Amicus Curiae Descriptions

•

Amicus American Academy of Child and Adolescent Psychiatry (AACAP)

is a non-profit organization whose membership includes over 7,400 child and adult

•

psychiatrists. Established in 1953, the AACAP is the leading national medical

association dedicated to treating the myriad of mental, behavioral, and

developmental disorders that affect an estimated seven to twelve million American

youth. The AACAP strives to improve the quality oflife of the children and

families subjected to these disorders by providing universal access to care for all

children and adolescents, expanding research programs for prevention and

treatment of mental disorders, and providing other integrated services that will

meet the needs of the affected children and their families in a community setting.

The AACAP is committed to protecting the well-being and rights of the children

and families who are afflicted by these disorders.

Amicus the American Academy of Pediatrics, California District IX (AAPCA) is a joint venture of the four regional AAP Chapters. AAP-CA is comprised of over 5,000 board-certified pediatrician members distributed statewide, representing over 80% of board-certified pediatricians in the state. The mission of the AAP-CA is to promote optimal physical, mental, and social health and wellbeing for all infants, children, adolescents and young adults living in California. To that end, the AAP-CA educates pediatrician members, the public and the press

LA2808010.1

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•

regarding the essential health care needs of California's children, adolescents and

•

young adults. In addition, the AAP-CA is a leader in the child advocacy

community in designing, developing and implementing policies and collaborative

•

strategies to improve and support quality child health care systems and delivery.

With numerous agencies dedicated to foster family-based care and

treatment, mental health treatment services, therapeutic behavioral services, and

wraparound services and support, amicus California Alliance of Child and Family

Services (CACFS) is deeply committed to improving the lives of children with

mental health disorders. CACFS is a statewide association of over !50 nonprofit

child and family service agencies that reflect the cultural, racial, and ethnic

•

diversity of the people of this State. The Alliance pursues an aggressive statewide

agenda oflegislative and regulatory advocacy designed to enhance the lives of the

children and families that they serve. The member associations of the CACFS

share a commitment to excellence and ardently strive to improve the quality of care

and services that are available to at-risk children and their families.

Amicus California Adolescent Health Collaborative (AHC) is a statewide coalition with an established history of working to increase understanding and support for adolescent health and well-being across California. Founded in 1996, the collaborative includes over 800 organizations and individuals involved with

LA2:808010.1

2

•

clinical care, policy development, research, public health, youth development,

•

advocacy, legal aid, schools, and youth services. This work is of particular

importance in California, as one out of every eight adolescents in the United States

lives in our state. It is the only statewide organization whose primary role is to

advance an adolescent health agenda that is comprehensive, integrated, and

focused on prevention.

Amicus California Association of Social Rehabilitation Agencies (CASRA) was one of the first agencies in the nation to develop a system of community-based residential treatment alternatives for people with mental disorders. Founded in 1969, CASRA is dedicated to providing better services and improving social conditions for people with mental health disabilities. CASRA accomplishes their goals by promoting the recovery, rehabilitation, and legal rights of the millions of people who have mental health disorders. CASRA has vast experience in promoting and supporting the development and implementation of communitybased systems of services.

Amicus California Nurses Association (CNA) and its national arm, the National Nurses Organizing Committee (NNOC), a is a nonprofit professional nursing association of more than 70,000 registered nurses, more than 60,000 of whom practice in the State of California. CNA's primary goal is to promote

LA2:808010.1

3

•

patient advocacy that protects patients and ensures a single standard of high quality

•

healthcare for all. CNA is a leader in the promotion of patient safety through

advocacy for appropriate healthcare staffing and a leader in the professional and

•

educational advancement of registered nurses designed to foster high standards of

nursing practice.

Amicus California Public Health Association- North (CPHA-N) is an

independent, member-supported association focused on the health of the public. It

draws its membership from professionals working in all sectors of public health.

CPHA-N provides leadership in California by studying public health needs and

problems, initiating action to remedy problems, and providing an opportunity for

•

persons actively engaged or interested in the broad field of public health to share

knowledge and experiences in order to achieve the primary goal of protecting and

promoting public, environmental, and personal health. CPHA- N influences the

development of statewide health policy through strong working relationships with

the State legislature and administration, local health officials and elected

representatives; close ties with schools of public health, teaching hospitals, and the

research community; collaboration with community-based organizations and

coalitions, advocates, and labor unions; and dialogue with public and private health

care providers. CPHA-N functions actively as an affiliate of the American Public

Health Association, supporting and contributing to the work of the national

LA2:808010.1

4

•

•

organization .

•

Amicus California School Nurses Organization (CSNO) is a non-profit

organization whose membership includes approximately 1,400 school nurses

across California. It is a unified affiliate member of the National Association of

School Nurses (NASN), having a seat on the NASN Board of Directors. The role

of school nurses is that of the primary health professional within the educational

community. CSNO was formally organized in 1950 for "the promotion of

comprehensive and constructive school health programs and for the promotion of

professional advancement of school nurses." Since the 1950's, CSNO has been

promoting and strengthening the role of school nurses in the educational

community. Today the organization's goals are professional development,

legislative advocacy, communication among school nurses, membership

recruitment, public relations, governance, and leadership development.

Amicus California Teachers Association has 330,000 members comprised of teachers, school counselors and nurses, librarians, and other certificated employees who work in California public schools. The vast majority of public school certificated employees belong to CTA, an organization that represents employees not only in their employment relations, but also provides resources for employees' professional development. One of the purposes of the Association is to further the

LA2 808010.1
•

5

•

educational interests of the State of California, to give increasing efficiency to its

•

school system, and to furnish a practicable basis for united action among those

devoted to the cause of education in California. The Association is guided in its

legislative and advocacy efforts by policies that call for effective social services to

be available to students and their families, positive and preventative programs

aimed at reducing child abuse and neglect, and full state funding for psychological, counseling, health and social services.

Amicus Children's Advocacy Institute (CAl), founded in 1989 as part of the University of San Diego School of Law, is a nonprofit academic and advocacy center dedicated to improving the health, safety, and well-being of California's children. Amicus CAI operates legal clinics representing abused and neglected children in juvenile dependency court and engaging in policy advocacy on behalf of children; operates advocacy offices in Sacramento and San Diego; and engages in legal and budget research relevant to children, which is published in several sources, including Child Rights & Remedies (a law school text), the California Children's Budget, the Children's Regulatory Law Reporter, and the Children's Legislative Report Card. CAl's goal is to educate policymakers about children's needs for economic security, adequate nutrition, health care, education, quality child care, and protection from abuse, neglect, and injury.

LA2:808010.1

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•
Amicus Children's Law Center (CLC) of Los Angeles is a nonprofit, public interest legal organization funded by the California State Courts. The CLC serves as the voice of abused and neglected youth in the Los Angeles County foster care system. The CLC, which represents more than 80% of the nearly 30,000 children under the jurisdiction of the Los Angeles County Juvenile Dependency Court. System, is the largest representative of foster children in California. With more than I85 attorneys and staff, the CLC is dedicated to advocating for the critical services and support that these at-risk youth need to flourish and mature into productive adult members of society. The attorneys and staff of the CLC passionately endeavor to secure the well-being and future success of each child who comes under their care.
Amicus Federation of Families for Children's Mental Health (FFCMH) is a national, family-run organization that serves as a voice for children with mental health disorders. Founded in 1989 as a grassroots organization, the FFCMH now has thousands of members and over 140 chapters spread among 48 different states and the District of Columbia. Amicus FFCMH uses their strong national presence to help educate both state and federal policy makers about the issues that affect the daily lives of the millions of children and families affected by mental health disorders. The Federation is avidly dedicated to helping these children and their families achieve a better quality of life and a successful future.

LA2808010.1

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•

With chapters in all 50 states as well as the District of Columbia and Puerto

•

Rico, the National Alliance for the Mentally Ill (NAMI) is the nation's largest

grassroots mental health organization. Founded in 1979, amicus NAMI has

•

blossomed into a national organization with over 220,000 members and chapters in

over I,200 local communities throughout the United States and its territories. By

facilitating numerous advocacy, research, support and education programs, NAMI

strives to improve the quality of life of the millions of people and families in this

country who are affected by mental disorders. The Alliance's strong national

presence combined with their vast network of local members and volunteers

enables them to effectuate wide-ranging policy changes while simultaneously

helping the individuals and families who cope with mental disorders every day.

The National Association of Social Workers (NASW), and the NASW California Chapter, is the largest organization of professional social workers in the world. Founded in 1955, amicus NASW currently has 56 chapters and over 150,000 members who are dedicated to improving the quality and effectiveness of social work in the United States. The California Chapter ofNASW represents 12,000 social workers. NASW is devoted to promoting the quality and effectiveness of social work practice, advancing the knowledge base of the social work profession, and improving the quality of life though utilization of social work knowledge and skills. NASW members provide services to individuals and

LA2 808010.1

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t

families in a variety of settings including mental health clinics, group homes,

t

private practice, and in all facets of child welfare.

One of the country's foremost advocates for the effectiveness of

t

community-based rehabilitative services, amicus National Council for Community

Behavioral Health (NCCBH) is a nonprofit organization of 1,300 behavioral

healthcare organizations. The National Council provides treatment and

rehabilitation to nearly six million adults, children and families who are afflicted

with various mental disorders. Since its inception in 1970, the NCCHN has served

as a testament to the increased effectiveness of medical, social, psychological, and

rehabilitation services when they are offered in community-based settings. The

NCCHN and its members bear testimony to the fact that such programs help

people with mental disorders recover from their ailments and lead productive lives.

The National Mental Health Association (NMHA) is the country's oldest and largest nonprofit mental health organization. Amicus NMHA has over 340 affiliates who are dedicated to improving the mental health of all Americans, especially the 54 million people who have severe mental disorders. Through various forms of advocacy, education, research, and service, the NMHA helps to ensure that the mentally ill are accorded respect, dignity, and the opportunity to achieve their full potential. The Association is deeply committed to enabling the

LA2:8080!0.!

9

•

mentally ill to blossom into fully functional adults who are free from the burdens

•

of stigma and prejudice often imposed upon them by society.

The Southern California Public Health Association (SCPHA) is an affiliate

of the American Public Health Association representing more than 300 health

professionals in Southern California. SCPHA provides public health leadership to

maintain and enhance health promotion, disease and injury prevention, and health

protection efforts in California. SCPHA strives to improve the health of people in

Southern California by: working with public health and other agencies in health

promotion and disease prevention activities; providing opportunities for public

health professionals to enhance their knowledge; and formulating and advocating

sound public health policy. SCPHA actively collaborates, educates, and advocates

with organizations and individuals who share this common vision.

LA2:808010.l

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EXHIBIT B

•
• P E D I AT R I C S@
•
Health Care Needs of Children in the Foster Care Svstem Mark D. Simms, Howard Dubowitz and Moira A. Sziiagyi Pediatrics 2000; I06;909-918 DOI: 10.1542/peds.l06.4.SI.909
This information is current as of July 7, 2006
The online version of this article, along with updated information and services, is located on the World Wide Web at:
http:;/\\'\\ w.pcdiatrics.org.'cgi;content'fuiL' I06/4/S 1/909
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright© 2000 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: I098-4275.
American Academy of Pediatrics /~~~'f) ,~\.:"-!
"'' DEDICATED TO THE HEALTH OF ALL CHILDREN'" ·~-,,--~~''':\'
Downloaded from \\\\\\ .pcd;;ltrics.IH~ by on July 7, 2006 1

•

Health Care Needs of Children in the Foster Care System
• Mark D. Simms, MD, MPH*; Howard Dubowitz, MD, MS*; and Moira A. Szilagyi, MD, PhD§

Abstract. Nearly 750 000 children are currently in fos~ tcr care in the United States. Recent trends in foster care include reliance on extended family members to care for children in kinship care placements, increased efforts to reduce the length of placement, acceleration of termina~ tion of parental rights proceedings, and emphasis on adoption. It is not clear what impact welfare reform may have on the number of children who may require foster care placement. Although most children enter foster care with medical, mental health, or developmental problems, many do not receive adequate or appropriate care while in placement. Psychological and emotional problems, in particular, may worsen rather than improve. Multiple harriers to adequate health care for this population exist. Health care practitioners can help to improve the health and well-being of children in foster care by performing timely and thorough admission evaluations, providing continuity of care, and playing an active advocacy role. Potential areas for health services research include study of the impact of different models of health care delivery, the role of a medical home in providing continuity of care, the perception of the foster care experience by the t;hild, children's adjustment to foster care, and foster parent education on health outt;omes. Pediatrics 2000;106:909-918; foster care, child welfare, children with special health care needs.
,\BBREVlATlONS. HlV, humBn immunodeficiency virus: ASFA, Adoption and Safe Families Act of HHJ7; AFDC, Aid to Fcm1ili~!S With Dependent Children: MCO, managed care organization: CATCH, Community Access to Child Health.
D espite efforts to prevent child abuse and neglect, decrease the rate of out-of-home placement of maltreated children through family preservation programs, and increase the number of adoptions of children out of foster care, nearly three-quarters of a million children are currently in foster care in the United States.1 Over the past 2 decades, the greatest increase in placements has occurred among African-American children and infants and children <5 years old. Increasingly, there is a preference for placing children deemed in need of substitute care with kin. In some cities and states, in 1994 there were more children in kinship
hom tht~ "Department of Pediatrics. Medical College of Wisconsin, )..1jJ. I·V<~IIkroe. Vllisconsin; TDepMIIlH:nt of p,;diatrir:s. llniversity of lvli!ryland Sdwui of MHdicine: Bnhimorfl. :Vlarylnnd: and §Fostflr Can'l Pediatrir.s, \1onroe County Health lJqJartment. 1\.odwster. Nnw Ynrk.
R.ect~ivnd for publication ;\pr 11.2000: accepted !ul10, ;woo.
Hnprint ref]tWsts to (\II.D.S.) Child DtoYelopment Cr.nter. Childwn·s l!os, pita! of Wisconsin, f:lox 1997 MS 744. Milwauknc. Wl53201·1997. E·mail: msimrns@mcw.Hrl!l PED!r\TRICS {!SSN 00:11 400r.). Copyright \0 2000 hy the t\merir:an t\cadt~mv of Pediatrics.

care than in regular foster care. 2 {In this article we use the generic term foster care to encompass care provided by both relatives, and nonrelatives, unless otherwise specified.) Nonetheless, in 1995 the Child Welfare League of America reported that out of a total of 483 000 children then living in out-ofhome care, 49% were living in family foster care, 23% in kinship care, 15% in residential group care, 1.7% in therapeutic foster care, and 11.3% in other facilities such as emergency shelters and psychiatric hospitals. J
The vast majority of children are placed in foster care as a result of neglect, physical abuse, parental substance abuse or abandonment. 4 Contrary to a prevailing misconception, only approximately 10[Yu of children for whom abuse or neglect is substantiated (approximately one-third of those reported) are removed from parental care. Consequently, children in foster care are a very high-risk group of children and yonth. Some children spend a substantial portion of childhood in foster care. For example, an analysis of national data on the characteristics of children in foster care revealed that approximately 37(Yo had been in out-of-home care for 2 years or more, and approximately 12% had been in care for more than 5 years," while in some large urban centers (eg, Cook County, Illinois) the median duration of placement approached 5 years in 1994.b
Many children enter foster care with chronic health, developmental, and psychiatric disorders, reflecting the neglect and abuse experienced before placement in addition to the trauma from being separated from their parents. More disturbing, however, is evidence that their health care is often neglected while in foster care. In 1995, the US General Accounting Office fonnd that young foster children do not receive adequate preventive health care while in placement, many significant problems go undetected, or, if diagnosed, are not evaluated and treated.' Among other things, this neglect of children's basic health care needs is a result of inadequacies in the foster care system, as well as inadequacies in the health care system.
Several efforts have been made to remedy this problem. More than a decade ago the Child Welfare League of America, in collaboration with the American Academy of Pediatrics, published guidelines for health care of foster children." Class action lawsuits in at least 21 states have challenged state agencies to ensure adequate care, including health care, for this very high-risk group." With a few notable exceptions, obstacles to delivering ade-

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•

quate care to these children have persisted. The law was the pervasive view that the pendulum had idealistic assumption that removing children from swung too far to the side of preserving families, and

their parents obligates the state to provide exem- away from protecting children. ASFA establishes

plary care has seldom materialized. Thus. clinical the health and safety of children in the child wei·

and research challenges continue for health care fare system as clear priorities. Well-justified con·

providers and others involved in the lives of these cern persists regarding the length of lime children

•

children.

linger in care; ASFA requires states to begin termi-

The purpose of this article is to review what is nating parental rights if a child has been in care for

known about the health status and health care 15 of the prior 22 Inonths. Under aggravated cir-

needs of children in the foster care system, offer cumstances, such as when a parent has been con-

practical guidelines for primary health care practi- victed of a felony against a child or a parent's rights

tioners who care for children in foster care, and to a sibling have been involuntarily terminated,

suggest areas for further medical, mental health. AFSA enables (but does not require) the states to

and developmental services research.

proceed with terminating parental rights without

BRIEF HISTORY OF FOSTER CARE IN THE UNITED STATES

providing further justification for doing so. For all children in foster care, states must obtain a court order at least every 12 months and demonstrate that

Until nearly 150 years ago, families who could reasonable efforts have been made toward estab-

not raise their own children relied for help on lishing a permanent plan for reunification, or to-

extended family members, charity from religious ward legal guardianship or adoption. The legisla-

organizations, or orphanages. Many older children tion also offers fiscal incentives for states to

were apprenticed to tradesmen as a means of pre- increase the number of children adopted. Clearly,

paring them for adulthood. 10 State-supported foster the intent is to limit foster care drift.

care in the United States arose in the 19th century

from social welfare programs that sent chi1drel1

TRADITIONAL VERSUS KINSHIP FOSTER CARE

from Eastern cities to the Midwest, where they

Nonre1ative care was the nann in foster care until

lived with farm families as an escape from th8 the earlv 1990s. However, as more women Emtered dangers of urban life. In 1863, the Massachusetts the lab~r force the number of nonrelative foster

State Board of Charities approved funding for a familv homes declined from about 147 000 in 1984

system of state-supported foster homes, paying to HJO 000 in 1990.14 In response to this trend,

nonrelatives a weekly stipend of $2.00 to care for public agencies sought assistance from the chil-

children in need of out-of-home placement. Federal dren's relatives to provide kinship foster care

support for foster care was established in 1933 un- homes. In current practice, the term kin includes

der Title IV of the Social Security Act. In the 1960s any relative, by blood or marriage, or any person
the number of children placed in foster care rose with close ties to the family. 1 :>

dramatically in response to increased awareness of

Kinship care may offer certain advantages. Chil-

the problem of child abuse. However, by the late dren may find placement with known family mem-

1970s social service researchers had documented bers less traumatic than placement with strangers.

that many children remained adrift in the foster Cultural and religious practices are more likely to

care system because little effort was made to either be continued, and this has been a major factor for

reunify them with their biological families or ar- advocates of kinship care. Kin frequently have a

range for adoptions."·" In 1980, the Child Welfare special commitment to helping their own (blood is

Reform Act (PL 96-272) directed social service thicker than water). Contact with parents is often

agencies to prevent out-of-home placements when more frequent, and may facilitate eventual reunifi-

possible, to make reasonable efforts to reunify them cation. There may also be disadvantages to kinship

with their biological families when feasible, or to care compared with regular foster care. Skeptics

find adoptive placement when necessary. Although question whether the extended family members of

the number of children in foster care initiallv de- these inadequate parents are appropriate surrogates

clined in the early 1980s, increases in the incidence to provide kinship care.

of substance abuse, single-parent families, home-

Although each situation should be individually

lessness, child poverty and child abuse, as well as weighed, il is crucial to ask how kinship care can

the emergence of human immunodeficiency virus be helped to succeed given tho strong ideological

(HIV) infection, resulted in even greater expansion preference for first seeking placement with kin.

of the foster care population.~:< Current efforts to Potential kinship caregivers must be carefully

reduce the number of children in foster care in- screened, especially because they are often notre-

clude increased use of family preservation pro- quired to meet the same standards used for licensed

grams to prevent out-of-home placement, more at- foster homes. Frequently, informal kinship place·

tention to returning children home quickly from ments (ie, no court involvement and no legal trans-

foster care, accelerating termination of parental fer of custody) are arranged by public or private

rights proceedings, and greater efforts to adopt social service agencies, and it is uncertain what

these children.

services kinship families receive and what obliga-

The Adoption and Safe Families Act (ASFA) of tions the agencies impose under these circum-

1997 is the most significant recent legislation af- stances. Moreover, we know little of how children

fecting children in foster care. The context for this fare in these infonnal arrangements. In most situa-

910 SUPPLEMENT

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tions involving abuse or neglect, it is probably preferable that care and custody be formally transferred to a social services agency~ to enable Ongoing support and oversight.
On the other hand, we do know that children in kinship care have needs similar to those in nonrelative foster care, especially regarding their mental and dental health. We also know that kinship caregivers tend to be older, less educated, less financially stable, and in poorer health than nonrelative foster parents.11u 7 Proponents of kinship care believe kin will/should provide for their own; but these families have typically received fewer services, even when the public agency has had legal custody. Therefore, because children in kinship and traditional foster care face similar conditions, in terms of reasons for their placement, their levels of health, mental health and developmental needs, and financial difficulties confronting many of the families who provide such care, more uniform approaches are necessary with respect to placement and support of all children in care, regardless of type of placement. Furthermore, children in kinship care have averaged longer stays than those in nonrelative foster care, largely because less vigorous efforts have been made to reunify them with their parents and to determine a perm.lnency plan. Again, it is incorrect to assume that because the child is with family there is little urgency to return him or her to the biological parents. All children in foster care need secure arrangen1ents, and careful long-term planning is needed to reduce the uncertainties in their lives.
Health and Mental Health of Children in Foster Care
For nearly 3 decades, researchers have noted a high prevalence of health and mental health problems in foster children. In 1972 and 1973 Kavaler and Swire'" systematically studied the health status of 668 children 0 to 15 years old who had been in foster care in New York City for at least 1 year. Approximately half (45%) of the children had 1 or more chronic medical problems and more than a third (37%) required a referral to a specialist for further evaluation and treatment. Nearly one-third (29%) of the preschool children were suspected of having delayed development and more than half (55%) of the school-aged children were suspected of having borderline or retarded mental develop· menl. Moderate to severe mental health problems were noted in approximately 70% of the children. Since then, cross-sectional surveys of children living in different cities or regiOns of the country,n_Hl-25 statewide population-based studies20·:u
and a multicity comparison study7 have confirmed Kavaler and Swire's initial observations.
The findings of consistently high rates of physical, mental health, and development problems in this population raise several important questions. To what extent did children bring these problems with them into foster care? To what degree are these (or additional) problems attributable to the foster care experience'( Does the foster care system attend to the special needs of these children and

help to improve their health status and overall functioning? A review of existing data sheds some light on these questions.
HEALTH PROBLEMS AT THE TIME OF
PLACEMENT
For the most part, children enter foster care in a poor state of health. In addition to abuse or neglect that commonly results in out~of-home placement, their poor health reflects exposure to poverty, poor prenatal care, prenatal infection, prenatal maternal substance abuse, family and neighborhood violence, and parental mental illness.-13 Children entering foster care are also more likely to have received inadequate routine preventive health care before placement than their peers. Similarly, children entering foster care may be at especially high risk for HIV infection, given the association between child maltreatment and substance abuse. For example, Flaherty and \Veiss2H reviewed the physical examination findings of 5181 children taken into protective custody in Chicago over a 22-month period. Nearly half (44%) had an identified health problem, including acute infections (otitis media, sexually transmitted diseases), anemia, and lead poison{ng. In addition, approximately 5% of the children evaluated for physical abuse were found to have occult fractures not suspected by their caseworkers. Chernoff et al21 reported that of 2419 children assessed shortly after placement in foster care in Baltimore, almost all (92%) had at least 1 abnormality on physical examination, including disorders of the upper respiratory tract (66%), skin (61%), genitals (10%), eyes (8%), abdomen (8%), lungs (7%), and extremities (6%). Nearly one-quar· ter (23%) of younger children failed a developmen· tal screening and 22% of older children were already receiving special education services before placement. As a result of these evaluations, 53% of the children were referred ](lf further medical ser· vices.
PSYCHOLOGICAL PROBLEMS AT THE TIME OF
PLACEMENT
A child's experience before placement plays a significant role in determining how he or she will fare emotionally in foster care. According to Bowlby,29 ·:w infants whose early needs are appro~ priately met form a secure attachment to their caregivers. This is the foundation for trust, important for forming relationships throughout life. Young children who have experienced chronic physical abuse or emotional neglect often show insecure, avoidant, or ambivalent attachment to their primary adult caretakers.:n.n Thus, if children enjoy a loving and supportive relationship with parents early in life, there may be a stronger likelihood of forll1ing positive relationships with the foster family. Converse.lv, and more commonly in foster care, children who" lack the experience .of loving relationships with parents may be unable to establish healthy relationships with new caretakers.
Children in foster care experience psychological difficulties for many reasons.:~:J Placement in foster

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SUPPLEMENT 911

I

care is rarely a planned transition for children. mative or community-based san1ples, even when

Many children do not understand why a stranger compared with children who have backgrounds of

has suddenly taken them to an unfamiliar setting. similar deprivation:14 ·:l-" Prevalence estimates of

Some children may he unable or afraid to even ask depression, conduct disorder, oppositional defiant

where they are going, when they can go home, and disorder, attention deficit hyperactivity disorder,

where their siblings or parents are. They are often attachment, and anxiety disorders in this popula-

I

tired, hungry, dirty, and confused, and some may be in pain or distress from recent physical abuse or

tion range from 29% to 96%Y1·20 ·23 ·:-m-4o In Chernoff et al's" study, the prevalence of extreme

untreated medical conditions. Most children feel a combination of fear of the unknown, guilt in having
somehow brought about separation from their fam~

psychological problems was also quite elevated:
15% of children entering foster care reported suicidal ideation; 7°/} reported homicidal ideation.

ily, and a sense of being punished. Removal from one's family, even an abusive one, is generally traumatic for children.

Possible overuse of psychotropic rr1edications in children in foster care has been raised as a significant problem,41 although the use of such medica-

CHILDREN'S ADAPTATION TO FOSTER CARE PLACEMENT

tions in this population may actually be too low given the prevalence of mental health problems.
For example, Zima et al 42 conducted structured

Although childrens' patterns of adaptation to mental health evaluations on a sample of 6- to

placement are quite individual and vary with age, 12-year-old children living in foster care in Los

several themes are common. For example, many Angeles and noted that only 16% had ever been

children go through an initial period of appearing treated with psychotropic medication; the most

to adapt well to their new foster homes, although con1monly prescribed agents were stimulants

this is most likely a period of intense emotional (62%), antidepressants (31 %), and mood stabilizers

turmoil during which they do not manifest overt (31 %). However, less than half (48%) of the chil-

behavioral disturbance. However, after a short pe- dren with a psychiatric diagnosis for which treat-

riod of time, often within 3 months, foster parents ment with medication was indicated had received

•

may notice a significant increase in negative behav- any psychotropic medication in the previous year. ior marked by provocative acting-out or limit-test-

ing. These children behave as though they need MAINTAINING FAMILY TIES DURING PLACEMENT:

proof that their foster parents really care for them

PARENTAL VISITS

before they can open themselves to a trusting rela-

Family reunification is a major objective of foster

tionship. Conversely, children may withdraw or be care placement for most children, and ongoing con-

rh;pressed, angry and aggressive, and resist the ef- tact with parents during placement is an important

forts of foster parents to comfort them. These chil- factor with regard to determining if children even-

dren, initially cautious and wary of their new sur- tually return homo.4 :1 Visits may also be a source of

roundings, are not willing to get too close to their much emotional stress for children and their bio-

foster parents. Both patterns may resolve favorably logical and foster parents. 44 Most children respond

if foster parents respond with sensitivity and un- to visits with parents with a combination of antic-

derstanding. Many foster parents need support to ipation and anxiety and it is not uncommon for

manage the difficult psychological challenges of a behavior problems to occur before and after visits.

foster child.

Children may feel anger at their parents, whom

Less common are children with severe attach- they feel have abandoned them. They may perceive

ment disorders. Although they may at first seem to the end of tho visit as another abandonrnent when

adapt well, these children have great difficulty de- they cannot go home with their parents. Less com-

veloping relationships with their foster parents and monly, they may be afraid of being subjected to

remain emotionally detached. They often act in an further abuse or neglect during the visit. Where

indiscriminate fashion toward adults. Many exhibit visits take place and how they are conducted may

extreme behavior problems, such as hiding or influence their impact on the children, but those

hoarding food, excessive eating (polyphagia) or factors have received scant research attention.

drinking (polydipsia), rumination, self-stimulating Many agencies have specific programs to facilitate

and repetitive behaviors (masturbation, rocking or visits but some visits take place in the foster par-

head banging), and sleep disturbance. Despite ex- ents' home, at a public site (eg, fast food restaurant)

cessive appetites, these children may fail to gain or in the biological parents' home. The last is par-

weight or grow normally while in placement. Un- ticularly problematic if not supervised, because be-

fortunately, these children frequently experience a havioral problems, skin marks, or the child's verbal

succession of foster homos because their extreme account of the meeting after tho visit may too

behaviors and lack of emotional reciprocity chal- readily be interpreted by foster parents or case-

lenge the abilities of foster parents. Children with workers as evidence of maltreatment by the biolog-

symptoms of attachment disorder and their foster ical parents.

parents clearly require the support and guidance of

Although visits with biological parents during

a mental health professional to interrupt this dys- placement are often stressful, such contact should

functional pattern of behavior.

reassure children that their parents still care about

Psychological and behavioral problems are more them. Visitation may help strengthen the biological

common among children in foster care than in nor- family's functioning and lead to n1ore successful

912 SUPPLEMENT

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outcomes once the child is returned home. Thus, child welfare agencies should carefully plan and implement visits, paying partkular attention to the purpose of visits for the individual child and family.4''-47 However, visits that subject lhe child to repeated neglect by the parent(s), exposure to violence, or conflict between the biological parents and the foster parents or child welfare agency may aggravate tho child's adjustment to placement and should be avoided until the situation can be improved.
HEALTH CARE UTILIZATION BY CHILDREN IN
FOSTER CARE
As might be expected from the high prevalence of physical and mental health problems in this population, children in foster care are also heavy utilizers of health care services. In 1992, Halfon et a]"' documented greater utilization and costs of medical care for children in foster care in California compared with other children receiviflg medical assistance coverage. The major health care expenses for children in foster care resulted from hospitalization for perinatal complications, infectious diseases, and mental health disorders. Length of stay was 36% greater for mental health conclitions and 27% greater for perinatal problems for children in foster care. Most striking was this population's use of outpatient mental health services. Although children in foster care comprised only 4 ";(, of all children enrolled in MediCal in 1988, they accounted for 55% of all visits to psychologists and 45% of visits to psychiatrists paid for by the program.
Takayama et aP 7 compared Washington State Medicaid claims data for children in foster care 0 to 7 yems old with those receiving Aid to Families With Dependent Children (AFDC:) benefits in 1990. The mean cost of health care for children in foster care was $3075 versus $543 for AFDC children. The greatest expenditures for children in foster care were for mental health, supportive care, hospitalization, and medical equipment. Mental health services were used by 25°;b of children in foster care, compared with only 3% of AFDC children; and supportive services of visiting nurses and physical therapists were used by 13% of children in foster care, compared with only 1% of AFDC children. More than twice as manv children in foster care used medical equipment~ or specialist services or were hospitalized, compared with AFDC children. Most striking was the finding that a small group of children in foster cme (8%), who suffered from psychiatric disorders, neurologic conditions, and other complex, chronic medical diseases, often of congenital origin, had health care expenses that exceeded $10 000 per year, and accounted for 63% of the total medical expenditures for children in foster care.
CHANGE IN HEALTH STATUS DURING PLACEMENT
IN FOSTER CARE
The impact on children of removal from their parents and placement in a foster home is a critical

issue for the child welfare field. However, only a few studies have examined how these childfen change over time while in out-of~home placement. Children who experience long-term, stable placement show significant improvements in health sta~ !us, physical growth, and educational achievement. For example, Fanshel and Shinn11 followed approximately 600 children who remained in foster care in New York City for 5 years and found substantial improvements in their intellectual and academic performance. A study of children who entered foster care in Baltimore in different time periods found that better health status was positively associated with length of placement.4H Arecent study of preschool children who entered foster care for the first time in Connecticut noted that nearly half the children, regardless of their height at the time of placement, experienced dramatic catch-up growth in height during the first year of placement.4 n Nevertheless, a subset of children does not do well in foster care, and this raises several questions: Is this a particularly disadvantaged subset of children, or are these children whose foster families do not provide adequate nurturance? Can we identify and remediate the factors that contribute to their poor outcome? Alternative! y, what can be learned from children who thrive in foster care'?
THE IMPACT OF WELFARE REFORM ON
FOSTER CARE
Recent changes in family policy, particularly in relation to federal and state programs that provide financial support to families with dependent chil~ dren may have a dramatic impact on the number of children requiring placement in foster care and on their health status. The passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PL 104-193), known as welfare reform, has resulted in substantial changes in the structure of public assistance for poor families and children by ending benefits under the AFDC program, reducing the Food Stamps program and reducing eligibility for benefits under the Supplemental Security Income program. As a result, the number of families receiving public support has declined dramatically. However, the extent to which these families have been absorbed into the general workforce is not clear at present.
Although the impact of these changes on the health and welfare of children is uncertain, there is concern that without adequate support to escape poverty, many families' ability to care adequately for their children will be compromised, increasing rates of maltreatment and the number of children who require out-of-home placement. Additionally, lack of affordable high-quality day care may further compromise these parents' ability to remain in the workforce, or influence parents to place their chilciren in inappropriate care settings. The current economic boom and large number of low-level jobs generated may also mask the true impact of welfare reform on this population. Once the economy returns to a more norrnal pace, the number of former

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SUPPLEMENT 913

welfare recipients unable to find work may increase significantly.
THE IMPACT OF HEALTH CARE FINANCING REFORM ON FOSTER CARE
For nearly 40 years the Medicaid program has been the nation's principal source of health care coverage for poor children. Yet, despite increased expenditures generally for this program, reimbursement to physicians, dentists, and mental health practitioners has not kept pace with inflation, and the number of physicians willing to care for these children has decreased. ''0 In an effort to control program costs and improve access to care, some state governments enroll Medicaid recipients in privately owned and operated managed health care organizations (MCOs). Because MCOs share some burden of financial risk for the health care of children in their program, they have an incentive to provide effective services in an efficient manner by offering access to primary heallh care providers and a network of specialty providers. In addition, MCO centralized data collection and tracking systems may permit child welfare agencies to monitor health utilization patterns of children in their care. c; 1 Nonetheless, despite their potential for rectifying many problems of the fee-for-service reimbursement systen1, MCOs have come under criticism for restriCting access to newer pharmacotherapeutic agents, pediatric subspecialty care, mental health, and other health services (og, speech, occupational, and physical therapy), Again, the impact on the health of foster children enrolled in MCO programs is not yet clear.
BARRIERS TO HEALTH AND MENTAL HEALTH CARE FOR CHILDREN IN FOSTER CARE
Despite more than 30 years of concern by health care and social service professionals about the health and mental health of children in foster care, relatively little progress has been made in improving the delivery of needed services. The causes for this inertia are complex and widespread.
Among barriers to providing health and mental health care for this population are problems within the child welfare system itself. Anecdotally, children have become ill or died after placement because neither social workers nor the foster parents were aware of childrens' immediate health care needs. Frequent moves among foster homes or out of and back into foster care also contribute to children receiving care from many different physicians with little or no continuity.
Many child welfare agencies lack specific policies regarding health care of children in foster care. For the most part, caseworkers rely on foster parents to exercise sound judgment to detennine when children require health and mental health care, yet foster parents are not empowered to give legal consent for treatment. In some jurisdictions, biological parents must provide direct consent for health, developmental, and mental health care their children receive while in placement, introducing a potential obstacle or delay to necessary services. Although

many parents sign consent for routine health care at the time of placement, caseworkers must locate and encourage parents to sign separate consents for other specific evaluations (eg, mental health, developmental, or educational) or treatments, including any psychotropic medications. Child welfare agencies are responsible for ensuring that children in their care and custody receive services necessary to optimize their health and development. However, most agencies have continued to struggle with significant resource shortages in the face of increasing case loads, and children's health care has not been a priority for the child welfare system. Both the Child Welfare League of America" and the American Academy of Pediatrics":! have provided general guidelines for health care to children in foster care, but these have not been widely implemented. State agency regulations are needed to specify how this should be accomplished."' There is clearly a need for creative and collaborative initiatives between the child welfare and health care systems to improve the health care of foster children,
The continuing lack of comprehensive and coordinated health programs for children in foster care was apparent in a recent study condur.ted by the US General Accounting Office. 7 Despite state and county regulations requiring comprehensive routine health care, nearly one-third of young children in foster care in Los Angeles, Philadelphia, and New York City had received no immunizations, one-third had identified health care needs that were not met, and an estimated 12% of children had received no routine health care services. Although 78% of the children were considered to be at high-risk of HIV infection resulting from parental drug abuse, only 9% had been tested for the virus. That children fail to receive even basic health care despite the presence of many adults and professionals who share responsibility for them, including biological parents, foster parents, caseworkers, guardians' ad litem, judges, and health care providers, points to the need to clarify roles these individuals should play to ensure that children receive needed services.
Health care professionals share responsibility for poor care children receive in the foster care system. Although many physical, psychological, and developmental problems of these children are similar to those occurring in the general population, especially among low-income families, many health care providers and mental health professionals have had little training regarding issues specific to children in foster care and may not recognize problems or refer these children for appropriate care. In particular, community health care providers are more likely to identify and refer young children entering foster care for evaluation and treatment of physical health and educational concerns than for developmental and mental health problems.54
Addressing the health care needs of children in foster care has not attracted many pediatricians. The children's complex soda] situations, the extra time required to provide care, and the modest reimbursement may explain why many health care

914 SUPPLEMENT

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providers have been deterred from becoming in~ ucational problems, foster children generally re-

volvecl. 55 Lack of communication with profession- quire more frequent visits and more time than most

als in the child welfare system and frustration with children. Many states require that children newly

the limitations of that system may also discourage placed in foster care have a comprehensive health

health care providers.

assessment within 30 to 60 days of placement. In

Nationally, the inflexibility of existing state-op- addition to the usual health maintenance activities

•

erated Medicaid health care funding structures, required at each age, young children entering foster ;_:mel the move to managed care contracting without care should be screened for anemia, elevated lead

appropriate consideration of the special needs of level, sickle cell disease (when appropriate) and

children in foster care, have made it difficult to tuberculosis exposure. Signs or symptoms of phys-

develop new approaches to delivering health and ical abuse, neglect, or sexually transmitted diseases

mental health services to this population. Further- should prompt referrals for more complete evalua-

more, private foundations have shown little inter- tion, if possible, to an interdisciplinary team spe-

est in supporting this aspect of child welfare. A cializing in these problems. Developmental and

notable exception has been the American Academy psychosocial screening should include direct ex-

of Pediatrics, in cooperation with Wyeth Lederle amination with standardized measures because

Vaccines, which has supported several grass-roots studies have shown that reliance on caseworker

efforts to develop innovative clinical programs for and foster parent history for developmental infor-

children in foster care through its CATCH (Com- mation identifies only about 30% of all children

munity Access to Child Health) initiative.

with developmental delays."' Thus, initial compre-

IMPROVING THE HEALTH CARE OF CHILDREN IN FOSTER CARE

hensive medical evaluation should include mental health and developmental assessments. A follow-up visit should be arranged within 1 to 2

Health care services for children in foster care months to monitor the child's adjustment to the

should not only enhance the health of individual foster home and to evaluate his or her development

children, but also facilitate and reinforce perma- and emotional well-being. After their health status

nency plans. To these ends, several broader goals has been fully assessed, children in foster care

must be met, including development of an individ- should be followed closely to monitor their

ualized health care plan for each child in foster progress.

care, and integration of that health care plan into

Each child's risk for HIV, hepatitis B and C. and

the child welfare plan. The latter requires good congenitally acquired infection (in particular,

communication between child welfare and health syphilis) should be assessed and followed with ap-

professionals.

propriate laboratory tests to confirm the diagnosis

Although it can be very difficult to obtair, infor- and ensure prompt treatment. 5 t; Identification of

mation from distraught, oflen angry, and some- children who are HIV-positive is critical because

times absent parents, caseworkers or agency health pneumocystis pneumonia prophylaxis and early

care management personnel should try to collect as antiretroviral therapy should be implemented

much health information as possible about the along with modifications of the immunization

child, including current medical conditions, use of schedule. For example, varicella vaccine should be

medication, past health history, previous health withheld until a child's HIV status is known to be

care providers, past hospitalizations, allergies, and negative.

need for ongoing services. Parental consent should

A health plan should be developed by the health

be obtained to release all of the child's health care care provider for each child, updated at each health

records to the child welfare agency, which should care encounter, and communicated to the case~

then make them available to new health care pro- worker and the foster family. Child welfare agen-

viders. Children in need of immediate medical care cies should also maintain a centralized medical file

should be seen in an emergency care facility; an so that health information can be included in case-

appointment for an initial health screening exami- planning decisions. Foster parents should be en-

nation should be arranged with a primary care couraged and supported to accompany the child on

practitioner. Ideally, agencies should identify a visits. In some areas of the country, Foster Care

medical home for each child in their care and cus- Medical Passports have been created to share med-

tody. Whenever possible, foster parents should be ical information among professionals involved in

encouraged to continue children in the care of their the child's care.44·57 These abbreviated medical

usual health care provider. However, if this is not record forms are usually kept by foster parents and

possible, child welfare agencies should recom- brought to each health care visit. When used con-

mend a provider in the community who has a par- sistently, medical passports contain essential

ticular interest in the health care of children in health information (eg, immunization history, a list

foster care. Continuity of health care, at least while of known chronic medical problems, routine

in the system, will decrease the fragmentation of screening test results, etc}. However, more effective

care that has been a serious problem for these chil- solutions to the problems of collecting, maintain-

dren.

ing, and disseminating information about the

Health care professionals can play valuable roles health and mental health status of children in

in the care of foster children. Because of the high the foster care system will require the develop-

rates of health, developmental, behavioral, and ed- ment of state-of-the-art computerized databases

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SUPPLEMENT 915

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thHt integrate data from a variety of sources and sition to independent living can raise many con1incorporate appropriate security and confidential- plex emotional and practical issues. Although there

ity safeguards.

are few easy answers, health care providers can

Health care providers can be effective advocates play a valuable role by supporting the teen and

for children in foster care in several key ways. foster family in preparing for the challenges ahead.

Caseworkers may need assistance in obtaining ap-

propriate records from previous health care provid-

RESEARCH ISSUES

ers and interpreting the information. Individuals responsible for the child's care must have a thorough understanding of the child's health problems and the reasons for treatment recommendations. Foster and biological families may also benefit from support and advice health care providers can offer about child development and parenting issues. The health care providers' ability to coordinate medical referrals and recommend specific community re-

Many important questions about foster care involve health, developmental, and mental health issues. Health care professionals, working with colleagues in social work and mental health, can help advance knowledge in this field, improve policy and practice in child welfare, and improve the lives of manv children.s'J.tlo Potential areas for research includ; the following:

sources can ensure that children receive appropriate care in a timelv manner. Adherence to reconlmendations should be monitored at each visit and health care providers should alert caseworkers if the plan has not been followed. Efforts should be1 made to identify reasons why actions are not taken, as this may help determine if foster or biological families need additional support to care for their children. Finally, health care providers should document both concerns and positive developments, and offer written opinions and recon1mendations to courts when necessary.

Models of Health Care Delivery
Systematic and coordinated approaches to meet~ ing health and mental health needs of children in foster care are needed, but salient elements remain to be identified. Delivery models have included specialized health clinics, primary care practices, hospital outpatienl clinics, and use of medical consultants by_ social service agencies. 44 ·n1 ,n:t There have been no comparisons of the impact of these varied approaches on health service utilization patterns, health status indicators of children, or costs. Given the high prevalence of health, developmen-

PREPARING ADOLESCENTS TO AGE OUT OF FOSTER CARE
As adolescents turn 18 they are generally no longer eligible for services through the foster care system, and their foster families may no longer accept responsibility for them. Clearly, this can result in a very difficult transition to independent

tal, and mental health problems in this population, it should be possible to measure favorable outcomes by reduction in the overall burden of illness and increases in positive outcomes such as the rate of physical growth, improvement in achieving developmental n1ilestones, and/or emotional functioning, measured by standardized instruments.

living. Many states provide assistance to adolescents in foster care, such as help with housing, college, and job training to ease this transition. The responsibility for preparing adolescents for this transition rests primarily with the child welfare svstem. However, studies have found that adolesc~nts who age out of foster care are generally poorly prepared for employment and independent living."'' Recent federal legislation (Title IV-E Independent Living Program) has doubled support for these efforts, from $70 million to $140 million. States are allowed to use some of these funds for easing the transition to independent living for youth aged 19to 21 by, for example, covering room and board or offering medical assistance. Advocates need to work with states to help ensure these funds will be well-used to serve these very highrisk youth during a difficult transition period.
Health care providers can help prepare these youth by discussing future plans and preparation. Ensuring continued medical coverage may be an-

Role of P6mGiy Health Care Providers
Although many children in foster care require the services of pediatric subspecialists and mental health providers, all children should have a medical home where preventive health services can be provided and both acute and chronic problems treated appropriately. The effectiveness of coordinated primary health care services may be reflected in reduced re1iance on inappropriate emergency department visits, subspecia1ist consultations, and laboratory investigations.
Health care practitioners need to be sensitized to the many issues raised in this article, and such efforts should be evaluated. Indeed, pediatricians seem willing to be primary health care providers for these children,5 5 but ways to lnvolve them and improve their communication with other professionals involved in the care of these children (eg, social workers, lawyers, judges, etc) need to be developed.

other important issue, and the health care practi-

tioner may offer to continue being the primary care How Foster Care Is Perceived by Children

provider for some period. Alternatively, assistance

Another potentially valuable area to evaluate

with finding a new provider is needed. There may concerns the children's thoughts, feelings, con-

also be a need to guide the foster family on how to cerns, and wishes. Understanding childrens' views

encourage and support autonomy, but also to main- of their foster homes, foster parents, and casework-

tain an important emotional connection. The tran- ers, the health care system and health care provid-

916 SUPPLEMENT

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•

ers, and what they would like to see changed, may children. Health care practitioners can play a sig-

help to improve their experiences in foster care.

nificant role in providing care and assisting foster

Chddren's Adjustment to Foster Care

parents and caseworkers to ensure that children receive appropriate services in a timely fashion.

Studies should be conducted of how children of Researchers can examine promising strategies for

different ages adjust to placement in foster care. achieving these goals.

•

Very little information currently exists about chi1drens' adjustments to care over time, and the im-

REFERENCES

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visltation patterns, or separation from siblings. A

Child Su/JsU!ule CorD Population~. (VCIS Research Notes No. l:J)_

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5~)4-€1()1
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•

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918 SUPPLEMENT

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II

Health Care Needs of Children in the Foster Care System

Mark D. Simms, Howard Dubowitz and Moira A Szilagyi

II

Pediatrics 2000; I 06;909-918

DOl: 10.1542/peds.l 06.4.S 1.909

This information is current as of July 7, 2006

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DEDICATED TO THE HEALTH OF ALL CHILDREN'" .,'ln,:,-nc 7

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Form 8.

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Unrepresented Litigant

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PROOF OF SERVICE BY MAIL I am a citizen of the United States and employed in Los Angeles County, California, at the office of a member of the bar of this Court at whose direction this service was made. I am over the age of eighteen years and not a party to the within action. My business address is 400 South Hope Street, Los Angeles, California 90071-2899. On August 10,2006, I served the following:
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Attorneys for Defendants DIANA BONTA, Director of California Department of Health Services, and RITA SAENZ, Director of California Department of Social Services

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County Counsel RAYMOND G. FORTNER, JR. County Counsel BRANDON T. NICHOLS Children's Services Division 500 W. Temple Street, Suite 602 Los Angeles, CA 90012 (213) 974-1938 (213) 687-4745- Fax

Attorneys for Los Angeles County

MARK D. ROSENBAUM, ESQ. American Civil Liberties Union of Southern California 1616 Beverly Blvd. Los Angeles, CA 90026-5752 (213) 977-9500 (213) 250-3919- Fax

Attorneys for Plaintiffs

ALISSA KOLEK, ESQ. Heller Ehrman LLP 333 S. Hope St., #3900 Los Angeles, CA 90071-3043 (213) 689-7511 (213) 614-1868- Fax

Attorneys for Plaintiffs

ROBERT D. NEWMAN, ESQ. KIMBERLY LEWIS, ESQ. Western Center for Law and Poverty 3701 Wilshire Blvd., #208 Los Angeles, CA 90010-2809 (213) 235-2619 (213) 487-0242- Fax

Attorneys for Plaintiffs

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MELINDA BIRD, ESQ.

Attorneys for Plaintiffs

MARILYN HOLLE, ESQ.

ll

Protection & Advocacy, Inc.

3580 Wilshire Blvd., #902

Los Angeles, CA 90010

(213) 427-8747

(213) 427-8767- Fax

IRA BURNIM, ESQ. Bazelon Center for Mental Health Law 1101 Fifteenth St., NW. #1212 Washington, DC 20006 (202) 467-5730 (202) 223-0409 - Fax

Attorneys for Plaintiffas

PATRICK GARDNER, ESQ. JOHN F. O'TOOLE, ESQ. National Center for Youth Law 405 14th Street, 15th Floor
Oakland, CA 94612-270 I (51 0) 835-8098 (510) 835-8099- Fax

Attorneys for Plaintiffs

GINA ZARAGOZA-CRUZ

Attorneys for Plaintiff

Law Offices of Gina Zaragoza-

Cruz

22020 Clarendon St., #108

Woodland Hills, CA 91367

'

(818) 884-0890

-3-

•

RAYMOND G. FORTNER, JR. County Counsel ANDREW W. OWENS Assistant County Counsel BRANDON T. NICHOLS Deputy County Counsel Los Angeles County Counsel's Office 500 W. Temple St., Suite 602 Los Angeles, CA 90012 (213) 974-1938 (213) 687-4745- Fax

Attorneys for Los Angeles County Defendants

I declare under penalty of perjury under the laws of the United States that

the above is true and correct. Executed on August 10, 2006, at Los Angeles,

California.

-

~~~--~

LA2 808014. I

Patricia Mackoff'------~

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 </s> Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 1 of 100 Page ID #:8349

1 WESTERN CENTER ON LAW & POVERTY 2 Robert D. Newman (SBN 86534)
rnewman@wclp.org 3 Antionette Dozier (SBN 244437) 4 adozier@wclp.org
Richard Rothschild (SBN 067356) 5 rrothschild@wclp.org 6 3701 Wilshire Blvd., Suite 208
Los Angeles, CA 90010 7 Telephone: (213) 487-7211 8 Facsimile: (213) 487-0242

9 Attorneys for Plaintiffs (continued on next page)

10
UNITED STATES DISTRICT COURT

11
CENTRAL DISTRICT OF CALIFORNIA

12
KATIE A. by and through her next friend

Case No. CV-02-05662 JAK

13 Michael Ludin; MARY B. by and through her (AJWx)

14 next friend Robert Jacobs; JANET C. by and through her next friend Dolores Johnson;

15 HENRY D. by and through his next friend

16 Gillian Brown: AND GARY E. by and through Assigned to The Honorable his next friend Michael Ludin; individually and John A. Kronstadt, Courtroom

17 on behalf of others similarly situated,

10B

18
Plaintiffs,

19 v.

20
TOBY DOUGLAS, Director of California 21 Department of Health Care Services; LOS

ADVISORY PANEL=S REPORT TO THE COURT – ANNUAL REPORT FOR

22 ANGELES COUNTY; LOS ANGELES COUNTY DEPARTMENT OF CHILDREN
23 AND FAMILY SERVICES; PHILIP

2017, DECEMBER 21, 2018

24 BROWNING, Director of the Los Angeles
County Department of Children and Family 25 Services; WILL LIGHTBOURNE, Director of

26 the California Department of Social Services, and DOES 1 through 100, Inclusive,
27

28

Defendants.

_________________________________1_______

Advisory Panel’s Report to the Court – Annual Report for 2017, December 21, 2018

Case No. CV-02-05662 JAK (AJWx)

Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 2 of 100 Page ID #:8350

1 [Additional Counsel]

2
NATIONAL HEALTH LAW PROGRAM 3 Kimberly Lewis (SBN 144879) 4 lewis@healthlaw.org
3701 Wilshire Boulevard, Suite 750 5 Los Angeles, CA 90034 6 Telephone: (310) 204-6010
Facsimile: (310) 204-0891
7
8 YOUNG MINDS ADVOCACY CORP. Patrick Gardner (SBN 208119)
9 patrick@youngmindsadvocacy.org 10 115 Haight Street
Menlo Park, CA 94025 11 Telephone: (650) 494-4930 12 Facsimile: (650) 494-4930

13 BAZELON CENTER FOR MENTAL HEALTH LAW
14 Ira Burnim pro hac vice) irab@bazelon.org
15 1101 Fifteenth Street, NW, Suite 1212
16 Washington, DC 20006 Telephone: (202) 467-5730
17 Facsimile: (202) 223-0409
18
NATIONAL CENTER FOR YOUTH LAW 19 John O’Toole (SBN 62327)
20 jotoole@youthlaw.org Leecia Welch (SBN 208714)
21 lwelch@youthlaw.org
22 Fiza, A Quaraishi (SBN 252033) fquraishi@youthlaw.org
23 405 14TH Street, 15th Floor
24 Oakland, CA 94612 Telephone: (510) 835-8098
25 Facsimile: (510) 835-8099
26

27

28
2
Advisory Panel’s Report to the Court – Annual Report for 2017, December 21, 2018

Case No. CV-02-05662 JAK (AJWx)

Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 3 of 100 Page ID #:8351

1 [Additional Counsel]
2
DISABILITY RIGHTS CALIFORNIA 3 Marilyn Holle (SBN 61530) 4 marilyn.holle@disabilityrightsca.org
Melinda Bird (SBN 102236) 5 melinda.bird@diabilityrightsca.org 6 350 South Bixel Street, Suite 290
Los Angeles, CA 90017 7 Telephone: (213) 213-8000 8 Facsimile: (213) 213-8001
9 AMERICAN CIVIL LIBERTIES UNION 10 OF SOUTHERN CALIFORNIA
Mark Rosenbaum (SBN 59940) 11 mrosenbaum@aclu-sc.org 12 Los Angeles, CA 90017
Telephone: (213) 977-9500 13 Facsimile: (213) 977-5297
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28 3
Advisory Panel’s Report to the Court – Annual Report for 2017, December 21, 2018

Case No. CV-02-05662 JAK (AJWx)

Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 4 of 100 Page ID #:8352

1

Pursuant to this Court=s Order, Plaintiffs are filing the Advisory Panel=s Report

2 to the Court – Annual Report for 2017, December 31, 2018. A true and correct copy 3 of the Advisory Panel=s Report to the Court is attached hereto.

4

5 Dated: January 22, 2019

Respectfully submitted,

6

7

8

By:______________________________________

9

Antionette Dozier for WESTERN CENTER

10

ON LAW AND POVERTY

Attorneys for Plaintiffs

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28
4
Advisory Panel’s Report to the Court – Annual Report for 2017, December 21, 2018

Case No. CV-02-05662 JAK (AJWx)

Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 5 of 100 Page ID #:8353
The Katie A. Advisory Panel Draft Report to the Court Annual Report for 2017
December 21, 2018
The Katie A. Advisory Panel c/o 428 East Jefferson Street
Montgomery, AL 36104 (334) 264-8300
Marty Beyer Paul Vincent Edward Walker
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Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 6 of 100 Page ID #:8354
TABLE OF CONTENTS

Executive Summary

3

I. Introduction

12

II. 2018 Updates

13

III. DMH Performance

21

IV. DCFS Performance

41

V. Qualitative Service Reviews

58

VI. Outcome Measures

65

VII. Panel Recommendations

76

Appendix

83

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Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 7 of 100 Page ID #:8355
EXECUTIVE SUMMARY
The following Panel Report addresses LA DCFS and DMH performance for the calendar year 2017 and includes a brief summary about implementation initiatives and challenges during 2018 to date. This report identifies major continuing concerns of the Panel about the County’s slow progress in implementing the Katie A. Settlement and uncertainty that current County strategies will succeed in implementing the Shared Core Practice Model, which is a key strategy for compliance.
The Panel commends the County’s progress in some important areas:
System Strengths
DCFS Staffing DCFS has increased its overall staffing notably since 2014, when it hired 526 staff. Since then it hired 601 staff in 2015, 682 staff in 2016, and 533 staff in 2017. According to DCFS, this permitted the continuing services caseload to decline from an average of 24.5 cases to 19.2 today. Emergency response caseloads declined from 15.2 to 9.9.
Development of Child and Family Team (CFT) Capacity DCFS reports that as of August 2018, it has certified 2, 635 CFT facilitators, 500 CFT coaches and 65 coach developers. Development of staff in these skills is an important step in building the capacity necessary to implement the Shared Core Practice Model.
Children in Congregate Placements DCFS advises that in an effort to identify children in group care settings who may be able to transition to a less restrictive setting, it has assessed over 800 children, 95 percent of whom have already had an initial CFT meeting.
Emergency Child Care Bridge Program DCFS has initiated a program to provide time-limited child care to caregivers who are providers of licensed and license-exempt caregivers for children. The lack of subsidized child care has been a significant barrier to foster care recruitment, since so many prospective foster parents are employed. DCFS expects to fully spend its $14 million allocation. This amount is far from being sufficient to meet the need for child care, but is a positive step.
School Continuity Through a partnership with the education community, DCFS used local funds to contribute $300 thousand in FY 17-18 and $800 thousand in FY 18-19 to fund transportation to the school of origin when a child is placed outside of that jurisdiction. This covers transportation costs until a determination is made about whether it is in the child’s interest to continue being transported. Over 500 children have been served. Having school stability is a priority for children who are adjusting to being removed from their families. DMH Coaching In July 2017, DMH was given authority to add 28 coaches and 3 supervisors, intended to support Shared Core Practice Model implementation among mental health providers. There are currently 25 coaches on board, with the remaining 13 pending start dates.
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Continuing County Implementation Challenges

DCFS Staffing While DCFS has commendably reduced caseloads over the past four years, the County goal of 24 cases per Continuing Services work is higher than the goal it set for staff in immersion offices, which was 20 cases per Continuing Service worker. The caseload standard of 24 cases is significantly higher than the standard in most other child welfare systems under settlement agreements. The goal of 20 cases per CS worker was what was identified as the standard necessary for full Shared Core Practice Model implementation. Currently, over half the CS caseloads exceed that number.

CFTM Implementation The following table shows how far the County has to go in fully implementing the CFT process. Only two DCFS offices were having initial team meetings with more than 40 percent of cases and performance was quite low in almost all the offices. The percent of follow-up CFT meetings conducted was even lower.

All DCFS Children

Office

ALL DCFS-SUPERVISED CHILDREN

Percent with timely

Percent with timely

Initial CFT Meetings

Follow-Up CFT Meetings

(within 60 days of case opening) (within 90 Days of Initial CFT Meeting)

American Indian

23%

6%

Asian Pacific

30%

14%

Deaf Services Unit

26%

13%

El Monte

25%

3%

Glendora

14%

4%

Lancaster

26%

9%

Metro North

18%

2%

Palmdale

16%

2%

Pasadena

23%

5%

Pomona

22%

2%

Santa Clarita

50%

22%

Van Nuys

27%

10%

West LA

17%

9%

West San Fernando Valley

38%

13%

Belvedere

15%

3%

Compton

23%

3%

Santa Fe Springs

41%

13%

South County

15%

2%

Torrance

19%

1%

Vermont Corridor

9%

1%

Wateridge North

14%

2%

Wateridge South

36%

11%

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The Immersion Process In 2016, after demonstrating little progress in implementing the Shared Core Practice Model, the County adopted a process for fully implanting the practice model in only a few offices each eighteen months, which permitted the provision of intense training and coaching and allocation of additional staff in those sites. This approach, called the immersion process, has been used successfully by other systems nationally to provide sufficient supports to permit lasting progress to be sustained. In 2018, the County decided to cease use of this process in favor of again attempting to reform all 19 offices and 3 specialized units simultaneously. Despite the fact that the parties and Panel had treated the immersion approach like part of the strategic plan, neither was formally notified of the change until after the decision had been made. The Panel does not have confidence that without intense training and coaching and the allocation of additional staff, this countywide approach will bring the County any closer to full implementation of the Shared Core Practice Model and in fact, believes it could will delay it further.

Specialized Mental Health Services (Wraparound and Intensive Field Capable Clinical Services - IFCCS) Both Wraparound services and IFCCS should be effective supports for children with high mental health needs. However, as it has in previous years, the Panel is deeply concerned at the apparent underutilization of these services. The County reports that as of December, 2017, Wraparound was serving 2,177 children and had 573 vacancies, a 21% vacancy rate. IFCCS, which can serve 765 children, had a 33% vacancy rate. The Panel frequently learns of cases from staff and stakeholders that involve children experiencing placement disruptions or placement in more restrictive settings without the involvement of these intensive services. Unfortunately, there is no effective tracking system to know the actual incidence of these missed opportunities or why they are occurring, making it difficult to develop a solution.

Congregate Care These have been modest reductions in the number of children in congregate care in the past 4 years. However, 2017 data reflect a continuing pattern of 80 or more children age 0-12 in congregate care. Data also show troubling time-in-care trends, as illustrated in the following table.

Age Group 0 - 12 13 - 17 18 plus

0 to 2 Months in Group Homes 314 2354 146

2 to 6 Months in Group Homes 235 2685 349

6 to 12 Months in Group Homes 196 1814 332

Over 12 Months in Group Homes
273 1420
578

Two hundred seventy-three children 12 and younger had group home stays of more than 12 months, a period for two long for this age group in the opinion of the Panel. And 2814 children had stays of 2 months or less, which suggests that if appropriate family based placement settings and intensive home-based services had been available or utilized early, many of these placements could probably be avoided. Given the underutilization of Wraparound and IFCCS, intensive support services should have been available to help some of these children avoid group home placements. It seems clear that additional services for highneed children are necessary.

Practice Quality In analyzing the QSR Practice Scores for all eighteen offices in the third cycle and comparing them to the baseline, system performance demonstrated slight improvement in the following indicators: Support and Services increased from 66% to 67% and Intervention Adequacy increased from 52% to 57%. System

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performance in Engagement remained at 60% in both the baseline and third cycle. In Overall Practice, scores decreased slightly from 47% in the baseline to 42% in the third cycle. Teamwork demonstrated a slight decline from 18% in the baseline to 11% in the third cycle. Current performance in the third cycle, after eight offices, indicates that:
 51% of children are making acceptable progress toward permanency  73% of children are considered to have acceptable emotional well-being  43% of families are making acceptable progress toward adequate functioning  11% of children have a functioning family team  38% of cases have an overall adequate assessment  30% of cases have a long-term view of child and family goals and strategies  30% of cases have plans adequate for achievement of case goals  42% of cases are adequately tracked toward achievement of goals
These low QSR scores are one of the major reasons for the Panel’s concern about the status of Shared Core Practice Implementation. Despite the County’s success in developing CFT facilitators and coaches, those gains are not producing a commensurate improvement in actual system performance. The Panel has encouraged the County to develop effective strategies to move beyond being stuck at the current level of performance.
Data Analysis One promising initiative the County, plaintiffs’ and Panel have been involved in is an effort to identify additional progress indicators that are reflective of Shared Core Practice Model implementation, such as placement stability, placement in family based settings and delivery of intensive mental health services. The parties were also considering quantifiable performance goals for these indicators, which were referred to as tipping points, which could indicate proximity to being “good enough” to satisfy settlement agreement objectives.
The County recently advised that it had discovered that the DMH data and payment system would not be able to capture key elements of DMH practice necessary to track DMH performance. The changes in the data system needed to track the indicators were originally forecast to require a multi-year process. However the County now projects that the initiative will be completed in 2019.
The parties are now in discussion about how to employ interim processes that might permit some level of additional data tracking, but as of yet there is no plan to do so. Without the ability to collect critical mental health data, the Panel is limited in its ability to inform the court about DMH progress in implementing the Shared Core Practice Model.
Panel Recommendations
The slow pace of improving practice and providing the right services at the right time to meet children’s needs continues to be the primary problem in Katie A. despite the commitment of both DCFS and DMH. The Panel had hoped the County’s work on developing data indicators that reflect progress toward full implementation and the identification of tipping points could aid in meeting settlement objectives. However, now that the County has concluded that its data systems will not currently support those tasks, other strategies will be necessary to improve performance. The County reports that it will continue to
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work on improving its data systems, but that seems like a long-term effort. DCFS and DMH still must answer the question: To what extent have DCFS staff and DMH providers implemented the Shared Core Practice Model? To what extent do DCFS and DMH provide children and families with timely mental health services specifically designed to meet the child’s needs? If this inquiry can produce data that is regularly updated, DCFS and DMH can enhance ongoing methods to ensure that staff change their practice accordingly. If not, other strategies will be required.
1. Ensure the Immediacy and Intensity of Intensive Home-Based Mental Health Services
It is imperative that DMH and DCFS collaborate to provide consistent, accurate and up-to-date data to track (1) immediate response to children at risk of placement disruption, (2) frequency and type of mental health services provided to children, their caregivers and their families, and (3) information dissemination to insure that the slots in IHBS are full.
DCFS and DMH agree that it is important to collaborate on achieving responsiveness of IHBS, especially to prevent placement in emergency shelter, group home, residential facilities and psychiatric settings and placement disruptions, including the speed of identifying the child’s needs, making an immediate IHBS referral, IHBS beginning services quickly, and provision of services as many hours a week as necessary to meet the child’s needs and support both the caregiver and the parent in visits in meeting those needs. However, there appears to be little progress in DCFS and DMH data collection and analysis on IHBS responsiveness. The CISR does not appear to analyze IHBS responsiveness.
The Panel is doing interview studies of children receiving IHBS and children/youth in group care (including CSW interviews) to collect information about responsiveness of IHBS, IHBS intensity and IHBS success of preventing placement disruptions. We will encourage DCFS and DMH to take action on the findings of those studies. But small studies of IHBS provided to children and families cannot provide the kind of up-to-date systemic data on responsiveness and intensity of IHBS necessary to exit Katie A.
Recent county data indicates that surprisingly, subclass members are not receiving more mental health services than other children, the highest amounts of children’s mental health service dollars continue to support services in residential treatment (over $30,000 of services annually per child as compared to $23,000 annually per child in IHBS), a third of IFCCS slots continue to be empty and Wraparound continues to have a large number of unsuccessful terminations. This information is discouraging.
The Panel reiterates its recommendation in our 2016 Report that DCFS and DMH implement improvements driven by data to ensure that (1) soon as DCFS recognizes that a child’s placement may disrupt or a child is being considered for placement in any setting outside a family home, an immediate referral to IHBS is made; (2) IHBS is provided immediately to address the child’s needs and provide support to caregivers to prevent disruption; and (3) IHBS services have a “whatever it takes” approach, with daily in-home services for the child and caregiver if necessary. A pre-defined team of mental health staff should not determine what services or their intensity are provided—staff assignments should be unique to the child and family; services for the child and support for the caregiver and family should target the child’s trauma-related needs.
2. Ensure Placement Stability
DMH and DCFS have a commitment to prevent the trauma of disruption for children. This has been a prominent priority in the tipping points discussion.
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 Continuing obstacles to achieving placement close to home appear to be that (1) the FFAs manage their own placements and placement moves and do not prioritize proximity to family (the FFAs are the majority of placements of children in foster homes) and (2) the fledgling Automated CommunityBased Home Reservation system encountered difficulties.
 The primary obstacle to ensuring that each child’s first placement was their only placement appeared to be insufficient support, including IHBS, for foster parents and kin caregivers to meet the traumarelated needs of children with difficult behaviors.
The Panel encouraged the county to investigate how many children are placed away from their siblings to begin a process of keeping children with at least one sibling to support those important attachments.
One reason for placement close to home is to make frequent visiting between parents and their children in care possible. DCFS is committed to improving the quality of visits, a key ingredient to safe reunification but with court-ordered multiple visits each week and limited staff to transport children long distances and monitor visits, it is unknown how much visit improvement can occur. Visits are less difficult for children when there is shared parenting between parents and caregivers, with agreement between them about the child’s needs and how to meet those needs, both during visits and in the caregiver’s home.
More than half the children in foster home placement in LA County are placed with relatives. CCR requires licensing of relative placements, but support for kin in meeting the needs of children—especially the subclass—is often overlooked. To ensure placement stability in kin placements, relatives should be involved in CFTs, asked what support they require to meet the child’s needs and IHBS provided if other supports do not have sufficient intensity.
3. Ensure Effective Teaming Teaming is an essential feature of SCPM. Teaming is both the process of collaboration among the family, CSW and providers to ensure needs are met and meetings together so all agree on the child’s needs and what the family, caregiver, provider, CSW, informal supports and others will do to meet those needs. As the Panel summarized in its 2016 Report, quality CFT meetings require:
 Ongoing communication among team members before and after team meetings  The family  A family support(s) chosen by the family  The caregiver (kin or foster family)  The CSW (with some exception if meetings occur more than monthly)  Key providers such as the child’s therapist and school team member,  Identify the strengths of the child, family and caregiver  Identify the specific unique needs of the child, especially trauma-related needs  Craft services to meet each of the child’s needs  Craft supports for the caregiver to meet the child’s needs  Craft supports for the family to meet the child’s needs (during visits)  An agreed-on plan with strengths, needs and supports and services provided to participants and incorporated into the court report and the mental health treatment plan
At this point DCFS and DMH cannot track the degree to which quality CFT meetings with these characteristics are occurring. There is less information available about CFT meetings facilitated by DMH staff than, including IHDS cases, than those facilitated by DCFS staff.
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Although in most cases, DCFS and DMH staff actively collaborate with the child, caregiver, and each other, in the most recent QSR cycle, the County scored acceptably on teaming in only 11 percent of cases because the CFT meeting has not occurred and/or all the important individuals in the child’s life were not included. The Panel has recommended training for QSR reviewers as well as targeted coaching of DCFS and DMH CFT facilitators regarding how to achieve the above characteristics of CFT meetings.
4. Strengthen the Supervisory Role in Shared Core Practice Model Implementation
The Panel believes that the County cannot meet QSR exit standards without DCFS and DMH supervisors leading Shared Core Practice Model practice, including holding staff accountable for quality CFT meetings in every case that produce CFT plans and mental health treatment plans with services crafted to meet the unique needs, particularly trauma-related needs, of children and supports for caregivers and families to meet those needs.
In the spring, 2018, DCFS and DMH increased the number of coaches and was beginning to provide more supervisory training and guidance for strengths/needs-based serviced service crafting. But the reassignment of coaches to state mandated CCR and to the four offices with the lowest number of CFTs set the county back six months in providing strong countywide support for supervisors. The Panel reiterates its recommendations from the 2016 Panel Report:
 Ensure sufficient coaching and training in strengths/needs-based service crafting is provided to supervisors in DCFS and DMH that they consistently guide the staff in their units include children’s underlying needs and unique services and supports to meet those needs in CFT plans, DCFS case plans, DCFS court reports and mental health treatment plans.
 Ensure sufficient coaching is provided to supervisors that they consistently monitor that each family in each worker’s caseload has had more than the initial CFT meeting and is having CFT meetings often enough to arrange unique services coordinated with both the parent and caregiver and together assess whether they are the right services at the right frequency.
5. Use the QSR as a Teaching Tool for Shared Core Practice Model The Panel views the County’s development of its QSR team as an important achievement. The system’s QSR reviewers are doing a commendable job in providing the County with accurate and valuable feedback on the quality of its practice. The Panel has encouraged DCFS and DMH to get more power from the QSR as a way to teach consistent SCPM across offices and providers. Ascending QSR scoring trend lines will confirm that countywide SCPM is being achieved. Some modest progress is reflected in some QSR scores, while other scores continue to be frustratingly slow in improving. The Panel reiterates past recommendations to enhance the QSR as a teaching tool for SCPM:
 Requiring all DCFS leadership, RAs and ARAs and their DMH manager counterparts and all DCFS and DMH trainers and coaches who have not already done so to shadow a QSR.
 Regularly hold cross learning sessions of QSR staff and coaching/training staff as well as twice annually convening the larger management team for a DCFS/DMH supervisors training that uses SCPM lessons learned from QSRs and selects illustrative QSR stories.
 Inviting QSR experts to lead a discussion of inter-rater reliability and consider possible modifications of (1) the QSR Assessment Indicator to require identification of specific child needs
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as a standard for acceptable rating, including a review to see if needs are in the case plan and court report; (2) the QSR Intervention Adequacy Indicator to require service crafting as a standard for acceptable rating and (3) the QSR Teaming Indicator to reflect that if the first CFT is in the review period, team formation may be off to a good start but all the potential team members or all the issues will not be addressed.
 A coaching session for QSR staff using the Panel’s analysis of the needs and services in the case stories of the most recent QSRs to guide the reviewers in enhancing how they can inspire SCPM practice by presenting a strong needs list and crafted services in each case story
6. CISR The CISR is designed to improve IHBS across many DMH providers. The Panel commended the recent CISR Report and recommended that in the next CISR DMH (1) ask more questions of each provider about the reasons for psychiatric hospitalization and placement change after enrollment in IHBS and what IHBS did to intensify services to prevent it and (2) establish a typical range frequency of each type of IHBS service, such as the percentage of children who receive individual therapy once a week or more, the percentage of caregivers who receive in-home guidance in meeting the children's needs once a week or more, and the percentage of children who receive in-home one-on-one support.
7. Immersion The fact that the County ceased using the immersion process was a surprise to the Panel. The strategy developed for this approach occurred over many months and involved frequent conversations about the design with plaintiffs’ and the Panel. Four offices were intensively involved in implementing the approach. The Panel considered the use of immersion as part of the revised Strategic Plan the parties had agreed to. The Panel expressed its reservations about the new system-wide approach previously about this report. We continue to believe that the County does not have the resources to fully implement the Shared Core Practice Model throughout the County at one time and that an immersion approach is the best strategy for meeting settlement objectives. The value of the immersion process includes:
 Providing sufficient training and coaching that all staff are thoroughly trained and coached, leading to greater sustainability of practice
 Thoroughly testing innovations before attempting to implement them system-wide
 Gradually intensifying the service array and staff size (which can be costly), so additional costs rise gradually
We recommend that the County resume the immersion strategy, which could include more than two offices at a time. The County could continue some support in non-immersion sites, as was anticipated in the original plan. If the County choses to continue its system-wide implementation approach, The Panel believes that it needs a detailed plan for that strategy, which includes more than training and coaching.
8. Improve the DMH Data System The County should fully support the DMH plan to strengthen the ability of its data system so that it tracks key practice areas such as the timeliness of provision of intensive mental health services and the type and frequency of services provided to class members. In the interim, the County should fully explore the use of interim processes that will contribute additional performance data about DMH practice and performance.
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2016 Report Recommendations The Panel has included the recommendations in its 2016 report in the Appendix. This was done in part to illustrate the commonality between issues raised in the 2016 report and many of those in the 2017 report. The Panel is also asking for a County response on the status of these recommendations.
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Katie A. Advisory Panel Draft Report to the Court Annual Report for 2017
December 21, 2018
I. Introduction
The following Report to the Court outlines the County’s progress toward achieving the objectives of the Katie A. Settlement Agreement and includes a description of its compliance with the current Joint DCFS/DMH Plan, Corrective Action Plan and the Strategic Plan. The court will recall that in late 2014, the County, plaintiffs and Panel began to discuss strategies to accelerate Katie A. implementation by undertaking an “immersion process” whereby the County would select two offices/regions per 18-month period in which there would be more intensive supports and resources invested to accelerate implementation. The County adopted this approach because of limited progress to date and the large size of the County, which makes it difficult to bring intense resources to bear in each jurisdiction simultaneously, and to provide an environment where innovation can be tested prior to implementation throughout the County. The first immersion offices were Compton and Van Nuys. The second two sites scheduled for immersion were Pasadena and Belvedere. As will be address later in this section, the County has now ceased using the immersion process.
Panel Report Background
Some background is useful in reviewing this report. This report covers the 2017 monitoring and reporting period. There is always a lag between the end of the reporting period and the publication of the report while end-of-year data are being collated by the County. As a result, the information in monitoring reports is somewhat dated. To make the report more current, some current information on implementation efforts is also included.
Second, of necessity, some County implementation strategies within the Strategic Plan have been revised because of experience with earlier efforts, new challenges and new initiatives. Performance on some of these early strategies reflect substantial compliance, such as in establishing the Medical Hubs and providing mental health screening to children served by DCFS. At this point the Panel monitors ongoing performance in areas such as these to assure that progress is sustained. Some of the newer implementation strategies underway are not reflected in the original Strategic Plan, but are considered by the parties to be functionally part of current planning. The Panel monitors and reports on these as essential functional revisions to the Plan.
Third, because of its limited capacity to continuously track and verify operations within DCFS and DMH, the Panel is unable to generate its own quantitative evaluative data on which to base its appraisal of County performance under the settlement. As a result, the Panel relies on County data to judge
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quantitative and some qualitative trends on system performance, outcomes and compliance. The County is asked to provide relevant data and its own analysis of trends, which the Panel utilizes in its reports. As a result, much the content of Panel reports consists of County-produced data, which the Panel has analyzed. The Panel is undertaking several studies in the fall of 2018, on placement stability with children receiving Intensive Home Based Services, and children in group care. Findings will be reported to the court.
II. 2018 Updates

Caseloads

The Panel is interested in tracking caseload size beyond reliance on average DCFS caseloads to better understand the relationship between caseload and performance. The County provided the Panel with actual caseload ranges, based on entries into its data system, The County cautions that the data system does not provide complete accuracy because information is reliant on accurate and consistent CSW input; however, data from this source is far more accurate than averages. The County has established a caseload standard (goal) of 18 cases per Emergency Response (ER) worker and 24 cases per Continuing Services (CS) worker. As of July, 2018, actual county-wide caseloads were in the following ranges.

Program Area ER

1-18 caseload 752 Staff

19-27 caseload 33 staff

28 + caseload 2 staff

Average 16.20

Program Area CS

1-10 caseload 72 staff

11-20 caseload 674 staff

21-30 caseload 748 staff

Average 20.03

Unfortunately, because the goal for CS workers is a caseload of 24, the ranges utilized by the County do not capture the exact number of caseloads within the goal. When DCFS was setting expectations for its initial Immersion offices, it utilized a goal of 20 cases per CS worker as the standard for fully implementing the Shared Case Practice Model. Currently, over half the CS caseloads exceed that number.

The Panel reviewed the caseload standards for a number of other systems that are under a settlement agreement and found the following. These mandatory limits provide some national context for LA’s caseload sizes.

Oklahoma

Caseload standards are 10 child protection (ER in LA County) cases and 15 children for ongoing services. Peer coach caseworkers have 1/2 of a caseload and there are graduated caseload standards for new workers. The last two requirements (peer coaches and new workers) are not in their settlement document, but reflect State goals.
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Tennessee
In Tennessee, which recently exited court supervision, DCS case managers responsible for the case of at least one class member cannot have case responsibility for more than:
 15 individual children in DCS custody if the case manager is a case manager 1;  20 individual children in DCS custody if the case manager is a case manager 2 or 3 with no
supervisory responsibility; and  10 individual children in DCS custody if the case manager 3 supervises one or two lower-level case
managers.
The Settlement Agreement allows DCS to propose a standard for "mixed caseloads" of custodial and noncustodial cases or for some "family case" standard (like New Jersey has), but until they do, the caseload limits are based on the number of children, not the number of families, and no distinction is made between a sibling group of five in a single foster home (or at home with their parent in a non-custodial case) and five individual unrelated children in five separate resource homes.
Supervisory workload limits permit a supervisor (with no caseload) to supervise up to five caseload carrying case managers.
Washington DC
 Child Protection Investigations: 1:12  In-home services: 1:15 families  Out of home care 1:15 children  Home studies 1:30  Supervisory 1:5
New Jersey
The intake/protective investigations caseload standard is 1:12 and not more than 8 new referrals per month. No intake worker with 12 or more open cases can be given more than 2 secondary assignments per month. Permanency caseloads are limited to (in-home and out of home) 15 families or fewer with no more than 10 children in out of home care. Adoption standards are 1:12 children Supervisory rations cannot exceed 1:5
It is clear that caseload limits are much lower in these systems than in DCFS.
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Child and Family Team Meetings (CFT)

The regular use of Child and Family Team Meetings is a primary principle of the Shared Core Practice Model and was considered so important to the parties that it was included within the Qualitative Service Review process as part of the exit conditions. The CFT process provides an effective locus for engaging families, identifying child needs, planning and crafting services to meet identified needs. The County has struggled to provide CFT meetings for children and families with quality and sufficient regularity.
As part of the County’s Strategic Plan, the County has worked diligently to develop the capacity to teach front-line staff to facilitate team meetings. As of July 31, 2018, DCFS reports that it has certified (through training and coaching) 3,200 staff as CFT facilitators. A total of 2,635 of these staff are facilitators, 500 staff are coaches and 65 staff are coach developers. DCFS also reports that as of August 2018, 16,989 CFT meetings have been held. Of 800 children placed in group care, 95 percent have had an initial CFT.
DCFS has consistently expressed the view that lower caseloads would permit CFT meetings to be held more frequently with greater numbers of families. From the Panel’s review of caseload data it appears that close to half of continuing service caseloads exceed the 20 case per worker average goal for Immersion offices.

The data in the following table is for Continuum of Care Reform (CCR) children (newly-removed since 1/1/17 or already in group care on that date and beyond), not the total children served by DCFS. These two cohorts of children are those covered by the State’s CCR requirements. Ordinarily, systems wouldn’t combine such different groups in the same table. The table following this one provides a more comprehensive view of CFT performance.

CCR Children

Office
American Indian Asian Pacific Deaf Services Unit El Monte Glendora Lancaster Metro North Palmdale Pasadena Pomona Santa Clarita Van Nuys West LA

Percent of Children with Initial CFT Meetings within
60 days of case opening

Percent of Children with Follow-Up CFT Meetings
within 90 Days of Initial CFT Meeting

67.7% 95.7% 50.0% 77.1% 63.01% 59.5% 39.6% 46.9% 67.8% 69.2% 71.4% 65.2% 67.8%

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45.2% 56.1% 33.3% 31.0% 24.2% 37.5% 11.9% 14.3% 27.7% 33.9% 58.4% 34.7% 57.9%

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West San Fernando Valley Belvedere Compton Santa Fe Springs South County Torrance Vermont Corridor Wateridge North Wateridge South

77.3% 52.9% 41.5% 66.5% 53.9% 52.8% 32.0% 39.4% 52.7%

50.4% 13.8% 14.1% 61.4% 9.9% 5.9% 1.8% 2.4% 35.6%

The CFT data in the table below are for all children with a DCFS case.

Office
American Indian Asian Pacific Deaf Services Unit El Monte Glendora Lancaster Metro North Palmdale Pasadena Pomona Santa Clarita Van Nuys West LA West San Fernando Valley Belvedere Compton Santa Fe Springs South County Torrance Vermont Corridor Wateridge North Wateridge South

All DCFS Children

ALL DCFS-SUPERVISED CHILDREN

Percent with timely

Percent with timely

Initial CFT Meetings

Follow-Up CFT Meetings

(within 60 days of case opening)

(within 90 Days of Initial CFT Meeting)

23%

6%

30%

14%

26%

13%

25%

3%

14%

4%

26%

9%

18%

2%

16%

2%

23%

5%

22%

2%

50%

22%

27%

10%

17%

9%

38%

13%

15%

3%

23%

3%

41%

13%

15%

2%

19%

1%

9%

1%

14%

2%

36%

11%

These data do not include all CFT cases where the meeting is convened by DMH staff, meaning the number of CFTs in which class members are involved is somewhat greater than that shown in the two tables. The additional number of DMH cases is relatively modest.

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Simply having a family meeting is not necessarily an effective strategy for achieving Shared Core Practice Model Practice. Effective CFT meetings provide for meaningful family input into planning, have the family’s informal supports present, identify child and family needs, craft services that meet needs and track progress regularly. The QSR process, mentioned earlier, not only captures the incidence of team meetings, but also the quality of the meetings. In the 2015 -2017 third cycle of quality reviews, the County scored acceptably on teaming in only 11 percent of cases.
The Immersion Process
In 2016 the County undertook an implementation recommendation the Panel made shortly after the Panel was formed and again in January 2015. Based on successful experience in other systems, the Panel recommended that rather than trying to reform the system county-wide at one time, the County should focus on a small number of office at one time with the most intensive supports offices would need. The cost of providing such intensity system-wide concurrently would be prohibitive and the County did not possess sufficient capacity to provide the necessary training and coaching for a system-wide initiative.
Once adequate progress occurred in initial offices, the County could then begin the process in another group of offices, following this serial implementation strategy until the entire the entire system completed implementation. Within the immersion model, staff supports frequently include extensive staff coaching and training, additional flexible funds, new services and expanded placement resources within the neighborhoods and communities where families live. Other systems using this approach have described it as the immersion process, as in immersing a locality in the supports needed to implement their new model of practice.
When the County chose to adopt this process, it did provide some additional staff and more intensive training and coaching supports to the selected offices, but did not target new services or other resources for these jurisdictions. Other resource expansion remained system-wide. In the second round of immersion, involving two more offices, no additional staff were allocated. The immersion process was part of the virtual implementation plan developed by the County, which the Panel considered to be a formal strategy the parties had agreed on.
Although the use of the immersion process was part of the virtual strategic plan the County was following in 2017, the Panel has learned that the County is no longer employing it. The Panel recently learned that that in 2018 the County ceased the use of the immersion process and has returned to a County-wide implementation approach. The County explains that with hiring of thousands of new workers in recent years, resulting in caseloads dropping from the high 30’s to the low 20’s, continued work with the union on expectations for use of the CFT process and development of large numbers or practice coaches, the immersion process was no longer seen as preferable. The County also noted that unlike DCFS, DMH doesn’t have the type of local office structure that permits and office-by-office approach. Based on how far offices have to go to fully implement the Shared Core Practice Model, as evidenced, for example, by QSR scores and metrics like CFT frequency, the Panel is not convinced that the County will have any more success in using a system-wide implementation approach than it did in the
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first years of the settlement. The scope of the system is, in our opinion, too great to be able to provide the intensity of supports needed in so many different offices at one time.
Children’s Intensive Service Review (CISR) Implementation
The Panel reviewed the Department’s 2018 CISR Report and found the following. DMH completed a review of 35 cases from Intensive Mental Health Providers (IMHP) between January 1, 2018 and May 31, 2018. Four Intensive Treatment Foster Care cases, 3 Full Service Partnership cases, 18 Wraparound cases and 10 Intensive Field Capable Clinical Services were included in the CISR. Cases from multiple service areas across LA that had been open for six months or longer and were not preparing for the transition phase were included in the CISR. Three-fourths were age 15 and under. About half were described as male and half as female. They were 43% Latino, 31% African American, and 26% other. 17% had 2 or more placements prior to this placement; at least 9% had prior psychiatric hospitalizations. It was disappointing that half had one or more placement changes after enrollment in intensive MH services and 9% had a psychiatric hospitalization after enrollment.
The CISR review focused on 5 elements of Core Practice Model practice in these intensive home-based mental health service cases:
Engagement: Utilizing trauma-informed engagement strategies and culturally-sensitive outreach efforts to engage the child or youth and family throughout the therapeutic process. Most of the providers achieved active participation of the child or youth, family members, and caregivers. The majority of the children, youth, and families spoke positively about their IMHPs and reported that the services they received were beneficial. The CISR recommended that creative strategies to engage and integrate biological parents into the CFT process be implemented.
Teamwork: Utilizing effective interpersonal skills to establish a strong collaborative with the child or youth, family and their support systems to ensure that the “right people” are identified and engaged as part of the Child and Family Team (CFT). Elements of team formation were present in most cases. The CISR recommended that efforts be increased to team with formal supports from other agencies and informal supports from the children, youth, and family’s home, school, work, and community.
Assessing & Understanding: Having a unified understanding of (1) the child or youth and family’s strengths, needs, preferences, and underlying needs; (2) what must change for the child or youth to function effectively day-to-day; (3) what must change for the child or youth and family to have improved overall well-being and family functioning; and (4) the path and pace to permanency. The preliminary process of identifying the child or youth’s underlying needs had begun for most of the cases and that providers appeared to understand what must change for the child or youth and family to improve overall well-being and family functioning. The CISR recommended that providers improve in identifying underlying needs and working from a trauma-informed lens.
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Intervention Adequacy: Utilizing effective clinical interventions at the necessary levels of intensity, duration, consistency, and continuity to produce desired results that match strategies to outcomes. The interventions addressed the stated concerns of the children, youth, and families and were typically delivered at the necessary levels of intensity, duration, consistency, and continuity warranted by the unique needs of the situation. “Ongoing training around underlying needs and the translation of those needs into specific trauma-informed interventions would highly benefit the children, youth, and families being served. It is also recommended that IMHPs engage in individualized service-crafting when providing trauma-informed interventions. Services should fit the uniqueness of the child or youth and family, and build upon their identified strengths. It is important for IMHPs to avoid providing “one-size-fits-all” interventions…it was not evident that the IMHPs implemented evidenced-based practices in their interventions.”
Child Well-Being: Improving the child or youth’s safety, permanency, and sustained functioning in the current placement. There were notable improvements of the child or youth’s safety over the course of their services. While the child or youth’s overall well-being was routinely addressed, the IMHPs often overlooked permanency issues. In many cases, the permanency of the child or youth’s placement had not yet been finalized, but it was recommended that the IMHPs identify sensitive permanency concerns as early as possible and collaborate and plan throughout the CFT process until a permanency plan is established.
The latest CISR protocol went into effect July 1, 2018 (after this review) and is designed to be similar to the Quality Service Review (QSR) protocol including the same six-point Likert scale used for scoring the QSR practice indicators. The next CISR will use the improved CISR protocol and will report on follow-through on these recommendations and the outcome of DMH’s plan for additional training to strengthen the intensive mental health providers’ skills in trauma-informed care, underlying needs, CFT facilitation and ICC/IHBS procedural codes.
The Multidisciplinary Assessment Process (MAT)
The MAT process involves utilizing a mental health provider to conduct an initial assessment of families entering the system, using a team meeting to finalize a statement of findings. MAT recommendations are intended to inform the court’s decision-making about the child and family. The County has been piloting an integration of its MAT process and the Child and Family Team process in three offices. It has long been the view of the Panel the MAT process duplicates the key elements of the CFT process and that this redundancy is confusing and costly. The Panel commends the efforts to better coordinate the two processes, but remains convinced that the MAT process needs to be replaced by the CFT process, not merged with it. Full implementation of the CFT process is the best solution to this duplication.
Progress Indicators
Over the past (18 months), the Panel and the parties have engaged in promising discussions focused on identifying quantitative progress indicators that help identify critical system performance and class member outcomes. These indicators would complement the qualitative measures within the Qualitative Service Review. Such indicators include measures such as rates of entry into foster care, placement of
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children with relatives, proximity of placement to home and community, placement stability, placement in the least restrictive, most normalized environment and permanency achievement, for example. A small number of process measures such as caseload size, the percentage of children having CFT meetings and receipt of Intensive Home-Based Services are also being considered. As part of these discussions, participants have been exploring potential performance targets for these indicators, or “tipping points” as the County describes them. Such targets would be considered goals for improvement and could be a factor in assessing progress toward full implementation of the Shared Core Practice Model.
Unfortunately, the County has recently determined that efforts to create a baseline of performance based on the selected indicators is not possible within the constraints of the DCFS and DMH data systems. Challenges related to the DMH data system are a particular challenge. While the County plans to continue working on addressing this problem, the County initially reported that it will take years to modify and or replace the DMH system so that appropriate DMH actions and outcomes can be tracked. The County now projects completion in 2019. Until those changes are completed, the Panel will be virtually blind to key aspects of DMH performance.
The Resource Family Approval Process (RFA)
The Resource Family Approval Process is a new state mandate that combines all elements of foster parent licensing; Adoptions and Safe Families Act-compliant approvals of relative caregivers; and adoption and guardianship approvals into one singular process. In May 2018, the California department of Social Services mandated that all county child welfare agencies complete RFA approvals for the caregivers of children already placed in their homes by no later than September 1, 2018. In March 2018, the state enacted AB 110, which allowed short-term care and supervision payments for RFA-pending relative caregivers and non-related extended family members already caring for children. To receive this funding, counties were required to submit a plan to eliminate the backlog of pending RFA applications by September 1, 2018. At that time, DCFS had 4,385 RFA approval-pending cases to complete.
According to DCFS, since the Department implemented RFA within existing staffing resources, it found itself inadequately staffed to comply with the state’s mandate by September 1, 2018. In order to comply with the state’s mandate, DCFS initiated a time-limited reassignment of some non-case-carrying Children’s Social Workers and Children’s Services Administrators to process RFA cases on a full-time basis; and assigning one RFA case for completion to each qualified DCFS employee – including the Director.
As of 8/24/18, there are 252 pending-RFA cases of caregivers with children already placed in their homes. Many of these await criminal clearances only prior to completion. Others were not completed due to the family’s vacation plans. DCFS hopes to complete all or to submit “Good Cause” justification for non-completion to CDSS no later than September 14, 2018.
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III. DMH Performance
Section three contains updates of County plans and progress and is supported by progress reports submitted by the County. Where the Panel has comments about these updates, its observations are underlined.
DMH Service Provision to Class Members
DMH reported that it conducted an analysis to compare matched client data from the last three calendar years (2015-2017), to identify members of the Katie A. class and subclass and determine the levels of mental health services they were provided. The analysis used the definition of the class and subclass contained in the settlement agreement in the Katie A. State case. The data contains only class and subclass members who received mental health services with DMH. The department points out that there are some limitations on the accuracy and comprehensiveness of these data; 1) This report may not fully reflect all class members and mental health services provided, as providers have up to 18 months to submit claims. 2) DMH used two different methods to capture the number of youth that were psychiatrically hospitalized due to limited DMH data available. 3) In CY 2017, there was a change in the method used to capture claims for clients enrolled in Wraparound FSP. Beginning July 2017, the Wrap-FSP billing plan was eliminated and Wrap Providers commenced billing to the FSP plan for these Wrap services. This change created additional challenges due to the utilization of rosters in order to track these clients. Overall, the data provides a useful view of mental health service provision in the County.
1) From the total number of DCFS clients in CY 2017 (54,777), 45% were Katie A. class1 members, slightly lower than the previous calendar year (CY 2016, 46%). Of the 24,737 class members in CY 2017, 15,486 (63%) belonged to a category identified as Class without Subclass (Class w/o Subclass: class members who are not part of the subclass). During CY 2017, about 37% of the Katie A. class were subclass2 members and received more intensive mental health services, a decrease from CY 2016 (40%) and CY 2015 (39%). The data indicates that the number of subclass members increased from calendar year 2015 to 2016 and decreased in 2017 (CY 2015: 9,952; CY 2016: 10,154; CY 2017: 9,251). The County believes that the decrease in subclass members in CY 2017 seems to be largely due to a decrease in the number of youth that received three or more placements within 24 months (CY 2016: 4,367; CY
1 Class: Children/youth who meet all of the following criteria: 1) Have an open child welfare services case; 2) Have full scope medical; 3) Meet medical necessity for mental health services; and 4) Received a mental health service or were considered for Intensive treatment.
2 Subclass: Children/youth who meet criteria # 1-3 for the class above and: 4) Considered for or received intensive treatment, i.e., one or more of the following: a) Wraparound (Wrap), b) Intensive Field Capable Clinical Services (IFCCS), c) Full Service Partnership (FSP), d) Treatment Foster Care (TFC), e) Therapeutic Behavior Services (TBS), f) Had a psychiatric hospitalization, g) Received services through Exodus, h) Resided in a Community Treatment Center (CTF), i) Placed in a Group Home RCL 10 and above and/or, j) Had 3 or more placement changes in 24 months due to behavioral needs.
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2017: 3,517. The following graph shows the breakdown of the class, subclass and class without subclass for CY 2015-2017.
2) The County reports that the cost associated with providing mental health services to the Katie A. class decreased in CY 2016 and then increased in CY 2017 (CY 2015: $208 million; CY 2016: $203 million; CY 2017: $207 million). The cost associated with providing mental health services to the Katie A. subclass has also decreased since CY 2015 (CY 2015: $142 million; CY 2016: $139 million; CY 2017: $139 million) but the percentage of subclass costs from the total class costs slightly increased in CY 2016 and then slightly decreased in CY 2017 (CY 2015: 68%; CY 2016: 69% and CY 2017: 67%). Overall, the mental health costs associated with providing services to the subclass group is still more than half of the total costs provided to the class w/o subclass.
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3) The CY 2017 data shows the average mental health cost associated with subclass members ($15,004) has increased compared to CY 2015 ($14,317) and is still much higher than the average cost of mental health services for class members who are not part of the subclass (CY 2017: $3,720). The average cost for the class without subclass category has increased since CY 2015 (CY 2015: $3,491; CY 2016: $3,436; CY 2016: $3,720). More specifically, subclass members are receiving more services than the average class member not belonging to the subclass.
4) The mental health service array varies between class and subclass members. Services included in the array are Team Consultation (TC) and Therapeutic Behavioral Services TBS. TC is a case consultation or team conference, with or without the client present, with the purpose of plan development. It - 27 -

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must include discussion regarding the client’s progress, or lack thereof, in treatment and/or discussion of the client’s plan for mental health treatment. TBS is an intensive, individualized, one-to-one behavioral coaching program available to children/youth up to age 21 who are experiencing a current emotional or behavioral challenge or experiencing a stressful life transition. In CY 2017, costs analysis indicates that subclass members received less individual therapy than the Class w/o Subclass (Subclass: 19%, Class w/o Subclass: 30%). Subclass members did receive more Targeted Case Management (TCM) and ICC (Subclass: 17%; Class w/o Subclass: 3%), and more rehabilitation services including TBS and IHBS (Subclass: 35%; Class w/o Subclass: 6%). In addition, within the last two calendar years, individual therapy for the Subclass increased slightly (CY 2016: 18%, CY 2017: 19%), TCM and ICC increased (CY 2016: 16%; CY 2017: 17%) as well as rehabilitation services including TBS and IHBS (CY 2016: 32%; CY 2017: 35%). The CY 2017 data indicates that the majority of subclass costs were for individual therapy (19%), IHBS (16%) and ICC (12%). DMH expects ICC and IHBS services to continue to increase due to recent expansions in the IFCCS and FSP programs. The IFCCS program was expanded from a 100 slot program to 780 slots in CY 2016 and Child FSP providers were allocated additional funding for 30% of their Katie A. slots. Each FSP provider will be accountable for providing a standardized service delivery system to the subclass.
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5) The data has been consistent and indicates that there are still more services being provided in the office for the Class w/o Subclass (CY 2015: 32%; CY 2016: 32%; CY 2017: 32%) than for the Subclass (CY 2015: 25%; CY 2016: 25%; CY 2017: 26%). Also, somewhat more services are being provided in non-office settings (home, school, other facility) for the Subclass (CY 2015: 63%; CY 2016: 64%: CY 2017: 63%) than for the Class w/o Subclass (CY 2015: 55%; CY 2016: 57%; CY 2017: 58%). DMH thinks that this may be partly due to subclass members being in need of more intensive mental health services within other types of facilities like psychiatric hospitals and urgent care centers. It should be noted that for CY 2017, the location of services was unknown for the service claims of 7% of the Class, 6% of the Subclass and 10% of the Class w/o Subclass. DMH believes that this is most likely the result of having two billing systems, the Integrated System (IS) and the Integrated Behavioral Health Information System (IBHIS). DMH expects that claim information will improve once all providers transition to one billing system.
6) DMH developed the following chart that indicates the criteria or programs youth were in that contributed to them being in the subclass. In CY 2017, the majorities of youth were in Wraparound (4,131), had three or more placements (3,517), or placed in a D-Rate home (1,750). Furthermore, many of the youth fell into multiple subclass categories. There has been an increase in the number of youth enrolled in Full Service Partnership (FSP) (CY 2015: 453; CY 2017: 599) and in IFCCS (CY 2015: 180; CY 2017: 731). The following programs/subclass criteria had a decrease in subclass members since CY 2015: 1) D-Rate (CY 2015: 2,124; CY 2016: 2,121; CY - 29 -

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2017: 1,750), 2) Exodus (CY 2015: 355; CY 2016: 274; CY 2017: 266), 3) Multiple Placements (CY 2015: 5,481; CY 2016: 4,367; CY 2017: 3,517) and TBS (CY 2015: 993; CY 2016: 849; CY 2017: 682). DMH points out that the multiple placement category continues to be refined in an effort to be in line with the State’s definition of this category (due to behavioral reasons). The data also show that the number of youth placed in a psychiatric hospital has decreased; however, it is important to note that DMH continues to have difficulty gathering data regarding psychiatric hospitalizations and much of the data is missing or not accurately reported (hospital staff can bypass the I.S. and IBHIS and bill services directly to the State). The graph below includes two hospitalization counts: 1) Psychiatric Hospitalization*: This count only includes members that were hospitalized and had a service claim submitted through the I.S. or IBHIS; 2) Psychiatric Hospitalization**: This count includes all members that were hospitalized (regardless of whether a claim was submitted through the I.S. or IBHIS).
[The subclass criteria below include Full Service Partnership (FSP), clients that have had three or more placements within 24 months (Multiple Placement), Intensive Treatment Foster Care (ITFC), Community Treatment Facility (CTF), D-Rate placement, Rate Classification Levels 10-14 (RCL 10–14), Psychiatric Hospitalization (Psych Hospitalization), Wraparound, Exodus, and/or Therapeutic Behavioral Services (TBS)].
7) The average cost associated with the subclass criteria or programs varies greatly, with costs associated with Community Treatment Facilities (CY 2017: $38,727), Rate Classification Level 14 (CY 2017: $30,598) and Intensive Field Capable Clinical Services (IFCCS) (CY 2017: $23,074) being the programs with the highest costs for subclass members in calendar year 2017 (see chart below). The subclass criteria or programs with the lowest average costs were Rate Classification Level 13 (CY 2017: $502) and Exodus (CY: $268).
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According to DMH, Psychiatric Hospitalizations only include the costs for claims that were submitted through the I.S. or IBHIS and do not include costs for services that the hospitals may have billed directly to the state. The costs in the following chart only include services billed under one of the procedure code groupers: Therapy, Family Therapy, Collateral, Crisis Intervention, Targeted Case Management (TCM), Therapeutic Behavior Services (TBS), Team Consultation, Rehabilitation, Intensive Care Coordination (ICC), In Home Based Services (IHBS), Medication Support, Crisis Stabilization, Other Treatment (Assessment, Psychological Testing, Report Writing, Record Review, Day Treatment and Psychiatric Hospitalization).
8) Utilization of Evidence-Based and Promising Practices DMH reports that for CY 2017, 5,675 class members received treatment using an evidence-based or promising practice (EBP). This reflects a decrease from 6,496 in CY 2016. In CY 2017, most class members received Managing and Adapting Practice (MAP) (2,239), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (1,910), Child Parent Psychotherapy (CPP) (799) and Parent-Child Interaction Therapy (PCIT) (570). The only EBP to show a steady of increase of class members since CY 2015 has been Parent-Child Interaction Therapy (PCIT) (CY 2015: 517; CY 2016: 562, CY 2017: 570). The reason for this decline is unknown. - 31 -

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I. EBPs by Calendar Year 2015-2017

Number of Clients Served (All Ages)

Number of Legal Entities (All Ages)

Number of Clients Served (Ages 0-5)

Number of Legal Entities (Ages 0-5)

Evidence Based and Promising Practices

CY 2015 CY 2016 CY 2017 CY 2015 CY 2016 CY 2017 CY 2015 CY 2016 CY 2017 CY 2015 CY 2016 CY 2017

Aggression

Replacement Training 128

43

22

16

11

7

2

1

1

2

1

1

(ART)

Alternatives for

Families - Cognitive

44

40

37

5

5

3

2

1

1

1

1

1

Behavioral Therapy

(AF - CBT)

Brief Strategic Therapy

14

6

6

7

3

4

6

1

1

4

1

1

Child Parent Psychotherapy (CPP)

1,112

878

799

39

38

36

1,056

842

767

38

37

36

Cognitive Behavioral

Intervention for

4

1

1

2

1

1

2

0

0

2

0

0

Trauma in Schools

(CBITS)

Functional Family Therapy (FFT)

114

98

40

10

9

4

9

2

1

3

2

1

Incredible Years (IY)

149

93

43

15

10

7

65

35

12

12

7

5

Managing and

Adapting Practice

2,684

2,325

2,239

84

74

66

466

512

567

52

51

47

(MAP)

Multisystemic Therapy (MST)

21

11

4

10

10

1

2

3

2

2

3

1

Parent-Child

Interaction Therapy

517

562

570

42

44

37

437

509

514

39

43

36

(PCIT)

Seeking Safety

706

414

244

62

45

43

7

3

1

6

2

1

Strengthening Families

5

4

2

1

1

2

0

0

0

0

0

0

Trauma Focused -

Cognitive Behavioral 2,917

2,261

1,910

77

72

66

417

352

318

46

49

40

Therapy (TF-CBT)

Triple P Positive Parenting Program

266

194

179

29

27

25

120

127

121

21

20

18

UCLA Ties Transition Model

27

27

12

2

2

2

20

20

8

2

2

1

9) Intensive Home-Based Services and Intensive Care Coordination
The County has been phasing in ICC and IHBS since FY 12-13. As mentioned previously, DMH expanded IFCCS slots from 100 to 780 in CY 2016. FSP also had a change in FY 2015-16, with providers receiving a funding increase for 1/3 of child FSP slots to be used specifically for Katie A. subclass members.

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The graphs below show the number of clients within Intensive Field Capable Clinical Services (IFCCS), Intensive Treatment Foster Care (ITFC), and Wraparound that have received ICC and IHBS during CY 2016 and CY 2017. The percentage of youth that received ICC and IHBS decreased for most of the programs. DMH believes that the decrease is due to claims that are pending submission by providers. As aforementioned, DMH contracted providers have 18 months to submit claims. DMH expects that ICC and IHBS percentages for CY 2017 will increase in the next couple of months as providers submit their claims.
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10) Mental Health Services Provided to Katie A. Subclass Members The following graph provides a breakdown of the numbers and percentages of subclass members during calendar years 2015 to 2017 that have received ICC, IHBS, and other intensives services (Wraparound (Wrap), FSP, IFCCS, ITFC, and TBS). The majority of subclass members received ICC, IHBS and Wraparound services in CY 2017. Some subclass members received more than one service and/or were enrolled in one or more programs during the calendar year. - 34 -

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The graph below indicates the types of mental health services subclass members received CY 2017. Some children/youth received more than one service. The percentage indicates that percent of subclass members that received the service. The majority of clients received Other Treatment (76%), Therapy (75%), and Team Consultation (70%). IHBS and ICC services were also provided to 42% and 43% of subclass members, respectively.
DMH provided the following summary of its analysis. - 35 -

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1. The data show that the number of subclass members has decreased since CY 2014, making up a smaller percentage of the Katie A. Class. This may be partly due to the decrease in the number of youth that had three or more placements (as subclass indicator) within the last 24 months.
2. While the Subclass made up about 37% of the Class during CY 2017, the Subclass costs made up about 67% of the total Class cost.
3. The average mental health cost associated with subclass members has remained steady over the last three calendar years and is much higher than the average cost of mental health services for class members who are not part of the subclass.
4. In CY 2017, subclass members received less individual therapy than class members who are not part of the subclass. Subclass members did receive more Team Consultation (TC) and Intensive Care Coordination (ICC), and more rehabilitation services including Therapeutic Behavior Services (TBS) and Intensive Home Based Services (IHBS) than the class members who are not part of the subclass.
5. The data have been consistent and indicates that there are still more services being provided in the office for class members who are not part of the subclass (CY 2017: 32%) than for subclass members (CY 2017: 26%). Also, more services are being provided in non-office settings (home, school, other facility) for the subclass (CY 2017: 63%) than for the class w/o subclass (CY 2017: 58%).
6. Consistent with previous years, the majority of youth in the subclass were enrolled in Wraparound, had three or more placements, or were placed in a D-Rate home.
7. The number of class members that received an Evidence-Based Practice or Promising Practice has decreased from CY 2016 (CY 2016: 6,496; CY 2017: 5,675). In CY 2017, the majority of youth received Managing and Adapting Practice (MAP), Trauma Focused-Cognitive Behavioral Therapy (TF-CBT), Child Parent Psychotherapy (CPP) and Parent-Child Interaction Therapy (PCIT).
8. From CY 2016 to CY 2017, the percentage of youth that received ICC and IHBS in Wraparound, IFCCS, and ITFC has decreased while there was an increase in the FSP program. DMH believes that the decrease is due to claims that are pending submission by providers. DMH expects that ICC and IHBS percentages for CY 2017 will increase in the next couple of months as providers submit their claims.
9. In CY 2017, the majority of subclass members received Other Treatment (76%), Therapy (75%), and Team Consultation (70%). IHBS and ICC services were also provided to 42% and 43% of subclass members, respectively.
Panel Comment: Mental health service data, which is produced by Medicaid claiming reports, covers prior periods, which makes it untimely. For IHBS providers, it is essential that DMH determine the specific elements of rehabilitative services, IHBS and other treatment reported and collect data about quantity of these services provided to subclass members. The one-year data for all subclass members is not informative about what an average subclass member is receiving. It is not possible to determine whether an average of $14,000/year is a lot or a little without know about services being delivered.
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Intensive field Capable Intensive Services (IFCCS)
The County reports that Intensive Field Capable Clinical Services (IFCCS) is a field-based program developed in direct response to the State’s expansion of services available to Katie A. Subclass members who have intensive mental health needs that are best met in a home-like setting. The goal of these services is to provide a coordinated child and family team approach to service delivery by engaging and assessing children and their families’ strengths and underlying needs to minimize psychiatric hospitalizations, placement disruptions, out-of-home placements and involvement with the juvenile justice system. The County provided the following status update.

On July 1, 2016, the IFCCS program expanded from five (5) Legal Entities to twenty one (21) Legal Entities and from one hundred (100) slots to seven sixty five (765) slots. The IFCCS referral portals were expanded from four (4) portals to thirteen (13) portals.

The IFCCS referral portals include the following:  Child and Youth Crisis Stabilization Team (funded by SB 82)  DCFS High Risk Services Division  DMH Emergency Outreach Bureau  DMH MAT Staff  DMH Wraparound Liaisons  Medical HUBs  Urgent Care Centers/Valley Coordinated

 DCFS Transitional Shelter Care Facilities
 DMH D-Rate Assessment Unit  DMH Hospital Discharge Unit  DMH Specialized Foster Care  IFCCS Providers  Service Area Child and TAY Navigators

Referrals were received from the following referral portals in 2017: DMH Specialized Foster Care – 43% IFCCS Providers – 15% DCFS Transitional Shelter Care Facilities – 13% DMH MAT Coordinators – 9% DMH Hospital Discharge Unit – 5% DMH Child and TAY Navigators – 2% Remaining Referral Portals – 12%

The Panel has learned that as of December 30, 2017, IFCCS currently has the capacity for 765 children, but 252 or 33% of those slots are unfilled. In light of the examples brought to the Panel’s attention of high
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need children disrupting due in part to the lack of intensive mental health intervention, it is surprising and disappointing to learn of this vacancy rate. Ensuring that these services are promptly available to class members should be a high priority for both DMH and DCFS. IFCCS Program Evaluation: The Panel has consistently encouraged the County to evaluate its mental health practice, to which the County responded with the Children’s Intensive Service Review (CISR). DMH describes the CISR as follows.
Children’s Systems of Care (CSOC) Administration created the Children’s Intensive Service Review (CISR) to evaluate the IFCCS Program. DMH views the purpose of the evaluation process as to ensure that IFCCS staff are adhering to the principles of the Shared Core Practice Model and consistently providing high quality mental health services to children and youth meeting the Katie A. Subclass criteria. The CISR process will be conducted by teams of two or more reviewers and can include clinicians, administrators, and parent partners. Parent Partners will lead the interviews with the client’s family in order to create an environment most conducive to candid and honest feedback. The IFCCS providers will be scored on the following performance indicators: Engagement, Teaming, Assessment and Understanding, Intervention Adequacy, Child Well-Being. In 2017, the CISR evaluation tool was updated based on feedback from the Katie A. Panel. The primary update was creating a more comprehensive scoring mechanism to accurately evaluate the mental health services. The CISR cases were randomly selected based on being enrolled for six (6) months or more of service and having a history of a psychiatric hospitalization. CSOC Administration successfully completed eleven (11) CISR evaluations in 2017.
Coaching and Training of DCFS and DMH Staff in the Shared Core Practice Model (SCPM)
DMH Coaches provided two Webinars to reach out to supervisors and administrators from the Wraparound agencies in SA 3 and 7. The first webinar was conducted on 3/30/17 on the Leadership and Implementation of the CFT process. The second webinar was conducted on 5/17/17 that focused on documenting the CFT plan.
DMH COACHING AND TRAINING ACTIVITIES
DMH provided the Panel with the following summary of its coaching and training efforts in 2017.
According to DMH updates, The Child Welfare Division Coaches implemented the Shared Core Practice Model (SCPM), Child and Family Team (CFT) Model, and Underlying Needs training during the reporting period from January through December of 2017. During this reporting period the DMH Coaches trained staff from the Wraparound agencies in the Immersion Service Areas (SA) 3 and 7 in addition to the DMH Wraparound Administration staff. The staff trained participated in the CFT training sequence that included the following trainings:
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1. 6 HR SCPM with an emphasis in underlying needs 2. CFT Overview: Preparing for Child and Family Teaming 3. 2 Day CFT Facilitator Training 4. Underlying Needs Training 5. Where Privilege Meets Oppression: Using a cultural lens with the child welfare
population
Upon completion of the CFT training sequence DMH coaches offered coaching and consultation to the trained Wraparound Facilitators as they implemented the SCPM and CFT process with children that were identified from the Immersion Pasadena and Belvedere DCFS Offices.
The DMH Coaches developed a 2 Day CFT Facilitator Training which provided an in-depth training on the tenets of the CFT process and the specific facilitation skills required to implement and effective teaming process with children and families. The 2 Day CFT Facilitator Training included mock videos of the CFT process and role play exercises. This new training replaced the see one do one model for training CFT Facilitators, and provided the DMH Coaches with the capacity to train a larger number of CFT Facilitators in a shorter amount of time.
In January of 2017 the DMH Coaches began the CFT training sequence for the Wraparound agencies in SA 3 and SA 7. The DMH Coaches provided several trainings on the SCPM and CFT Overview: Preparing for Child and Family Teaming in both service areas to reach all 11 Wraparound agencies in SA 3 and all 14 Wraparound agencies in SA 7.
By March the DMH Coaches began training Wraparound Facilitators in the 2 Day CFT Facilitator Training. Each agency selected two staff to be trained during the first round of trainings in each service area. DMH states that “By the end of March, 40 CFT Facilitators were fully trained in the CFT process and had acquired the skills to successfully implement the CFT process with children and families. “
DMH also reported the following regarding agency training in Immersion sites.
Intensive coaching was offered by the DMH Coaches to agencies with identified cases for Immersion. Intensive coaching was individualized and tailored to meet the agency’s needs. It provided continuous modeling of CFT facilitation skills. It reinforced strength-based practice principles including family’s voice and choice. It emphasized service crafting; individualized, out of the box interventions, tailored to meet the client’s underlying needs and recognizing the impact of trauma. The agencies participating in SA 3 were Benvenidos/Hillsides Family Agency, California Mentor Family Support Services Foothill Family Services, and Spiritt. The agencies participating in SA 7 were Alma Family Services, Florence Crittenton Services, Helpline Youth Center and Masada Homes. For agencies without identified cases for immersion, they were invited to participate in monthly coaching conference calls that provided an opportunity for consultations and continued learning of the CFT process.
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Additionally, the DMH coaches were available to provide individualized coaching sessions and consultations as needed.
With the transition of the Wraparound Program to DMH, the Coaching Unit provided a 1 Day of the Overview of the CFT Process and the CFT Matrix training to over 100 participants. This training focused on providing participants with an understanding of the CFT process and the expectations of teaming with children and families. In addition, participants received training on how to document the CFT process.
Immersion Provider Meetings
The DMH Coaches hosted Immersion Provider Meetings during this period with staff from all of the Wraparound agencies trained in addition to those providers trained during the Immersion Pilot in SA 6 and SA 2. The first meeting for the year was held on 4/26/17. During this meeting results from the Post CFT Interviews were shared. There was also a skills building workshop on underlying needs. The second meeting was held on 8/16/17 where there was a discussion on the strengths and challenges of the integration of the CFT Process at their agency, and a skills building workshop on the 3 levels of listening to support engagement and teaming practice. The last meeting for this reporting period was held on 12/06/17. There was discussion on how the CFT Process is supporting outcomes for children and families. There was also presentation on developing effective “worry” statements, to support engagement with children, youth, and families.
DMH Administrative Staff
During the last quarter of this reporting period, the DMH Coaches focused their training on the newly hired DMH staff for the expansion of Wraparound, Coaching and QSR Programs. The DMH Coaches provided two round of the CFT Training Sequence to fully train the newly hired DMH administration staff.
DMH Staff Trainings (January 2017 to December 2017)
Child Welfare Division’s Training division coordinates monthly trainings to support on-going learning and skill development of mental health staff, community providers and child welfare workers to deliver services to support strengths and needs of children and their families. These trainings are specifically designed and targeted for Department of Mental Health (DMH) Child Welfare Division programs that provide mental health services such as Specialized Foster Care, MAT, Family Preservation, Wraparound, and Treatment Foster Care services to children, youth, and families in the Child Welfare System.
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Trainings
Shared Core Practice Model with an Emphasis on Underlying Needs Shared Core Practice Model

Date 1/12/17

Participants SA 7 Children’s Wraparound Providers

1/12/17 Pathways Community Services

Shared Core Practice Model
Infant and Toddler Development within a Relational Context
Shared Core Practice Model with an Emphasis on Underlying Needs
Core Practice Concepts in Working with LGBTQ Youth
Infant and Toddler Development within a Relational Context
Infant and Toddler Development within a Relational Context
Shared Core Practice Model with an Emphasis on Underlying Needs Trauma Informed Practice
Infant and Toddler Development within a Relational Context
Shared Core Practice Model with an Emphasis on Underlying Needs
Shared Core Practice Model with an Emphasis on Underlying Needs
Shared Core Practice Model with an Emphasis on Underlying Needs
Infant and Toddler Development within a Relational Context
Trauma Informed Practice
Shared Core Practice Model

1/17/17 1/17/17 1/19/17 1/25/17 1/25/17 1/26/17 1/26/17 1/26/17 1/27/17 2/2/17 2/7/17 2/9/17 2/15/17 2/16/17 2/16/17

DMH Staff and Children’s Providers Countywide DMH staff and Contracted Providers working with Birth to 5 population SA7 SA 3 Children’s Wraparound Providers
DMH Staff and Children’s Providers Countywide DMH staff and Contracted Providers working with Birth to 5 population SA2 DMH staff and Contracted Providers working with Birth to 5 population SA8 SA 7 Children’s Wraparound Providers
DMH Staff and Children’s Wraparound; IFCCS; ITFC; and FSP providers Countywide LA+USC VIP CMHC
SA 7 Children’s Wraparound Providers
SA 3 Children’s Wraparound Providers
SA 7 Children’s Wraparound Providers
SA 7 MAT Assessors
DMH Staff and Children’s Wraparound; IFCCS; ITFC; and FSP providers Countywide DMH Countywide Resource Services staff

Shared Core Practice Model

2/17/17 El Centro De Amistad

Infant and Toddler Development within a Relational Context

2/22/17

DMH Children’s System of Care

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Trainings
Culturally Sensitive Practice: Integration of Core Practice Concepts
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach
Core Concepts in Working with LGBTQ Youth
Shared Core Practice Model

Date 2/23/17 3/7/17 3/16/17 3/20/17

Participants
DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers SA2
DMH Staff and Children’s Providers Countywide Pacific Clinics Family Preservation Program

Child and Family Team Facilitator Training
Trauma Informed Practice for the Mental Health Professionals
Culturally Sensitive Practice: Integration of Core Practice Concepts
Culturally Sensitive Practice: Integration of Core Practice Concepts
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach
Shared Core Practice Model

3/21/17 & 3/22/17 3/23/17
3/28/17
3/29/17
4/4/17
4/11/17
4/18/17

DMH Staff and Wraparound Providers in SA3 DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers SA2
DMH Staff and Children’s Providers SA2
Tessie Cleveland SA6

Shared Core Practice Model
Trauma Informed Practice for the Mental Health Professionals Shared Core Practice Model

4/25/17 4/27/17 4/28/17

Almansor—Outpatient and Family Preservation
DMH Staff and Children’s Providers Countywide
Aviva—SA 4

Infant and Toddler Development within a Relational Context
Shared Core Practice Model

4/28/17 5/9/17

Star View children’s mental health services. Los Angeles Child Guidance Clinic—SA 6

Core Concepts in Working with LGBTQ Youth
Culturally Sensitive Practice: Integration of Core Practice Concepts
Shared Core Practice Model

5/10/17 5/10/17 5/11/17

DMH Staff and Children’s Providers Countywide
DMH Staff and Children’s Providers Countywide
Children’s Institute Inc.—SA 8 Family Preservation

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Trainings Shared Core Practice Model

Date 5/16/17

Participants Los Angeles Child Guidance Clinic—SA 6

Infant and Toddler Development within a Relational Context
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach
Culturally Sensitive Practice: Integration of Core Practice Concepts
Trauma Informed Practice for the Mental Health Professionals
Infant and Toddler Development within a Relational Context
Where Privilege Meets Oppression: Utilizing a Cultural Lens with the Child
Welfare Population Core Concepts in Working with LGBTQ
Youth Shared Core Practice Model
Trauma Informed Practice for the Mental Health Professionals
Sensory Integration in School-Aged Children and Youth
Best Practice Interventions with Complex Trauma Victim
Infant and Toddler Development within a Relational Context
Infant and Toddler Development within a Relational Context
Shared Core Practice Model
Infant and Toddler Development within a Relational Context
Shared Core Practice Model
Shared Core Practice Model
Infant and Toddler Development within a Relational Context

5/17/17 5/19/17 5/24/17 5/25/17 5/25/17 6/7/17
6/8/17 6/20/17 6/22/17 6/22/17 6/30/17 7/17/17 7/21/17 7/25/17 8/3/17 8/4/17 8/24/17 8/24/17
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SA 3 DMH MAT and Specialized Foster Care staff The Help Group SA2
DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers Countywide Helpline Counseling Services—SA 7
DMH Staff and Children’s Providers Countywide SA2
DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers Countywide DMH Staff and Children’s Providers Countywide DMH staff and Children’s Contracted Providers Countywide DMH staff and Children’s Contracted Providers Countywide Penny Lane Center—Family Preservation
The Help Group—SA 2
DMH staff and Children’s Contracted Providers Countywide Pathways Community Services—Family Preservation Program Pacific Clinics Family Preservation and Outpatient DMH staff and Children’s Contracted Providers Countywide DMH staff and Contracted Providers working with Birth to 5 population SA3

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Trainings
Shared Core Practice Model with an Emphasis on Underlying Needs
Infant and Toddler Development within a Relational Context
Where Privilege Meets Oppression: Utilizing a Cultural Lens with the Child
Welfare Population Module 1a: Overview Preparing for the
Child and Family Teaming Shared Core Practice Model
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach Shared Core Practice Model

Date 8/29/17 8/30/17 9/6/17
9/13/17 9/25/17 9/27/17 9/27/17

Participants DMH CWD New-Hire staff
The Children’s Center of the Antelope Valley SA1 DMH CWD New-Hire staff
DMH CWD New-Hire staff
D ’Veal Family Preservation and Outpatient programs DMH CWD New-Hire staff
Uplift Family Services SA4

Shared Core Practice Model with an Emphasis on Underlying Needs
Module 1a: Overview Preparing for the Child and Family Teaming
Infant and Toddler Development within a Relational Context
Child and Family Team Facilitator Training
Shared Core Practice Model with an Emphasis on Underlying Needs
Child and Family Team Facilitator Training
Infant and Toddler Development within a Relational Context
Shared Core Practice Model
Shared Core Practice Model with an Emphasis on Underlying Needs
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach
Module 1a: Overview Preparing for the Child and Family Teaming
Underlying Needs: A Strengths/NeedsBased Service Crafting Approach

9/28/17
10/03/17
10/3/17
10/10/17 & 10/11/17 9/19/17
10/25/17 & 10/26/17 10/31/17
11/7/17
11/9/17
11/16/17
12/04/17
12/08/17

DMH staff and Children’s Contracted Providers Countywide DMH CWD New-Hire staff
DMH staff and Contracted Providers working with Birth to 5 population SA7 DMH CWD New-Hire staff
DMH staff and Children’s Contracted Providers Countywide—SA 3 Children’s Contracted Providers Countywide—SA 3 DMH CWD New-Hire staff
DMH staff and Children’s Contracted Providers Countywide—SA 7 DMH staff and Children’s Contracted Providers Countywide—SA 3 DMH staff and Children’s Contracted Providers Countywide—SA 3 DMH CWD staff and Wraparound Contracted Providers DMH staff and Children’s Contracted Providers Countywide—SA 3

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Trainings
Infant and Toddler Development within a Relational Context
Quality Service Review Foundational Training

Date 12/08/17 12/20/17

Participants The Village Family Services—SA 2
DMH staff and Children’s Contracted Providers Countywide

The Panel is pleased that DMH is expanding the number of mental health professionals who can facilitate child and family team meetings. However, the DMH strategy to forego the opportunity for staff to observe an actual team meeting and then facilitate a team meeting with a trained coach supporting them as part of the development process in favor of classroom training alone raises serious concerns. DMH took this step to speed up the facilitator certification process; however the Panel believes that this compromise will impair the quality of the CFT process.

IV. DCFS Performance

Training and Coaching

DCFS also provided updates on its coaching and training initiatives.
The Core Practice Model (CPM) team has been collaborating and partnering with various stakeholders in different ways - through presentations, shared collaboration, team meetings, conference calls and in focus groups. Partners have included: the DCFS training section, the Office of Child Protection (OCP), DPSS, DMH, Casey Family Foundation, Recognize Intervene Support Empower (RISE) and the L.A. Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) Center, Eliminating Racial Disparity and Disproportionality (ERDD) and GARE (Government Alliance on Race and Equity), Juris Partners, State Partners, community and families. The shared goal is to align and integrate the Shared Core Practice Model (SCPM) and Child and Family Teams (CFT) into everyday Social Work practice. This is an intentional effort to skillfully coach and train staff in the Strengths, Needs, Service Crafting model of practice. To this end, the CPM team’s focus has been:
1. Alignment and Integration; 2. Crafting a Coaching Practice; and 3. Installing the practice using an Implementation Structures framework.

Alignment and Integration

Messaging has been a particular focus for the team. When interacting with partners and communities, the team uses several tools to ground the CPM work:
 Gettothecore.org  CPM Handbook
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 CPM cube  23 Practice Behavior flashcards  QSR pamphlet  Tool and Resource Kit from the State, received 3/2018
Strengths Needs Service Crafting (SNSC)
The CPM team has continued to work directly with Dr. Marty Beyer, Katie A. Panel member, since in August 2015, to align practice across systems, using a Strengths Needs Service Crafting lens. We have learned that Strengths Needs Service Crafting (SNSC) is a way of thinking and being; it's how staff practice with providers, stakeholders, partners, other staff and families. The CPM team co-created curriculum that is responsive to the needs of the various partners. This collaborative approach has inspired the team to build a framework for sustainable practice.
The CPM team, in partnership with Dr. Marty Beyer, convened several focus groups which included:  ER/DI/CS SCSWs  Coaching skills groups  Coaching Roundtable team  DMH community providers  Immersion offices  New hire Academy group
These focus groups served as learning opportunities to expose staff to SNSC practice, deepen understanding and practice, and support the transfer of learning and skill development. These focus groups helped to inform teaching strategies, as the small teams allowed for practice and feedback.
With the guidance of Dr. Marty Beyer, the SNSC Curriculum team has begun to focus outside of the CFT and to look at practice in unit meetings during home visits and family visits, and to consider every meeting as an opportunity for engagement, teamwork and practice.
In August 2017, the team launched the first SNSC practice module with the Van Nuys office. Below is a very broad overview of the curriculum the team co-created with Dr. Beyer.
Strengths Needs Service Crafting
Curriculum is delivered to staff in small groups, while sitting at tables of 6-7. Context Setting, Opening/Welcome (.5hr) Video is recommended:
 Morning Session for CSWs and SCSWs 1. (1.25 hr.) Strengths-Functional Strengths (SFS). Functional Strengths are everyday activities that can be operationalized to support case planning. SFS Tablework.  ACT (Affirm, Counter and Transform) Role Play  IVI (intent, value, and impact)  Documentation discussion and examples, integrated throughout the discussion. 2. (1.25 hr.) Underlying Needs and Service Crafting, Tablework. - 46 -

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3. Tools

 Afternoon Session for SCSWs

1. (1hr.) Tablework to practice facilitating the SNSC in a unit meeting, to deepen practice and develop

skills at the SCSW level.

2. (1hr.) Facilitation team panel discussion; Feedback and debrief with SCSW.

Offices

Date

Participants

Skills

CPM practice behaviors

Van

August 29, About 30

- Identify and affirm strengths

Ask global questions

Nuys

2017

CSWs 8 SCSWs

- Convert strengths to functional Use understandable language

Palmdal March 12, About 30

strengths identifying underlying Engagement

e

2018

CSWs 12

needs, trauma needs and

Facilitating honest dialogue

SCSWs

developmental needs

Assessment and Visitation

Metro North,

March 15, About 30

2018

CSWs and 9

- Practice crafting unique services Activities

and supports

Solution focused

South County and

SCSWs

- Exploring solutions - asking who can help
- Documentation

Vermont

Skills Lab

Dr. Beyer visited a skills lab and was supportive of this coaching and training approach.

The CFT Skills Lab is designed to strengthen the understanding of Core Practice Model (CPM) and Child and Family Team (CFT) practice, support use of the CPM, and expose participants to the four steps of the CFT meeting process for the purposes of alignment and integration. The CFT Skills Lab is provided by the CPM Coaching Team and is offered to staff in the regional offices and specialized programs. SCSWs are expected to attend to provide leadership and support to their unit and to support practice change. The county-wide coaching team supports the process through demonstration of CPM skills that promote staff development and use of the model. Participation in the skills lab serves as a “See One” for the CFT certification process.
Goals: Strengthen staff’s understanding of the Core Practice Model and Child and Family Teaming (CFT) through exposure and practice; connect outcomes to practice; provide a supportive, experiential environment for staff that builds competencies and supports use of the model.

Objectives: Provide opportunities for staff to practice facilitation, with an SCSW coach/facilitator and unit member support; help staff understand the power of the CFT, through participation in vignettes, as they take on different roles; reduce/eliminate staffs worries of facilitation by providing SCSW and coaching support through an observation and feedback process; thread the significance of outcomes throughout the lab.
2017 CPM Skills Labs

Dates Nov 9/10 Dec 21/Jan 17 Jan 26/Feb 02

Selected Location West L.A. Torrance Santa Fe Springs
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Number Attendees 55 50 45

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Feb 13 /17 Feb 23 Mar 9/23 Mar 7/14 Mar 21 Apr 13/20 April 6 May 4 May 9 May 18/ 30 June 15/21 July 6 July 12/18 Sept 12/Oct 3 Sept 19/Sept 26 Total

Palmdale Chatsworth Metro North Wateridge (N) & (S) Santa Clarita Vermont Corridor Compton Torrance Pasadena Pomona Glendora South County Van Nuys Lancaster MCMS

70 51 70 70 40 60 45 35 21 104 w/ Marty 32 35 50 50 50 933 Participants

CFT Skills Lab Outcome Summary Report
The following summary reflects data that was collected for the CFT Skills Labs in participating regional offices to date. Subsequent evaluations of the CFT Skills Lab will be provided as data becomes available.
Methodology:
The CFT Skills Lab Evaluation Questionnaire was developed to evaluate the skills acquired during the CFT Skills Lab. The questionnaire is administered at the conclusion of each lab and consists of 10 items rated on a Likert-type scale where “1” indicates “strongly disagree”, and “4” indicates “strongly agree.” Additionally, demographic data is collected from participants.
Results:
A total of 921 participants took part in the CFT Skills Lab and completed an evaluation questionnaire. Most participants (74.9%) were CSWs. The length of time that participants had been with the department varied across time (see Figures 1 and 2 below).
Figure 1. Participant Type (N = 921)

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Participant Type

CSW SCSW ARA Other Missing

Other, 7.3% ARA, 1.3% SCSW, 14.5%

Missing, 2.0%

CSW, 74.9%

Data Source: CFT Skills Lab Evaluation Questionnaire, SurveyMonkey database. Extracted on 1/4/18.
Figure 2. Length of Time with DCFS (N = 921)

Percentage of Participants

30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0%

10.0% 5.4%
< 6 months 6-12 months

Length of time with DCFS
25.6%

15.2%

12.2%

13.1%

1-5 years

6-10 years 11-15 years 16-20 years Length of Time

12.5% > 20 years

6.0% Missing

Data Source: CFT Skills Lab Evaluation Questionnaire, SurveyMonkey database. Extracted on 1/4/18.
Regarding participants’ experience during the CFT Skills Lab, a weighted average of 3.00 or higher was achieved for each statement/measure asked except for the statements regarding understanding how to enter data into the CFT database (mean = 2.62) (see Table 1).

Table 1. Summary of Percentages and Weighted Averages for the CFT Skills Lab Evaluation Questionnaire (N = 921)

Measures 1. I have a clear understanding of the differences between the Core
Practice Model and the Child and Family Team (CFT) meeting.

Strongly Disagree
(1)

Disagree (2)

Agree (3)

1.5%

3.6% 59.1%

2. I understand the importance of the Quality Service Review (QSR) in measuring effective team functioning and CFT performance.

1.4%

9.0% 59.2%

Strongly Agree (4)

Total Response
s

Mean

35.7%

915

3.29

30.3%

910

3.18

3. Reviewing the vignette for the family was effective in helping me build upon the family’s story and identifying their underlying needs and strengths.

1.4%

2.9% 53.1% 42.6%

904

3.37

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4. I feel confident in creating trustful working relationships with children and their families.

1.1%

0.8% 51.1% 47.0%

919

3.44

5. Modeling the CFT practice helped me to understand how to effectively facilitate CFT meetings.

1.0%

2.7% 52.4% 44.0%

903

3.39

6. I feel that the various CFT tools (e.g., CFT Coaching Guide, Family Engagement Form, and CFT Meeting Notes) are helpful in tracking and documenting the progress of CFT meetings.
7. I have a clear understanding of how to enter data from a CFT meeting into the CFT database.

1.1% 14.0%

1.4% 56.5% 29.9% 38.1%

41.0% 18.0%

903

3.37

866

2.60

8. I feel that the CFT practice is effective in helping families develop their goals and in tailoring plans to meet the child and family’s individual needs.

0.9%

1.1% 51.3% 46.7%

906

3.44

9. The Coach/Coach Developer provided adequate instructions and modeling of the CFT practice.

0.9%

1.5% 39.9% 57.7%

907

3.54

10. I feel confident in facilitating CFT meetings.

2.4%

15.6% 59.9% 22.1%

890

3.02

Data Source: CFT Skills Lab Evaluation Questionnaire, SurveyMonkey database. Extracted on 1/4/18. Note: The “mean” reflects the weighted average for each statement and excludes missing values.

Figure 3. Overall Weighted Averages for the CFT Skills Lab Evaluation Questionnaire by Office (N = 921)

Overall Weighted Averages by Office
4.00 3.03 3.30 3.41 3.33 3.15 3.19 3.35 3.44 3.27 3.35 3.26 3.26 3.17 3.37 3.32 3.23 3.24 3.00 2.00 1.00

Weighted Averages

DCFS Office
Data Source: CFT Skills Lab Evaluation Questionnaire, SurveyMonkey database. Extracted on 1/4/18.
Limitations: It was later discovered that the measure on understanding CFT data entry was not a part of the core goals of the CFT Skills Lab and has subsequently been removed from the questionnaire.
Conclusion:
The findings presented here indicated that participants had an overall positive experience. They were able to understand the concepts of the CPM and CFT meeting process and understand what the work looks like in everyday practice. The participants also felt that the modeling of the CFT meeting process and the available tools/resources were helpful in understanding how to facilitate a CFT meeting. However, additional training and practice may be needed for participants to build up their confidence in facilitating CFT meetings. In the short term, the results will be used to improve CFT Skills Lab training methods and
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delivery. Looking forward, the findings will be used to support the forthcoming CFT Evaluation to assess the extent to which the skills and knowledge gained during trainings such as the CFT Skills Lab are effectively applied and maintained in everyday practice.
Module 3:
From April 1, 2016 through September 30, 2017, Tricia Mosher Consultants (TMC) Tricia Mosher and Alissa Kraman facilitated Module 3 training in collaboration with the Core Practice Model team. Module 3 is required to become a Coach or Coach Developer. TMC provided direct coaching and support to DCFS and DMH training facilitators to help align the practice and to build capacity. Effective October 2017, the CPM Coaching team assumed full responsibility for Module 3 delivery. The following table reflects the number of certified facilitators in Calendar Year 2017:

Facilitator

Regional SCSW (592)

118

20%

Regional CSW (3114) 1,971

63%

*Regional/ Other

55

* includes regional ARAs, CSAs, and program staff

Coach
393 23 25

Coach

Developer

66%

57

9.6%

1%

0

20

2017/2018 MODULE 3 SESSIONS

Total
568 1,994 100

Dates January 3 – 4, 2017 January 24 – 25, 2017 February 7 – 8, 2017 February 22 – 23, 2017 March 28 – 29, 2017 April 4 – 5, 2017
April 19 – 20, 2017
May 10 – 11, 2017 May 24 – 25, 2017
June 7 – 8, 2017 August 16 – 17, 2017 August 30 – 31, 2017 September 27 – 28, 2017 October 18 – 19, 2017

Selected Location (Host Office) Wateridge Office Lancaster Office Metro North Office Santa Fe Springs Office Belvedere Office Santa Clarita Office
Torrance Office
El Monte Office South County Community Facility
Glendora Community Facility Santa Clarita Office Baldwin Park Library Santa Fe Springs Office Van Nuys Office
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Number of Enrollees 14 11
Cancelled 19 14 15
Cancelled
21 25
24 11 11 11 Cancelled

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November 15 – 16, 2017

Compton West Office

10

January 17 – 18, 2018

Belvedere Office

26

February 21 – 22, 2018

Lancaster Office

25

March 21 – 22, 2018

Metro North Office

21

April 18 – 19, 2018

Torrance Office

17

May 16 – 17, 2018

Glendora Office

7

Crafting a Coaching Practice
Coaching Team: The coaching team is comprised of one CSA II, to provide support and guidance, thirteen CSA I County-wide lead Coaches, and one CSA I administrative staff.

The team and its leadership provides the following supports: certification, unit case coaching, individual case coaching, curriculum development, Skills Labs, skill development-coaching cycles/groups, Modules 1a, 1b, 2, 3 and SCPM Implementation Team support, participation on various workgroups as subject matter expert, attendance at the Waiver learning circle, and on steering committees as needed.

Coaching Leadership Opportunities: Participating in national coaching conferences has provided opportunities to share the Los Angeles model, but also to collaborate with other jurisdictions.

Coaching Roundtable: The purpose of the roundtable is to create a shared, supportive learning environment to discuss lessons learned, office protocols, and barriers, while also creating a space to address the operational and developmental needs of Coaches.

The goal is to equip regional staff, partners, stakeholders and agency staff with skills to support and sustain practice. The participants are, in turn, to coach and train their staff to build coaching capacity.

Roundtable Date March 1, 2018 February 7, 2018 January 3, 2018 December 6, 2017 November 1, 2017 October 4, 2017 September 2017 August 2017
July 5, 2017
June 2017

Skill or Discussion Topic Operational Follow-up Strengths-Functional Strengths Fidelity: review the CFT Agenda
Fidelity: Review Skill Development: DMH Mapping, Genograms Fidelity, overview Skill Development: Family Story Skill Development: deepening Listening skills, Active Listening and Helping Styles Skill Development: 3 levels of listening
Skill Development: Introducing listening

Attendees 16 DCFS offices 12 DCFS offices, RISE and DMH 10 DCFS offices, DMH and RISE 16 DCFS offices 14 DCFS offices, DMH
19 DCFS offices 16 DCFS offices, Casey
14 DCFS offices, DMH, Casey, sensitive case unit 12 DCFS offices, DMH

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May 3, 2017

Skill development: Staff Engagement and Coaching Model (70% skill building -20% reflective practice 10% support NIRN)

15 offices represented, Sensitive Case unit, DMH, DCFS Training

Coaching Skills Development: Listening Skills

Listening is a skill and one of 23 Practice Behaviors. The CPM countywide Coaches committed to coach and train each of their two offices in reflective listening.

Method

Week 1: SCSW group Week 2: CSW group and SCSW observation Week 3: CSW group and SCSW observation Week 4: SCSW feedback and observation

Office

Three Levels of Listening

% SCSW Participation

% CSW Participation

Coaching Date

Belvedere Corporate

100%

82%

Oct/Nov 2017

Covina

100%

88%

El Monte

100%

100%

Glendora

53%

32%

Sept/Oct 2017

Lancaster

36%

61%

Oct/Nov 2017

Pomona

100%

69%

Oct/Nov 2017

Santa Clarita

80%

76%

Oct/Nov 2017

Santa Fe Springs

100%

92%

Oct/Nov 2017

Torrance

100%

80%

Oct/Nov 2017

Van Nuys

62%

65%

Nov/Dec 2017

Vermont

58%

53%

Oct/Nov 2017

Wateridge N/S

75%

25%

West San Fernando Valley 95%

89%

Sept/Oct 2017

WLA

38%

31%

Oct/Nov 2017

Total

73% SCSW participation 63% CSW participation

*Staffing as of August 2017 info is point in time. Surveys were distributed; the information is currently being compiled.

Implementation Technical Assistance

The CPM team was a part of the California Partners for Permanency (CAPP) grant, which earmarked funds to focus on the disproportionate outcomes for African American and Native American children in the child welfare system. Technical support from the CAPP grant included weekly conference calls with Implementation Specialists who supported LA practice and helped to provide an implementation lens for installing CPM. The 23 Practice Behaviors were cocreated by community and CAPP funded the Los Angeles County supply of flash cards.

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Implementation Drivers
 Coaching and Training: Much of the work through Coaching and Training is represented above.
 Data and Tracking: Los Angeles County has a team that works with BIS regarding CFT data collection.
 Selection and Retention: The Coaching team has tested an approach from Humboldt County as a part of its selection process.
 Linked Leadership: Historically CPM practice structures include both Design and Implementation teams at the county-wide level and at the regional level. The CPM teams regularly attend and support these meetings.
 Community Engagement: The CPM team has worked to have a collaborative and shared approach to CPM and CFT installation.
Implementation Terms of Reference
The CPM team crafted terms of reference, to help define the role of the countywide coaching team in the organization.
 Mission: The countywide coach team supports the development of staff’s skillful and ongoing use of, and confidence in, the Core Practice Model 23 Practice Behaviors.
 Objectives and Functions: To support staff’s skillful and ongoing use of the CPM 23 Practice Behaviors and, through system coaching, to create a nurturing environment for use of CPM 23 at all levels. This includes ongoing attention to supporting staff and other functions.
The team also identified values and principles, characteristics and competencies, team membership and communication, deliverables, authority and boundaries. Likewise, every Regional Office developed terms of reference for the functioning of their implementation structures. Copies of these documents were collected and bound to support a formal implementation charter. Wraparound Services In April 2015, the Los Angeles County Board of Supervisors approved a motion instructing the Chief Executive Officer to work with the Directors of DCFS and DMH to achieve optimal arrangements for administrative and programmatic oversight of Wraparound and transition the administration of the contracts from DCFS to DMH. DCFS and DMH planned a two-phase transition, beginning in June 2016. In Phase I, which was completed in May 2017, DMH amended its Legal Entity (LE) Agreements with all Wraparound providers to incorporate the Wraparound services into the LE Agreements. DCFS retained
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the client start/stop function and the case rate payment function until DMH could develop its own electronic system for these functions and implement them in Phase II.

The County provided the update below to describe Wraparound developments in 2017.

DMH has now developed a Wraparound Tracking System (WTS) for the client start/stop function and payment of the case rate. DMH has provided trainings for Wraparound Providers on the newly established WTS. DMH is currently targeting July 1, 2018 as the date that Providers will be responsible for the timely inputting of case rate claims into the WTS for reimbursement by DMH.

From January through December, 2017, a total of 2,947 children/youth were enrolled in Wraparound. The following tables show monthly enrollments and active cases by month.

Number of Children/Youth Enrolled

Wraparound Enrollments from January - December 2017

300

240

265

295

261

264

247

251

248

189

232

242

213

200

100

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Data Source-DCFS Wraparound System - 5/10/2018
From January through December 2017, there was an average of 2,633 monthly active Wraparound cases:

Active Wraparound Cases from January - December 2017

Active Wraparound Cases

3000 2800 2600 2400 2200

2528

2532

2621

2610

2659

2626

2618

2647

2836

2669

2705

2550

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Data Source-DCFS Wraparound System – 5/10/2018
Wraparound Graduations, Neutral Terminations and Terminations by Category
Wraparound exits from both DCFS and the Department of Probation totaled 2,609:  Graduations for both departments totaled 1,033  Non-Graduations for both departments totaled 1,078  Neutral terminations for both departments totaled 498 - 55 -

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Graduation is defined when a Wraparound child, youth and family successfully exits the Wraparound program. Non-graduation (i.e. termination) is defined when a Wraparound child, youth, and family prematurely exits the Wraparound program. These terminations include subcategories that have been identified by DCFS as a neutral termination under the following categories: County Case Closure under DCFS and Probation, Family Moving, or Out of County or State Placements.

2017 Wraparound Graduations, Non-Graduations, and Neutral Terminations

Neutral Terminations
498 (19%)

Graduations 1,033 (40%)

Non-Graduations 1,078 (41%)

Graduations Data Source-DCFS Wraparound System – 5/10/2018

Non-Graduations Neutral Terminations

DCFS and Probation Graduations January - December 2017

140

120

100

80

60

40

20

0 Jan Feb Mar April May Jun July Aug Sep Oct Nov Dec

DCFS

73 58 65 51 132 94 87 87 75 84 79 75

Probation 7

0

4

9

8

10

7

4

8

4

5

7

DCFS Graduation Total - 960 Data Source-DCFS Wraparound System – 5/10/18

Probation Graduation Total – 73

Grand Total = 1,033

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DCFS and Probation Terminations by Category from

January - December 2017

399

400

375

350

325

300

275

250

225

200

175

150

125

100 75

75

42

50 25

12 2

0

-25

233

74 56
40 25
2

96 1

21

24 91

358

11

32 18 25

DCFS Probation
Data Source-DCFS Wraparound System – 5/10/2018
As of December 30, 2017, Wraparound was serving 2,177 children and had 573 vacancies or a 21% vacancy rate. The Panel has raised concerns about the Wrap vacancy rate in prior reports. Many of the children with unmet high mental health needs could be served if more efficient use of this resource was made.
Placement of Children and Youth in Group Homes and Short-Term Residential treatment Facilities (STRTP)
In each monitoring report the Panel provides a snapshot of patterns of placement in group homes. The following tables reflect those patterns.
The following table and graph shows the monthly group home census, by age range and purpose of placement for 2017. The County reports that the average census was 891 children for that period (excluding Emergency Shelter Care and Specialized Placement for Medically Fragile Children).

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Monthly Group Home Census (Excluding Adoptive, Guardian Home, and Non-Foster Care Placement)
January 2017 to December 2017

GH 0 - 12 13 - 17 18 plus Total

Jan 2017
74 707 132
913

Feb 2017
76 699 118
893

Mar 2017
81 698 120
899

Apr 2017
88 695 123
906

May 2017
89 697 116
902

Jun 2017
79 695 111
885

Jul 2017
85 695 110
890

Aug 2017
78 689 103
870

Sep 2017
89 696 114
899

Oct 2017
98 672 115
885

Nov 2017
92 664 125
881

Dec 2017
89 666 118
873

ESC 0 - 12 13 - 17 18 plus Total

45

48

43

44

5

4

93

96

42

38

45

53

3

3

90

94

36

49

33

30

10

9

45

40

41

41

27

23

3

2

2

2

4

1

84

91

76

73

41

33

10

14

16

14

1

26

29

MCMS 0 - 12 13 - 17 18 plus Total

1

2

23

22

4

4

28

28

2

2

21

20

5

6

28

28

2

4

4

3

2

1

23

24

25

21

18

18

6

7

5

5

6

5

31

35

34

29

26

24

1

1

16

14

4

4

21

19

MCMS/ESC

0 - 12

0

0

13 - 17

0

0

18 plus

0

0

Total

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

1

1

0

0

0

0

1

2

0

0

0

0

0

0

0

0

0

Average 85 689 117 891
30 36
3 69
2 20
6 28
0 0 0 0

2017 Los Angeles County

Group Home Placements by Age Group

1000 900 800 700 600 500 400 300 200 100 0
0 - 12

Jan-17 Feb-17 Mar-17 Apr-17

May17

Jun-17

Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

74 76 81 88 89 79 85 78 89 98 92 89

13 - 17 707 699 698 695 697 695 695 689 696 672 664 666

18 plus 132 118 120 123 116 111 110 103 114 115 125 118

Total 913 893 899 906 902 885 890 870 899 885 881 873

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Note: Data source is CWS/CMS History Database. Data reflects Group Home placement as of May 31, 2018
The following table and graph shows the monthly STRTP census in CY 2017. (STRTP – A Short Term Residential Therapeutic Program that provides intensive psychiatric services to children/youth identified as severely emotionally disturbed – this is a State redefinition of group care). ). Only a small number of facilities had been licensed as STRTP prior to the end of the calendar year.

STRTP 0 - 12 13 - 17 18 plus Total
ESC 0 - 12 13 - 17 18 plus Total
MCMS 0 - 12 13 - 17 18 plus Total
MCMS/ESC 0 - 12 13 - 17 18 plus Total

Sep 2017 0 3 0 3
0 0 0 0
0 0 0 0
0 0 0 0

Oct 2017 0
15 3
18
0 6 3 9
0 0 0 0
0 0 0 0

Nov 2017 4
29 4
37
2 5 2 9
0 1 0 1
0 0 0 0

35 30 25 20 15 10
5 0
0 - 12
13 - 17
18 plus

Short Term Residential Therapeutic Program September to December 2017

Sep 2017 0 3 0

Oct 2017 0 15 3

Nov 2017 4 29 4

Dec 2017 7 26 5

Dec 2017 7
26 5
38
0 3 1 4
0 1 0 1
0 0 0 0

The County reported the following update:

Of the 21,015 DCFS youth reported to be in out-of-home care on December 31, 2017, 4.3% (911) were placed in a Group Home or STRTP. In addition to developing and aligning strategies and resources to support the implementation of the Continuum Care Reform, DCFS has focused considerable effort
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and attention into supporting children in the least restrictive placement and reducing the number of children requiring placement in Group Homes. A successful strategy in this area included providing one-to-one behavioral aide services to children in foster, relative, and home-of-parent care. The County continues to struggle with a lack of foster homes willing and able to care for children with intensive mental, developmental, and medical challenges.

Length of Stay in a Group Home Setting

The following chart depicts the average length of placement, by age in a group setting, excluding Emergency Shelter Care and specialized placement for medically fragile children.

Age Group 0 - 12 13 - 17 18 plus

0 to 2 Months in Group Homes 314 2354 146

2 to 6 Months in Group Homes 235 2685 349

6 to 12 Months in Group Homes 196 1814 332

Over 12 Months in Group Homes
273 1420
578

The County summarized the findings as follows.

 A majority of children in congregate care at any given time were between the ages of 13 and 17 years old; 29% of these children exited within 2 months, 61% exited within 6 months, and 83 % exited within 12 months of placement in a Group Home.
 The smallest population of children in a group home was between the ages of 6-12 years old; 31% of these children exited the Group Home within 2 months, 54% exited within 6 months, and 73% exited within 12 months.
 For the young adults, ages 18 years and older, 10% exited the group home within 2 months, 35% exited within 6 months and 59% exited within 12 months.

Almost 3,000 children and youth were placed in care for 2 months or less, which suggests that for many of these children, these were merely interim placements until other settings could be located. Given the trauma children experience with placement disruption, this pattern is deeply concerning. It illustrates the urgent need for more appropriate decision-making, Intensive Home-Based Mental Health Services and placements for these class members.

Multidisciplinary HUBS

As previously reported, the County committed to providing a comprehensive medical examination for all newly detained children in its Strategic Plan. These assessments are completed by the Medical Hubs, located mostly in medical center settings. The County, through a partnership among the Departments of Children and Family Services, Health Services, and Mental Health, continues to implement efforts to ensure that newly detained children are referred to and served by the Medical Hubs. The County reports the following improvement in performance.

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For Calendar Year 2017, the County reports that 93.5% of newly detained children were referred to a Medical Hub for an Initial Medical Examination (IME). This is an increase from 91.8 % that was previously reported for Calendar Year 2016. In seeking the goal of 100% of newly detained children referred, the County states that it continues to implement opportunities to educate DCFS staff on the requirement for the newly detained children to be referred and served by the Medical Hubs for an IME. Efforts include periodic DCFS regional office presentations and regular dissemination of a monthly report to management of the regional offices, highlighting the current percentages, recognizing the regional offices that achieved the highest percentages and reminding management of the mandate to refer all newly detained children to a Medical Hub for the IME per DCFS policy.
Along with attention and efforts to increase the percentage of children being referred to the Medical Hubs, efforts have continued since the 2016 Annual Report to address the timeframes for the submission of the referral for the IME for newly detained children. Specifically, there is interest strengthening the alignment of the submission of the referral with the timeframes that are in DCFS policy. Periodic review of data during 2017 identified the need to implement further action over and beyond the e mail communications sent out on a quarterly basis to line operations staff as a reminder of DCFS policy. Stronger alignment will positively impact the newly detained children being seen or examined through the provision of the IME specific to the timelines in DCFS policy. Further, a timely completion of the IME with results of the examination made available sooner will assist in meeting the needs of the child and in case planning. Current consideration is to establish an internal notification to the assigned social worker and his/her chain of command specific to a newly detained child who has not been referred to a Medical Hub with the instruction to take prompt action to submit the referral along with serving as a reminder of DCFS policy.
The Medical Hubs continue to meet the goal of serving the comprehensive needs of children through the provision of on-going/medical home care as one option available to caregivers who serve children placed in out of home care.
The County partners continue to review the effectiveness of the DHS E-mHub System towards identifying and planning for enhancements that contribute to stronger communication between social workers and the Medical Hubs providers on the timely provision of care to children.
As previously reported in 2016, the County implemented the requirement that youth admitted to Temporary Shelter Care, now the Transitional Shelter Care Program, receive a screening examination at a Medical Hub. This effort has served children well such that an unaddressed or inadequately addressed medical issue can come to the attention of Hub medical providers, experts in serving children in foster care, over and above identifying a communicable disease or condition prior to admission into a shelter.
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The County has improved on what was already good performance in referring newly detained children to a Medical HUB.
V. Qualitative Service Reviews
Consistent with its Strategic Plan, the County continues to conduct Qualitative Service Reviews (QSR), interview-based evaluations of the quality of frontline practice involving a sample of cases in each office. The Qualitative Service Review permits an examination of the quality of services (not just whether the service was delivered) as well as an assessment of the child’s current status. Each DCFS office is reviewed on an 18-24 month cycle. QSR performance is an element of the Katie A. Settlement Agreement’s exit criteria for the County.
The QSR Baseline was completed in August 2012, and the corresponding QSR Baseline Report was completed and issued in early 2013. The second QSR Review cycle was completed at the end of October 2014, with the scores finalized in December 2014. The third cycle began in February 2015. Reviews for all 18 offices have been completed. The Santa Clarita Office and the West San Fernando office were reviewed as one office.
The QSR provides a basis for measuring, promoting, and strengthening the Shared Core Practice Model, and the protocol includes two domains. These are Child and Family Status Indicators, which measure how the focus child and the child’s parents/caregivers are doing within the last 30 days, and Practice Indicators; which measure the core practice functions being provided with and for the focus child and the child’s parents/caregivers for the most recent 90-day period. The team consists of trained DCFS and DMH reviewers who conduct a case review, and conduct interviews within a two-day period with key players in the life of the child and family’s case.
The team assesses status and performance indicators to determine facts such as:
Child and Family Status  Is the focus child safe?  Is the focus child stable?  Is the focus child making progress toward permanency?  Is the focus child making progress emotionally and behaviorally?  Is the focus child succeeding in school?  Is the focus child healthy?  Are the focus child’s parents making progress toward acquiring necessary parenting skills and capacity?
Practice Performance  Are the focus child and family meaningfully engaged and involved in case decision making, referred to as Family Voice and Choice? - 62 -

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 Is there a functional team made up of appropriate participants?  Does the team understand the focus child and family’s strengths and underlying needs?  Is there a functional and individualized plan?  Are necessary services available to implement the plan?  Does the plan change when family circumstances change?  Is there a stated and shared vision of the path ahead leading to safe case closure and beyond?
Overall, scores are reflective of the aggregate scores of each of the indicators for each case reviewed in the sample. Opportunities for organizational learning and practice development include providing the CSW and their supervisor face-to-face feedback on findings in the cases reviewed. In addition, oral case presentations are made in group debriefings called “Grand Rounds” and a written case story for each case reviewed is produced to provide context for the scores and to enhance learning.
The QSR scores are subject to an exit standard approved by the court. The QSR Exit Standard is stated as follows:
Each Service Planning Area is expected to individually meet passing standards for both the Child and Family Status Indicators and the System Practice Indicators (85 percent of cases with overall score of “acceptable” respectively and 70 percent “acceptable” score on Engagement, Teamwork and Assessment). Once the targets have been reached, at the next review cycle the regional office must not score lower than 75 percent respectively on the overall Child and Family Status and System Practice Indicators, and no lower than 65 percent on a subset of System Practice indicators respectively (Engagement, Teamwork, and Assessment). The County will continue the QSR process for at least one year following exit and will post scores on a dedicated Katie A website.
The first set of three tables reflects the Status Indicators for the Third, Second and Baseline QSR Cycles. The second set of three tables reflects the Practice Indicators for the same three QSR Cycles.
The first table reflects the percentage of cases scoring within the acceptable range for Status Indicators in the Belvedere, Pomona, Compton, San Fernando Valley (now Van Nuys), Vermont Corridor, El Monte, Metro North, Glendora, Lancaster, Wateridge, Santa Fe Springs, Santa Clarita/West San Fernando, South County, West Los Angeles, Pasadena, Torrance, and Palmdale offices during the third cycle, followed by the overall scores combined. All scores are rounded to the nearest full percent.
QSR Third Cycle Status Indicators (2015-2017) Percent Acceptable

Office

Safety Overall

Stability

Permanency

Living Arrangements

Health/ Physical Well-being

Emotional Well-being

Learning & Develop.

Family Functioning

Caregiver Functioning

Belvedere Pomona Compton

100% 78% 89%

100% 67% 67%

100% 56% 33%

100% 89% 100%

100%

89%

100%

67%

89%

56%

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100% 67% 44%

100% 50% 17%

100% 75% 83%

Family Connections
60% 50% 63%

Overall Child & Family Status
100% 56% 56%

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Van Nuys 100% 89%

44%

Vermont Corridor

80%

60%

50%

El Monte 100% 80%

50%

Metro North

80% 60%

50%

Glendora 82% 82%

55%

Lancaster 100% 91%

64%

Wateridge 73% 100%

64%

Santa Fe Springs

92%

100%

58%

Santa

Clarita 100% 73%

45%

West SFV

South County

83%

67%

42%

West LA 100% 92%

67%

Pasadena 91% 91%

50%

Torrance 75% 83%

25%

Palmdale 83% 83%

25%

Overall 88% 82%

51%

89%

78%

89%

78%

25%

86%

90%

80%

60%

70%

25%

100%

100% 100% 70%

80%

0%

100%

90%

80%

70%

90%

43%

100%

100%

82%

91%

91%

63%

100%

100% 100% 82%

100%

38%

100%

100%

91%

73%

64%

57%

75%

75%

75%

75%

83%

38%

80%

91%

82%

64%

64%

33%

100%

83%

83%

58%

75%

43%

100%

100%

83%

75%

92%

67%

100%

91%

100%

73%

82%

57%

86%

92%

83%

67%

75%

50%

89%

75%

100%

83%

83%

33%

88%

92%

88%

73%

79%

43%

92%

44%

89%

50%

60%

67%

80%

75%

80%

63%

82%

63%

100%

88%

55%

91%

83%

75%

91%

50%

75%

78%

92%

67%

73%

64%

67%

30%

83%

63%

78%

QSR Second Cycle Status Indicators (2012-2013) – Percent Acceptable

Office

Safety Overall

Stability

Permanency

Belvedere 100% 83%

92%

Santa Fe 92%

83%

58%

Springs

Compton 92%

67%

67%

Vermont 100% 91%

82%

Corridor

Wateridge 92%

75%

75%

Pomona 100% 91%

80%

Glendora 90%

80%

60%

El Monte 100% 80%

80%

San Fernando
Valley Lancaster

100%
100%

89%
63%

56%
50%

Metro

89%

78%

78%

North

Pasadena

67%

89%

56%

Santa

78% 56%

67%

Clarita

Torrance 90%

70%

40%

West LA 90% 100%

80%

Living Arrangements
100% 100% 92% 100% 83% 100% 90% 100%
100%
100% 89% 100% 89% 100% 100%

Health

Emotional Well Being

100% 100% 100% 91%
100% 100% 80% 100%

92% 83% 83% 100%
75% 73% 70% 90%

100%

78%

100% 63%

89%

78%

89%

67%

78%

67%

100% 90% 100% 90%

- 64 -

Learning & Development
75% 75% 67% 64% 67% 82% 90% 70%
78%
88% 78% 56% 67% 70% 60%

Family Functioning
57% 50% 63% 60% 38% 86% 50% 100%
40%
43% 40% 50% 50% 29% 57%

Caregiver Functioning
100% 100% 100% 100% 90% 100% 88% 100%
100%
100% 100% 100% 86% 100% 100%

Family Connections
67% 67% 38% 88%
78% 71% 75% 88%
67%

Overall Child & Family Status
100% 83%
75% 100%
83% 100% 90% 90%
78%

67%

88%

67%

89%

67%

78%

71%

78%

67%

80%

71%

80%

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South

90% 90%

60%

100%

80%

90%

70%

71%

100%

County

Palmdale 90%

90%

40%

80%

80%

60%

60%

43%

100%

Overall

92%

81%

66%

95%

94%

80%

71%

55%

98%

75%

90%

43%

60%

69%

85%

QSR Baseline Status Indicators (2011-2012) - Percent Acceptable

Office
Overall

Safety Overall
99%

Stability
80%

Permanency
57%

Living Arrangements

Health

Emotional Well Being

95% 97%

70%

Learning & Development
80%

Family Functioning
61%

Caregiver Functioning
96%

Family Connections
71%

Overall Child & Family Status
88%

QSR Third Cycle Practice Indicators (2015-2017) – Percent Acceptable

Office

Engagement

Belvedere
Pomona
Compton
Van Nuys
Vermont Corridor
El Monte Metro North
Glendora
Lancaster
Wateridge Santa Fe Springs
Santa Clarita West SFV South County West LA
Pasadena
Torrance

89% 100% 89% 44% 40%
80% 80% 64% 64% 73% 50%
45%
50% 67% 36% 50%

Voice & Choice
67% 78% 56% 56%
60%
30% 40% 64% 55% 82% 42%
36%
42% 50% 45% 58%

Teamwork
0% 44% 0% 11% 0% 10% 10% 0% 18% 0% 8%
9%
8% 50% 9% 0%

Assessment OVERALL

Longterm View

78%

78%

56%

44%

33%

22%

44%

22%

40%

30%

40%

30%

30%

40%

36%

18%

36%

45%

55%

36%

33%

17%

18%

9%

33%

17%

58%

58%

27%

36%

25%

25%

- 65 -

Planning
56% 67% 22% 22% 20% 40% 30% 0% 45% 55% 8%
18%
17% 50% 27% 25%

Supports and Services
78% 89% 56% 56%
70%
70% 70% 73% 91% 73% 67%
64%
58% 75% 64% 50%

Intervention Adequacy
89% 78% 33% 44%
50%
60% 70% 64% 73% 55% 33%
36%
50% 67% 64% 67%

Tracking and Adjustment
78% 78% 56% 44%
20%
50% 50% 27% 45% 45% 42%
27%
25% 50% 45% 25%

Overall Practice
78% 78% 44% 44%
20%
40% 50% 18% 64% 45% 25%
36%
25% 67% 36% 42%

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Palmdale

25%

Overall

60%

8%

8%

50%

11%

17%

0%

17%

42%

42%

38%

30%

30%

67%

57%

25%

17%

42%

42%

QSR Second Cycle Practice Indicators (2012-2013) - Percent Acceptable

Office

Engagement

Belvedere Santa Fe Springs Compton
Vermont Corridor Wateridge
Pomona
Glendora
El Monte
San Fernando
Valley Lancaster
Metro North Pasadena
Santa Clarita Torrance
West LA
South County Palmdale
Overall

92% 75% 75% 55% 58% 91% 80% 90%
89%
88% 100% 78% 44% 50% 70% 50% 70% 74%

Voice & Choice
64% 67% 67% 45% 75% 73% 70% 70%
56%
75% 78% 67% 67% 50% 70% 50% 50% 64%

Teamwork
33% 8% 17% 9% 58% 55% 40% 20%
22%
25% 11% 22% 11% 30% 20% 20% 20% 25%

Assessment OVERALL
58% 50% 42% 36% 67% 45% 70% 70%
33%
50% 44% 33% 33% 40% 30% 40% 30% 46%

Long-term View
67% 50% 50% 55% 67% 64% 60% 60%
44%
50% 56% 44% 56% 20% 50% 20% 40% 51%

Planning
50% 42% 50% 27% 75% 64% 60% 50%
56%
38% 44% 56% 44% 30% 30% 30% 30% 46%

Supports and Services
67% 67% 58% 36% 58% 73% 70% 70%
78%
63% 44% 44% 89% 60% 60% 70% 50% 62%

Intervention Adequacy
55% 58% 58% 36% 58% 55% 70% 70%
67%
50% 22% 44% 56% 50% 60% 60% 30% 53%

Tracking and Adjustment

Overall Practice

58%

67%

50%

58%

50%

58%

27%

45%

50%

58%

55%

73%

40%

60%

50%

60%

78%

56%

50%

50%

22%

33%

33%

33%

44%

44%

30%

30%

40%

50%

40%

50%

20%

30%

44%

51%

QSR Baseline Practice Indicators (2011-2012) – Percent Acceptable

Engagement

Voice & Choice

Teamwork

Overall

60%

52%

18%

Assessment OVERALL

Long-term View

Planning

Supports and Services

Intervention Adequacy

Tracking and Adjustment

Overall Practice

50%

39%

41%

66%

52%

45%

47%

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Analysis of QSR Findings
In analyzing the QSR Practice Scores for all eighteen offices in the third cycle and comparing them to the baseline, system performance demonstrated modest improvement in the following indicators: Support and Services increased from 66% to 67% and Intervention Adequacy increased from 52% to 57%. System performance in Engagement remained at 60% in both the baseline and third cycle. In Overall Practice, scores decreased slightly from 47% in the baseline to 42% in the third cycle. Teamwork demonstrated a slight decline from 18% in the baseline to 11% in the third cycle.
Current performance in the third cycle, after eight offices, indicates that:
 51% of children are making acceptable progress toward permanency  73% of children are considered to have acceptable emotional well-being  43% of families are making acceptable progress toward adequate functioning  11% of children have a functioning family team  38% of cases have an overall adequate assessment  30% of cases have a long-term view of child and family goals and strategies  30% of cases have plans adequate for achievement of case goals  42% of cases are adequately tracked toward achievement of goals
The County offered the following as an explanation of the modest progress in raising QSR scores. “The shift from Team Decision Making (TDM) meetings to a more family-centered practice of Child and Family Team (CFT) meetings appears to have had an impact on the number and frequency of meetings occurring with children, youth and families. The lengthy certification process and learning curve required to ensure model fidelity in a county as large as Los Angeles, is likely contributing to the lower scores being seen in Teamwork during the current cycle. As practitioners learn and embed the process more deeply into practice, it is more likely that the scores will improve in the fourth cycle which began in February 2018 with the Van Nuys office.”
Identification of System Barriers
The following system barriers were identified in two Qualitative Service Reviews, one in the Compton Office and one in the Van Nuys office. These two offices were the initial immersion sites. In each case reviewed, reviewers note any system barriers impeding Shared Case Practice Model practice. Barriers were noted in 23 cases of the 24 cases selected randomly for review. The full list of barriers is placed in the appendix. Some the more frequently identified barriers are as follow.
 Teaming and communication barriers – Team meetings not being held, informal supports and other key members not present
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 Lack of case communication and coordination – Mainly occurring when there are not regular team meetings
 Lack of family housing  Lack of placements, especially for some older youth  Language and other cultural barriers  Delays in initiation mental health services  Delays in paying relative caregivers due to RFA backlog  Workload  Underlying needs, especially trauma-related needs not understood  Confidentiality barriers between agencies  Lack of family engagement  Reliance primarily on court ordered services rather than the services actually needed  MediCal policies that prevent key professionals being in the family home on the same day
(double-billing issue)
DMH- QSR Provider Training and Outreach
The County reported that “DMH takes multiple steps to increase the understanding of the QSR by the Mental Health Providers by conducting a “QSR Foundational Training for Providers” prior to each review in the Service Area where the review is based. The three-hour session includes an overview of the Katie A. Lawsuit, explains the connection between the lawsuit, SCPM, and the QSR, and gives in-depth training of how the key QSR indicators are utilized to measure the implementation of the model. A scoring exercise is included to help participants connect practice behaviors to QSR outcomes. DMH QSR team began tracking these numbers in the Third Cycle. At the end of the Third Cycle, 358 individuals from agencies countywide completed the QSR Foundational Training,
The DMH QSR team conducts Mental Health Debriefings, an individually-tailored 90-minute feedback session, with every mental health provider agency actively providing services to focus children in the QSR sample. Debriefings are typically conducted two to six weeks after the QSR and utilize the QSR case summary to highlight strengths and challenges of the case. The Debriefing allows a space to provide individualized training to agency participants based on the results of the review. Key topics such as the role of the therapist in the CFT, formulation of underlying needs statements, and development of next steps are explored. Participants typically include the Agency Director, Clinical Supervisors, Managers, Quality Assurance Staff, Therapists, Wraparound staff, Psychiatrists, Case Managers, and any other individuals that agency administration includes. The DMH QSR team began tracking these numbers in the Third Cycle. At the end of the Third Cycle, 269 individuals participated in 71 Debriefings facilitated by QSR staff.”
The Panel views the County’s development of its QSR team as an important achievement. The system’s QSR reviewers are doing a commendable job in providing the County with accurate and valuable feedback on the quality of its practice. The Panel also remains deeply concerned over the continuing low QSR scores. It is the Panel’s view that the County must significantly improve the quality and
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frequency of CFT meetings to fully implement the Shared Case Practice Model and that lower caseloads are an essential step in achieving that goal.
VI. Outcome Measures
A series of child outcomes in the areas of safety and permanency have been identified to be tracked over time to show progress. As part of this process, the parties agreed to exit targets for each indicator, meaning that the targets would have to be met as one of several conditions for ending court oversight. There is a “minimum level of performance” target and an “aspirational” target assigned to each indicator. The aspirational target is an improvement goal unrelated to exit from Court oversight. Minimum Performance Levels were set only after this data became available and essentially assured that current performance, at that time, would be a baseline below which the County does not fall. The Panel considers the minimum levels of performance, which were established during the budget shortfalls of the recession, to be so minimal that they don’t provide meaningful standards for system adequacy.
The table below provides data for all newly opened cases, by calendar year. The table sorts data by DCFS initial case plans of Family Maintenance (Children Remained Home) or Family Reunification (Children Removed from Home), each of which is further sorted according to whether or not DMH services are in place. This table reflects that the number of open cases has once again dropped from 20,011 (CY 2015) to 19,500 (CY 2016). The percentage of cases that were provided Family Maintenance Services as the initial case plan decreased slightly over that period of time, as did the percentage of Family Maintenance cases receiving services from DMH.

Population of CY 2009- 2016
All Children

With DMH Services

Without DMH Services

Calendar Year

Children Initially Remained Home

%

Children

Initially

Removed

%

from

Home

Total

Children Initially Remained Home

%

Children Initially Removed
from Home

%

Total

Children Initially Remained Home

Children

Initially

%

Removed

%

Total

from

Home

2009 2010 2011 2012 2013 2014 2015 2016

11,915 14,061 15,252 14,743 15,121 13,992 12,644 12,057

57.7% 62.8% 67.1% 65.5% 64.3% 63.8% 63.2% 61.8%

8,747 8,318 7,468 7,766 8,406 7,935 7,367 7,443

42.3% 37.2% 32.9% 34.5% 35.7% 36.2% 36.8% 38.2%

20,662 22,379 22,720 22,509 23,527 21,927 20,011 19,500

3,660 4,867 6,377 6,645 6,989 5,376 4,915 5,129

41.2% 46.3% 53.4% 51.2% 50.6% 46.9% 51.7% 46.4%

5,216 5,654 5,565 6,322 6,828 6,075 4,583 5,936

58.8% 53.7% 46.6% 48.8% 49.4% 53.1% 48.3% 53.6%

8,876 10,521 11,942 12,967 13,817 11,451 9,498 11,065

8,255 9,194 8,875 8,098 8,132 8,616 7,729 6,928

70.0% 77.5% 82.3% 84.9% 83.7% 82.2% 73.5% 82.1%

3,531 2,664 1,903 1,444 1,578 1,860 2,784 1,507

30.0% 22.5% 17.7% 15.1% 16.3% 17.8% 26.5% 17.9%

11,786 11,858 10,778
9,542 9,710 10,476 10,513 8,435

Notes: 1.

The Entry Cohort Report includes children whose DCFS case started in the Calendar Year indicated.
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2. Children with DMH services are those who received DMH services 12 months before and 12 months after the case start date. 3. Data Source is CWS/CMS DataMart as of 12/13/17.

Safety Indicator 1 Repeated Reports of Abuse and Neglect
This indicator tracks the degree to which children who are the subject of a substantiated referral for abuse or neglect, but are not removed from home, do not experience another substantiated report during the subsequent 12 months. The County’s goal is to assess risk and provide supportive services, so that maltreatment does not reoccur. Data shows that the County’s performance on this indicator has improved from 80% of class members having no subsequent substantiated referrals within 12 months for FY 2002-2003 (previously reported) to 92% of Class members having no subsequent referrals within 12 months in CY 2016.

The parties agreed to a Minimum Performance Level of 82.8% and the County aspires to a goal of 83.3%. The County currently exceeds both the Minimum Performance Level goal and the aspirational goal.

Safety Indicator 1: Percent of cases where children remained home and did not experience any new incident of substantiated referral during case open Period, up to 12 months
Calendar Year 2009 – 2016

All Children

With DMH Services

Without DMH Services

Calendar Children

Children

Children

Children

Children

Children

Year

initially

without any

remained substantiated

%

initially without any remained substantiated

%

initially remained

without any substantiated

%

home

referrals

home

referrals

home

referrals

2009 2010 2011 2012 2013 2014 2015 2016

11,915 14,061 15,252 14,743 15,121 13,992 12,644 12,057

10,736 12,659 13,804 13,350 13,671 12,773 11,576 11,107

90.1% 90.0% 90.5% 90.6% 90.4% 91.3% 91.6% 92.1%

3,660 4,867 6,377 6,645 6,989 5,376 4,915 5,129

3,093 4,150 5,520 5,838 6,103 4,701 4,385 4,558

84.5% 85.3% 86.6% 87.9% 87.3% 87.4% 89.2% 88.9%

8,255 9,194 8,875 8,098 8,132 8,616 7,729 6,928

7,643 8,509 8,284 7,512 7,568 8,072 7,191 6,549

92.6% 92.5% 93.3% 92.8% 93.1% 93.7% 93.0% 94.5%

Minimum Performance
Level 82.8%
Aspire to 83.3%

Notes: 1. Intent of indicator: Of those children who initially remained home in the Calendar Year, and did not experience any new
(first occurrence of re-abuse) substantiated referrals during the case open period, up to 12 months. 2. The table above excludes evaluated-out referrals. 3. Children with DMH services are those who received DMH services 12 months before and 12 months after the DCFS case start date. 4. Data Source is CWS/CMS DataMart as of 12/11/2017.
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Safety Indicator 2 Incidence of Maltreatment by Foster Parents
This indicator reflects the incidence of maltreatment of children by their foster parents. The incidence is small and the County’s performance for Class members has been consistently in the 99th percentile range, meaning that over 99% of Class members in foster home settings experienced no substantiated maltreatment by their foster parents. The chart does not include the experience of Class members in residential settings; incidence of maltreatment is captured differently for this population, and is reflected in the chart on the following page.
The parties agreed to a Minimum Performance Level of 98.4% and the County aspires to a goal of 98.6% for this indicator. The County CY 2016 performance exceeds the Minimum Performance Level goal and the aspirational goal.

Safety Indicator 2: Of all children served in foster care in the Calendar Year, how many did not experience Maltreatment by their foster care providers?

Calendar Year
2009 2010 2011 2012 2013 2014 2015 2016

All children served in foster care
in Calendar
Year 24,700
23,629
22,667
22,346
23,930
22,125
24,563
40,131

All Children
Children with no
maltreatment
24,379 23,284 22,393 22,073 23,702 21,978 24,319 39,878

%
98.7% 98.5% 98.8% 98.8% 99.0% 99.3% 99.0% 99.4%

Calendar Year 2009 - 2016 With DMH Services

All children

served in Children with

foster care

no

%

in Calendar maltreatment

Year

12,505 15,297 15,710 15,522 17,943 15,625 15,130 28,308

12,283 15,031 15,495 15,303 17,747 15,508 14,974 28,106

98.2% 98.3% 98.6% 98.6% 98.9% 99.3% 99.0% 99.3%

Without DMH Services

All children

served in Children with

foster care

no

%

in Calendar maltreatment

Year

12,195 8,332 6,957 6,824 5,987 6,500 9,433 11,823

12,096 8,253 6,898 6,770 5,955 6,470 9,345 11,772

99.2% 99.1% 99.2% 99.2% 99.5% 99.5% 99.1% 99.6%

Minimum Performance
Level 98.4%
Aspire to 98.6%

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Notes:
1. The table above excludes children with abuse/neglect in group homes and guardian homes.
2. Children placed in group homes are not included in this data.
3. Children placed in guardian homes are not included because DCFS policy identifies legal guardianships as permanent placements and not as out-of-home placements.
4. The table is based on "Soundex" match of perpetrator's name and substitute care provider's name.
5. All children served in foster care includes: children already in foster care on the first day of the Calendar Year, children who initially entered foster care in the Calendar Year, and children who entered foster care as a result of a FM disruption.
6. Children with DMH services are: children already in foster care on the first day of the calendar year - those who received DMH services 12 months before and 12 months after the first day of the calendar year; children who initially entered foster care in the calendar year, and children who entered foster care as a result of an FM disruption – those who received the DMH services 12 months before and 12 months after the DCFS case start date.
7. Data source is CWS/CMS DataMart as of 12/11/2017.

This indicator reflects the incidence of maltreatment of children in group homes:

Safety Indicator 2b: Of all children placed in Group Homes in the Calendar Year, how many did not experience maltreatment by

their foster care providers?

Calendar Year 2009 – 2016

All Children

With DMH Services

Without DMH Services

Calendar Year

All children served in group home in calendar
year

Children with no maltreatment

All children

%

served in group home in
calendar

Children with no maltreatment

year

All children

served in

Children

%

group home

with no

in calendar maltreatment

year

2009

3,084

3,060

99.2%

2,284

2,266

99.2%

800

794

2010

3,133

3,119

99.6%

2,619

2,607

99.5%

514

512

2011

3,393

3,371

99.4%

2,907

2,890

99.4%

486

481

2012

3,407

3,383

99.3%

2,832

2,808

99.2%

575

575

2013

3,675

3,665

99.7%

3,186

3,178

99.7%

489

487

2014

4,253

4,247

99.9%

3,629

3,625

99.9%

624

622

2015

3,959

3,957

99.9%

2,890

2,888

99.9%

1,069

1,069

2016

3,897

3,883

99.6%

3,281

3,268

99.6%

616

615

%
99.3% 99.6% 99.0% 100.0% 99.6% 99.7% 100.0% 99.8%

Notes: 1. Table includes children placed in a group home anytime during the reporting period. 2. Table includes group home placement count. If children were placed in the two different group homes, it was counted twice. 3. The maltreatment is based on Non Protecting Parent Code indicator on CWS/CMS. 4. Data Source is CWS/CMS DataMart as of 12/11/2017.
Safety Indicator 3 Recurrence of Maltreatment within 6 Months
This indicator measures the percentage of all children who were victims of a substantiated abuse and neglect referral who were not victims of another substantiated referral within six months. It provides some
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evidence of the effectiveness of efforts to prevent subsequent abuse and neglect. Class members are not identified separately in this indicator. The data shows improvement in reducing subsequent substantiated referrals between FY 2002-2003 (previously reported), when 90.4% of children did not experience subsequent substantiated referrals within six months and in CY 2016, when 99.6% of children did not experience a subsequent substantiated referral.

The parties agreed to a Minimum Performance Level of 92.3%, and the County aspires to a goal of 92.8% for this indicator. The County FY 2016 performance exceeds the Minimum Performance Level goal and the aspirational goal.

Safety Indicator 3: No recurrence of maltreatment within 6 months.

Calendar Year
2009 2010 2011 2012 2013 2014 2015
2016

Time Period
Jan-2009 Jul-2009 Jan-2010 Jul-2010 Jan-2011 Jul-2011 Jan-2012 Jul-2012 Jan-2013 Jul-2013 Jan-2014 Jul-2014 Jan-2015 Jul-2015 Jan-2016 Jul-2016

Calendar Year 2009 - 2016
No Maltreatment
9,440 11,779 12,345 12,838 13,693 12,362 12,977 12,270 12,786 12,250 12,145 11,570 10,923 10,576 10,172 9,769

Total
10,187 12,752 13,555 13,869 14,694 13,250 13,919 13,186 13,755 13,124 13,078 12,433 11,797 11,239 10,845 10,335

Percent
92.7% 92.4% 91.1% 92.6% 93.2% 93.3% 93.2% 93.1% 93.0% 93.3% 92.9% 93.1% 92.6% 94.1% 93.8% 94.5%

Minimum Performance
Level 92.3%
Aspire to 92.8%

Notes:
1. Intent of indicator: Of all children who come into contact with DCFS and were victims of a substantiated maltreatment referral during the 6-month time period, what percent were victims of another substantiated maltreatment referral
within the next 6 months?
2. The table includes children who had a substantiated referral in the 6-month time period indicated.
3. The table above excludes allegations of “at risk, sibling abused” and “substantial risk”.
4. No maltreatment includes children who were not victims of another substantiated maltreatment referral within 6-months of the initial substantiated referral of maltreatment.
5. This is a referral based report and DMH match is not applicable
6. Data Source is CWS/CMS DataMart as of 12/11/2017
.

Permanency Indicator 1 Median Length of Stay in Out-of-Home Care
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This indicator measures the median number of days that Class members are in out-of-home care, grouped by the year they entered care. The County has reduced the median length of stay for Class members from 656 days in FY 2002-2003 (previously reported) to 156 in CY 2016.
The parties agreed to a Minimum Performance Level of 409 days and the County aspires to a goal of 383 for this indicator. Data for CY 2016 reflects a sustained improvement, and exceeds both the Minimum Performance Level and the Aspirational Performance Level.

Permanency Indicator 1: Median length of stay for children in foster care

Calendar Year
2009 2010 2011 2012 2013 2014 2015 2016

All Children

Children initially removed
from home

No. of children
who exited foster care

8,747 8,318 7,468 7,766 8,406 7,935

3,805 7,915 6,891 6,734 6,340 4,465

7367 7,443

3573 3,695

Median Days
283 300 301 358 299 187 153 156

With DMH Services

Children initially removed
from home

No. of children
who exited foster care

Median Days

5,216

3,456

349

5,654

5,324

378

5,565

5,065

368

6,322

5,424

405

6,828

5,062

322

6,075

3,221

241

4583

2144

187

5,936

2,791

207

Without DMH Services

Children initially removed
from home

No. of children
who exited foster care

Median Days

3,531

349

181

2,664

2,591

118

1,903

1,826

110

1,444

1,310

112

1,578

1,278

140

1,860

1,244

40

2784

1429

108

1,507

904

32

Minimum Performance
Level 409 days
Aspire to 383 days

Notes:
1. Intent of indicator: Of all the children who were initially placed into foster care within the calendar year, what is the median number of days that the children remained in foster care?
2. Children with DMH services are those who received DMH services between 12 months before and 12 months after the DCFS case start date.
3. Data Source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 2 Reunification within 12 Months
This indicator reflects the County’s success in quickly returning children to their parents. The County continues to be challenged with this Permanency Indicator. The percentage of children who are reunified within 12 months has remained around 30% for the last several calendar years.
The parties agreed to a Minimum Performance Level of 36.4% and the County aspires to a goal of 45.6% for this indicator. The County currently does not meet the Minimum Performance Level.
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Permanency Indicator 2: Reunification within 12 months

All Children

Calendar Year

Children initially removed from home

Children reunified within 12 months

2009 2010 2011 2012 2013 2014 2015 2016

8,747 8,318 7,468 7,766 8,406 7,935 7,367 7,443

3,479 2,999 2,761 2,471 2,659 2,350 2,116 2,182

%
39.8% 36.1% 37.0% 31.8% 31.6% 29.6% 28.7% 29.3%

With DMH Services

Children Children

initially removed

reunified within 12

%

from home months

5,216 5,654 5,565 6,322 6,828 6,075 4,583 5,936

2057 2101 2085 1992 2,216 1,835 1,409 1,787

39.4% 37.2% 37.5% 31.5% 32.5% 30.2% 30.7% 30.1%

Without DMH Services

Children Children

initially removed

reunified within 12

%

from home months

3,531 2,664 1,903 1,444 1,578 1,860 2,784 1,507

1,422 898 676 479 443 515 707 395

40.3% 33.7% 35.5% 33.2% 28.1% 27.7% 25.4% 26.2%

Minimum Performance
Level 36.4%
Aspire to 45.6%

Notes: 1. Intent of indicator: How successful is DCFS at reunifying all children under its supervision quickly? 2. The table includes all children who exited foster care through reunification within 12 months of removal from home. 3. The table is based on removal date and episode end date. 4. The table includes placement episodes with 8 days or longer. 5. The percent equals children reunified within 12 months divided by children initially removed from home. 6. Children with DMH services are those who received the DMH services 12 months before and 12 months after the DCFS case start date. 7. Data Source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 3 Adoption within 24 Months
This indicator reflects the County’s success in quickly moving children to adoption who cannot return home.
The parties agreed to a Minimum Performance Level of 2% and the County aspires to a goal of 2.9% for this indicator. The County currently exceeds the Minimum Performance Level, but does not exceed its aspirational performance goal.

Permanency Indicator 3: Adoption within 24 months

Calendar

All Children

With DMH Services
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Without DMH Services

Minimum Performance
Level 2.0%

Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 76 of 100 Page ID #:8424

Year
2009 2010 2011 2012 2013 2014 2015

Children initially removed from home

Children adopted within 24 months

%

Children Children

initially adopted removed within 24

%

from home months

Children initially removed
from home

Children adopted within 24 months

%

Aspire to 2.9%

8,747

270

3.1%

5,216

118

2.3%

3,531

152

4.3%

8,318

303

3.6%

5,654

172

3.0%

2,664

131

4.9%

7,468

249

3.3%

5,565

159

2.9%

1,903

90

4.7%

7,766

265

3.4%

6,322

183

2.9%

1,444

82

5.7%

8,406

219

2.6%

6,828

139

2.0%

1,578

80

5.1%

7,935

211

2.7%

6,075

48

0.8%

1,860

163

8.8%

7,367

198

2.7%

4,583

138

3.0%

2,784

60

2.2%

Notes: 1. Intent of indicator: How successful is DCFS at moving children under its supervision into finalized adoption quickly? 2. The table includes all children who exited foster care through adoption within 24 months of removal from home. 3. The table is based on removal date and placement episode end date. 4. Children with DMH services are those who received DMH services between 12 months before and 12 months after the DCFS case start
date. 5. % equals children adopted within 24 months divided by children initially removed from home. 6. Data Source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 4 Re-entry into Foster Care

This indicator reflects the County’s success in ensuring that reunified children remain in their parents’ care for at least 12 months after reunification. The data indicates that Class members re-entered foster care at a rate of 13.9% in CY 2016.

The parties agreed to a Minimum Performance Level of 13.9% and the County aspires to a goal of 12.9% for this indicator. For the CY 2016, the County did meet the Minimum Performance Level, but did not meet the aspirational performance goal.

Permanency Indicator 4: Reentry into foster care during the Calendar Year and reentry within 12 months of the date of reunification

Calendar Year

All Children

Children who were reunified

Children who
re-entered foster care

With DMH Services

Without DMH Services

Minimum

%

Children who were reunified

Children who
re-entered foster care

%

Children who were reunified

Children who
re-entered foster care

Performance Level 13.9%

%

Aspire to

12.9%

2009 2010 2011 2012 2013

7,193 7,075 6,894 6,009 5,927

870

12.1%

3,458

819

11.6%

4,357

890

12.9%

4,663

758

12.6%

4,107

661

11.2%

4,346

545

15.8%

3,735

566

13.0%

2,718

695

14.9%

2,231

593

14.4%

1,902

538

12.4%

1,581

325

8.7%

253

9.3%

195

8.7%

165

8.7%

123

7.8%

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2014 2015 2016

6,367 5,740 5,067

716

11.2%

4,598

691

12.0%

3,530

704

13.9%

3,641

529

11.5%

1,769

456

12.9%

2,210

548

15.1%

1,426

187

10.6%

235

10.6%

156

10.9%

Notes: 1. Intent of indicator: How successful is DCFS at ensuring children successfully remain with their parents after being reunified with parents? 2. The numerator is children who re-entered foster care within 12 months of reunification. The denominator is children who were reunified
during the calendar year. Placement episodes less than 8 days were included in accordance with the Federal Methodology. 3. Children with DMH services are those who received the DMH services 12 months before and 12 months after the DCFS case start date. 4. Date source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 5a Placement Stability in First Year of Placement
This indicator measures those children in foster care less than 12 months, who remain in their first or second placement. The County’s performance continues to improve, from 74.0% of Class members having two or fewer placements in their first year of care in FY 2002-2003 (previously reported), to 89.2% in CY 2016.
The parties agreed to a Minimum Performance Level of 82.5% and the County aspires to a goal of 84.1% for this indicator, both of which the County is currently exceeding.

Permanency Indicator 5a: Children in foster care less than 12 months with 2 or less placements

All Children

With DMH Services

Without DMH Services

Calendar Year

Children in foster care less than 12 months

Children with 2 or
fewer placements

%

Children in foster care less than 12 months

Children with 2 or
fewer placements

%

Children in foster care less than 12 months

Children with 2 or
fewer placements

Minimum

%

Performance Level

82.5%

Aspire to

84.1%

2009 2010 2011 2012 2013 2014 2015 2016
Notes:

3,788 3,342
2,998
2,698 2,930 2,579 2,321 2,143

3,320 2,916
2,635
2,362 2,606 2,325 2,069 1,911

87.6% 87.3%
87.9%
87.5% 88.9% 90.2% 89.1% 89.2%

2,218 2,271
2,223
2,159 2,405 1,952 1,513 1,703

1,891 1,931
1,924
1,869 2,112 1,741 1,339 1,501

85.3% 85.0%
86.5%
86.6% 87.8% 89.2% 88.5% 88.1%

1,570 1,071
775
539 525 627 808 440

1,429 985
711
493 494 584 730 410

91.0% 92.0%
91.7%
91.5% 94.1% 93.1% 90.3% 93.2%

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1. Intent of indicator: Of those children who are in foster care for less than 12 months, how many remain in their first or second placement?
2. This table includes all types of placement moves. 3. This table includes children who were in foster care for at least 8 days, but less than 12 months. 4. Children in foster care less than 12 months is determined by placement episode end date and removal date. 5. Children with DMH services are those who received DMH services 12 months before and 12 months after the DCFS case start date. 6. Data Source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 5b Placement Stability in Second Year of Placement
This indicator measures children in foster care between 12 and 24 months who did not experience a third or greater placement in the second year. In FY 2002-2003 (previously reported), 89.5% of Class members did not experience a third or greater placement, compared to 88.9% not experiencing a third or greater placement in FY 2016.
The parties agreed to a Minimum Performance Level of 89.2% and the County aspires to a goal of 89.7% for this indicator. Foster home stability for class members currently exceeds Minimum Performance Level and the Aspirational Goal.

Permanency Indicator 5b: Children in foster care 12 months but less than 24 months, without a move to a third or greater placement(s) in the second year

All Children

With DMH Services

Without DMH Services

Calendar Year

Children in foster care 12 months
but less than 24 months

Children who did not move to a
third or greater placement

%

Children in foster care 12 months but less than 24
months

Children who did not move to a third or greater placement

%

Children in foster care 12 months but less than 24
months

Children who did not move to a third or greater placement

%

Minimum Performance
Level 89.2%
Aspire to 89.7%

2009 2010 2011 2012 2013 2014 2015

1,888 1,905 1,672 2,066 2,043 2,273 1,805

1,690 1,721 1,522 1,892 1,880 2,051 1,605

89.5% 90.3% 91.0% 91.6% 92.0% 90.2% 88.9%

1,299 1,441 1,362 1,815 1,727 1,543 1,559

1154

88.8%

589

1302

90.4%

464

1,243

91.3%

310

1,669

92.0%

251

1590

92.1%

316

1,388

90.0%

730

1397

89.6%

246

536

91.0%

419

90.3%

279

90.0%

223

88.8%

290

91.8%

663

90.8%

208

84.6%

Notes:
1. Intent of indicator: Of those children in foster care for 12 months but less than 24 months, what percent did not move to a third or greater placement(s) in the second year?
2. This table includes all types of placement moves.

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3. The denominator is children who were in foster care 12 months but less than 24 months. The numerator is children who did
not move to a third or greater placement in the second year.
4. Children in foster care 12 months but less than 24 months is determined by placement episode end date and removal date.
5. Children with DMH services are those who received DMH services 12 months before and 12 months after the DCFS case start date.
6. Data Source is CWS/CMS DataMart as of 12/11/2017.

Permanency Indicator 5c Stability for Children in Care for More than 24 Months
This indicator is similar to 5a and 5b, except it applies to the stability of children in care more than 24 months. County performance has dropped slightly in this indicator, with 74.9% of Class members in care 24 months or more not experiencing a third or greater move in CY 2016, compared with 79.6% for CY 2015.
The parties agreed to a Minimum Performance Level of 58.8% and the County aspires to a goal of 61.7% for this indicator. Foster home stability for Class members currently exceeds Minimum Performance Level and the aspirational goal.

Permanency Indicator 5c: Children in foster care on the first day of the Calendar Year who have been in foster care for 24 months or more, and have not experienced a move to a third or greater placement(s) during the Calendar Year.

All Children

With DMH Services

Without DMH Services

Calendar Year

Children in foster care for at least 24 months
or more

Children who did not move to a
third or greater placement

%

Children in foster care for at least 24 months
or more

Children who did not move to a
third or greater placement

2009 2010 2011 2012 2013 2014 2015 2016

8,342 7,292 6,570 6,312 6,394 6,640 7,102 5,794

6,598 5,731 5,187 4,894 5,033 4,632 5,655 4,338

79.1% 78.6% 78.9% 77.5% 78.7% 69.8% 79.6% 74.9%

4,200 4,588 4,101 3,649 3,830 3,775 3,961 2,916

2,950 3,298 2,971 2,594 2,811 2,333 3,017 1,885

%
70.2% 71.9% 72.4% 71.1% 73.4% 61.8% 76.2% 64.6%

Children in foster care for at least 24 months or
more

Children who did not move to a
third or greater placement

4,142 2,704 2,469 2,663 2,564 2,865 3,141 2,878

3,648 2,433 2,216 2,300 2,222 2,299 2,638 2,453

%
88.1% 90.0% 89.8% 86.4% 86.7% 80.2% 84.0% 85.2%

Minimum Performance
Level 58.8%
Aspire to 61.7%

Notes:
1. Intent of indicator: Of those children in foster care for at least 24 months, what percent did not move to a third or greater placement(s) during the calendar year?
2. This table includes all types of placement moves. 3. The denominator is children who were in foster care on the first day of the calendar year and who have been in foster care for 24 months or more. The numerator is children who have not experienced a move to a third or greater placement(s) during the calendar year.
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4. Children with DMH services are those who received DMH services 12 months before and 12 months after the first day of each calendar year.
5. Data Source is CWS/CMS DataMart as of 12/11/2017.
VII. Panel Recommendations
The slow pace of improving practice and providing the right services at the right time to meet children’s needs continues to be the primary problem in Katie A. despite the commitment of both DCFS and DMH. The Panel had hoped the County’s work on developing data indicators that reflect progress toward full implementation and the identification of tipping points could aid in meeting settlement objectives. However, now that the County has concluded that its data systems will not currently support those tasks, other strategies will be necessary to improve performance. The County reports that it will continue to work on improving its data systems, but that seems like a long-term effort. DCFS and DMH still must answer the question: To what extent have DCFS staff and DMH providers implemented the Shared Core Practice Model? To what extent do DCFS and DMH provide children and families with timely mental health services specifically designed to meet the child’s needs? If this inquiry can produce data that is regularly updated, DCFS and DMH can enhance ongoing methods to ensure that staff change their practice accordingly. If not, other strategies will be required.
1. Ensure the Immediacy and Intensity of Intensive Home-Based Mental Health Services
It is imperative that DMH and DCFS collaborate to provide consistent, accurate and up-to-date data to track (1) immediate response to children at risk of placement disruption, (2) frequency and type of mental health services provided to children, their caregivers and their families, and (3) information dissemination to insure that the slots in IHBS are full.
DCFS and DMH agree that it is important to collaborate on achieving responsiveness of IHBS, especially to prevent placement in emergency shelter, group home, residential facilities and psychiatric settings and placement disruptions, including the speed of identifying the child’s needs, making an immediate IHBS referral, IHBS beginning services quickly, and provision of services as many hours a week as necessary to meet the child’s needs and support both the caregiver and the parent in visits in meeting those needs. However, there appears to be little progress in DCFS and DMH data collection and analysis on IHBS responsiveness. The CISR does not appear to analyze IHBS responsiveness.
The Panel is doing interview studies of children receiving IHBS and children/youth in group care (including CSW interviews) to collect information about responsiveness of IHBS, IHBS intensity and IHBS success of preventing placement disruptions. We will encourage DCFS and DMH to take action on the findings of those studies. But small studies of IHBS provided to children and families cannot provide the kind of up-to-date systemic data on responsiveness and intensity of IHBS necessary to exit Katie A.
Recent county data indicates that surprisingly, subclass members are not receiving more mental health services than other children, the highest amounts of children’s mental health service dollars continue to support services in residential treatment (over $30,000 of services annually per child as compared to $23,000
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annually per child in IHBS), a third of IFCCS slots continue to be empty and Wraparound continues to have a large number of unsuccessful terminations. This information is discouraging.
The Panel reiterates its recommendation in our 2016 Report that DCFS and DMH implement improvements driven by data to ensure that (1) soon as DCFS recognizes that a child’s placement may disrupt or a child is being considered for placement in any setting outside a family home, an immediate referral to IHBS is made; (2) IHBS is provided immediately to address the child’s needs and provide support to caregivers to prevent disruption; and (3) IHBS services have a “whatever it takes” approach, with daily in-home services for the child and caregiver if necessary. A pre-defined team of mental health staff should not determine what services or their intensity are provided—staff assignments should be unique to the child and family; services for the child and support for the caregiver and family should target the child’s trauma-related needs.
2. Ensure Placement Stability
DMH and DCFS have a commitment to prevent the trauma of disruption for children. This has been a prominent priority in the tipping points discussion.
 Continuing obstacles to achieving placement close to home appear to be that (1) the FFAs manage their own placements and placement moves and do not prioritize proximity to family (the FFAs are the majority of placements of children in foster homes) and (2) the fledgling Automated CommunityBased Home Reservation system encountered difficulties.
 The primary obstacle to ensuring that each child’s first placement was their only placement appeared to be insufficient support, including IHBS, for foster parents and kin caregivers to meet the traumarelated needs of children with difficult behaviors.
The Panel encouraged the county to investigate how many children are placed away from their siblings to begin a process of keeping children with at least one sibling to support those important attachments.
One reason for placement close to home is to make frequent visiting between parents and their children in care possible. DCFS is committed to improving the quality of visits, a key ingredient to safe reunification but with court-ordered multiple visits each week and limited staff to transport children long distances and monitor visits, it is unknown how much visit improvement can occur. Visits are less difficult for children when there is shared parenting between parents and caregivers, with agreement between them about the child’s needs and how to meet those needs, both during visits and in the caregiver’s home.
More than half the children in foster home placement in LA County are placed with relatives. CCR requires licensing of relative placements, but support for kin in meeting the needs of children—especially the subclass—is often overlooked. To ensure placement stability in kin placements, relatives should be involved in CFTs, asked what support they require to meet the child’s needs and IHBS provided if other supports do not have sufficient intensity.
3. Ensure Effective Teaming Teaming is an essential feature of SCPM. Teaming is both the process of collaboration among the family, CSW and providers to ensure needs are met and meetings together so all agree on the child’s needs and what the family, caregiver, provider, CSW, informal supports and others will do to meet those needs.
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As the Panel summarized in its 2016 Report, quality CFT meetings require:
 Ongoing communication among team members before and after team meetings  The family  A family support(s) chosen by the family  The caregiver (kin or foster family)  The CSW (with some exception if meetings occur more than monthly)  Key providers such as the child’s therapist and school team member,  Identify the strengths of the child, family and caregiver  Identify the specific unique needs of the child, especially trauma-related needs  Craft services to meet each of the child’s needs  Craft supports for the caregiver to meet the child’s needs  Craft supports for the family to meet the child’s needs (during visits)  An agreed-on plan with strengths, needs and supports and services provided to participants and incorporated into the court report and the mental health treatment plan
At this point DCFS and DMH cannot track the degree to which quality CFT meetings with these characteristics are occurring. There is less information available about CFT meetings facilitated by DMH staff than, including IHDS cases, than those facilitated by DCFS staff.
Although in most cases, DCFS and DMH staff actively collaborate with the child, caregiver, and each other, in the most recent QSR cycle, the County scored acceptably on teaming in only 11 percent of cases because the CFT meeting has not occurred and/or all the important individuals in the child’s life were not included. The Panel has recommended training for QSR reviewers as well as targeted coaching of DCFS and DMH CFT facilitators regarding how to achieve the above characteristics of CFT meetings.
4. Strengthen the Supervisory Role in Shared Core Practice Model Implementation
The Panel believes that the County cannot meet QSR exit standards without DCFS and DMH supervisors leading Shared Core Practice Model practice, including holding staff accountable for quality CFT meetings in every case that produce CFT plans and mental health treatment plans with services crafted to meet the unique needs, particularly trauma-related needs, of children and supports for caregivers and families to meet those needs.
In the spring, 2018, DCFS and DMH increased the number of coaches and was beginning to provide more supervisory training and guidance for strengths/needs-based serviced service crafting. But the reassignment of coaches to state mandated CCR and to the four offices with the lowest number of CFTs set the county back six months in providing strong countywide support for supervisors. The Panel reiterates its recommendations from the 2016 Panel Report:
 Ensure sufficient coaching and training in strengths/needs-based service crafting is provided to supervisors in DCFS and DMH that they consistently guide the staff in their units include children’s underlying needs and unique services and supports to meet those needs in CFT plans, DCFS case plans, DCFS court reports and mental health treatment plans.
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often enough to arrange unique services coordinated with both the parent and caregiver and together assess whether they are the right services at the right frequency.
5. Use the QSR as a Teaching Tool for Shared Core Practice Model
The Panel views the County’s development of its QSR team as an important achievement. The system’s QSR reviewers are doing a commendable job in providing the County with accurate and valuable feedback on the quality of its practice. The Panel has encouraged DCFS and DMH to get more power from the QSR as a way to teach consistent SCPM across offices and providers. Ascending QSR scoring trend lines will confirm that countywide SCPM is being achieved. Some encouraging progress is reflected in QSR scores, while other scores continue to be frustratingly slow in improving:
 51% of children are making acceptable progress toward permanency  73% of children are considered to have acceptable emotional well-being  43% of families are making acceptable progress toward adequate functioning  11% of children have a functioning family team  38% of cases have an overall adequate assessment  30% of cases have a long-term view of child and family goals and strategies  30% of cases have plans adequate for achievement of case goals  42% of cases are adequately tracked toward achievement of goals
The Panel reiterates past recommendations to enhance the QSR as a teaching tool for SCPM:
 Requiring all DCFS leadership, RAs and ARAs and their DMH manager counterparts and all DCFS and DMH trainers and coaches who have not already done so to shadow a QSR.
 Regularly hold cross learning sessions of QSR staff and coaching/training staff as well as twice annually convening the larger management team for a DCFS/DMH supervisors training that uses SCPM lessons learned from QSRs and selects illustrative QSR stories.
 Inviting QSR experts to lead a discussion of inter-rater reliability and consider possible modifications of (1) the QSR Assessment Indicator to require identification of specific child needs as a standard for acceptable rating, including a review to see if needs are in the case plan and court report; (2) the QSR Intervention Adequacy Indicator to require service crafting as a standard for acceptable rating and (3) the QSR Teaming Indicator to reflect that if the first CFT is in the review period, team formation may be off to a good start but all the potential team members or all the issues will not be addressed.
 A coaching session for QSR staff using the Panel’s analysis of the needs and services in the case stories of the most recent QSRs to guide the reviewers in enhancing how they can inspire SCPM practice by presenting a strong needs list and crafted services in each case story
6. CISR
The CISR is designed to improve IHBS across many DMH providers. The Panel commended the recent CISR Report and recommended that in the next CISR DMH (1) ask more questions of each provider about the reasons for psychiatric hospitalization and placement change after enrollment in IHBS and what IHBS did to intensify services to prevent it and (2) establish a typical range frequency of each type of IHBS service, such
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as the percentage of children who receive individual therapy once a week or more, the percentage of caregivers who receive in-home guidance in meeting the children's needs once a week or more, and the percentage of children who receive in-home one-on-one support.
7. Immersion
The fact that the County ceased using the immersion process was a surprise to the Panel. The strategy developed for this approach occurred over many months and involved frequent conversations about the design with plaintiffs’ and the Panel. Four offices were intensively involved in implementing the approach. The Panel considered the use of immersion as part of the revised Strategic Plan the parties had agreed to. The Panel expressed its reservations about the new system-wide approach previously about this report. We continue to believe that the County does not have the resources to fully implement the Shared Core Practice Model throughout the County at one time and that an immersion approach is the best strategy for meeting settlement objectives.
The value of the immersion process includes:
 Providing sufficient training and coaching that all staff are thoroughly trained and coached, leading to greater sustainability of practice
 Thoroughly testing innovations before attempting to implement them system-wide  Gradually intensifying the service array and staff size (which can be costly), so additional costs rise
gradually
We recommend that the County resume the immersion strategy, which could include more than two offices at a time. The County could continue some support in non-immersion sites, as was anticipated in the original plan. If the County choses to continue its system-wide implementation approach, The Panel believes that it needs a detailed plan for that strategy, which includes more than training and coaching.
8. Improve the DMH Data System
The County should fully support the DMH plan to strengthen the ability of its data system so that it tracks key practice areas such as the timeliness of provision of intensive mental health services and the type and frequency of services provided to class members. In the interim, the County should fully explore the use of interim processes that will contribute additional performance data about DMH practice and performance.
2016 Report Recommendations
The Panel has included the recommendations in its 2016 report in the Appendix. This was done in part to illustrate the commonality between issues raised in the 2016 report and many of those in the 2017 report. The Panel is also asking for a County response on the status of these recommendations.
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GLOSSARY OF TERMS
Child and Family Team (CFT) – A team consisting of the child and family, their informal supports, professionals and others that regularly meet face-to-face to assess, plan, coordinate, implement and adjust the services and supports provided.
Coaching - Coaching is supportive; solution focused; skillfully listening to others; sensitively asking questions; self-reflective; and strengths-needs driven.
D-Rate – Special rate for a certified foster home for children with severe emotional problems.
DCFS – Department of Children and Family Services
DMH – Department of Mental Health
ER – Emergency response
ESC – Emergency Shelter Care
Full Service Partnership (FSP) – An approach to mental health services that is strength-based, individualized, child and family driven, coordinated and flexible in response to child and family needs.
FM – Family maintenance services provided for families with children living in the home of either of his/her parent or LG.
Hub – Six regional sites where children will receive a comprehensive medical evaluation, mental health screening and referral for services.
ICC - Intensive Care Coordination – ICC is similar to the activities routinely provided as Targeted Case Management (TCM); however, they must be delivered using a Child and Family Team Process to guide the planning and service delivery process. Service Components and Activities are related to the elements of the Core Practice Model.
IFCCS - Intensive Field Capable Clinical Services – phase one of the county’s implementation of ICC and IHBS. Target population is youth who are in DCFS’ Emergency Response Command Post, Exodus Recovery Urgent Care Center, discharging from a psychiatric hospitalization, or had a response by Field Response Operations or PMRT without a psychiatric hospitalization.
IHBS - Intensive Home-Based Mental Health Services – IHBS are intensive, individualized, and strengthbased, needs-driven intervention activities that support the engagement of the child and family in the intervention strategy. IHBS are medically necessary, skill-based interventions.
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MAT – Multi-Disciplinary Assessment Team PCIT – Parent Child Interaction Therapy is an evidence base practice for ages 2 to 5 children with externalized acting out behaviors. RCL – Rate Classification Level (levels of group home care, with RCL 14 being considered residential treatment; about 2,332 children are in 83 group homes SCPM - Shared Core Practice Model is a practice model adopted by the Department of Children and Family Services and the Department of Mental Health to focus our work on identifying and addressing the underlying strengths and needs of children and families. TFC – Treatment Foster Care – DMH will provide additional information about TFC. Wraparound - Wraparound is a family-centered, strengths-based, and needs driven planning process for children, youth, and families that take place in a team setting
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Appendix
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Recommendations from the 2016 Report
1. Ensure the Immediacy and Intensity of Intensive Home-Based Mental Health Services
The Panel has been encouraging DMH and DCFS to collaborate on data-driven improvements in the responsiveness of IHBS, especially to prevent placement in emergency shelter, group home, residential facilities and psychiatric settings and placement disruptions, including the speed of identifying the child’s needs, making an IHBS referral, and IHBS beginning services, and whether services were provided as many hours a week as necessary to meet the child’s needs and support both the caregiver and the parent in visits in meeting those needs.
Specifically, the County should take the following steps:
 As soon as DCFS recognizes that a child’s placement may disrupt or a child is being considered for a higher level of care, an immediate referral to IHBS should be made (not delaying for lengthy triaging or committee process).
 IHBS should begin providing services immediately to address the child’s needs and provide support to caregivers to prevent disruption.
 IHBS services should be designed immediately with a “whatever it takes” approach, with daily in-home services for the child and caregiver if necessary. A pre-defined team of mental health staff should not determine what services or their intensity are provided—staff assignments should be unique to the child and family, with some children receiving daily 1:1 services, some caregivers having no parent partner, some families having the assistance of parent partners in visits and sometimes trauma treatment with guidance from the child’s therapist for the caregiver and family being the primary service initially.
2. Develop Additional Measures that Reflect IHBS Quality and Effectiveness
The County should develop the capacity to expand its data collection and analysis to include new performance and outcome indicators for intensive home-based mental health services. These indicators might include the following, some of which are already reported.
Indicators reflecting service timeliness (beyond just initial contact) Indicators reflecting service intensity
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Indicators reflecting service duration Indicators reflecting service tailoring Indicators reflecting placement stability Indicators reflecting placement level Indicators reflecting duration of restrictive placement stays Indicators reflecting runaway incidence and duration
3. Strengthen Training and Coaching
For staff in all DCFS regional offices and DMH providers to practice according to the SCPM requires (1) identifying each child’s unique needs, including trauma-related needs, in discussions with families and caregivers and the rest of their team; and (2) crafting unique services and supports to meet each child’s needs, including support for parents and caregivers in meeting the child’s needs, and building on child and family strengths. Guiding strengths/needs-based practice relies on coaches and supervisors in DCFS regional offices and DMH providers, and as a result, a range in practice is coached and supervised. For the culture change DCFS and DMH leadership recognize is necessary, supervisors must become more confident in consistent approaches to teaching staff to guide families and teams in reaching agreement about children’s underlying needs and crafting unique services and supports. Agreement about children’s underlying needs and crafting unique services and supports should be apparent in CFT plans, DCFS case plans, DCFS court reports and mental health treatment plans.
Caseloads in the four DCFS immersion offices are dramatically reduced, and hiring and Academy training is resulting in decreasing caseloads in all the offices. More and more DCFS staff (and DMH providers) are learning how to facilitate a CFT meeting. Now the County has to enable CSWs to regularly utilize CFT meetings for all children and families throughout the family’s experience with the system. The recent DCFS report on the frequency with which families experienced multiple CFT meetings confirmed that their incidence remains disappointingly low. Most families must experience more than an initial CFT meeting. The union’s resistance to committing to this practice has long been a barrier to achieving compliance in this area.
Specifically, the County should take the following steps:
 Ensure sufficient coaching and training in strengths/needs-based service crafting is provided to supervisors in DCFS and DMH that they consistently guide the staff in their units to children’s include children’s underlying needs and unique services and supports to meet those needs in CFT plans, DCFS case plans, DCFS court reports and mental health treatment plans.
 Ensure sufficient coaching is provided to supervisors that they consistently monitor that each family in each worker’s caseload has had more than the initial CFT meeting and is having CFT meetings often enough to arrange unique services coordinated with both the parent and caregiver and together assess whether they are the right services at the right frequency.
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4. Increase Placement Resource Capacity and Stability
DMH and DCFS view their commitment to prevent the trauma of disruption for children as being reflected in the steps taken to develop an Automated Community-Based Home Reservation system, interagency collaboration (that unfortunately does not include Family Foster Care Agencies) to keep children close to their families, school-based recruitment of foster parents, and designing IHBS specifically to prevent each child from having a disrupted placement. Child well-being will be enhanced if each newly placed child remains near the parent with whom reunification is being planned and if the child does not have to change schools. This requires a major change from the past management of foster care placement, especially as the supply of homes has been shrinking.
Improving the quality of visits is a key ingredient to safe reunification. Visits are improved when there is shared parenting between parents and caregivers, with agreement between them about the child’s needs and how to meet those needs, both in visits and in the caregiver’s home.
DCFS offices have increased efforts to place children in family settings rather than group care, and the Panel has encouraged a new analysis of children in group care, reasons for their placement in the past year, and assessment of adequacy of mental health services for children in group care.
Specifically, the County should:
 Track any increase in placement changes within each office catchment area and identify the factors that make such placements a challenge to sustain
 Direct each immersion office to work with their FFAs to develop a plan for recruitment of additional family foster homes and place children close to home.
5. Expand the Use of the Automated Community-Based Home Reservation System.
This system informs DCFS staff where foster home vacancies in state-licensed homes exist system-wide. The County has been piloting a revision in this process for selected sites, whereby foster home vacancies in nine sites are reserved for that regional office for seven business days to permit the site to use them first. After seven days the vacancies are available system-wide. DCFS has recently implemented an improvement in which there is an automatic alert to staff when a vacancy occurs. The Panel views this innovation as promising in its ability to place children closer to their homes and communities. However, it has significant limitations in that the majority of family foster homes are licensed by private family foster care agencies (FFAs) and these agencies are not included in this application. According to the DCFS, the following table reflects the distribution of family foster homes between state-licensed homes and FFA-licensed homes as of 2017.
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State-Licensed Foster Homes

Available

Available

Placed

Homes

Beds

Children

954

2,476

1,838

(74.2%)

Available Homes 3,195

FFA Homes Available Beds
7,366

Placed Children
4,736 (64.2%)

For the placement system to serve all class members, the application would need to be extended to apply to FFAs as well.

The Panel recommends that DCFS formally approach FFAs about applying the process to their agencies as well.

6. Strengthen the Supervisory Role in Shared Core Practice Model Implementation

The County should develop a supervisory process that guides supervisors in mentoring CSMs and holding them accountable for performance in the CFT process, identification of underlying needs and matching services and supports to needs through service crafting. This process would likely involve case file reviews and court reports (work products) and supervisory case conferences (supervisory forums) as ways to assess performance and skill development needs, underscore accountability and teach workers SCPM skills. The development of a supervisory guide would help structure this process. Supervisors would need training/coaching themselves to fully master this element of the supervisory role. The Panel does not believe that the County can meet QSR exit standards without addressing this vital supervisory role, which is not currently being performed on an ongoing basis beyond the CFT facilitation coaching, which is quite limiting. Continuing low QSR performance in these areas provide clear evidence of the necessity of implementing such supervisory review and mentoring.
7. Complete the CFT Tracking Application
The County should complete the development of a CFT frequency tracking system that provides management data on the performance of CSWs and the percentage of youth and families that have experienced a CFT in the past three months. As part of implementing this process, the County needs to issue policy guidance outlining how staff determine if contacts with families constitute a legitimate and reportable CFT. Because functional CFTs can take varying forms, policy guidance that provides for this variability would need to be carefully crafted, probably consisting of principles. The following examples have been shared with the County by the Panel previously.
Principles of SCPM CFT Meetings
 Are usually planned in advance, with participants prepared/notified in advance
 Entail ongoing communication among team members before and after team meetings to ensure follow up on service plans and other actions decided by the child and family team

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 Always involve the family  Should include a family support or supports member chosen by the family  Should include the CSW (with some exception for weekly Wrap meetings) and at least one other team
member other than the family. (Teams usually grow in size over time)  Should include the caregiver (kin or foster family)  Should include key providers such as the child’s therapist and school team member, where needed  Are strength and needs-based  Identify the strengths of the child, family and caregiver  Identify the needs of the child  Are outcome focused  Specify services to meet the child’s needs  Specify supports for the family (during visits) and the caregiver to meet the child’s needs  Result in notes about the decisions made in the meeting provided to participants  Result in an agreed-on plan with strengths, needs and supports and services
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Systemic Barriers Impacting Practice

The following system barriers were identified in two Qualitative Service Reviews, one in the Compton Office and one in the Van Nuys office. These two offices were the initial immersion sites. In each case reviewed, reviewers note any system barriers impeding Shared Case Practice Model practice. Barriers were noted in 23 cases of the 24 cases selected randomly for review. The barriers that were identified follow.
Compton Systemic Issues Impacting Practice:

1.      
2. 



3. 


4.

Key informal and formal supports have not been engaged and are absent from the CFT Long waiting periods and ineffective mental health services due to high caseloads Homelessness/limited affordable housing impacts client’s ability to focus on other case plan goals Confidentiality is a barrier to information sharing among systems CSWs lack training in mental illness and how to effectively engage clients with mental illness. Service providers lack training in the dependency process and what is required for safe case closure.
Access to medical records or consultation between mental health providers can help the FY meet treatment goals and prevent being re-traumatized by having to re-tell his story Sharing information within department programs can expedite referral process, improve recommendations for services, and satisfaction/effectiveness of services received Early and ongoing engagement of parents who are distrustful of multiple systems can strengthen the long term view for the FY and family Departmental policies and/or billing limitations limit the duplication of services (i.e., sessions provided by two mental health clinicians)
The roll out and implementation of the Share Core Practice Model takes time. In this case, a team has not been formed and planning is limited. When there is little understanding of underlying needs and effects of trauma of the parents it can impact long term view. Placing primary emphasis on court-mandated services (particularly related to substance abuse) rather than developing more specific interventions and services based on the family’s needs can lead to a long term view without enough power to sustain long term goals.

 A lack of training in the Core Practice Model (CPM) and concerns about breaking confidentiality can impact how providers implement the CPM in their daily practice and can impede the sharing of valuable information that could contribute to the team’s assessment and understanding of the strengths & needs of the family.
 When a formal mental health assessment of a child is not completed, important and valuable information can be missed (i.e. infant hair and face pulling).
 Issues with Media-Cal can prevent the timely completion of a mental health assessments and can create concerns about double billing when the linkage agency (DMH) and the provider are able to conduct the assessment on the same day. In this case, the assessment was deferred to the
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
5.  
6. 



7.   
8. 
  9.  


provider who only completed a partial assessment, when a full assessment could have ultimately been completed by the linkage agency. A delay in the Resource Family Approval (RFA) process causes a delay in payment to relative caregivers that results in unnecessary financial stress, even once the RFA is approved. The RFA process can also be a confusing process for relative caregivers.
Relative Placements - Relatives can experience financial challenges when RFA approval is delayed. Resources - There are challenges to meeting the needs for impoverished clients and the mental health needs of undocumented Spanish speaking adults when they must pay out-of-pocket for services and are struggling financially/unable to pay.
Communication and Information Sharing: When a child/youth is seen by multiple mental health practitioners and given varying and sometimes opposing diagnoses, it can create confusion and a challenge for team members to know how best to support the child and family in the effort to stabilize the child’s mental health as part of permanency planning. Lack of Placement Resources: Systemically, family style placement options are slim to none for a FY who is an older African-American male, with a learning disability, unresolved mental health issues, and placed on probation. The youth’s team has not explored the underlying need that drives the youth’s resistance to ILP services and adoption. Fear Factor: Assessing and understanding the placement concerns of a youth and their underlying needs can be a challenge when the youth is guarded and distrustful of the system, and the key party they do trust who is with the child daily has not explored the child’s underlying needs. Family Connections: Teamwork can be impacted when family members no longer participate in the Child and Family Team meeting process due to difficulty engaging the family or family members seeming to be adversarial to the process.
Sharing of information- there are communication barriers between Adult Mental Health Providers and the Child Mental Health Providers. Although the caregivers never complained, the length of the RFA approval process did create a financial strain on the caregivers. Engagement of parents in the CFT process can be a challenge when the parent has significant mental health issues and the only person the parent trusts is the CSW.
Children who have a history of trauma but do not exhibit obvious symptoms and appear to be functioning well do not meet medical necessity for needed trauma based therapy due to billing and funding criteria. There may be barriers to establishing permanency when an identified co-guardian lives out of state or an already established guardian chooses to move out of state. The fear of loss of professional support to families that already have limited resources can be a barrier to closing cases.
Development of a CFT is difficult when key individuals in child’s life are not aware of each other, nor the roles and purposes of other potential key team members in the child’s life. The Sharing of Information can improve team functioning and help to move a case forward. Ensuring the parent and the focus child have access to the right types of services at the right time, including but not limited to mental health services, can facilitate moving a case forward and prepare a family to function better together.

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

10. 
 11.
   12. 
 

Initial and ongoing review of the CG’s constraints on ability to ensure timely transportation for mental health, pediatric, and other appointments necessary for the FC’s well-being and development of contingency alternatives when the CG’s work or other life demands require such assistance. Development of a flagging status to ensure a mental health provider does not close a case for the FC missed appointments before alerting the CSW and the Specialized Foster Care of missed appointments and potential case closure.
Conflicting Policy- Provider agencies may have strict policy about not getting involved in court recommendations related to placement or jurisdiction, which can impact the team’s effectiveness to work with the family on their long term view plan affecting the children’s stability and permanency. Court Requirements - Legal preference for relative placement sometimes may not be in the best interest of the children, and may fail after a short period of time, if done without careful consideration.
A focus on compliance with having CFTM’s when a case is stable and moving expeditiously towards adoption can impact the assessment of underlying needs and planning on how best to meet them. Planning and outcomes for families can be impacted when key team members are not present at CFTMs and overall consistent outreach and communication is not occurring on an ongoing basis. There are legal barriers in obtaining Regional Center services when educational rights remain with parent’s whose whereabouts are unknown.
CSWs and other professionals working with transitional-age youth face the unique challenge of promoting independence while also providing support when needed. It is crucial that a youth’s trauma history be understood and taken into account when developing plans for their transition from DCFS care to independent living. When a youth is in a stable home and free of safety concerns, there is a tendency to perceive them as an “easy case” not requiring the close attention of higher-risk cases. This may in turn lead to underpowered interventions that do not adequately prepare the youth for adulthood. A cohesive team of formal and informal supports sharing information and resources promotes clear planning and the sharing of responsibility. Without this coordination, fragmented teams may develop in which individuals make efforts that are underpowered without the feedback and assistance from others who are closely involved in the youth’s life.

Van Nuys

Systemic Issues Impacting Practice:

1. 
 

When the court liberalizes parents visits from monitored to unmonitored in Permanent Placement cases when the department is actively searching for an adoptive home, it can create confusion and a challenge for team members as to how best to include the parent in permanency planning. It is very difficult to find adoptive homes for sibling sets that are older and of mixed gender.
Assessing and understanding the placement concerns of a youth, their underlying needs and that of their caregiver can be a challenge when the youth is very guarded and distrustful of the Department, and the key party they do trust who visits weekly, is unaware of the concerns.
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 2.


3. 

 4.

  5. 
 6.



Teamwork can be impacted when family members who remain involved in the youth’s life no longer remain as key participants in the Child and Family Team meeting process due to difficulty in engaging them or them seeming to be adversarial to the process.
A parent’s legal status can create challenges in the family immediately accepting and trusting individuals providing services, which can create a delay in services starting and limiting the amount of time a family has to fully address underlying needs. Timelines and policies around the maximum amount of time families can receive Voluntary Family Maintenance Services can impact the degree to which a family is able to address underlying needs, especially when services such as Wraparound are viewed and received positively by a family, yet are contingent on having an open DCFS case.
Communication can be limited without a functioning CFT, where the youth’s team members all know one another, are aware of the youth’s strengths, needs, and goals. In this case, team members are not all on the same page about how the youth’s medical diagnosis affects his needs and strengths. Legal status of caregiver impacts the CFT’s ability to develop a permanency plan that does not include her pursuing Legal Guardianship or Adoptions, which all team members believe would be the best option for the FC. Financial, geographical, and language limitations can make accessing services or providers who have specialty training of certain conditions/diagnoses can be difficult for families.
Information sharing can improve team functioning and help to move a case forward. When a holder of pertinent information does not share information with other providers involved with the FC and family, it can limit the understanding of the underlying needs of the FC. Limited providers of similar cultural and linguistic backgrounds as parents can impede a parent’s ability to effectively engage with all service providers. There is a need to provide more training to professionals to clarify understanding of what a CFT is and how to successfully develop a CFT with all the “right people”.
Mental Health Services delays: Children do not always exhibit outward signs of emotional disturbance and instability. As a result, they may not meet medical necessity for immediate therapeutic intervention, thus delaying assessment for needed services. Funding delays: The caregiver has not received any foster care funding for over seven months due to the RFA process. In this case, there are no anticipated barriers to RFA approval, but the process is timely, placing extraordinary financial burdens on caregivers, and may affect stability.
Information Sharing and CPM Installation: Family participation is key to the design and implementation of the CFT and communication can be limited without a functioning CFT where all team members know one another and are aware of the strengths, needs, and goals of the FC, BM and SF. Communication between parties has not been supported by a team process in place to ensure that strengths and underlying needs are identified, addressed, information is shared, and effective planning takes place for the child and family. Caseloads and CPM Installation: High caseloads and highly complex cases can affect teamwork and engagement. This family is involved with multiple systems such as DMH, DCFS, the school system, and potentially Regional Center.

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  7.  
 8.
    9.  
10.

Access to Resources: The family has limited financial means and requires free or low-cost services, many of which have resulted in a wait list. Basic needs such as a functioning stove, refrigerator, transportation and rent have been a challenge for this family. Billing Requirements/Limits: More intensive services have been recommended for the FC, such as PCIT, however, billing issues will require the FC to stop attending his day treatment program. Additionally, BM was timed out of mental health counseling with limited improvement in goals.
The roll out and implementation of the Shared Core Practice Model takes time. In this case, a team has not been formed and planning is limited. Communication can be limited without a functioning CFT where the FC’s team members all know one another and are aware of the child’s and family’s strengths, needs and goals. In this case, the FC is struggling academically and has been since the case was opened, and the FC’s Mo is struggling to find a home. The lack of understanding of underlying needs and effects of trauma can impact planning and services.
Multiple case reassignments in a short period of time can impact the assessment and understanding of the case history, as well as create barriers in identifying the family’s underlying needs. A lack of ongoing communication and information sharing between DCFS and community based service providers can negatively impact the assessment and understanding of a family’s needs. When the focus of the CFT process is on compliance, opportunities to engage the family in having input in their case plan and identifying underlying needs can be missed. Due to a lack of continuity of CSW’s important documentation was not in the case file, therefore creating a barrier in verifying completion of court ordered services.
Access to Services - Lack of services offered in foreign languages. This is a family where the father is Armenian and his primary language is Russian. Father and the CSW have been challenged to locate services offered in Russian or that would accommodate an interpreter. Cultural Sensitivity - There is a need when working with all families, and particularly those who have relocated from other countries, to be aware of the assumptions we make. Through the QSR process, in addition to the parents wanting to convey that the detention of their son could have been handled more professionally, father wanted to express dismay regarding a comment made court that because he could speak English with a good amount of fluidity, that he did not need an interpreter. Mother, is much more proficient in English than father, however, one of her group counselors shared that she often uses a word translator on her cell phone during group meetings to help aide in her understanding of conversations. It is important that the Department make the effort to ensure that interpretations of our words and their nuances are well understood by our families as they work to rebuild their families.

 Child and Family Team (CFT) and Core Practice Model Installation Although CFT meetings are designed to allow the voice of the youth along with their supports to plan around the youth’s strengths and needs, the youth may feel the meeting is focused on all the accomplishments made by the adults in the room and less about what the youth feels she needs. In this case, it appears that the youth and her team were making progress towards her goals (applying for colleges, obtaining driver’s license, etc.) that the meeting did not feel helpful to the youth. Including the

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youth in discussions around what she feels she needs and what she feels would make the meetings helpful could create a more child focused meeting.
 Transitions and Case Handoffs Training is needed for DCFS and FFA workers about how to ensure necessary placements moves are less traumatic and how to address the harm that is caused by the moves. In this case the FY was replaced from her former foster home, where she resided for approximately 4 years abruptly due to the caregiver allowing an unauthorized person to live in the garage of the home. The FY would have benefited from better communication in the planning and a space where she could have said good bye to this important adult in her life. In response the child experienced some depression surrounding this move where she was picked up from school with all of her belongings in hand.
 Working with Transition Aged Youth The opportunities from the AB12 program and some ILP services and benefits are not available to foster youth prior to graduating high school which could be more helpful early on as a youth plans for their future. In this case, the youth felt she did not receive the guidance/support in the college application process from these services when she needed them. She further was not able to obtain resources like a lap top and driver’s education until after she turns 18 years of age.
11..
 Extended family members (such as MGM) and persons without a biological relationship with the child (such as stepfather) are often not seen as crucial, fully-participating members of the team despite having a primary role in the child’s life.
 Due to high workloads, CSWs have difficulty prioritizing CFTMs and completing them within the required timeframes. (CSW had done a CFTM with this family right before the review and had wanted to do the next one the beginning of February 2018 but he had others that needed to be done first).
 Confidentiality concerns (the concern of DCFS, for example about sharing information with school personnel or the concern of mother’s therapist about sharing information with DCFS) can be a barrier to the development of a common understanding of strengths and underlying needs that can help team members form a unified support system helping the family to achieve safe case closure.
12.
 When completion of court-mandated services takes priority over family-specific interventions, family members may feel that compliance with court orders is more important than their contributions.
 Additional efforts must be made to repair professional relationships with family members who feel they were wronged during the initial stages of a case, as it can lead to additional challenges in building relationships based upon mutual trust and respect with families.
 Formal and informal supports who possess valuable insights into a child’s or family’s needs may be hesitant to disclose this information to people outside of the family system out of concern that such disclosures would negatively impact their relationships with these individuals.
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Case 2:02-cv-05662-JAK-AJW Document 942 Filed 01/23/19 Page 100 of 100 Page ID #:8448

1

PROOF OF SERVICE

Katie A., et al. v. Diana Bonta, et al.

2

Case No.V-02-05662 JAK (SHx)

3
I, the undersigned, say: I am over the age of 18 years and not a party to the 4 within action or proceeding. My business address is 3701 Wilshire Boulevard,
Suite 208, Los Angeles, California 90010.
5
On January 23, 2019, I served the foregoing documents described ADVISORY 6 PANEL=S REPORT TO THE COURT – ANNUAL REPORT FOR 2017,

7 DECEMBER 21, 2018 on all interested parties in this action by placing copies

8 thereof enclosed in a sealed envelope addressed as follows:

9
John F. O’Toole 10 National Center for Youth Law
11 405 14th St., 15th Floor Oakland, CA 94612-2701
12

Kathleen R. Wolfe US Department of Justice 950 Pennsylvania Avenue N W NYA Washington, DC 20503

13 [X] BY MAIL - I deposited such envelope in the mail at Los Angeles, California, with first class postage thereon fully prepaid. I am readily familiar with
14 the business practice for collection and processing of correspondence for mailing.

15 Under that practice, it is deposited with the United States Postal Service on that

16

same day, at Los Angeles, California, in the ordinary course of business. I am aware that on motion of the party served, service is presumed invalid if postage

17 cancellation date or postage meter date is more than one (1) day after the date of

18 deposit for mailing in affidavit; and/or

19 [X] BY CM/ECF NOTICE OF ELECTRONIC FILING: I electronically filed the 20 document(s) with the Cleark of the Court by using the CM/ECF system.
Participants in the case who are registered CM/ECF users will be served by the 21 CM/ECF system. Participants in the case who are not registered CM/ECF users 22 will be served by mail or by other means permitted by the court rules.

23
I declare that I am employed in the office of a member of the bar of this 24 court at whose direction the service was made.

25

I declare under penalty of perjury that the foregoing is true and correct.

Executed on January 23, 2019, at Los Angeles, California.

26

27

__________________________

28

CRISTA MINNECI

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PROOF OF SERVICE

 </s> Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 1 of 92
(AJWx),CLOSED,DISCOVERY,PROTORD
UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA (Western Division − Los Angeles)
CIVIL DOCKET FOR CASE #: 2:02−cv−05662−JAK−AJW

Katie A, et al v. Diana Bonta, et al Assigned to: Judge John A. Kronstadt Referred to: Magistrate Judge Andrew J. Wistrich Demand: $0 Cause: 28:1343 Violation of Civil Rights
Plaintiff

Date Filed: 07/18/2002 Date Terminated: 08/12/2015 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: Federal Question

Katie A by & through her nex friend Michael Ludin

represented by Alison N Barkoff Bazelon Center for Mental Health Law 1101 15th Street Northwest, Suite 1212 Washington, DC 20005 202−467−5730 TERMINATED: 02/08/2011 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Fiza A. Quraishi National Center for Youth Law 405 − 14th Street 15th Floor Oakland, CA 94612 510−835−8098 x 3004 Fax: 510−835−8099 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ira Burnim Judge Bazelon Center for Mental Health Law 1101 15th St NW, Ste 1212 Washington, DC 20005 202−467−5730 Email: Irab@bazelon.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

John F O'Toole National Center for Youth Law 405 14th Street 15th Floor Oakland, CA 94612−2701 510−835−8098 Email: otoole@youthlaw.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kimberly Lewis National Health Law program 2639 South La Cienega Boulevard Los Angeles, CA 90034 310−204−6010 Fax: 310−204−0891 Email: lewis@healthlaw.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kirk A Hornbeck , Jr Hunton Andrews Kurth LLP 550 South Hope Street Suite 2000 Los Angeles, CA 90071−2627

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 2 of 92
213−532−2000 Fax: 213−532−2020 Email: khornbeck@HuntonAK.com LEAD ATTORNEY
Marilyn L Holle Disability Rights California 350 South Bixel Street Suite 290 Los Angeles, CA 90017 213−213−8000 Fax: 213−213−8001 Email: marilyn.holle@disabilityrightsca.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark D Rosenbaum Public Counsel 610 South Ardmore Avenue Los Angeles, CA 90005 213−385−2977 Fax: 213−385−9089 Email: mrosenbaum@publiccounsel.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mary Giliberti Bazelon Center for Mental Health Law 1101 15th St NW, Ste 1212 Washington, DC 20006 202−467−5730 TERMINATED: 05/14/2004 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Melinda Ruth Bird Disability Rights California 350 South Bixel Street, Suite 290 Los Angeles, CA 90017 213−213−8000 Fax: 213−213−8001 Email: melinda.bird@disabilityrightsca.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael J Stortz Disability Rights California 1111 Sixth Avenue Suite 200 San Diego, CA 92101 619−239−7861 Fax: 619−239−7906 Email: michael.stortz@disabilityrightsca.org TERMINATED: 08/03/2015 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Patrick H Gardner Gardner Law, Adolescent Mental Health 115 Haight Street Menlo Park, CA 94025 650−933−9394 Email: pgardner@adolescentmentalhealth.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard A Rothschild

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 3 of 92
Western Center on Law and Poverty 3701 Wilshire Boulevard Suite 208 Los Angeles, CA 90010 213−487−7211 Fax: 213−487−0242 Email: rrothschild@wclp.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert D Newman , Jr Robert Newman Law Offices 3701 Wilshire Boulevard Suite 208 Los Angeles, CA 90010−2809 213−487−7211 Fax: 213−487−0242 Email: rnewman@wclp.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ronald C Peterson Heller Ehrman White & McAuliffe 601 S Figueroa St, 40th Fl Los Angeles, CA 90017−5758 213−689−0200 Fax: 213−614−1868 TERMINATED: 04/07/2009 LEAD ATTORNEY
Alice Bussiere Youth Law Center 200 Pine Street, Suite 300 San Francisco, CA 94104 415−543−3379 Email: abussiere@ylc.org TERMINATED: 04/08/2003
Alissa Beth Kolek Mayer Brown Rowe and Maw 350 South Grand, 25th Floor Los Angeles, CA 90071 213−229−9500 TERMINATED: 06/06/2007
Andrew Marc Mudryk Protection and Advocacy Inc 1111 Sixth Avenue Suite 200 San Diego, CA 92101 619−239−7861 Email: andrew.mudryk@disabilityrightsca.org TERMINATED: 10/11/2017
Antionette D Dozier Western Center on Law and Poverty 3701 Wilshire Boulevard Suite 208 Los Angeles, CA 90010 213−235−2629 Fax: 213−487−0242 Email: adozier@wclp.org ATTORNEY TO BE NOTICED
Benjamin E Wizner ACLU Foundation of Southern California 1616 Beverly Blvd P O Box 26907 Los Angeles, CA 90026−5752

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 4 of 92
213−977−9500 TERMINATED: 02/20/2007
Carlyle W Hall , III Heller Ehrman White & McAuliffe 601 S Figueroa St, 40th Fl Los Angeles, CA 90017−5758 213−689−0200 TERMINATED: 06/03/2004
Carole B Shauffer Youth Law Center 417 Montgomery St, Ste 900 San Francisco, CA 94104 415−543−3379 TERMINATED: 04/08/2003
Gina L Zaragoza−Cruz Gina L Zaragoza−Cruz Law Offices 22020 Clarendon Street Suite 108 Woodland Hills, CA 91367 818−884−0890 TERMINATED: 06/06/2006
Katina Ancar National Center For Youth Law 405 14th St, 15th Fl Oakland, CA 94612 510−835−8098 TERMINATED: 08/04/2004
Katrina McIntosh USDC − Judge King 255 East Temple Street, Suite 660 Los Angeles, CA 90012 213−894−0228 Email: katrinam@stanfordalumni.org TERMINATED: 06/06/2007
Laura N Diamond Knauf Associates 2001 Wilshire Boulevard Suite 305 Santa Monica, CA 90403 310−829−4250 Fax: 310−622−7263 Email: lauradiamondlaw@gmail.com TERMINATED: 06/06/2007
Lew Hollman Center for Law in the Public Interest 1055 Wilshire Boulevard, Suite 1660 Los Angeles, CA 90017−2499 310−314−1947 TERMINATED: 06/06/2007
Lin Min Kong Center for Law in the Public Interest 1055 Wilshire Blvd., Suite 1660 Los Angeles, CA 90017−2499 310−314−1947 TERMINATED: 11/01/2006
Robert Garcia Center for Law in the Public Interest 1055 Wilshire Boulevard, Suite 1660

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 5 of 92

Los Angeles, CA 90017 213−977−1035 TERMINATED: 06/06/2007

Plaintiff
Mary B by & thru her next friend Robert Jacobs

represented by Alison N Barkoff (See above for address) TERMINATED: 02/08/2011 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Fiza A. Quraishi (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ira Burnim (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

John F O'Toole (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kimberly Lewis (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kirk A Hornbeck , Jr (See above for address) LEAD ATTORNEY

Marilyn L Holle (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Mark D Rosenbaum (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Mary Giliberti (See above for address) TERMINATED: 05/14/2004 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Melinda Ruth Bird (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael J Stortz (See above for address) TERMINATED: 08/03/2015 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Patrick H Gardner (See above for address)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 6 of 92

LEAD ATTORNEY ATTORNEY TO BE NOTICED

Richard A Rothschild (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert D Newman , Jr (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ronald C Peterson (See above for address) TERMINATED: 04/07/2009 LEAD ATTORNEY

Alissa Beth Kolek (See above for address) TERMINATED: 06/06/2007

Andrew Marc Mudryk (See above for address) TERMINATED: 10/11/2017

Antionette D Dozier (See above for address) ATTORNEY TO BE NOTICED

Benjamin E Wizner (See above for address) TERMINATED: 02/20/2007

Carlyle W Hall , III (See above for address) TERMINATED: 06/03/2004

Katrina McIntosh (See above for address) TERMINATED: 06/06/2007

Laura N Diamond (See above for address) TERMINATED: 06/06/2007

Lew Hollman (See above for address) TERMINATED: 06/06/2007

Lin Min Kong (See above for address) TERMINATED: 11/01/2006

Robert Garcia (See above for address) TERMINATED: 06/06/2007

Plaintiff
Janet C by & thru her next friend Dolores Johnson

represented by Alison N Barkoff (See above for address) TERMINATED: 02/08/2011 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 7 of 92
Fiza A. Quraishi (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ira Burnim (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
John F O'Toole (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kimberly Lewis (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk A Hornbeck , Jr (See above for address) LEAD ATTORNEY
Marilyn L Holle (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark D Rosenbaum (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mary Giliberti (See above for address) TERMINATED: 05/14/2004 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Melinda Ruth Bird (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael J Stortz (See above for address) TERMINATED: 08/03/2015 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Patrick H Gardner (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard A Rothschild (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert D Newman , Jr (See above for address) LEAD ATTORNEY

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 8 of 92

ATTORNEY TO BE NOTICED

Ronald C Peterson (See above for address) TERMINATED: 04/07/2009 LEAD ATTORNEY

Alissa Beth Kolek (See above for address) TERMINATED: 06/06/2007

Andrew Marc Mudryk (See above for address) TERMINATED: 10/11/2017

Antionette D Dozier (See above for address) ATTORNEY TO BE NOTICED

Benjamin E Wizner (See above for address) TERMINATED: 02/20/2007

Carlyle W Hall , III (See above for address) TERMINATED: 06/03/2004

Katrina McIntosh (See above for address) TERMINATED: 06/06/2007

Laura N Diamond (See above for address) TERMINATED: 06/06/2007

Lew Hollman (See above for address) TERMINATED: 06/06/2007

Lin Min Kong (See above for address) TERMINATED: 11/01/2006

Robert Garcia (See above for address) TERMINATED: 06/06/2007

Plaintiff
Henry D by & thru his next friend Gillian Brown

represented by Alison N Barkoff (See above for address) TERMINATED: 02/08/2011 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ira Burnim (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

John F O'Toole (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 9 of 92
Kimberly Lewis (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk A Hornbeck , Jr (See above for address) LEAD ATTORNEY
Marilyn L Holle (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark D Rosenbaum (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mary Giliberti (See above for address) TERMINATED: 05/14/2004 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Melinda Ruth Bird (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael J Stortz (See above for address) TERMINATED: 08/03/2015 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Patrick H Gardner (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard A Rothschild (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert D Newman , Jr (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ronald C Peterson (See above for address) TERMINATED: 04/07/2009 LEAD ATTORNEY
Alissa Beth Kolek (See above for address) TERMINATED: 06/06/2007
Andrew Marc Mudryk (See above for address) TERMINATED: 10/11/2017
Antionette D Dozier

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 10 of 92

(See above for address) ATTORNEY TO BE NOTICED

Benjamin E Wizner (See above for address) TERMINATED: 02/20/2007

Carlyle W Hall , III (See above for address) TERMINATED: 06/03/2004

Katrina McIntosh (See above for address) TERMINATED: 06/06/2007

Laura N Diamond (See above for address) TERMINATED: 06/06/2007

Lew Hollman (See above for address) TERMINATED: 06/06/2007

Lin Min Kong (See above for address) TERMINATED: 11/01/2006

Robert Garcia (See above for address) TERMINATED: 06/06/2007

Plaintiff
Gary E by & thru his next friend Michael Ludin, individually & on behalf of others similarly situated

represented by Alison N Barkoff (See above for address) TERMINATED: 02/08/2011 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ira Burnim (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

John F O'Toole (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kimberly Lewis (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kirk A Hornbeck , Jr (See above for address) LEAD ATTORNEY

Marilyn L Holle (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Mark D Rosenbaum (See above for address)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 11 of 92
LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mary Giliberti (See above for address) TERMINATED: 05/14/2004 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Melinda Ruth Bird (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael J Stortz (See above for address) TERMINATED: 08/03/2015 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Patrick H Gardner (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard A Rothschild (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert D Newman , Jr (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ronald C Peterson (See above for address) TERMINATED: 04/07/2009 LEAD ATTORNEY
Alissa Beth Kolek (See above for address) TERMINATED: 06/06/2007
Andrew Marc Mudryk (See above for address) TERMINATED: 10/11/2017
Antionette D Dozier (See above for address) ATTORNEY TO BE NOTICED
Carlyle W Hall , III (See above for address) TERMINATED: 06/03/2004
Katrina McIntosh (See above for address) TERMINATED: 06/06/2007
Laura N Diamond (See above for address) TERMINATED: 06/06/2007
Lew Hollman

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 12 of 92
(See above for address) TERMINATED: 06/06/2007
Lin Min Kong (See above for address) TERMINATED: 11/01/2006
Robert Garcia (See above for address) TERMINATED: 06/06/2007

V. Movant United States

represented by Kathleen R Wolfe US Department of Justice 950 Pennsylvania Avenue N W NYA Washington, DC 20530 202−307−0663 Fax: 202−307−1197 ATTORNEY TO BE NOTICED
Leon W Weidman AUSA − Office of US Attorney Major Frauds Section 312 North Spring Street Suite 1100 Los Angeles, CA 90012 213−894−6530 Fax: 213−894−6269 Email: USACAC.Criminal@usdoj.gov ATTORNEY TO BE NOTICED
Renee M Wohlenhaus US Department of Justice Civil Rights Division 1425 New York Ave NW P O Box 66738 Washington, DC 20035−6738 202−307−2229 Fax: 202−307−1197 TERMINATED: 09/24/2012
Robyn−Marie L Monteleone AUSA − Office of US Attorney Civil Division 300 North Los Angeles Street Suite 7516 Los Angeles, CA 90012 213−894−2458 Fax: 213−894−7819 Email: USACAC.Civil@usdoj.gov ATTORNEY TO BE NOTICED
Travis W England US Department of Justice 950 Pennsylvania Avenue NW NYA Washington, DC 20530 202−307−2042 Fax: 202−307−1197 Email: travis.england@usdoj.gov ATTORNEY TO BE NOTICED

V.

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 13 of 92

Defendant
Diana Bonta Director of CA Dept of Health Services

represented by Catherine J Pratt Children Services Division 201 Centre Plaza Dr, Ste 1 Monterey Plaza, CA 91754−2143 323−526−6100 TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Gerald M Custis Montery County Counsel Children's Services Div 201 Centre Plz Dr Suite 1 Monterey Park, CA 91754−2143 323−526−6257 TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ira P Lustbader Children's Rights 404 Park Avenue South 11th Fl New York, NY 10016 212−683−2210 Email: ilustbader@childrensrights.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Karen Ackerson−Brazille CAAG − Office of Attorney General of California 300 South Spring St. Suite 1700 Los Angeles, CA 90013−1230 213−897−2448 Email: docketinglaawt@doj.ca.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katherine M Bowser County of Los Angeles Office of County Counsel 648 Kenneth Hahn Hall of Administration 500 West Temple Street Suite 602 Los Angeles, CA 90012−2713 213−974−1949 Fax: 213−667−4745 Email: kbowser@counsel.lacounty.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Lionel Zevi Glancy Glancy Prongay & Murray LLP 1925 Century Park East Suite 2100 Los Angeles, CA 90067 310−201−9150 Fax: 310−201−9160 Email: lglancy@glancylaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Brandon T Nichols Los Angeles County Counsel

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 14 of 92
648 Kenneth Hahn Hall of Administration 500 West Temple Street Los Angeles, CA 90012 213−974−1938 Fax: 213−626−7446 Email: bnichols@counsel.lacounty.gov TERMINATED: 05/24/2012 ATTORNEY TO BE NOTICED
Carmen Denise Snuggs CAAG − Office of Attorney General of California 300 South Spring Street Suite 1702 Los Angeles, CA 90013 213−897−2450 Fax: 213−897−2450 Email: carmen.snuggs@doj.ca.gov ATTORNEY TO BE NOTICED
Cristina Felix CAAG − Office of the Attorney General of California 300 S Spring St, Ste 1702 Los Angeles, CA 90013 213−897−2455 Fax: 213−897−2805 Email: cristina.felix@doj.ca.gov TERMINATED: 05/30/2003
Erik S Pitchal Children's Rights 404 Park Avenue South 11th Fl New York, NY 10016 212−683−2210 TERMINATED: 06/04/2007
Ernest Martinez CAAG − Office of Attorney General of California 300 South Spring Street Suite 5000 Los Angeles, CA 90013−1230 213−897−2000 Fax: 213−897−2805 Email: ernest.martinez@doj.ca.gov ATTORNEY TO BE NOTICED
Jennifer M Kim CAAG − Office of CA Attorney General California Department of Justice 300 South Spring Street Suite 1702 Los Angeles, CA 90012 213−897−2443 Fax: 213−897−2805 Email: jennifer.kim@doj.ca.gov ATTORNEY TO BE NOTICED
Marcia Robinson Lowry Children's Rights 404 Park Avenue South 11th Fl New York, NY 10016 212−683−2210 TERMINATED: 06/04/2007
Sandra L Goldsmith CAAG − Office of the Attorney General of

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 15 of 92

California 300 S Spring St, Ste 1702 Los Angeles, CA 90013 213−897−2000 Fax: 213−897−2805 Email: sandra.goldsmith@doj.ca.gov TERMINATED: 06/05/2008

Sara Ugaz Los Angeles City Attorney's Office Business and Complex Litigation 200 North Main Street City Hall East, 6th Floor Los Angeles, CA 90012 213−978−7564 Fax: 213−978−7011 Email: sara.ugaz@lacity.org TERMINATED: 07/23/2012 ATTORNEY TO BE NOTICED

Defendant
Los Angeles County TERMINATED: 12/05/2011

represented by Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katherine M Bowser (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Brandon T Nichols (See above for address) TERMINATED: 05/24/2012

Carmen Denise Snuggs (See above for address) ATTORNEY TO BE NOTICED

Catherine J Pratt (See above for address) TERMINATED: 05/24/2012

Gerald M Custis (See above for address) TERMINATED: 05/24/2012

Jennifer M Kim (See above for address) ATTORNEY TO BE NOTICED

Laura Elizabeth Hinoj Quinonez Office of the County Counsel Los Angeles County 648 Kenneth Hahn Hall of Administration 500 West Temple Street Los Angeles, CA 90012 213−974−1938 Fax: 213−687−4745 Email: lquinonez@counsel.lacounty.gov ATTORNEY TO BE NOTICED

Sara Ugaz (See above for address)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 16 of 92

TERMINATED: 07/23/2012

Defendant
Los Angeles County Department of Children and Family Services TERMINATED: 12/05/2011

represented by Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katherine M Bowser (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Brandon T Nichols (See above for address) TERMINATED: 05/24/2012

Brian Procel Miller Barondess LLP 1999 Avenue of the Stars Suite 1000 Los Angeles, CA 90067 310−552−4400 Fax: 310−552−8400 Email: bprocel@millerbarondess.com ATTORNEY TO BE NOTICED

Carmen Denise Snuggs (See above for address) ATTORNEY TO BE NOTICED

Catherine J Pratt (See above for address) TERMINATED: 05/24/2012

David W Schecter Miller Barondess LLP 1999 Avenue of the Stars Suite 1000 Los Angeles, CA 90067 310−552−4400 Fax: 310−552−8400 Email: dschecter@millerbarondess.com ATTORNEY TO BE NOTICED

Gerald M Custis (See above for address) TERMINATED: 05/24/2012

Jennifer M Kim (See above for address) ATTORNEY TO BE NOTICED

Laura Elizabeth Hinoj Quinonez (See above for address) ATTORNEY TO BE NOTICED

Louis R Miller Miller Barondess LLP 1999 Avenue of the Stars Suite 1000 Los Angeles, CA 90067 310−552−4400 Fax: 310−552−8400 Email: smiller@millerbarondess.com ATTORNEY TO BE NOTICED

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 17 of 92

Mary Conway Wickham Los Angeles County Counsels Office 648 Kenneth Hahn Hall of Administration 500 West Temple Street Los Angeles, CA 90012 213−974−1811 Fax: 213−662−7446 ATTORNEY TO BE NOTICED

Sara Ugaz (See above for address) TERMINATED: 07/23/2012

Vicki Kozikoujekian Los Angeles County Counsels Office 648 Kenneth Hahn Hall of Administration 500 West Temple Stree Los Angeles, CA 90012 213−974−1811 Fax: 213−626−7446 Email: vkozikoujekian@counsel.lacounty.gov ATTORNEY TO BE NOTICED

Defendant
Anita Bock Direcotr of the LA Cty Dept of Children & Family Services TERMINATED: 12/20/2002

represented by Brandon T Nichols (See above for address) TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Catherine J Pratt (See above for address) TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Gerald M Custis (See above for address) TERMINATED: 12/20/2002 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Rita Saenz Director of CA Dept of Social Services

represented by Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katherine M Bowser (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Carmen Denise Snuggs (See above for address) ATTORNEY TO BE NOTICED

Cristina Felix (See above for address)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 18 of 92

TERMINATED: 05/30/2003

Ernest Martinez (See above for address) ATTORNEY TO BE NOTICED

Jennifer M Kim (See above for address) ATTORNEY TO BE NOTICED

Sandra L Goldsmith (See above for address) TERMINATED: 06/05/2008

Sara Ugaz (See above for address) TERMINATED: 07/23/2012 ATTORNEY TO BE NOTICED

Defendant
Does 1 thru 100 inclusive TERMINATED: 06/18/2003

Defendant Los Angeles County

represented by Brandon T Nichols (See above for address) ATTORNEY TO BE NOTICED

Brian Procel (See above for address) ATTORNEY TO BE NOTICED

David W Schecter (See above for address) ATTORNEY TO BE NOTICED

Laura Elizabeth Hinoj Quinonez (See above for address) ATTORNEY TO BE NOTICED

Louis R Miller (See above for address) ATTORNEY TO BE NOTICED

Mary Conway Wickham (See above for address) ATTORNEY TO BE NOTICED

Vicki Kozikoujekian (See above for address) ATTORNEY TO BE NOTICED

Special Master Richard Saletta

represented by Richard Saletta 7950 Ridge Road Newcastle, CA 95658 Email: rsalpham@sbcglobal.net PRO SE

Defendant

represented by

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Marjorie Kelly Acting Director of the Los Angeles County Department of Children & Family Services TERMINATED: 05/21/2003

Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant David − Sanders

represented by Brandon T Nichols (See above for address) TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Catherine J Pratt (See above for address) TERMINATED: 05/24/2012 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Karen Ackerson−Brazille (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Brian Procel (See above for address) ATTORNEY TO BE NOTICED

Carmen Denise Snuggs (See above for address) ATTORNEY TO BE NOTICED

David W Schecter (See above for address) ATTORNEY TO BE NOTICED

Jennifer M Kim (See above for address) ATTORNEY TO BE NOTICED

Laura Elizabeth Hinoj Quinonez (See above for address) ATTORNEY TO BE NOTICED

Lauren M Black Los Angeles County Counsel Office 500 W Temple Street 6th Floor Los Angeles, CA 90012−2713 213−974−1943 Email: lblack@counsel.lacounty.gov ATTORNEY TO BE NOTICED

Louis R Miller (See above for address) ATTORNEY TO BE NOTICED

Mary Conway Wickham (See above for address) ATTORNEY TO BE NOTICED

Sara Ugaz (See above for address) TERMINATED: 07/23/2012 ATTORNEY TO BE NOTICED

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 20 of 92

Objector Children's Rights Inc

represented by Ira P Lustbader (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Lionel Zevi Glancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Erik S Pitchal (See above for address) TERMINATED: 06/04/2007
Marcia Robinson Lowry (See above for address) TERMINATED: 06/04/2007

Date Filed 07/18/2002 07/18/2002 07/18/2002 07/22/2002 07/25/2002 08/01/2002 08/02/2002
08/06/2002 08/07/2002
08/07/2002 08/07/2002 08/07/2002 08/07/2002

# Docket Text
1 COMPLAINT filed Summons(es) issued referred to Discovery Stephen J. Hillman (jp) (Entered: 07/22/2002)
2 NOTICE OF INTERESTED PARTIES filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (jp) (Entered: 07/22/2002)
3 NOTICE by plaintiff of related case(s) CV 98−4181 AHM (rn) (Entered: 07/24/2002)
NOTICE OF FILING FEE DUE On Pro Hac Vice Application mailed to attorneys Ira Burnim, Mary Gilberti for plaintiffs (jp) (Entered: 07/22/2002)
4 OBJECTIONS filed by defendant Los Angeles County to related case notice [3−1] (lc) (Entered: 07/26/2002)
6 STIPULATION filed to extend time to answer complaint [1−1] to 9/7/02 as to Diana Bonta, Los Angeles County, LA Cty Children, Anita Bock (lc) (Entered: 08/02/2002)
5 ORDER RE TRANSFER PURSUANT TO GENERAL ORDER 224 (Related Case) filed. [ Related Case no.: CV 98−4181 AHM (AIJx)] Case transferred from Judge Ronald Lew to Judge A. H. Matz for all further proceedings. The case number will now reflect the initials of the transferee Judge [ CV 02−5662 AHM (SHx)] (cc: all counsel) (rn) (Entered: 08/02/2002)
7 INITIAL ORDER following filing of cmp (See doc for fur details) by Judge A. H. Matz (ir) (Entered: 08/07/2002)
8 PROOF OF SERVICE executed upon defendant Rita Saenz Director of Calif Dept of Social Services; Service by FRCP on 7/22/02 via personal svc by serving S/C to Larry Bolton, Chief Counsel, authorized to receive svc of process (twdb) (Entered: 08/08/2002)
9 PROOF OF SERVICE executed upon defendant Diana Bonta, Director of Calif Dept of Health Svcs; Service by FRCP on 7/22/02 via personal svc by serving S/C to John P. Krause, staff atty authorized to receive svc of process (twdb) (Entered: 08/08/2002)
10 PROOF OF SERVICE executed upon defendant LA Cty Dept Children & Family Svcs; Service by FRCP on 7/19/02 via personal by serving S/C to Anita Bock, Director, authorized to receive svc of process. (twdb) (Entered: 08/08/2002)
11 PROOF OF SERVICE executed upon defendant Anita Bock Director of the Los Angeles Cnty Dept of Children; Service by FRCP on 7/19/02 via personal svc by serving S/C to Anita Bock (twdb) (Entered: 08/08/2002)
12 PROOF OF SERVICE executed upon defendant Los Angeles County; Service by FRCP on 7/19/02 via personal svc by serving S/C to Roy Sinclair, Deputy City Clerk

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 21 of 92

08/07/2002 08/12/2002 08/13/2002 08/13/2002
08/13/2002 08/14/2002
08/14/2002
08/14/2002 08/20/2002 08/27/2002 09/06/2002
10/04/2002
10/04/2002 10/04/2002 10/10/2002

authorized to receive svc. (twdb) (Entered: 08/08/2002)
SUMMONS issued as to defendant Diana Bonta, defendant Los Angeles County, defendant LA Cty Dept Children, defendant Anita Bock, defendant Rita Saenz (twdb) (Entered: 08/08/2002)
13 COUNTER−STATEMENT by defendants Diana Bonta, Rita Saenz in opp plfs ntc of related casese [4−1] (rrey) (Entered: 08/13/2002)
14 STIPULATION and ORDER by Judge A. H. Matz extending time to answer complaint [1−1] through & incl 9/11/02 as to defendants Diana Bonta, & Rita Saenz (ir) (Entered: 08/14/2002)
15 CORRECTED STIPULATION filed to extend time to answer complaint [1−1] through & incl 9/11/02 as to defendants Diana Bonta, Director of the CA Dept of Health Services & Rita Saenz, Director of the CA Dept of Social Services (ir) (Entered: 08/14/2002)
18 NOTICE of initial order entered following filing of complaint assigned to Judge Matz by plaintiff Katie A, plaintiff Mary B, plaintiff Janet C, plaintiff Henry D, plaintiff Gary E (ca) (Entered: 08/15/2002)
16 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case filed for plaintiffs by Mary Giliberti of Bazelon Center for Mental Health Law. Designating Mark Rosenbaum of American Civil Liberties Union of Southern California as local counsel. Approved by Judge A. H. Matz. (Fee pd) (ir) (Entered: 08/15/2002)
17 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case filed for plaintiffs by Ira A Burnim of Bazelon Center for Mental Health Law. Designating Mark Rosenbaum of American Civil Liberties Union of Southern California as local counsel. Approved by Judge A. H. Matz. (Fee pd) (ir) (Entered: 08/15/2002)
RESPONSE by Pro Hac Vice Attorneys Ira Burnim Gary E, Mary Giliberti for plaintiff Gary E re pro hac vice application [17−1] [16−1]; PHV fee: paid (nhac) (Entered: 08/23/2002)
19 NOTICE OF CHANGE Of Address filed by atty Alice Bussiere for plaintiff Katie A, Carol Shauffer for plaintiff Katie A. 3250 Ocean Park Blvd, Ste 300, Santa Monica, CA (twdb) (Entered: 08/22/2002)
20 CORRECTED PROOF OF SERVICE by plaintiff on 8/13/02 of ntc of intial ord entered following filing of cmp assigned to Judge Matz (rrey) (Entered: 08/30/2002)
21 STIPULATION and ORDER by Judge A. H. Matz extending time to answer complaint [1−1] up to & incl 10/11/02 as to State Dfts & Cnty Dfts to file & serve their Ans or other responsive pldg to Plfs' cmp ; Plfs shall have up to & incl 11/18/02 to file & serve their mot for Class certification (ir) (Entered: 09/09/2002)
22 NOTICE OF DISCREPANCY AND ORDER by Judge A. H. Matz ordering Ptys' Joint Req for Status Conf submitted by plaintiffs received on 10/2/02 to be fld and processed; fld date to be the date the doc was stamped "received but not fld" w/the Clerk (ir) (Entered: 10/07/2002)
23 PARTIES JOINT REQUEST filed for Status Conf (ir) (Entered: 10/07/2002)
24 MINUTES: (IN CHAMBERS) Purs to ptys' req [23−1]; Crt hereby sets a Status conf for 11:00 10/10/02 by Judge A. H. Matz CR: Not Reported (ir) (Entered: 10/07/2002)
25 MINUTES: Status conference held ; Cnsl updates Crt as to the status of sttlmnt negotiations & status of the action; Dfts req that the time to respond to cmp be ext for an addt 30 days from 10/11/02; Crt ord ptys to submit a stip & ord ext the response date to 12/9/02; Crt sets another status conf for 3:00 11/26/02 & ord ptys to file a joint status rpt NLT 11/21/02 w/a conformed courtesy copy delivered to chambers via Crt's courtesy box NLT noon by Judge A. H. Matz CR: Lynne Smith (ir) (Entered: 10/11/2002)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 22 of 92

10/21/2002
11/21/2002 12/04/2002 12/05/2002
12/10/2002
12/10/2002
12/13/2002 12/13/2002 12/20/2002 12/20/2002 01/09/2003
01/27/2003 01/27/2003 02/18/2003 02/18/2003 02/19/2003

26 STIPULATION and ORDER by Judge A. H. Matz extending time to answer complaint [1−1] up to & incl 12/9/02 as to defendants Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock, Diana Bonta, Rita Saenz IT IS FUR ORD that Plfs shall have up to & incl 1/20/03 to file & serve their mot for class certification (ir) (Entered: 10/22/2002)
27 JOINT STATUS CONFERENCE STATEMENT by plaintiffs (ir) (Entered: 11/22/2002)
28 STIPULATION filed re available dats for Status Conference (ir) (Entered: 12/05/2002)
29 STIPULATION and ORDER by Judge A. H. Matz extending time to answer complaint [1−1] up to & including 12/31/02 as to defendants Diana Bonta, Director of California Department of Health Services & Rita Saenz, Director of the California Department of Social Services ; Court reschedules the 11/26/02 Status Conference for 3:00 12/10/02 (ir) (Entered: 12/05/2002)
30 MINUTES: Status conference held ; Counsel updates Court as to the status of the action; Court questions counsel regarding the creation of an advisory panel & whether or not a special master would also be appropriate to manage this action; Counsel for Plf informs the Court that it plans to file a 1st Amended Complaint by 12/25/02; Court orders that the state Dfts will have 60 days & the county Dfts 90 days to respond to the 1st Amended Complaint; Court grants Plfs 120 days from the date they file their 1st Amended complaint to file their motion for class certification; Court sets another status conference for 3:00 3/20/03 & orders parties to file a joint status report no later than 3/10/03 by Judge A. H. Matz CR: Lynne Smith (ir) (Entered: 12/11/2002)
31 STIPULATION and ORDER by Judge A. H. Matz extending time to answer complaint [1−1] up to & including 12/31/02 as to defendants Los Angeles County, Los Angeles County Department of Children & Family Services & Marjorie Kelly, Interim Director of the Los Angeles County Department of Children & Family Services & successor−in−interest to Anita Block (ir) (Entered: 12/11/2002)
32 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 10/10/02 (Re: ) CR: Lynne Smith (weap) (Entered: 12/16/2002)
TRANSCRIPT filed for proceedings held on 10/10/02 (weap) (Entered: 12/16/2002)
33 FIRST AMENDED COMPLAINT [1−1] by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E; terminating defendant Anita Bock; adding Marjorie Kelly. Summons not issued (ir) (Entered: 12/23/2002)
SUMMONS issued on first amended complaint (lc) (Entered: 12/23/2002)
34 RETURN OF ORIGINAL SUMMONS AND PROOF OF SERVICE executed upon defendant Los Angeles County Department of Children & Family Services; Service by Federal Statute on 12/23/02 via personal service by serving Summons on 1st Amended complaint & 1st Amended Complaint to Michelle R Victor, MA, LMFT, authorized to receive service of process (ir) (Entered: 01/10/2003)
35 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 12/10/02 (Re:) CR: Lynne Smith (weap) (Entered: 01/28/2003)
TRANSCRIPT filed for proceedings held on 12/10/02 (weap) (Entered: 01/28/2003)
37 ANSWER filed by defendants Diana Bonta, Director of California Department of Health Services, Rita Saenz, Director of the California Department of Social Services to 1st amended complaint [33−1] (ir) (Entered: 02/20/2003)
38 NOTICE OF INTERESTED PARTIES filed by defendants Diana Bonta, Director of California Department of Health Services & Rita Saenz, Director of the California Department of Social Services (ir) (Entered: 02/20/2003)
36 ORDER setting Rule 26(f) Scheduling Conference by Judge A. H. Matz Scheduling conf set for 1:30 4/14/03 ; Parties are reminded of their obligations to disclose information to confer on a discovery plan not later than 21 days prior to the scheduling conference & to file a report with the Court entitled "Joint Rule 26(f) Report" not later than 14 days after they confer; Failure to comply with the following requirements or to

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 23 of 92

03/10/2003 03/13/2003 03/20/2003
04/07/2003 04/07/2003 04/07/2003 04/08/2003 04/18/2003
04/18/2003 04/25/2003 04/25/2003 04/28/2003 04/28/2003 04/28/2003 04/28/2003 04/28/2003 04/28/2003

cooperate in the preparation of the Joint Rule 26(f) Report may lead to the imposition of sanctions (See document for further details) (ir) (Entered: 02/20/2003)
39 JOINT STATUS CONFERENCE STATEMENT (jp) (Entered: 03/11/2003)
40 JOINT STATEMENT of Plfs' counsel & County Dfts on progress of Named Plfs by defendant Los Angeles County (ir) (Entered: 03/14/2003)
41 MINUTES: Status conference held; Court & counsel confer regarding the status of the proposed settlement; Counsel advises the Court that the settlement will be finalized within a week; An unsigned copy of the proposed settlement agreement is lodged with the Court; Counsel also advises the Court of a vacancy on the 6−memeber advisory panel; Court orders Ms Goldsmith to set forth her clients' views concerning the proposed settlement & provide them to the parties no later than 3/31/03; Plfs shall file their class certification motion no later than 4/28/03 to be heard six weeks after the motion is filed; The State shall have two weeks after service of the motion to oppose; Plfs' reply must be submitted not later than four weeks after service of the class certification motion; Court vacates the 4/14/03 scheduling conference & provisionally set a new scheduling conference for 1:30 5/12/03 ; Court also grants the County Dfts a 60−day extension to respond to the 1st Amended complaint; Court reporter shall provide the Court with a copy of the transcript of this hearing by Judge A. H. Matz CR: Hope Goldsmith (ir) (Entered: 03/25/2003)
42 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 3/20/03 (Re: ) CR: Sheri S. Ogata (pjap) (Entered: 04/08/2003)
TRANSCRIPT filed for proceedings held on 3/20/03 (pjap) (Entered: 04/08/2003)
43 APPLICATION filed of Youth Law Center to w/draw as counsel ; Declaration in support of application; Lodged Order (ir) (Entered: 04/09/2003)
44 ORDER by Judge A. H. Matz granting application to w/draw as counsel [43−1] withdrawing attorneys Alice Bussiere & Carol Shauffer for Katie A (ir) (Entered: 04/09/2003)
45 MINUTES (IN CHAMBERS): The parties are Ordered to discuss in the next status conference, what, (if any) implications the report published by the US Department of Justice concerning juvenile halls maintained in Los Angeles County may have in this case; Articles about that report appear in the Los Angeles Daily Journal on 4/17/03 and 4/18/03 by Judge A. H. Matz; CR: Not reported (nhac) (Entered: 04/21/2003)
46 NOTICE LODGING FULLY EXECUTED Settlement Between Plaintiffs and County Defendants filed by defendant Los Angeles County (nhac) (Entered: 04/21/2003)
48 MEMORANDUM IN SUPPORT of appicatioin to file documents under seal; declaration of Katrina McIntosh by plaintiffs (lc) (Entered: 04/28/2003)
49 ORDER by Judge A. H. Matz upon plaintiff's application: that for each of the five named plaintiffs the documetns listed in the application be filed under seal (lc) (Entered: 04/28/2003)
50 NOTICE OF MOTION AND MOTION by plaintiffs for class certification ; motion hearing set for 10:00 6/9/03 (nhac) (Entered: 04/30/2003)
51 MEMORANDUM POINTS OF Authorities by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)
52 DECLARATION of Ronald C Peterson by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)
53 DECLARATION of Mark D Rosenbaum by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)
54 DECLARATION of Robert D Newman by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)
57 DECLARATION of Ira A Birnum by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 24 of 92

04/28/2003 04/28/2003 05/01/2003 05/01/2003 05/02/2003
05/05/2003 05/08/2003 05/09/2003 05/09/2003 05/12/2003 05/12/2003 05/12/2003
05/12/2003 05/14/2003 05/16/2003 05/20/2003

62 DECLARATION of Laura Diamond by plaintiffs in support of motion for class certification [50−1] (nhac) (Entered: 04/30/2003)
63 STIPULATION and ORDER by Magistrate Judge Stephen J. Hillman re protective order to seal records and protect the confidentiality of information relating to plaintiffs and putative class members (see documents for further details) (nhac) (Entered: 04/30/2003)
64 APPLICATION filed by plaintiffs to seal documents and for a protective order to seal records ; Lodged Proposed Order (filed under seal) (mch) (Entered: 05/02/2003)
65 MEMORANDUM OF POINTS AND AUTHORITIES by plaintiffs in support of application to seal documents and for a protective order to seal records [64−1] (mch) (Entered: 05/02/2003)
66 ORDER TO SEAL CERTAIN RECORDS by Judge A. H. Matz granting application to seal documents and for a protective order to seal records [64−1]. It is hereby ordered that certain declarations filed in support of plaintiffs' motion for class certification which are listed as items 1 through 6 in Application to Seal Documnets and for a Protective Order to Seal Records be filed under seal (see document for further details). (mch) (Entered: 05/02/2003)
72 JOINT RULE 26(f) REPORT filed; est length of trial 20−70 days (ir) (Entered: 05/06/2003)
73 NOTICE OF ERRATA by defendants Diana Bonta, Rita Saenz in State Dfts' portion of Joint Rule 26(f) Report [72−1] (ir) (Entered: 05/09/2003)
74 JOINT APPLICATION filed by plaintiffs for preliminary approval of Class Settlement, provisional certification of settlement class, approval of form and manner of notice to class and scheduling of fairness hearing ; Lodged 2 Proposed Orders (ir) (Entered: 05/12/2003)
75 JOINT MEMORANDUM of Points and Authorities by plaintiffs in support of application for preliminary approval of Class Settlement, provisional certification of settlement class, approval of form and manner of notice to class and scheduling of fairness [74−1] (ir) (Entered: 05/12/2003)
76 OPPOSITION by State defendants to motion for class certification [50−1] (ir) (Entered: 05/13/2003)
77 DECLARATION of Sandra L Goldsmith by defendants Diana Bonta, Rita Saenz in support of opposition to motion for class certification [50−1] (ir) (Entered: 05/13/2003)
78 MINUTES: mandatory status/scheduling conference held ; State defendant informs court it may seek to add other California counties if court grants plaintiff's upcoming motion for class certification; court orders dates as indicated on scheduling/case management order filed this date and orders counsel to discuss settlement selction; further scheduling conference will be set at a later date; discussion of proposed fairness hearing and class certification hearing held; after review of revised proposed notice, Court will set a date for fairness hearing; Court rules notice to be mailed shall be in both Spanish and English; plaintiffs shall establish a mechanism for creating a record of comments received via the 1−800 number by Judge A. H. Matz CR: Hope Goldsmith (lc) Modified on 05/14/2003 (Entered: 05/14/2003)
79 SCHEDULING AND CASE MANAGMENT ORDER by Judge A. H. Matz non expert discovery ddl set on 5/31/04 (lc) (Entered: 05/14/2003)
80 SELECTED AUTHORITIES by State defendants in support of their opposition to Plfs' motion for class certification [50−1] (ir) (Entered: 05/15/2003)
81 NOTICE of lodging of (1) Revised Notice of Proposed Settlement Agreement and (2) Toll−Free Phone Line Text by defendant Los Angeles County (ir) (Entered: 05/19/2003)
82 ORDER by Judge A. H. Matz: Granting application for preliminary approval of Class Settlement, provisional certification of settlement class, approval of form and manner of notice to class and scheduling of fairness hearing [74−1]. The Court gives its

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 25 of 92

05/21/2003
05/21/2003 05/27/2003 05/27/2003 05/27/2003 05/30/2003 06/09/2003
06/12/2003 06/12/2003 06/13/2003 06/18/2003

preliminary approval to the proposed settlement of this lawsuit between plaintiffs & County defendants and the related stipulated order. A Fairness Hearing shall be held on 7/16/03 at 3:00 to hear objections of class members, if any are made, to the approval of the settlement & entry of the stipulated order. (See document for further details). As to the "Revised Notice of Proposed Settlement Agreement & Settlment Hearing," which was filed on 5/16/03, the Court Orders that in the paragraph captioned "Description of the Class" the word "provisionally" be substituted for "preliminary" on the first line and the words "after the Fairness Hearing" be added after "If the Settlement is approved" on the third line. In addition, for option #3 on Exhibit Two, concerning the Toll−Free Phone Line, the recorded message should specify the address of the courthouse referred to on page four. (mg) (Entered: 05/21/2003)
83 SUBSTITUTION OF PARTIES and Order by Judge A. H. Matz; County defendants, through their respective attorneys of record, inform the Court as follows: 1)Marjorie Kelly is no longer the Interim Director of the Los County Department of Children and Family Services ; 2)David Sanders is the current Director of the Los Angeles County Department of Children and Family Services and is therefor substituted as a party to this action in place of Marjorie Kelly; 3)David Sanders has actual notice of the suit and submits to the jurisdiction of this Court. (nhac) (Entered: 05/22/2003)
84 STIPULATION and ORDER by Judge A. H. Matz that the County Defendants shall have up to and including 7/25/03, to file and serve their answer or other responsive pleading to plaintiffs' complaint [1−1] for declaratory and injunctive relief (nhac) (Entered: 05/22/2003)
85 Supplemental declaration by plaintiff Katie A, plaintiff Mary B, plaintiff Janet C, plaintiff Henry D, plaintiff Gary E of Robert D Newman in support of plaintiffs' motion for class certification [50−1] (yc) (Entered: 05/29/2003)
86 REPLY by plaintiff Katie A, plaintiff Mary B, plaintiff Janet C, plaintiff Henry D, plaintiff Gary E in support of of motion for class certification [50−1] (yc) (Entered: 05/29/2003)
87 Supplemental declaration by plaintiff Katie A, plaintiff Mary B, plaintiff Janet C, plaintiff Henry D, plaintiff Gary E of Robert D Newman in support of motion for class certification [50−1] (yc) (Entered: 05/29/2003)
88 NOTICE OF CHANGE OF ATTORNEY INFORMATION: terminating attorneys Richard Waldow and Cristina Felix−Carrasco for Rita Saenz, Diana Bonta by defendants Diana Bonta, Rita Saenz and substituting attorney Sandra L Goldsmith (ir) (Entered: 06/02/2003)
89 MINUTES: Plaintiff's motion for class certification [50−1] (Filed 4/28/03); Cause called; appearances made; Court advises counsel that it requires additional time to consider the above motion and continues the hearing until 4:00 pm this afternoon; In preparation for this afternoon's hearing, Court informs counsel that it is inclines to grant the above motion but with modifications to the class definition; Counsel return to Court for further hearing; Court issues its oral tentative ruling granting the above motion and hears oral argument; Court GRANTS the above motion with slight modifications; Order to issue by Judge A. H. Matz CR: Hope Goldsmith (ir) (Entered: 06/10/2003)
90 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 5/12/03 (Re: ) CR: Hope Goldsmith (pjap) (Entered: 06/13/2003)
TRANSCRIPT filed for proceedings held on 5/12/03 (pjap) (Entered: 06/13/2003)
91 STATE Defendants' Authorities regarding Class Definition (ir) (Entered: 06/16/2003)
92 ORDER by Judge A. H. Matz Plaintiffs' motion for class certification [50−1] is GRANTED; The following class is certified: "Children in California who (a) are in foster care or are at imminent risk of foster care placement and (b) have a mental illness or condition that has been documented or had an assessment already been conducted, would have been documented and (c) who need individualized mental health services, including but not limited to professionally acceptable assessments, behavioral support and case management services, family support, crisis support, therapeutic foster car and other necessary services in the home or in a home−like

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 26 of 92

07/01/2003 07/02/2003 07/02/2003
07/03/2003 07/08/2003 07/09/2003 07/09/2003 07/09/2003 07/09/2003 07/09/2003 07/09/2003 07/09/2003 07/09/2003 07/11/2003 07/11/2003
07/11/2003

setting to treat or ameliorate their illness or condition; For the purpose of this case, 'imminent risk of foster care placement' means that within the last 180 days a child has been participating in voluntary family maintenance services or voluntary family reunification placements and/or has been the subject of either a telephone call to the Child Protective Services hotline or some other documented communication made to a local Child Protective Services agency regarding suspicions of abuse, neglect or abandonment; However Plaintiff Gary E may not serve as a class representative because his recent relocation to Idaho prevents him from satisfying the Rule 23(a)(3) typicality requirement (ir) (Entered: 06/19/2003)
93 NOTICE of Unavailability of State Defendants' counsel by defendants Diana Bonta, Rita Saenz (ir) (Entered: 07/02/2003)
94 OPPOSITION by defendants Diana Bonta, Rita Saenz to Plaintiffs' motion for approval of the Settlement agreement between Plaintiffs and Los Angeles County Defendants [74−1] (ir) (Entered: 07/03/2003)
95 DECLARATION of Lois Van Beers by defendants Diana Bonta, Rita Saenz in support of State Defendants' opposition to Plaintiffs' mtion for approval of the settlement agreement between Plaintiffs and Los Angeles County Defendants [74−1] (ir) (Entered: 07/03/2003)
96 MOTION by defendants Diana Bonta, Rita Saenz for reconsideration of Court's Order regarding Class Certification ; motion hearing set for 10:00 7/28/03; memorandum of Points and Authorities (ir) (Entered: 07/07/2003)
97 NOTICE OF ERRATA by defendants Diana Bonta, Rita Saenz correcting their opposition to Plaintiffs' motion for approval of the Settlement Agreement between Plaintiffs and Los Angeles County Defendants [94−1] (ir) (Entered: 07/09/2003)
98 BRIEF by defendant County of Los Angeles in support of Joint application for approval of Class Settlement [74−1]; Declarations in support thereof; Lodged Order (ir) (Entered: 07/10/2003)
99 OBJECTION filed by objector Children's Rights Inc to Proposed Class Action Settlement Agreement [74−1] and memorandum of Points and Authorities in support thereof (ir) (Entered: 07/10/2003)
100 DECLARATION of Marcia Robinson Lowry, Esq by objector Children's Rights in support of objection to Proposed Settlement Agreement [74−1] (ir) (Entered: 07/10/2003)
101 DECLARATION of Lionel Z Glancy by objector Children's Rights in support of Objection to Proposed Settlement Agreement [74−1] (ir) (Entered: 07/10/2003)
102 OBJECTION filed by Objectors to Court Approval of Proposed Class Settlement agreement [74−1]; Declaration of Sanford Jossen (ir) (Entered: 07/10/2003)
102 REQUEST filed by Objectors for opportunity to be heard (ir) (Entered: 07/10/2003)
103 REQUEST for Judicial Notice in support of objection to Court Approval of Proposed Class Settlement Agreement [74−1] (ir) (Entered: 07/10/2003)
104 NOTICE of Availability of members of Advisory Panel by defendant County of Los Angeles (ir) (Entered: 07/10/2003)
105 ORDER by Judge A. H. Matz; Court hereby sets a meeting with the members of the Advisory Panel in the Katie A litigation on 7/23/03 at 2:00 (ir) (Entered: 07/11/2003)
106 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case filed for objector Children's Rights by Ira P Lustbader of Children's Rights. Designating Lionel Z Glancy of Glancy & Binkow LLP as local counsel. Approved by Judge A. H. Matz. (Fee pd) (ir) (Entered: 07/14/2003)
107 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case filed for objector Children's Rights by Erik S Pitchal of Children's Rights. Designating Lionel Z Glancy of Glancy & Binkow as local counsel. Approved by Judge A. H. Matz. (Fee pd) (ir) (Entered: 07/14/2003)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 27 of 92

07/11/2003
07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/14/2003 07/15/2003 07/15/2003

108 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case filed for objector Children's Rights by Marcia Robinson Lowry of Children's Rights. Designating Lionel Z Glancy of Glancy & Binkow as local counsel. Approved by Judge A. H. Matz. (Fee pd) (ir) (Entered: 07/14/2003)
109 MEMORANDUM of Points and Authorities filed by plaintiffs in opposition to State Defendants' motion for reconsideration [96−1] (ir) (Entered: 07/15/2003)
110 PRE−HEARING MEMORANDUM FILED by plaintiffs urging approval of the Settlement Agreement between Plaintiffs and The Los Angeles County Defendants (ir) (Entered: 07/15/2003)
111 DECLARATION of Shahrzad Talieh by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
112 DECLARATION of Becky Norris by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
113 DECLARATION of Deborah Dentler by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum Urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
114 DECLARATION of Bruce Saltzer by plaintiffs in support of Plaintiff's Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
115 DECLARATION of Michael Nash by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum Urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
116 DECLARATION of Marjorie Shelvy by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
117 DECLARATION of Miriam Aron Krinsky by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
118 DECLARATION of Katrina McIntosh by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
119 DECLARATION of Robert D Newman by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
120 DECLARATION of Carlyle W Hall III by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum Urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
121 DECLARATION of Ben Wizner by plaintiffs in support of Plaintiffs' Pre−Hearing memorandum Urging approval of the 4/18/03 Settlement Agreement [110−1] (ir) (Entered: 07/15/2003)
122 RESPONSE to the Objections of Children's Rights Inc, The Jazzmon R Objectors and The State Defendants to the Settlement between Plaintiffs and Los Angeles County Defendants by plaintiffs (ir) (Entered: 07/15/2003)
123 PROOF OF SERVICE by plaintiffs on 7/14/03 of Declaration of Bruce Saltzer in support of Plaintiffs' Pre−Hearing memorandum urging approval of the 4/18/03 Settlement Agreement (Missing items 1−8) (ir) (Entered: 07/15/2003)
125 SUPPLEMENTAL DECLARATION of Catherine J Prattt by defendant County of Los Angeles in support of approval of Class Settlement (ir) (Entered: 07/16/2003)
126 NOTICE of Lodging of California's Child and Family Service Review Program Improvement Plan by defendants Diana Bonta, Rita Saenz (ir) (Entered: 07/16/2003)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 28 of 92

07/16/2003 07/16/2003 07/16/2003
07/16/2003
07/16/2003 07/16/2003 07/16/2003 07/17/2003 07/17/2003 07/21/2003 07/23/2003
07/23/2003 07/23/2003 07/23/2003

124 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 6/9/03 (Re: ) CR: Hope I. Goldsmith. (ghap) (Entered: 07/16/2003)
TRANSCRIPT filed for proceedings held on 6/9/03. (ghap) (Entered: 07/16/2003)
127 MINUTES: FAIRNESS HEARING ; Cause called; appearances made; Court questions counsel and the parties regarding any outstanding objections to the proposed settlement; Court also hears oral argument from the objectors; Court rejects Jazzman or CRI's objections; Court permits lat objections on behalf of the individual class members to be filed; Court hears arguments regarding those objections; Court also hears argument regarding the State Defendant's objections to the proposed settlement; Court orders the parties to order a transcript of this hearing and make it available to any person necessary to effectuate the proposed settlement including the advisory panel; Court approves the proposed settlement as clarified by counsel for Plaintiffs and Los Angeles County for reasons and findings made on the record by Judge A. H. Matz CR: Hope Goldsmith (ir) (Entered: 07/17/2003)
128 STIPULATION and ORDER by Judge A. H. Matz that this Court has jursidiction over the claims against Defendants Los Angeles County, Los Angeles County Departmenet of Children and Family Services, and Marjorie Kelly, Interim Director of the Los Angeles County Department of Children and Family Services and successor−in−interest to Anita Block; This case shall be certified as a class action for purposes of all causes of action in Plaintiffs' complaint against the County Defendants on behalf of a class of children and young adults; Settlement Agreement is fair, reasonable and adequate for members of the class; Court shall retain jurisdiction to enforce the accompanying Settlement Agreement between the parties until the case has been dismissed pursuant to the terms of the Settlement Agreement; Settlement Agreement shall be construed and implemented according to and consistent with the clarifications the parties orally concurred in and continued to at the 7/16/03 hearing (See document for further details) (ir) (Entered: 07/17/2003)
129 OBJECTIONS and comment filed and Comment on Notice of Proposed Agreemtn and Settlement (ir) (Entered: 07/17/2003)
130 PROOF OF SERVICE on 7/16/03 of Document does not state what was served (ir) (Entered: 07/17/2003)
132 LETTER received from Viki J Day (ir) (Entered: 07/18/2003)
131 NOTICE OF DISCREPANCY AND ORDER by Judge A. H. Matz ordering Day's Report ot submit letter submitted received on 7/16/03 to be fld and processed; fld date to be the date the doc was stamped "received but not fld" w/the Clerk (ir) (Entered: 07/18/2003)
133 LETTERS from Individual Class members and/or their Caretakers (ir) (Entered: 07/18/2003)
134 REPLY by defendants Diana Bonta, Rita Saenz to Plaintiffs' opposition to State Defendants' motion for reconsideration of Court's Order regarding Class Certification [96−1] (ir) (Entered: 07/22/2003)
135 MINUTES: TELEPHONIC STATUS CONFERENCE; Cause called; appearances made; Court and counsel confer regarding the ground rules for this afternoon's meeting with the advisory panel; Court is advised that 5 out of the 6 panel members are expected to be present at this hearing by Judge A. H. Matz CR: Hope Goldsmith (ir) (Entered: 07/24/2003)
136 MINUTES: MEETING WITH MEMBERS OF THE ADVISORY PANEL; Cause called; appearances made; Court ordered the transcript of this hearing sealed; Parties may submit an application and proposed order to the Court if they require a transcript of this hearing by Judge A. H. Matz CR: Hope Goldsmith (ir) (Entered: 07/24/2003)
138 RECEIPT OF TRANSCRIPT of proceedings for the following date(s): 07/16/03. CR: H. Godsmith. (cbr) (Entered: 07/24/2003)
TRANSCRIPT filed for proceedings held on 07/16/03. (cbr) (Entered: 07/24/2003)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 29 of 92

07/24/2003 07/24/2003 09/22/2003 10/09/2003 10/09/2003 11/06/2003 12/12/2003 12/12/2003 01/30/2004 02/05/2004
02/05/2004 02/20/2004 02/20/2004 02/23/2004
02/24/2004

137 MINUTES: In Chambers; State's motion for reconsideration of Court's Order regarding Class Certification [96−1] is DENIED IT IS SO ORDERED by Judge A. H. Matz CR: NONE (ir) (Entered: 07/24/2003)
139 ORIGINAL SIGNATURE PAGE of personal service by defendants Diana Bonta, Rita Saenz (ir) (Entered: 07/25/2003)
140 ORDER FROM USCA: Petitioners' motion for permission to file reply brief is granted. Clerk shall file reply brief received on 09/02/03. Court, in its discretion, denies petition for permission to appeal district court's 07/24/03 order denying reconsideration. (03−80083) (cbr) (Entered: 09/24/2003)
141 NOTICE OF DISCREPANCY AND ORDER by Judge A. H. Matz ordering Petitioner Settlement Letter submitted received on 10/9/03 to be fld and processed; fld date to be the date the doc was stamped "received but not fld" w/the Clerk (ir) (Entered: 10/14/2003)
142 LETTER from petitioner Patricia Mulcahey (ir) (Entered: 10/14/2003)
143 MINUTES: granting letter requesting extension of the date for submitting its initial report to December 15, 2003 [142−1] by Judge A. H. Matz CR: Not Reported (bg) (Entered: 11/07/2003)
144 MINUTES: (IN CHAMBERS) Court GRANTS the Advisory Committee's request to extend the date for filing of first report to 1/15/04 IT IS SO ORDERED by Judge A. H. Matz CR: Not Reported (ir) (Entered: 12/15/2003)
145 NOTICE OF ASSOCIATION of Counsel for plaintiff Katie A by attorneys Patrick H Gardner, Katina Ancar of National Center for Youth Law (ir) (Entered: 12/15/2003)
146 RESPONSE filed by Defendant Los Angeles County to 1/13/04 Report from Katie A Advisory Panel (ir, ) (Entered: 02/07/2004)
147 MINUTES: Status Conference held; Court advises counsel that former federal court extern David Ambrose has agreed to provide assistance to the advisory panel. Court orders that subsequent panel reports contain a separate section describing Mr Ambrose role in the process. Court orders parties to prepare and submit within ten days a brief document confirming the definition of the class that they agreed to at the 7/16/03 fairness hearing. Court orders Mr Newman to order a transcript of this hearing by Judge A. Howard Matz : Court Reporter: Jennifer Cheshire. (ir, ) (Entered: 02/09/2004)
148 FAIRNESS HEARING − REPORTERS'S TRANSCRIPT OF PROCEEDINGS; Wednesday, July 16, 2003, Los Angeles, California. (lm, ) (Entered: 02/17/2004)
150 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 2/5/04 Court Reporter: Jennifer Cheshire. (ghap, ) (Entered: 02/24/2004)
TRANSCRIPT filed for proceedings held on 2/5/04. Court Reporter: Jennifer Cheshire. (ghap, ) (Entered: 02/24/2004)
149 STIPULATION AND ORDER by Judge A. Howard Matz: That the following definition of the Plaintiff class shall be used for the purpose of the settlement agreement approved by this Court on 7/16/03: Class member include children and young adults who: (a) are in the custody of Los Angeles County Department of Children and Family Services, (b) are eligible for services under the Early and Periodic Screening Diagnosis and Treatment program of the Medicaid Act, (c) have a mental illness or condition, (d) need individual mental health services. The Definition shall replace the definition of the class included in the written settlement agreement previously lodged with this Court and comports with the definition agreed to by counsel for Plaintiffs and the County at the fairness hearing conducted on 7/16/03 (See document for further details)(ir, ) (Entered: 02/23/2004)
151 MINUTES: (IN CHAMBERS) Court has reviewed the Advisory Panel 2/15/04 request to adopt the revised schedule. Court GRANTS the Adivsory Committe attached revised schedule IT IS SO ORDERED by Judge A. Howard Matz Court Reporter: Not Reported. (ir, ) (Entered: 02/25/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 30 of 92

04/19/2004 05/03/2004
05/14/2004 05/21/2004
06/02/2004 06/02/2004 06/02/2004 06/02/2004 06/03/2004 06/03/2004 06/03/2004 06/03/2004 06/04/2004

152 RESPONSE to Katie A Advisory Panel 1st Report to the Court and County of Los Angeles response filed by Defendants Diana Bonta, Rita Saenz (ir, ) (Entered: 04/26/2004)
153 STIPULATION regarding Disclosure of Advisory Panel Reports AND ORDER by Judge A. Howard Matz: All subsequent reports by the Advisory Panel and any responses by the parties to these reports shall not disclose the true names of the Plaintiffs and any members of the class. Named Plaintiffs shall continue to be identified by the appropriate pseudonyms. Other children besides the named Plaintiffs shall not even be identified by their actual initials and shall instead be identified in more generic ways. (2) Copies of all such subsequent reports by the Advisory Panel and any responses thereto by the parties shall be filed with the Clerk of the Court. (3) Copies of all such subsequent reports by the Advisory Panel and any responses thereto by the parties can be made available to the general public. (4) A courtesy copy of all such subsequent reports by the Advisor Panel and any responses thereto by the parties shall be filed directly with the chambers of the Court. (ir, ) (Entered: 05/04/2004)
154 STIPULATION AND PROTECTIVE ORDER by Judge Stephen J. Hillman: Relating to identities of the Plaintiffs, medical history, treatment, mental and physical assessments, or mental or physical therapy. (See document for further details)(ir, ) (Entered: 05/14/2004)
155 MINUTES: In Chambers; Court has reviewed the "State Defendants Response" to the Advisory Panels First Report and does find it informative and helpful. If Plaintiffs and/or the County disagree with the legal analysis or characterizations in the State Defendants response, they must file a brief, non−argumentative analysis of their own IT IS SO ORDERED by Judge A. Howard Matz Court Reporter: NONE. (ir, ) (Entered: 05/24/2004)
157 EX PARTE APPLICATION for permission to file State Defendants Application for extension of non−expert discovery cut−off ex parte filed by Defendants Diana Bonta, Rita Saenz. Lodged Order. (ir, ) (Entered: 06/07/2004)
158 DECLARATION of Cristina Felix−Carrasco in support of State Defendants Application for permission to file State Defendants Application for extension of non−expert discovery cut−off ex parte and in support of State Defendants Application for Expert Discovery cut−off 157 filed by Defendants Diana Bonta, Rita Saenz. (ir, ) (Entered: 06/07/2004)
159 APPLICATION for Extension of Non−Expert Discovery cut−off filed by Defendants Diana Bonta, Rita Saenz. Memorandum of Points and Authorities. Lodged Order. (ir, ) (Entered: 06/07/2004)
160 DECLARATION of Sandra L Goldsmith in support of State Defendants Application for extension of non−expert discovery cut−off 159 filed by Defendants Diana Bonta, Rita Saenz. (ir, ) (Entered: 06/07/2004)
161 MEMORANDUM of Points and Authorities in Opposition to State Defendants Ex Parte Application to extend the discovery cut−off 159 filed by Plaintiffs. (ir, ) (Entered: 06/07/2004)
162 DECLARATION of Robert D Newman in support of Plaintiffs opposition to State Defendants Ex Parte Application to extend the discovery cut−off 159 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (ir, ) (Entered: 06/07/2004)
163 DECLARATION of Carlyle W Hall in support of Plaintiffs opposition to State Defendants Ex Parte motion to extend the discovery cut−off 159 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (ir, ) (Entered: 06/07/2004)
164 PROOF OF SERVICE filed by Plaintiffs of Plaintiffs memorandum of Points and Authorities in opposition to State Defendants Ex Parte Application to extend the discovey cut−off 162 , Declaration of Robert D Newman 163 , Declaration of Carlyle W Hall III in support 161 was served on 6/3/04. (ir, ) (Entered: 06/07/2004)
156 MINUTES: In Chambers; Court requires counsel for all parties to this action, including the County Defendants to attend a manddtory status conference at 3:00 pm on 6/16/04 in Courtroom 14 IT IS SO ORDERED by Judge A. Howard Matz Court Reporter: NONE. (ir, ) (Entered: 06/07/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 31 of 92

06/04/2004 06/04/2004 06/04/2004 06/04/2004 06/14/2004 06/24/2004
06/24/2004 06/24/2004 06/24/2004 06/24/2004 06/24/2004
07/02/2004

165 OPPOSITION to Ex Parte Application to extend discovery cut−off 159 filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services. (ir, ) (Entered: 06/07/2004)
166 ORDER by Judge A. Howard Matz: State Defendants Ex Parte Application to file State Defendants Application for Extensiion of Non−Expert discovery cut−off 157 is DENIED. (ir, ) (Entered: 06/07/2004)
167 ORDER by Judge A. Howard Matz: State Defendants Application for Non−Expert Discovery cut−off 159 is DENIED. (ir, ) (Entered: 06/07/2004)
168 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. re 162 Declaration (Motion related), 163 Declaration (Motion related), 161 MEMORANDUM in Opposition to Motion, was served on 6/3/04. (yc, ) (Entered: 06/14/2004)
169 STIPULATION AND ORDER by Judge A. Howard Matz: Mandatory Status Conference set for 6/16/04 at 3:00 pm shall be continued to 6/24/2004 03:00 PM in Courtroom 14.(ir, ) (Entered: 06/14/2004)
170 MINUTES: Status Conference held; appearances made. Court and counsel discuss status of case. Court tentatively extends the non−expert discovery cut−off date six months until 12/27/04. As soon as possible, all parties shall meet and confer and lodge with the Court a Stipulation and Proposed Order regarding Extension for Discovery cut−off. Stipulation shall (1) set forth what specific discovery each party has agreed to provide (2) propose a sequence and dates for such discovery; and finally (3) explanin any discovery issues that the parties have been unable to agree upon. Both the discovery the parties agree to and the discovery to which the parties disagree shall be clearly in plain language. There will be a further Status Conference on Wednesday 7/28/04 at 3:00 pm. Counsel for Plaintiffs and State Defendants request a transcript of this hearing by Judge A. Howard Matz Court Reporter: Kathy Mechanic. (ir ) (Entered: 06/28/2004)
171 NOTICE OF MOTION AND MOTION joining Tommy G Thompson, Secretary of the United States Department of Health and Human Services and the United States Department of Health and Human Services as parties in the action herein filed by Defendants Diana Bonta, Rita Saenz. Motion set for hearing on 7/26/2004 at 10:00 AM before Honorable A. Howard Matz. Lodged Proposed Order. (ir, ) Modified on 6/28/2004 (ir, ). (Entered: 06/28/2004)
172 MEMORANDUM of Points and Authorities in Support of motion joining Tommy G Thompson, Secretary of the United States Department of Health and Human Services and the United States Department of Health and Human Services as parties in the action herein 171 filed by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 06/28/2004)
173 DECLARATION of Mary Jean Duckett in support of State Defendants Notice of motion and motion joining Tommy G Thompson, Secretary of the United States Department of Health and Human Services and the United States Department of Health and Human Services as parties in the action herein 171 filed by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 06/28/2004)
174 DECLARATION of Sandra L Goldsmith in support of State Defendants Notice of motion and motion joining Tommy G Thompson, Secretary of the United States Department of Health and Human Services and the United States Department of Health and Human Services as parties in the action herein 171 filed by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 06/28/2004)
175 NOTICE of Lodging of Certified Copies of Transcripts of the Depositions of (1) David Sanders, PhD, (2) Jackie Acosta, (3) Dr Charles Sophy, and (4) John S Hatakeyama regarding motion joining Tommy G Thompson, Secretary of the United States Department of Health and Human Services and the United States Department of Health and Human Services as parties in the action herein 171 filed by Defendants Diana Bonta, Rita Saenz.; Lodged (4) Deposition Transcripts.(ir) (Entered: 06/28/2004)
176 SUPPLEMENTAL DECLARATION of Sandra L. Goldsmith in support of re MOTION for joinder 171 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered:

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 32 of 92

07/12/2004 07/12/2004
07/13/2004 07/15/2004 07/19/2004 07/19/2004 07/19/2004 07/21/2004 07/22/2004 07/28/2004
07/28/2004
07/29/2004
07/30/2004 08/02/2004

07/09/2004)
177 OPPOSITION to State Defendants motion for joinder 171 filed by Plaintiffs.(ir) (Entered: 07/15/2004)
178 PROOF OF SERVICE filed by Defendants Diana Bonta, Rita Saenz regarding (1) State Defendants Diana Bonta and Rita Saenz Notice of motion and motion for joinder, (2) State Defendants Notice of motion and motion for joinder, Memorandum of Points and Authorities, (3) Declaration of Mary Jean Duckett in support (See document for further details). (ir) (Entered: 07/15/2004)
179 NOTICE OF NON−OPPOSITION to State Defendants Motion for joinder 171 filed by Defendant Los Angeles County. (ir) (Entered: 07/15/2004)
180 PROOF OF SERVICE filed by Plaintiffs of Plaintiffs opposition to State Defendants motion for joinder 177 was served on 7/12/04. (ir ) (Entered: 07/19/2004)
181 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 6/24/04 Court Reporter: Kathleen L. Mechanic (weap, ) (Entered: 07/20/2004)
TRANSCRIPT filed for proceedings held on 6/24/04. Court Reporter: Kathleen L. Mechanic. (weap, ) (Entered: 07/20/2004)
183 REPLY to Plaintiffs opposition to State Defendants motion for joinder 171 filed by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 07/21/2004)
182 MINUTES: (IN CHAMBERS) On Courts own motion, Court hereby continues State Defendants motion for joinder 171 (Filed 6/24/04) from 7/26/04 to 7/28/04 at 3:00 pm by Judge A. Howard Matz Court Reporter: Not Reported. (ir ) (Entered: 07/21/2004)
186 Original PROOFS OF SERVICE filed by Defendants Rita Saenz. re 183 Reply to Opposition to State Defendants motion for joinder, was served on 7/21/04. (shb, ) (Entered: 08/02/2004)
184 MINUTES: (1) State Defendants Motion for Joinder 171 (Filed 6/24/04); (2) Further Status Conference; Cause called; appearances made. Court issues tentative order and hears oral argument. Court DENIES States Defendants motion for joinder. Court and counsel confer regarding (1) inviting the DHHS to submit an amicus brief setting forth its views; (2) proposed discovery schedule. Court extends the non−expert discovery cut−off date to 12/27/04. Court also deems the parties Stipulation Regarding Outstanding and Proposed Non−Expert Discovery (Lodged 7/28/04) is made pursuant to Local Rule 37.2 and refers the said stipulation to Magistrate Judge Stephen J Hillman; (3) status of the Advisory Panel. Another Advisory Panel Report is expected by 9/30/04; (4) a recent directive wherein no new enrollments will be allowed in the federally funded wrap around programs beyond 6/30/04; (5) a recent Pew Commission publication by Judge A. Howard Matz Court Reporter: Leonore LeBlanc. (ir) (Entered: 07/29/2004)
PLACED IN FILE − NOT USED re (Proposed) Order on State Defendants Diana Bonta, Director of California Department of Health Services and Rita Saenz, Director of The California Department of Social Services Notice of motion and motion for joinder, lodged 6/24/04 submitted by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 08/04/2004)
185 ORDER by Judge A. Howard Matz: DENIES the State Defendants motion for joinder 171 . At a later time, Court will require the current parties to this lawsuit to meet and confer and submit a proposed series of issues and questions that the Court would incorporate into a invitation to DHHS to submit an amicus brief setting forth its views. (ir) (Entered: 07/30/2004)
187 MINUTES OF In Chambers before Judge Stephen J. Hillman : Stipulation Regarding Outstanding and Proposed non−Expert Discovery ( Lodged 7−28−04) is placed on calendar for Status hearing 8/4/2004 10:00 AM before Magistrate Judge Stephen J. Hillman.Court Reporter: not present. (sbu, ) (Entered: 08/02/2004)
188 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 7/28/04 Court Reporter: Leni Leblanc. (ghap, ) (Entered: 08/02/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 33 of 92

08/02/2004 08/03/2004 08/04/2004 08/05/2004 08/16/2004 08/18/2004 08/19/2004
08/25/2004
08/25/2004 08/25/2004 08/25/2004 08/27/2004 08/31/2004 09/07/2004
09/14/2004

TRANSCRIPT filed for proceedings held on 7/28/04. Court Reporter: Leonore A. LeBlanc. (ghap, ) (Entered: 08/02/2004)
189 NOTICE of Lodging of Materials in Advance of 8/4/04 Discovery hearing filed by Plaintiffs. (ir ) (Entered: 08/04/2004)
190 NOTICE of Departure of Counsel Katina Ancar from the National Center for Youth Law as of 8/24/04 filed by Plaintiffs. (ir, ) (Entered: 08/05/2004)
191 PROOF OF SERVICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. re 189 Notice of Lodging of materials in advance of August 4, 2004 discovery hearing was served on 8/3/04. (shb, ) (Entered: 08/06/2004)
193 DECLARATION of Sandra L Goldsmith regarding Proposed Discovery Order filed by Defendants Diana Bonta, Rita Saenz. (ir ) (Entered: 08/23/2004)
194 SUPPLEMENTAL DECLARATION of Sandra L Goldsmith regarding Proposed Discovery Order filed by Defendants Diana Bonta, Rita Saenz.; Lodged Proposed Order. (ir ) (Entered: 08/25/2004)
192 MINUTES (In Chambers) before Judge Stephen J. Hillman : The court declines the request to conduct a status conference. The court orders that all discovery disputes which are currently ripe for ruling by the court, including the matters discussed at the 8/4/04 hearing, are now subject to the Joint Stipulation process. Court requires counsel to start afresh, and will ignore the 7/28/04 Stipulation Regarding Outstanding and Proposed Discovery. Court vacates deadline for a Joint Stipulation. Counsel shall abide by the Local Rules, and Notice the matter for hearing upon adequate notice as required by the Local Rules. (th) (Entered: 08/20/2004)
195 ORDER by Judge Stephen J. Hillman,regarding discovery related to State Defendants and Federal Government. Having conferred with counsel for all parties at the Status Hearing held in chambers on 8−4−04 court hereby orders State Defendants may proceed with their proposed discovery to the Secretary of the United States Department of Health and Human Services(DHHS), DHHS, the Center for Medicare & Medicaid Services (CMS) and the Adminstration for Children and Families(ACF) which are not parties to this action. Any futher ruling regaring this proposed discovery is premature at this time.(sbu, ) (Entered: 08/26/2004)
PLACED IN FILE − NOT USED re Proposed order regarding outstanding and proposed non expert dsicovery relating to State Defendants and Los Anegels County defendants (sbu, ) (Entered: 08/26/2004)
196 NOTICE of Change of Attorney Information by attorney Sandra L Goldsmith for Defendants Diana Bonta, Rita Saenz, changing from Sandra L Goldsmith and Cristina Felix−Carrasco to Sandra L Goldsmith and Jennifer M Kim Filed by Defendants Diana Bonta and Rita Saenz (ir ) (Entered: 08/27/2004)
FAX number for Attorneys Sandra L Goldsmith, Jennifer M Kim is 213−897−2805. (ir ) (Entered: 08/27/2004)
197 NOTICE OF DISCREPANCY AND ORDER: by Judge A. Howard Matz, ORDERING Letter to Judge Matz submitted and received on 8/26/04 is not to be filed but instead rejected. Denial based on: No copy for judge, letter to judge.(shb, ) (Entered: 09/01/2004)
198 NOTICE of Change of Attorney Information by attorneys Jerry M Custis, Catherine J Pratt, Ada Gardiner, Dawyn Harrison for Defendants changing address to 201 Centre Plaza Drive, Monterey Park, CA 91754. Filed by defendants (jp, ) (Entered: 09/02/2004)
199 NOTICE OF DISCREPANCY AND ORDER: by Judge A. Howard Matz, ORDERING Proof of service and letter to Judge submitted by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E received on 9/3/04 is not to be filed but instead rejected. Denial based on: Local Rule 83.2−10 No letter fomat and Patricia Mulcahey was presented by attorney.(ir ) (Entered: 09/10/2004)
200 NOTICE of Change of Attorney Information by attorney Ben Wizner from ACLU Foundation of Southern California to Mark D Rosenbaum for Plaintiffs filed by Plaintiffs. (ir ) (Entered: 09/17/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 34 of 92

10/06/2004 10/18/2004 10/21/2004 10/22/2004 10/26/2004
10/27/2004
11/03/2004
11/04/2004
11/08/2004 11/19/2004 11/22/2004 11/24/2004 11/24/2004 11/29/2004 11/29/2004

201 RESPONSE filed by Defendant Los Angeles County t 9/30/2004 report for Katie A Advisory Panel. (yc, ) (Entered: 10/07/2004)
202 RESPONSE filed by Plaintiffs to 9/30/04 Report From Advisory Panel (mch, ) (Entered: 10/22/2004)
204 REQUEST FOR CLARIFICATION From Magistrate Judge Regarding Minuted Order dated 8/19/2004 filed by Plaintiffs Katie A, Mary B, Janet C and Henry D. (yl, ) (Entered: 10/22/2004)
203 MINUTES OF In Chambers before Judge Stephen J. Hillman : The court clarifies the August 19, 2004, Minute Orders as follows. Plaintiffs' interpretation is precisely correct.Court Reporter: not present. (sbu, ) (Entered: 10/22/2004)
205 ORDER by Judge A. Howard Matz, in light of September 30,2004 advisory panel report. The Court ORDERS as follows: A. Advisory Panel. B. The County, by not later than 11/19/2004 the county shall file with the court a document entitled "Supplemental Response to the panel's third report." (see document for details) C. Plaintiffs, by not later than 11/8/2004 please respond to the following (see file)(yc, ) (Entered: 10/27/2004)
206 MINUTES held before Judge A. Howard Matz : The court ORDERS all the parties and the advisory panel to serve their respective filing relating to the panel's third report on David Ambroz, at the following address: 1810 Prosser Ave #2, Los Angeles, CA 90025. (Mr Ambroz has authorized the court to provide the information about his address). In the future all filings shall include Mr Ambroz on the proof of service. Court Reporter: Not Available. (yc, ) (Entered: 11/01/2004)
207 NOTICE OF MEETING ORDER by Judge A. Howard Matz,The court notified the parties and their respective counsel that today the cour tfor the first time visited the dependency court and has lunch with the Hon. Jan Levine. (see file) Unless the court receives any objection (in which event it will rule on them) the court reserves the right to meet periodically with Judge Nash and Levine about matters and issues affecting their court's and this court's respective functions and dutes. (yc, ) (Entered: 11/04/2004)
208 MINUTES held before Judge A. Howard Matz : In the report that counsel for plaintiffs shall file pursuant to the court's 10/26/2004 order, the parties shall set forth their joint (or, if different, respective) views about the impact on this case of the passage of proposition 63. If it is too soon to say or otherwise uncertain they may so report. Court Reporter: Not Available. (yc, ) (Entered: 11/05/2004)
209 Joint Report of to the Court re Meeting (shb, ) (Entered: 11/09/2004)
211 SUPPLEMENT of LOS ANGELES SUPPLEMENT RESPONSE TO THE PANELS THIRD REPORT filed by Defendant Los Angeles County. (yc, ) (Entered: 11/23/2004)
210 SUPPLEMENT JOINT REPORT TO COURT RE MEETING filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 11/23/2004)
212 APPLICATION to file document under Seal ; Declaration of Sandra L. Goldsmith in support. filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/01/2004)
213 APPLICATION that Magistrate judge act as a referee or appoint a person to act as a referee at the deposition of plaintiff Katie A ; Declaration of Sandra L Goldsmith in support filed by defendants Diana Bonta, Rita Saenz. Lodged ORDER. (yc, ) Modified on 12/1/2004 (yc, ). (Entered: 12/01/2004)
214 OPPOSITION to APPLICATION for Order 213 filed by plaintiffs Katie A, Mary B, Henry D. (yc, ) (Entered: 12/01/2004)
215 ORDER by Judge Stephen J. Hillman denying APPLICATION that magistrate judge act as a referee, or appoint a person to act as a referee, at the deposition of plaintiff Katie A 213 . The Magistrate Judge will be telephonically available for the deposition of Plaintiff Katie A. Counsel may call the Magistrate Judge for this deposition only. (mg, ) Modified on 12/1/2004 (mg, ). (Entered: 12/01/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 35 of 92

12/07/2004 12/07/2004 12/07/2004 12/07/2004 12/07/2004 12/07/2004 12/07/2004
12/07/2004 12/07/2004 12/07/2004 12/07/2004
12/07/2004

216 NOTICE OF MOTION AND MOTION to Compel Answers to Interrogatories numbers 1−20 and 22−25 of the interrogatories propounded to Henry D., by and through his next friend Gillian Brown, By Diana Bonta, Director of the California Department of Health Services Set Number one filed by defendants Diana Bonta, Rita Saenz. Motion set for hearing on 12/27/2004 at 02:00 PM before Honorable A. Howard Matz. Lodged PROPOSED ORDER. (yc, ) (Entered: 12/08/2004)
217 DECLARATION of Sandra L. Goldsmith in support of re MOTION to Compel Answers to Interrogatories of Henry D., by and through his next friend Gillian Brown, By Diana Bonta, Director of the California Department of Health Services Set Number one 216 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/08/2004)
218 NOTICE OF MOTION AND MOTION to Compel Answers to Interrogatories numbers 27,29,31,33,34−38,40 and 42−46 of the inter of Janet C By and through her next friend Dolores Johnson, by Rita Saenz, Director of the California Department of Social Service, Set Number one. filed by defendants Diana Bonta, Rita Saenz. Motion set for hearing on 12/27/2004 at 02:00 PM before Honorable A. Howard Matz. (yc, ) (Entered: 12/08/2004)
219 MEMORANDUM of points and authorities in Support of MOTION to Compel Answers to Interrogatories of Janet C By and through her next friend Dolores Johnson, by Rita Saenz, Director of the California Department of Social Service, Set Number one. 218 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/08/2004)
220 DECLARATION of Sandra L. Goldsmith in support of re MOTION to Compel Answers to Interrogatories of Janet C By and through her next friend Dolores Johnson, by Rita Saenz, Director of the California Department of Social Service, Set Number one. 218 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/08/2004)
221 MEMORANDUM of points and authorities in Support of MOTION to Compel Answers to Interrogatories of Henry D., by and through his next friend Gillian Brown, By Diana Bonta, Director of the California Department of Health Services Set Number one 216 filed by defendants Rita Saenz. (yc, ) (Entered: 12/08/2004)
222 NOTICE OF MOTION AND MOTION to Compel Answers to Interrogatory number 26−29,32−36 and 39−49 of the Interrogatories propounded to Janet C., by and through her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One filed by defendants Diana Bonta, Rita Saenz. Motion set for hearing on 12/27/2004 at 02:00 AM before Honorable A. Howard Matz. Lodged PROPOSED ORDER. (yc, ) Modified on 12/9/2004 (yc, ). (Entered: 12/09/2004)
223 MEMORANDUM of points and authorities in Support of MOTION to Compel Answers to Interrogatories of Janet C., by and throuhg her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/09/2004)
224 DECLARATION of Sandra L. Goldsmith in support of re MOTION to Compel Answers to Interrogatories of Janet C., by and through her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/09/2004)
225 DECLARATION of defendants re MOTION to Compel Answers to Interrogatories of Janet C., by and through her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by defendants Rita Saenz. (yc, ) (Entered: 12/09/2004)
226 NOTICE OF MOTION AND MOTION to Compelling response to request number 1−8,10−20, and 22−25 of the request for production of documents propounded to plaintiff Henry D., by and through his next friend Gillian Brown, by defendant Diana Bonta, Director of the California Department of Health Services, Set number one. filed by Defendants Diana Bonta, Rita Saenz. Motion set for hearing on 12/27/2004 at 02:00 PM before Honorable A. Howard Matz. Lodged proposed order. (yc, ) (Entered: 12/09/2004)
227 MEMORANDUM of points and authorities in support of MOTION to Compel 226 filed by Defendants Diana Bonta, Rita Saenz. (yc, ) (Entered: 12/09/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 36 of 92

12/07/2004 12/09/2004
12/09/2004 12/13/2004
12/13/2004 12/13/2004 12/14/2004 12/14/2004
12/14/2004 12/14/2004 12/14/2004
12/14/2004 12/14/2004
12/20/2004

228 DECLARATION of Sandra L. Goldsmith in support of re MOTION to Compel 226 filed by defendants Rita Saenz. (yc, ) (Entered: 12/09/2004)
229 MINUTES OF In Chambers Conference held before Judge A. Howard Matz: The Court has reviewed the parties' Supplemental Joint Report (filed 11/22/04) and the County's Supplemental Response to the Panel's Third Report, filed 11/9/04. The Court recognizes that the parties are in most respects acting with admirable diligence, is pleased about Dr Sophy's designation and awaits th enext update.Court Reporter: not applicable. (rl, ) (Entered: 12/10/2004)
230 NOTICE of Association of Counsel associating attorney Gina L Zaragoza−Cruz on behalf of Plaintiff Katie A. Filed by Plaintiff Katie A (rl, ) (Entered: 12/13/2004)
231 DECLARATION of Robert D Newman in support of plaintiffs opposition to state defendants re MOTION to Compel Answers to Interrogatories of Janet C., by and throuhg her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
232 OPPOSITION to MOTION to Compel Answers to Interrogatories of Janet C By and through her next friend Dolores Johnson, by Rita Saenz, Director of the California Department of Social Service, Set Number one. 218 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
233 PROOF OF SERVICE filed by plaintiff Katie A, Mary B, Janet C, Henry D, Gary E. re Declaration (Motion related), Declaration (Motion related) 231 , Response in Opposition to Motion, 232 , was served on 12/13/2004. (yc, ) (Entered: 12/15/2004)
234 MEMORANDUM of points and authorities in opposition to defendants Bonta's MOTION to Compel 226 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
235 MEMORANDUM of points and authorities in opposition in Support of MOTION to Compel Answers to Interrogatories of Janet C., by and throuhg her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
236 MEMORANDUM of points and authorities in opposition to defendant Bonta motion to Compel 226 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
237 DECLARATION of Robert D Newman in opposition to re MOTION to Compel 226 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
238 DECLARATION of Robert D Newman in opposition to re MOTION to Compel Answers to Interrogatories of Janet C., by and throuhg her next fried Dolores Johnson, by Diana Bonta, Director of the California Department of Health Services, Set Number One 222 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
239 DECLARATION of Robert D Newman in opposition to re MOTION to Compel 226 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/15/2004)
240 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. re Memorandum in Support of Motion, 235 , Memorandum in Support of Motion 236 , Declaration (Motion related) 237 , Declaration (Motion related), Declaration (Motion related) 238 , Declaration (Motion related) 239 , Memorandum in Support of Motion 234 , was served on 12/13/04. (yc, ) (Entered: 12/15/2004)
241 DECLARATION of Sandra L Goldsmith in support of state defendants' reply to Plaintiff Janet C's opposition to Defendant Bonta's MOTION to Compel further responses to interrogatories from Plaintiff Janet C 222 , 218 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 37 of 92

12/20/2004 12/20/2004 12/20/2004 12/20/2004 12/20/2004 12/20/2004 12/21/2004 12/28/2004
12/28/2004 12/28/2004 12/28/2004 01/04/2005 01/04/2005 01/05/2005 01/06/2005 01/07/2005

242 STATE DEFENDANTS' REPLY BRIEF regarding MOTION to Compel Plaintiff Henry D's responses to Request for production of documents propounded to Plaintiff Henry D by and through his next friend Gillian Brown 226 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) Modified on 12/27/2004 (rl, ). (Entered: 12/27/2004)
243 STATE DEFENDANTS' REPLY BRIEF regarding MOTION to Compel Plaintiff Henry D's answers to interrogatories propounded to Plaintiff Henry D by and through his nex friend Gillian Brown 226 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)
244 DECLARATION of Jennifer M Kim in support of stte defendants' reply brief regarding MOTION to Compel Plaintiff Henry D's responses to request for production of documents propounded to Plaintiff Henry D by and through his next friend Gillian Brown 226 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)
245 DECLARATION of Sandra L Goldsmith in support of state Defendants' reply to Plaintiffs Janet C's opposition to Defendant Saenz's MOTION to Compel Interrogatories of Janet C By 218 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)
246 STATE DEFENDANTS' REPLY to Plaintiffs' opposition to state Defendants' MOTION to Compel Plaintiff Janet C's further answers to interrogatories propounsed to Janet C by and through her next friend Dolores Johnson 218 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)
247 STATE DEFENDANTS' REPLY to Plaintiff Janet C's opposition to Defendant Bonita's MOTION to Compel Further responses to interrogatories from Plaintiff Janet C 222 , 216 , 218 filed by Defendants Rita Saenz, Diana Bonta. (rl, ) (Entered: 12/27/2004)
248 SECOND SUPPLEMENTAL JOINT Report To Court 209 , filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services. (rl, ) (Entered: 12/27/2004)
249 NOTICE OF MOTION AND MOTION for Protective Order precluding the depositions of Robert D Newman and Kimberly Lewis; memorandum of points and authorities filed by plaintiffs Katie A, Mary B, Janet C, Henry D. Motion set for hearing on 1/18/2005 at 02:00 PM before Honorable A. Howard Matz. Lodged LODGED PROPORSED ORDER. (yc, ) (Entered: 12/29/2004)
250 DECLARATION of Kyle R Gehrmann insupport of re MOTION for Protective Order 249 filed by plainitiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 12/29/2004)
251 DECLARATION of Robert D Newman in support of re MOTION for Protective Order 249 filed by plainitffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 12/29/2004)
252 PROOF OF SERVICE filed by plainitffs Katie A, Mary B, Janet C, Henry D. re MOTION for Protective Order 249 , Declaration (Motion related) 250 , Declaration (Motion related) 251 , was served on 12/28/04. (yc, ) (Entered: 12/29/2004)
253 OPPOSITION to MOTION for Protective Order 249 precluding the depositions of Robert D Newman and Kimberly Lewis. filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 01/05/2005)
254 DECLARATION of Sandra L Goldsmith in support of re MOTION for Protective Order 249 precluding the depositions of Robert D Newman and Kimberly Lewis. filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 01/05/2005)
255 MINUTES by Judge A. Howard Matz : The court awaits the next such report and advisory panel report both due 1/31/2005.Court Reporter: Not Available. (yc, ) (Entered: 01/07/2005)
259 SUPPLEMENT Declaration 254 , filed by Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 01/12/2005)
257 MINUTES OF Discovery Hearing held before Stephen J. Hillman :Court confer with counsel and counsel argue. Court rules on the motions as follows. Granted and denied

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01/10/2005
01/10/2005 01/11/2005 01/11/2005 01/11/2005 01/11/2005
01/20/2005 01/26/2005 01/31/2005 02/01/2005 02/01/2005 02/01/2005
03/22/2005 03/22/2005

in part. Counsel for plaintiff/defendant to prepare proposed order for issuance by Court.Tape #: 05−1,2. (sbu, ) (Entered: 01/10/2005)
256 MINUTES OF IN CHAMBERS ORDER by Judge Stephen J. Hillman : Plainiffs' Motion for protective order precluding depostion of counsel, surrently set for 1−18−05, shall be re−set for hearing either before Judge Matz or Judge Hillman, depending on who Judge Matz determines should rule on the State's related discovery regarding counsels' post−settlement communications with the Katie A Advisory Panel and the County. The Motion for protective order concerns the same issues as the other discovery propounded by the State. If Judge Matz desires the magistrate judge to rule on these issues, then the Motion for Protective Order shall be re−set before the magistrate judge on shortened notice. No deposition of plaintiff's attorney shall commence absent Order of the court.Court Reporter: not present. (sbu, ) (Entered: 01/10/2005)
258 DECLARATION of Robert D Newman and Marissa Prayongratana re Cherkship of Ms prayongratano at Western filed by Plaintiffs(yc, ) (Entered: 01/11/2005)
260 DECLARATION of Kimberly Lewis in suppor tof plainitff reply to state defendants opposition re MOTION for Protective Order 249 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 01/12/2005)
261 REPLY to opposition to MOTION for Protective Order 249 filed by plaintiffs Katie A, Mary B. (yc, ) (Entered: 01/12/2005)
262 PROOF OF SERVICE filed by plaintiffs Mary B. re Reply (Motion related) 261 , Declaration (Motion related) 260 , was served on 1/11/2005. (yc, ) (Entered: 01/12/2005)
263 MINUTES by Judge A. Howard Matz : The court ORDERS each of them to file a supplemental declaration explicitly confirming what is implicit in their previous declarations; that Ms Prayongratana will not do any work whatsoever, (including for example legal research) that in any way was intended to be used or reference in the Katie A Case. (She in theory could have been asked to reached a question without being told why or without being told the case to which the research was relevant}. Also if the Western Center has been counsel on any other case now pending in this court that also was pending when Mr Prayongratana was an estern in the summer of 2004, comparable declaration to those already filed and to be filed in this case shall be filed in such case. Court Reporter: Not Available. (yc, ) (Entered: 01/13/2005)
264 SUPPLEMENTAL DECLARATIONS of Robert D. Newman and Marissa Prayongratana Re: Clerkship of Ms. Prayongratana at Western Center On Law & Poverty filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (ca, ) (Entered: 01/24/2005)
265 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D regarding Notice of motion was served on 12/28/2004. (yc, ) (Entered: 01/28/2005)
269 THIRD supplemental joint report to court filed by County defendants (lc, ) (Entered: 02/04/2005)
266 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 01/07/05 Court Reporter: Dorothy Babykin. (cbr, ) (Entered: 02/02/2005)
267 TRANSCRIPT filed for proceedings held on 01/07/05. Court Reporter: Dorothy Babykin. (cbr, ) (Entered: 02/02/2005)
268 MINUTES by Judge A. Howard Matz : The court has received a letter form Paul Vincent Chair of the Katie A Advisory Panel dated 1/28/2005, requesting that the court extend the date for submission of the Katie A Review Panel initial report until 2/28/2005. The court hereby GRANTS this request.Court Reporter: Not Available. (yc, ) (Entered: 02/04/2005)
270 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 2/24/05 Court Reporter: Dorothy Babykin. (ghap, ) (Entered: 03/23/2005)
271 TRANSCRIPT filed for proceedings held on 2/24/05. Court Reporter: Dorothy Babykin. (ghap, ) (Entered: 03/23/2005)

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04/15/2005 04/19/2005
05/05/2005
05/06/2005 05/06/2005 05/13/2005 05/13/2005 05/13/2005 05/18/2005 05/18/2005 05/20/2005 05/23/2005 05/23/2005 05/23/2005

272 JOINT Report of (proposed) order on state defendants motions to compel plainitiffs responses filed by Defendant Rita Saenz. (yc, ) (Entered: 04/21/2005)
273 ORDER by Judge Stephen J. Hillman, re state defendants MOTIONS plaintiffs responses. 222 , 216 , 218 , 226 Interrogatory Nubmer 1−8 granted, Interrogatory Number 10; denied; Interrogatory number 11−13 granted, Interrogatory number 14 denied; Interrogatory number 15 denied. Interrogatory Number 16−20 granted; Interrogatory Number 22−23 and 24−25 denied, Interrogatory number 27,29,31 is granted, Interrogatory number 33 denied; Interrogatory number 24−36 37 granted, Interrogatory number 38 denied as cumulative, Interrogatory number 40 denied; Interrogatory Number 42 43,45 granted. Interrogatory Number 44 denied as redundant. Request Numbers 45−47 No ruling; Request Number 48−53 granted; Request Numbers 59−60 denied; Request number 65−67,59,71 and 73 granted; Request Numbers 74−75 The court makes no ruling; Request number 85 denied; Request Number 86 The court makes no ruling; Interrogatory number 26 28,32−33 denied; Interrogatory number 27 29 granted, Interrogatory number 34 no ruling, Interrogatory number 35,36,37−38 39−43 granted; Interrogatory Number 44 denied, Interrogatory number 45−46 the court makes no ruling, Interrogatory number 48 granted Interrogatory number 49 denied. (see document for details)(yc, ) (Entered: 04/21/2005)
274 MINUTES by Judge A. Howard Matz : The court ORDERS each of the parties to file a separate statement as to its intentions and propsals concerning any possible furture role for the panel. Also in the same statemant each party shall state whether it believes an in court status conference would be advisable and if so what matters should be addressed. Finally, the statement should discuss what(if andy) relationship to, or impact on this case the Jasmine v. County of Los Angleles BC 303732. (see minutes) court reporter: Not Available. (yc, ) (Entered: 05/06/2005)
281 NOTICE OF MOTION AND MOTION for Review of Magistrate Judge's Ruling filed by Defendant Rita Saenz AND Diana Bonta. Motion set for hearing on 6/6/2005 at 10:00 AM before Honorable A. Howard Matz. Lodged Proposed Order. (yl, ) (Entered: 05/23/2005)
282 MEMORANDUM OF POINTS AND AUTHORITIES in Support of MOTION for Review of Magistrate Judge's Ruling 281 filed by Defendants Rita Saenz and Diana Bonta. (yl, ) (Entered: 05/23/2005)
275 STATEMENT to court regarding future advisory panel role filed by Plaintiffs (yc, ) (Entered: 05/17/2005)
276 STATEMNET IN RESPONSE to Court May 5, 2005 Minute Order 274 filed by Defendants Rita Saenz, Diana Bontato. (jp, ) (Entered: 05/20/2005)
277 STATEMENT OF LOS ANGELES COUNTY IN RESPONSE to Order of May 5, 2005 274 filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Servicesto. (jp, ) (Entered: 05/20/2005)
279 PRELIMINARY OBJECTIONS to plaintiffs proposed supplemental responses; exhibits filed by Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 05/23/2005)
280 PRELIMINARY OBJECTIONS TO PLAINTIFF proposed supplemental response; Exhibits filed by Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 05/23/2005)
278 ORDER by Judge Stephen J. Hillman : the documents listed below were improperly filed for the following reasons: Preliminary document need not be filed; State Defendant's Preliminary Objection to plaintiff's proposed Supplemental Volume 1 and Vol 2.(sbu, ) (Entered: 05/23/2005)
283 DECLARATION of Kyle R Gehrmann in support of re MOTION for Review of Magistrate Judge's Ruling 281 , filed by Plaintiffs Katie A, Mary B. (yc, ) (Entered: 05/24/2005)
284 OPPOSITION to state defendants MOTION for Review of Magistrate Judge's Ruling 281 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 05/25/2005)
285 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. re Declaration (non−motion) 283 , Response in Opposition to Motion 284 , was served on 5/23/2005. (yc, ) (Entered: 05/25/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 40 of 92

05/23/2005
05/26/2005 05/31/2005 05/31/2005 05/31/2005 05/31/2005 06/02/2005 06/02/2005 06/03/2005 06/06/2005
06/06/2005
06/06/2005 06/16/2005 06/16/2005 07/11/2005 07/12/2005 07/12/2005 07/12/2005 07/14/2005

286 MINUTES by Judge A. Howard Matz : The court has reviewed the parties, respective statement in response to the 5/5/2005 order. At its next regularty−scheduled session in Los Angeles on June 1,2005, the court requests the Advisory Panel to address the following questions and to state its views as to those questions in the final report (currently due on or about June 16,2005). (see minutes for details)Court Reporter: Not Available. (yc, ) (Entered: 05/27/2005)
287 JOINT REQUEST to District Court Judge for Ruling filed by defendants Rita Saenz, Diana Bonta. Lodged Proposed Order. (ca, ) (Entered: 06/02/2005)
291 DECLARATION of Sandra L. Goldsmith in support re MOTION for Review of Magistrate Judge's Ruling 281 filed by defendants Rita Saenz, Diana Bonta. (yc, ) VOL 2 OF 4. (Entered: 06/08/2005)
292 DECLARATION of Sandra L. Goldsmith in support of re MOTION for Review of Magistrate Judge's Ruling 281 VOL 3 OF 4 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 06/08/2005)
293 DECLARATION of Sandra L. Goldsmith in support of re MOTION for Review of Magistrate Judge's Ruling 281 filed by defendants Rita Saenz, Diana Bonta. (yc, ) VOL 4 OF 4 (Entered: 06/08/2005)
294 REPLY to opposition MOTION for Review of Magistrate Judge's Ruling 281 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 06/08/2005)
288 ORDER RE JOINT REQUEST TO DISTRICT COURT JUDGE FOR RULING by Judge A. Howard Matz granting 287 Request for Order (smo, ) (Entered: 06/02/2005)
PLACED IN FILE − NOT USED re proposed orer re joint request to district court judge for ruling (Entered: 06/08/2005)
295 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D. re MOTION for Review of Magistrate Judge's Ruling 281 , was served on 5/23/2005. (yc, ) (Entered: 06/08/2005)
289 MINUTES OF Motion Hearing held before Judge A. Howard Matz :, Court denies MOTION for Review of Magistrate Judge's Ruling 281 . Court orders plaintiffs to provide defendants, within 30 days, with the actual names of the children themselves.Court Reporter: Leslie A. King. (smo, ) (Entered: 06/06/2005)
296 MINUTES by Judge A. Howard Matz :, RE: MOTION for Review of Magistrate Judge's Ruling 281 is DENIES. The court however orders plaintiffs to provide defendants within thirty days with the actual names of the children themselves. Court Reporter: Leslie A King. (yc, ) (Entered: 06/08/2005)
297 NOTICE OF CLERICAL ERROR: Due to clerical error Re: Minutes, 296 this document was enter twice by mistake. (yc, ) (Entered: 06/08/2005)
298 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 6/06/05 Court Reporter: Leslie A. King (nm, ) (Entered: 06/17/2005)
299 TRANSCRIPT filed for proceedings held on 6/06/05. Court Reporter: Leslie A. King. (nm, ) (Entered: 06/17/2005)
304 NOTICE of unavailability of counsel filed by state defendants Rita Saenz, Diana Bonta. (dmjr, ) (Entered: 07/22/2005)
301 APPLICATION to Withdraw as Attorney filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Lodged order. (dmjr, ) (Entered: 07/22/2005)
302 DECLARATION of Robert Garcia re APPLICATION to Withdraw as Attorney 301 filed by plaintiffs. (dmjr, ) (Entered: 07/22/2005)
303 PROOF OF SERVICE filed by plaintiffs re APPLICATION to Withdraw as Attorney 301 , Declaration (Motion related) 302 , was served on 7/12/5. (dmjr, ) (Entered: 07/22/2005)
305 NOTICE of stipulated agreement re advisory panel filed by County defendants (dmjr, ) (Entered: 07/22/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 41 of 92

07/19/2005
07/22/2005 07/22/2005 08/08/2005 09/01/2005 09/01/2005 09/01/2005 09/01/2005
09/06/2005 09/09/2005 09/09/2005 09/09/2005 09/09/2005 09/09/2005 09/09/2005 09/09/2005

300 STIPULATED ORDER Regardint Extension of Court Jurisdiction and Advisory Panel Assitance by Judge A. Howard Matz that 1) The Advisory Panel shall submit the report currently due to the Court on or about July 16, 2005, by no later than August 16, 2005. Toe the extent possible, this report shall include the proposed corrective action plan required by this Court Order of May 27, 2005 and paragraph 19 of the Settlement Agreement or, alternative, shall identify those areas where the County Defendants and the Advisory Panel are unable to agree on appropriate corrective action (see document further details). (jp, ) (Entered: 07/19/2005)
306 DECLARATION of Sandra l. Goldsmith filed by Defendants Rita Saenz, Diana Bonta. re revised notice of unabailability of State defendants counsel.(yc, ) (Entered: 07/25/2005)
307 REVISED NOTICE of unavailability of state defendants counsel. filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 07/25/2005)
308 NOTICE of unavailability of plaintiffs counsel, Robert D. Newman filed by plaintiff Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 08/12/2005)
310 EX PARTE APPLICATION for Leave to to file memorandum of points and authorities in excess of twenty−five pages filed by plaintiffs Katie A, Mary B, Janet C, Henry D. Lodged PROPOSED ORDER. (yc, ) (Entered: 09/07/2005)
311 MEMORANDUM of points and authorities in Support of EX PARTE APPLICATION for Leave to to file memorandum of points and authorities in wexcess of twenty−five pages 310 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 09/07/2005)
312 DECLARATION of Robert D Newman in support re EX PARTE APPLICATION for Leave to to file memorandum of points and authorities in wexcess of twenty−five pages 310 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 09/07/2005)
313 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D. re EX PARTE APPLICATION for Leave to to file memorandum of points and authorities in wexcess of twenty−five pages 310 , Memorandum in Support of Motion 311 , Declaration (Motion related) 312 , was served on 9/1/2005. (yc, ) (Entered: 09/07/2005)
314 ORDER by Judge A. Howard Matz : granting 310 Ex Parte Application for Leave. Plaintiff are granted leave to file a memorandum of points and authorities in support of their motion for preliminary injunction exceeding 25 pages, but not to exceed 35. (yc, ) (Entered: 09/07/2005)
315 NOTICE OF MOTION AND MOTION for Preliminary Injunction filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 10/3/2005 at 10:00 AM before Honorable A. Howard Matz. Lodged PROPOSED ORDER. (yc, ) (Entered: 09/15/2005)
316 MEMORANDUM of points and authorities in Support of MOTION for Preliminary Injunction 315 filed by PLAINTIFFS Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
317 DECLARATION of in support of re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
318 Exhibits in support of re MOTION for Preliminary Injunction 315 VOLUME I OF III. filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
319 DEPOSITION EXCERPTS re MOTION for Preliminary Injunction 315 filed by PLAINTIFFS Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
320 DECLARATION of in support re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 09/15/2005)
321 EXHIBITS IN SUPPORT MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 42 of 92

09/09/2005 09/09/2005 09/09/2005
09/09/2005
09/19/2005
09/19/2005 09/22/2005 09/23/2005 09/23/2005 09/27/2005 09/27/2005

322 EXHIBITS in support of MOTION for Preliminary Injunction 315 volume III of III filed by PLAINTIFFS Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
323 DECLARATION of in support of re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 09/15/2005)
324 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. re Motion Related Document 318 , Motion Related Document 319 , Declaration (Motion related) 320 , MOTION for Preliminary Injunction 315 , Motion Related Document 321 , Memorandum in Support of Motion 316 , Motion Related Document 322 , Declaration (Motion related) 323 , Declaration (Motion related) 317 , was served on 9/9/2005. (yc, ) (Entered: 09/15/2005)
325 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D. re Motion Related Document 318 , Motion Related Document 319 , Declaration (Motion related) 320 , MOTION for Preliminary Injunction 315 , Motion Related Document 321 , Memorandum in Support of Motion 316 , Motion Related Document 322 , Declaration (Motion related) 323 , Declaration (Motion related) 317 , was served on 9/9/2005. (yc, ) (Entered: 09/15/2005)
326 STIPULATION AND ORDER by Judge A. Howard Matz : re MOTION for Preliminary Injunction 315 ., Resetting hearing and deadline as to MOTION for Preliminary Injunction 315 Motion set for hearing on 10/31/2005 at 10:00 AM before Honorable A. Howard Matz. and that plaintiff and State Defendants comply with the followinf briefing schedule for the filing of state defendants oppositon papers and plaintiffs reply papers; State defendants shall file and serve their opposition papers no later than 10/11/2005. State defendants shall deliver their opposition papers to the office of plaintiff counsel no later thatn noon on 10/11/2005. Plaintiffs shall file and serve their reply papers no later than 10/24/2005. Plaintiff shall deliver their reply papers to the office of the state defendants counsel no later than 4pm on 10/24/2005.(yc, ) (Entered: 09/21/2005)
329 DECLARATION of Sandra L. Goldsmith in support of stipulation between plaintiffs and state defendants re continuation of hearing on plaintiffs MOTION for Preliminary Injunction 315 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 09/28/2005)
330 RESPONSE to county 9/15/2005 letter to court re plan pursuant to settlement agreement. filed by Plaintiffs Katie A, Mary B, Janet C, Henry D (yc, ) (Entered: 09/28/2005)
327 APPLICATION of non−resident attorney to appear in a specific case (attorney Alison N Barkoff to Appear Pro Hac Vice) filed by plaintiffs, Katie A, Mary B, Janet C, Henry D, Gary E. FEE PAID. Lodged order. (sv) (Entered: 09/26/2005)
331 AMENDED PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D. re MOTION for Preliminary Injunction 315 , was served on 9/12/2005. (yc, ) (Entered: 09/28/2005)
328 APPLICATION AND ORDER of Non−Resident Attorney to Appear in a Specific Case by Alison N. Barkoff as counsel for Plaintiff Katie A, Approved by Judge A. Howard Matz.(yc, ) (Entered: 09/28/2005)
332 MINUTES OF IN CHAMBERS ORDER by Judge A. Howard Matz : Having reviewed the parties' various recent letters and court−filed documents, the Court ORDERS as follows: (1) Court thanks the Advisory Panel for its thoughtful and extensive Fifth Report. Plaintiffs shall file a copy of that Fifth Report with the Court, so that interested parties may have ready access to it; (2) The County's counsel shall not mail letters to the Court; consistent with Local Rule 83−2.11, all communications shall be filed; (3) If the County has revised in any way the plan it submitted to the Board of Supervisors (now expected to be addressed at the Board's 10/11/05 meeting ), it shall promptly provide the other parties with copies of the revisions. Counsel for the County presumably have provided each of the Supervisors with copies of the Panel's Fifth Report; if not, they shall do so forthwith; and (4) To the extent that the State, in opposing the plaintiffs' motion for a preliminary injunction (on calendar for 10/31/05), proffers evidence or makes contentions that the County believes affects its ability to comply with the Settlement Agreement, the County may thereafter file a statement of

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10/04/2005 10/12/2005 10/12/2005 10/13/2005
10/13/2005
10/13/2005 10/13/2005
10/13/2005 10/13/2005 10/13/2005 10/13/2005 10/13/2005 10/13/2005
10/13/2005
10/13/2005
10/13/2005 10/13/2005 10/13/2005 10/13/2005
10/13/2005

its position on what the State filed. The County shall do so by not later than 10/24/05.Court Reporter: Not Reported. (smo, ) (Entered: 09/29/2005)
333 ADVISORY PANEL FIFTH REPORT TO THE COURT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/06/2005)
334 OBJECTIONS to evidence in support of MOTION for Preliminary Injunction 315 filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 10/14/2005)
335 OPPOSITION to MOTION for Preliminary Injunction 315 filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 10/14/2005)
336 DECLARATION of in support of opposition to re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. VOLUME III OF VI(yc, ) (Entered: 10/17/2005)
337 DECLARATION of in support of state opposition re MOTION for Preliminary Injunction 315 filed by DEFENDANTS Diana Bonta. VOLUME IV OF VI(yc, ) (Entered: 10/17/2005)
338 DECLARATION of in support of opposition re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
339 DECLARATION of in support of opposition to re MOTION for Preliminary Injunction 315 filed by state defendants Diana Bonta. VOLUME VI OF VI(yc, ) (Entered: 10/17/2005)
340 DECLARATION of in support of oppositon re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
341 DECLARATION of in support of oppositon to re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
342 EXHIBITS IN SUPPORT OF MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. VOLUME I OF III (yc, ) (Entered: 10/17/2005)
343 Exhibits re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. VOLUME II OF III(yc, ) (Entered: 10/17/2005)
344 EXHIBITS re MOTION for Preliminary Injunction 315 filed by State defendants Diana Bonta. VOLUME III OF III.(yc, ) (Entered: 10/17/2005)
345 DEPOSITIONS in support of state defendants opposition to MOTION for Preliminary Injunction 315 filed by STATE DEFENDANTS Diana Bonta. (yc, ) (Entered: 10/17/2005)
346 Deposition in support of state defendants opposition to plaintiff's MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. VOLUME VI OF XII (yc, ) (Entered: 10/17/2005)
347 DEPOSITION IN SUPPORT OF OPPOSITION MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. volume v of xii(yc, ) (Entered: 10/17/2005)
348 DEPOSITION IN SUPPORT OF OPPOSITION MOTION for Preliminary Injunction 315 filed by state defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
349 DEPOSITIONS in support of opposition MOTION for Preliminary Injunction 315 filed by STATE DEFENDANTS Diana Bonta. (yc, ) (Entered: 10/17/2005)
350 DEPOSITIONS IN SUPPORT of opposition to MOTION for Preliminary Injunction 315 filed by state defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
351 DEPOSITIONS in support of state opposition to MOTION for Preliminary Injunction 315 filed by state defendants Diana Bonta. VOLUME VII OF XII(yc, ) (Entered: 10/17/2005)
352 DEPOSITIONS in support of opposition MOTION for Preliminary Injunction 315 filed by State defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 44 of 92

10/13/2005 10/13/2005 10/13/2005 10/13/2005 10/13/2005 10/14/2005 10/18/2005 10/21/2005
10/21/2005 10/21/2005 10/24/2005 10/24/2005 10/24/2005 10/24/2005 10/24/2005 10/24/2005
10/27/2005 10/27/2005
10/27/2005

353 DEPOSITIONS OPPOSITION TO MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
354 DEPOSITION in suppo0rt of opposition to plaintiff MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. VOLUME II OF XII(yc, ) (Entered: 10/17/2005)
355 Depositions in support of opposition to MOTION for Preliminary Injunction 315 filed by STATE DEFENDANTS Diana Bonta. (yc, ) (Entered: 10/17/2005)
356 DEPOSITIONS in support of opposition re MOTION for Preliminary Injunction 315 filed by State Defendants Diana Bonta. (yc, ) (Entered: 10/17/2005)
358 PROOF OF SERVICE filed by State Defendants Diana Bonta. was served on 10/11/2005.regarding opposition (yc, ) (Entered: 10/17/2005)
357 RESPONSE to 9/27/2005 order filed by county defedants David − Sanders. (yc, ) (Entered: 10/17/2005)
359 NOTICE of plaintiffs to lodge original depositon transcripts in their custody. filed by state defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 10/20/2005)
360 STATEMENT of Position regarding Plaintiffs Motion for Preliminary Injunction 315 filed by County Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (ir, ) (Entered: 10/25/2005)
361 DECLARATION of Brandon T Nichols and Exhibits in support of County Defendants Statement of Position regarding Motion for Preliminary Injunction 315 filed by County Defendants. (ir, ) (Entered: 10/25/2005)
362 NOTICE OF ERRATA filed by Defendant Diana Bonta. to opposition to MOTION for Preliminary Injunction 315 (yc, ) (Entered: 10/26/2005)
363 OBJECTIONS TO STATE DEFENDANTS EVIDENCE IN OPPOSITION TO re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/26/2005)
364 REPLY memorandum in support of their MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/26/2005)
365 ADDITIONAL EXHIBITS in support of MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/26/2005)
366 RESPONSE to objection to plaintiffs evidence in support of MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/26/2005)
367 SUPPLEMENTAL DECLARATIONS re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 10/26/2005)
368 PROOF OF SERVICE filed by plaintiff Katie A, Mary B, Janet C, Henry D, re Motion Related Document 363 , Reply (Motion related) 364 , Motion Related Document 365 , Response to Motion 366 , Motion Related Document 367 , was served on 10/24/2005. (yc, ) (Entered: 10/26/2005)
370 Advisory Panel's Letter in responsent to County compliance plan entitled "Countywide Enhanced Specialized Mental Health Services Joint Plan" (jp, ) (Entered: 11/01/2005)
373 EX PARTE APPLICATION to Continue the hearing on plaintiffs motion for preliminary injunction to allow state defendants to respond to new evidence submitted by plaintiffs with their reply brief from 10/31/05 to 11/14/05 filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 11/02/2005)
374 DECLARATION of Sandra L. Goldsmith in support of EX PARTE APPLICATION to Continue the hearing on plaintiffs motion for preliminary injunction to allow state defendants to respond to new evidence submitted by plaintiffs with their reply brief from 10/31/05 to 11/14/05 373 filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 11/02/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 45 of 92

10/27/2005 10/27/2005
10/27/2005 10/28/2005 10/31/2005
10/31/2005 10/31/2005 10/31/2005 10/31/2005 11/04/2005 11/07/2005 11/07/2005 11/07/2005 11/17/2005 11/18/2005 11/18/2005

375 NOTICE of portions of deposition transcripts marked filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 11/02/2005)
376 DECLARATION of Rita McCabe in support of EX PARTE APPLICATION to Continue the hearing on plaintiffs motion for preliminary injunction to allow state defendants to respond to new evidence submitted by plaintiffs with their reply brief from 10/31/05 to 11/14/05 373 filed by defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 11/02/2005)
377 OBJECTIONS to new evidence submitted with plaintiffs reply memorandum in support of their motion for preliminary injunction filed by Defendants Rita Saenz, Diana Bonta. (ca, ) (Entered: 11/02/2005)
372 OPPOSITION to ex parte application to continue the hearing on plaintiffs motion for preliminary injunction filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (ca, ) (Entered: 11/02/2005)
369 MINUTES OF Motion Hearing held before Judge A. Howard Matz : Court questions counsel and takes Plaintiffs' MOTION for Preliminary Injunction UNDER SUBMISSION. Court orders the parties to monitor new case law regarding EPSDT and to promptly notify this Court of any developments. Court orders the parties to exchange proposals regarding the possible appointment of a special master. Court invites the parties to submit, by no later than 11/7/05, a document, not to exceed three pages in length, identifying the most important exhibits, declarations, and depositions upon which they rely.Court Reporter: Leslie A. King. (smo, ) (Entered: 11/01/2005)
371 DENIED ORDER by Judge A. Howard Matz,REGARDING EX PARTE APPLICATION TO CONTINUE THE HEARING. (yc, ) (Entered: 11/01/2005)
378 DECLARATION of Sandra L Goldsmith re MOTION for Preliminary Injunction 315 filed by State Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 11/02/2005)
379 RESPONSE to objection to evidence in opposition to MOTION for Preliminary Injunction 315 filed by State Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 11/02/2005)
380 NOTICE OF LODGING OF ELECTRONIC COPY OF TRANSCRIPT OF DEPOSITION OF RITA McCabe taken re MOTION for Preliminary Injunction 315 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 11/02/2005)
381 MINUTES OF IN CHAMBERS ORDER by Judge A. Howard Matz : Pursuant to Sandra L. Goldsmith's oral request, the Court is temporarily returning to her today the box of deposition transcripts that were left at the Court's courtesy box for resubmission.Court Reporter: Not Reported. (smo, ) (Entered: 11/04/2005)
382 SUMMARY OF MOST IMPORTANT EXHIBITS, DECLARATION AND DEPOSITION EXCERPTS IN SUPPORT OF THEIR MOTION re MOTION for Preliminary Injunction 315 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 11/08/2005)
383 Citations to additional excerpts from depositonof Rita McCabe filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 11/08/2005)
386 RESPONSE to Court Order dated October 31, 2005 regarding Identification of most important exhibits, Declarations and Depositions upon which they rely 371 filed by Defendants Rita Saenz, Diana Bontato. (jp, ) (Entered: 11/21/2005)
387 NOTICE of Change of Address by Alissa Beth Kolek, Ronald C Peterson attorney for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E, changing address to 333 South Hope Street, Suite 3900; Los Angeles CA 90071−3043. Filed by plaintiffs All plainitts (yc, ) (Entered: 11/22/2005)
384 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 10/31/05 Court Reporter: Leslie A. King (mo, ) (Entered: 11/18/2005)
385 TRANSCRIPT filed for proceedings held on 10/31/05. Court Reporter: Leslie A. King. (mo, ) (Entered: 11/18/2005)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 46 of 92

12/07/2005 12/21/2005
12/22/2005 01/03/2006
01/03/2006 01/09/2006 01/12/2006 01/12/2006 01/27/2006 02/14/2006 02/14/2006 02/27/2006 02/27/2006 02/28/2006 03/06/2006

388 December 6, 2005 Letter to the advisory panel from Los Angeles County (twdb, ) (Entered: 12/13/2005)
389 MINUTES OF IN CHAMBERS ORDER by Judge A. Howard Matz : Court hereby ORDERS Plaintiffs to submit a supplemental brief by not later than 1/3/06, not to exceed four (4) pages in length, discussing whether and how, absent a waiver, Title IV−E funds may be used to pay for wraparound and therapeutic foster care. Plaintiffs should not submit new copies, or portions thereof, of any exhibits, depositions, and/or declarations that have already been filed with the Court. If necessary, however, Plaintiffs may provide a succinct declaration in support of their brief. Because the State Defendants have sufficiently argued their position, they will not have the opportunity to file a response.Court Reporter: Not Reported. (smo, ) (Entered: 12/21/2005)
390 STATUS REPORT regarding exchange of proposals as to special masters filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (ca, ) (Entered: 01/03/2006)
391 MINUTES OF IN CHAMBERS ORDER by Judge A. Howard Matz : The Court has received Plaintiffs' supplemental brief regarding the use of Title IV−E funds to pay for wraparound and therapeutic foster care. The State Defendants, if they so choose, may file a response, not exceeding four pages in length, by not later than 1/9/06.Court Reporter: Not Reported. (smo, ) (Entered: 01/04/2006)
392 Plaintiffs' Supplemental BRIEF regarding use of Title IV−E Funds to Pay for Wraparound and Therapeutic Foster Care filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (shb, ) (Entered: 01/11/2006)
394 RESPONSE filed by Defendants Rita Saenz, Diana Bontato Brief 392 (yc, ) (Entered: 01/20/2006)
393 STATUS REPORT filed by Defendants Rita Saenz, Diana Bonta. regarding exchange of proposals as to special master and objections to plaintiffs purported status report regarding exchange of proposals as to special masters and to plaintiffs ex parte communications with the court. (yc, ) (Entered: 01/20/2006)
395 DECLARATION of Sandra L. Goldsmith re Status Report, 393 filed by Defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 01/20/2006)
396 NOTICE OF RECENT EPSDT DECISION filed by plaintiffs (esa, ) (Entered: 02/07/2006)
397 MEMORANDUM of Points and Authorities in Support of their motion to compel county defendants compliance with settlement agreement. filed by plaintiff Katie A, Mary B. (yc, ) (Entered: 02/16/2006)
398 NOTICE OF MOTION AND MOTION to Compel County Defendants Compliance with Settlement Agreement filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 3/13/2006 at 10:00 AM before Judge A. Howard Matz. Lodged Proposed Order. (jp, ) (Entered: 02/24/2006)
399 OPPOSITION to MOTION to Compel County Defendants Compliance with Settlement Agreement 398 filed by defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (jag, ) (Entered: 03/06/2006)
400 DECLARATIONS in support of OPPOSITION to MOTION to Compel County Defendants Compliance with Settlement Agreement 398 filed by defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (jag, ) (Entered: 03/06/2006)
401 NOTICE OF ERRATA Regarding Opposition to Motion to Compel County Defendants Compliance with Settlement Agreement 399 filed by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (jp, ) (Entered: 03/10/2006)
404 DECLARATION of Kimberly Lewis re MOTION for Order for to Compel County Defendants Compliance with Settlement Agreement 398 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 03/17/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 47 of 92

03/06/2006 03/10/2006
03/14/2006 03/14/2006
03/15/2006 03/15/2006 03/23/2006 03/23/2006 03/23/2006 03/27/2006 03/27/2006 03/27/2006 03/28/2006
03/28/2006
03/28/2006 03/28/2006

405 REPLY in support of MOTION for Order for to Compel County Defendants Compliance with Settlement Agreement 398 filed by plaintiffs Children's Rights Inc, Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 03/17/2006)
402 MINUTES OF IN CHAMBERS ORDER by Judge A. Howard Matz : On the Court's own motion, the Court hereby takes OFF−CALENDAR and UNDER SUBMISSION plaintiffs' Motion to Compel County Defendants' Compliance with Settlement Agreement 398 . The parties will be notified if a hearing is necessary. Court Reporter: Not Reported. (smo, ) (Entered: 03/10/2006)
403 ORDER by Judge A. Howard Matz, re MOTION for Preliminary Injunction 315 is granted. (see document for details)(yc, ) (Entered: 03/14/2006)
407 NOTICE of Change of Attorney Information: adding Brandon T. Nichols as attorney as counsel of record for County of Los Angeles, Los Angeles County Department of Children and Family Service, David Sanders for the reason indicated in the G−06 Notice. Adding Brandon T Nichols for David − Sanders and Los Angeles County Department of Children and Family Services as attorney as counsel of record for the reason indicated in the G−06 Notice. Filed by defendants David − Sanders, Los Angeles County Department of Children and Family Services (yc, ) (Entered: 03/21/2006)
406 NOTICE OF TRANSCRIPT REIMURSEMENT PURSUANT TO BUSINESS AND PROFESSIONS CODE filed by PLAINTIFFS Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 03/17/2006)
PLACED IN FILE − NOT USED re proposed order granting plaintiff motion for preliminary injuction submitted by plaintiffs Katie A, Mary B. (yc, ) (Entered: 03/17/2006)
408 Mail Returned addressed to Lin Min Kong re 402 In Chambers Order (bg, ) (Entered: 03/27/2006)
409 Mail Returned addressed to Lew Hollman re 402 In Chambers Order (bg, ) (Entered: 03/27/2006)
410 Mail Returned addressed to Laura N Diamond re 402 In Chambers Order(bg, ) (Entered: 03/27/2006)
421 Mail Returned addressed to Laura N Diamond re 403 Order (shb, ) (Entered: 04/04/2006)
422 Mail Returned addressed to Lew Hollman re 403 Order (shb, ) (Entered: 04/04/2006)
423 Mail Returned addressed to Lin Min Kong re 403 Order (shb, ) (Entered: 04/04/2006)
411 STATE DEFENDANTS NOTICE OF MOTION AND MOTION for Reconsideration OF ORDER GRANTING PLAINTIFFS MOTION FOR PRELIMINARY INJUNCTION 403 ; MEMORANDUM OF POINTS AND AUTHORITIES IN SUPPORT THEREOF filed by State Defendants Rita Saenz, Diana Bonta. Motion set for hearing on 4/17/2006 at 10:00 AM before Judge A. Howard Matz. Lodged proposed order. (shb, ) (Entered: 03/30/2006)
412 State Defendants' NOTICE OF MOTION AND MOTION for clarification and/or correction of order granting plaintiffs motion for preliminary injunction; Memorandum of points and authorities in support thereof filed by Defendants Rita Saenz, Diana Bonta. Motion set for hearing on 4/17/2006 at 10:00 AM before Judge A. Howard Matz. Lodged proposed order. (shb, ) (Entered: 03/30/2006)
413 DECLARATION of Donna Richardson in support of State Defendants' MOTION for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) (Entered: 03/30/2006)
414 DECLARATION of Sara Jane Gilb in support of State Defendants MOTION for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) (Entered: 03/30/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 48 of 92

03/28/2006 03/28/2006 03/28/2006
03/30/2006
03/30/2006 03/30/2006 04/06/2006 04/06/2006 04/07/2006
04/10/2006 04/10/2006 04/10/2006

415 DECLARATION of Sandra L Goldsmith MOTION for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) (Entered: 03/30/2006)
416 DECLARATION of Barbara Lemus in support of State Defendants MOTION for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) (Entered: 03/30/2006)
417 STATE DEFENDANTS' NOTICE OF MOTION AND MOTION for Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction; Memorandum of points and authorities in support thereof filed by Defendants Rita Saenz, Diana Bonta. Motion set for hearing on 4/17/2006 at 10:00 AM before Judge A. Howard Matz. Lodged proposed order. (shb, ) (Entered: 03/30/2006)
418 STATE DEFENDANTS' AMENDED NOTICE OF MOTION AND MOTION FOR STAY PENDING DETERMINATION OF STATE DEFENDANTS' MOTIONS CLARIFICATION AND/OR CORRECTION OF ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCITON 417 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) Modified on 4/4/2006 (shb, ). (Entered: 04/04/2006)
419 State Defendants Amended Notice of Motion and Motion for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Defendants Rita Saenz, Diana Bonta. (shb, ) (Entered: 04/04/2006)
420 State Defendants AMENDED NOTICE OF MOTION AND MOTION FOR RECONSIDERATION OF ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION 403 411 filed by Defendant Rita Saenz, Diana Bonta. (shb, ) (Entered: 04/04/2006)
424 EX PARTE APPLICATION for Order for granting plaintiffs motion for preliminary injunction pending determination of state defendants motions for clarification and or correction reconsideration and stay of order granting plaintiff motion for preliminary injuctions Memorandum of points and authorities. filed by defendants Diana Bonta. (yc, ) (Entered: 04/10/2006)
425 DECLARATION of Sandra L. Goldsmith re EX PARTE APPLICATION for Order for granting plaintiffs motion for preliminary injunction pending determination of state defendants motions for clarification and or correction reconsideration and stay of order granting plaintiff motion for preliminary i 424 filed by defendants Diana Bonta. (yc, ) (Entered: 04/10/2006)
427 SUPPLEMENT declaration of Sandra L. Goldsmith in support of EX PARTE APPLICATION for Order for granting plaintiffs motion for preliminary injunction pending determination of state defendants motions for clarification and or correction reconsideration and stay of order granting plaintiff motion for preliminary i 424 filed by defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (yc, ) (Entered: 04/11/2006)
429 PLAINTIFF'S MEMORANDUM OF POINTS AND Authorities in Opposition to MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Plaintiff Katie A, Mary B, Janet C, Henry D and Gary E. (yl, ) (Entered: 04/17/2006)
430 PLAINTIFF'S MEMORANDUM OF POINTS AND Authorities in Opposition to MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D and Gary E. (yl, ) (Entered: 04/17/2006)
431 PLAINTIFF'S MEMORANDUM OF POINTS And Authorities in Opposition to State Defendants' MOTION for Reconsideration Of the Order Granting Preliminary Injunction 403 411 filed by Plaintiff Katie A, Mary B, Janet C, Henry D and Gary E. (yl, ) (Entered: 04/17/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 49 of 92

04/10/2006 04/10/2006
04/10/2006
04/10/2006
04/10/2006
04/10/2006
04/10/2006 04/10/2006 04/11/2006 04/12/2006
04/12/2006 04/13/2006 04/17/2006

432 DECLARATION of LEECIA WELCH In Opposition to MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yl, ) (Entered: 04/17/2006)
433 SUPPLEMENTAL DECLARATION of BRUCE J. KAMRADT In Opposition to MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by Plaintiffs Does, Katie A, Mary B, Janet C, Henry D, Gary E. (yl, ) (Entered: 04/17/2006)
434 SUPPLEMENTAL DECLARATION of ROBERT D. NEWMAN In Opposition MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yl, ) (Entered: 04/17/2006)
435 SUPPLEMENTAL DECLARATION of MINDY WATROUS In Opposition to MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by Plaintiff Katie A, Mary B, Janet C, Henry D and Gary E. (yl, ) (Entered: 04/17/2006)
436 DECLARATION of PATRICIA CHAMBERLIN In Support of MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by Plaintiff Katie A, Mary B, Janet C, Henry D and Gary E. (yl, ) (Entered: 04/17/2006)
437 PROOF OF SERVICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E, the Plaintiff's Memorandum of Points and Authorities in Opposition to State Defendant's Motion for Clarification and/or Correction of the Order Granting Preliminary Injunction, etc (see document for further details) was served on 4/10/2006. (yl, ) (Entered: 04/17/2006)
439 PROOF OF SERVICE filed by plaintifs Katie A, Mary B, Janet C, Henry D, Gary E, was served on 4/10/2006. (yc, ) (Entered: 04/18/2006)
446 PLAINTIFF'S OPPOSITION TO STATE DEFENDANT'S Ex Parte Application to Stay Order Granting Preliminary Injunction; Declaration of Robert D. Newman filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yl, ) (Entered: 04/24/2006)
426 ORDER by Judge A. Howard Matz, DENYING EX PARTE APPLICATION for Order for immediate stay of order granting plaintiffs motion for preliminary injunction pending determination of state defendants' motions for clarification and/or correction reconsideration, and stay of order 424 (smo, ) (Entered: 04/11/2006)
428 NOTICE OF PRELIMINARY INJUNCTION APPEAL/Representation Statement to 9th CCA filed by defendants Rita Saenz, Diana Bonta. Appeal of Order 403 Filed On: 03/14/06; Entered On: 03/14/06. Filing fee $455, Paid, receipt number 84273. cc: Sandra L. Goldsmith, Deputy Attorney Geneal; Mark D. Rosenbaum; Alissa Kolek; Robert D. Newman; Melinda Bird; Ira Burnim; Patrick Gardner; Gina Zaragoza−Curz; Raymond G. Fortner, Jr., County Counsel. (cbr, ) (Entered: 04/13/2006)
Civil Appeals Docketing Statement received from defendants Rita Saenz, Diana Bonta forwarded to 9th CCA. RE: Appeal to Circuit Court 428 (cbr, ) (Entered: 04/13/2006)
Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals re: Appeal to Circuit Court 428 (cbr, ) (Entered: 04/13/2006)
438 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : The State Defendants have appealed the Court's 3/14/06 Order Granting Plaintiffs' Motion for Preliminary Injunction. The State Defendants are ORDERED to SHOW CAUSE by not later than noon on 4/20/06, why their three motions on calendar for 4/24/06, should not be denied for mootness. Court Reporter: Not Reported. (smo, ) (Entered: 04/17/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 50 of 92

04/17/2006 04/17/2006 04/17/2006 04/17/2006 04/17/2006 04/19/2006
04/20/2006
04/20/2006 04/21/2006 04/24/2006
04/24/2006 04/24/2006 04/24/2006

440 REPLY to oppositon to MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 04/20/2006)
441 SUPPLEMENT to MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 04/20/2006)
442 REPLY to opposition to state defendants MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 04/20/2006)
443 REPLY to plaintiff opposition to MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 04/20/2006)
444 SUPPLEMENT declartion of Sandra L. Goldsmith in reply to plaintiffs opposition to state defendants MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by defendants Rita Saenz, Diana Bonta. (yc, ) (Entered: 04/20/2006)
445 TRANSCRIPT DESIGNATION AND ORDERING FORM For Dates: 10/10/02, 12/10/02; Court Reporter: Lynne Smith; 03/20/03, 05/12/03, 06/09/03, 07/16/03, 07/23/03, 07/23/03 (seal) Court Reporter: Hope Goldsmith; 02/05/04, Court Repoter: Jennifer Cheshire; 06/24/04, Kathy Mechanic; 07/28/04, Court Reporter: Leonore LeBlanc; 01/07/05, 02/24/05, Court Repoter: Dorothy Babykin; 06/06/05, 10/31/05, Court Reporter: Leslie A. King. Re: Appeal to Circuit Court, 428 (cbr, ) (Entered: 04/21/2006)
447 STATEMENT of on Courts' jurisdiction over state defednant pending motions re MOTION for Reconsideration re Order 403 411 , MOTION to Stay pending Determination of State Defendants' Motion for Clarification/correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 , MOTION for Order for to Compel County Defendants Compliance with Settlement Agreement 398 , MOTION for Order for clarification and/or correction of order granting plaintiffs motion for preliminary injunction 412 filed by plaintiffs Katie A, Mary B. (yc, ) (Entered: 04/25/2006)
448 RESPONSE filed by Defendant Diana Bontato 438 (yc, ) (Entered: 04/25/2006)
449 RESPONSE to plaintiffs statemetn on court's jurisdiction over state defendants pending 412 filed by defendants Diana Bonta. (yc, ) (Entered: 04/25/2006)
450 MINUTES OF Motion Hearing held before Judge A. Howard Matz : Court questions counsel and hears oral argument. For reasons stated on the record, the Court DENIES state defendants' MOTION to Stay pending Determination of State Defendants' Motion for Clarification/Correction and Reconsideration of Order Granting Plaintiff's Motion for Preliminary Injunction 417 , state defendants' MOTION for Reconsideration re Order 403 411 , and state defendants' MOTION for Order for Clarification and/or Correction of Order Granting Plaintiffs' Motion for Preliminary Injunction 412 . The Court orders the parties to obtain a copy of the transcript and for plaintiffs to file an addendum to the 3/14/06 Order Granting Plaintiffs' Motion for Preliminary Injunction. Court Reporter: Leslie A. King. (smo, ) (Entered: 04/26/2006)
PLACED IN FILE − NOT USED re Proposed Order Granting State Defendants' Motion for Clarification and/or Correction of Order Granting Plaintiffs' Motion for Preliminary Injunction submitted by State Defendants. (gk, ) (Entered: 05/02/2006)
PLACED IN FILE − NOT USED re Proposed Order Granting State Defendants' Motion for Stay of Order Granting Plaintiffs' Motion for Preliminary Injunction Pending Determination of State Defendants' Motions for Clarification and Reconsideration of the Order submitted by State Defendants. (gk, ) (Entered: 05/02/2006)
PLACED IN FILE − NOT USED re Proposed Order Granting State Defendants' Motion for Reconsideration of Order Granting Plaintiffs' Motion for Preliminary Injunction submitted by State Defendants. (gk, ) (Entered: 05/02/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 51 of 92

05/03/2006 05/03/2006 05/03/2006 05/10/2006 05/10/2006 05/12/2006 05/12/2006 05/12/2006 05/17/2006 05/17/2006 05/19/2006
05/23/2006 05/25/2006 06/06/2006 06/15/2006
06/15/2006 07/26/2006

451 Mail Returned addressed to 3250 Ocean Park Blvd Ste 300; Santa Monica CA 90405−3219 re 438 In Chambers Order/Directive − no proceeding held,, Set Deadlines, (yc, ) (Entered: 05/09/2006)
452 Mail Returned addressed to 3250 Ocean park Blvd, STe 300; Santa Monica CA 90405 re 438 In Chambers Order/Directive − no proceeding held,, Set Deadlines, (yc, ) (Entered: 05/09/2006)
453 Mail Returned addressed to 3250 Ocean Park Blvd Ste 300; Santa Monica CA 90405 re 438 In Chambers Order/Directive − no proceeding held,, Set Deadlines, (yc, ) (Entered: 05/09/2006)
455 NOTICE of lodging copy of transcript of 4/24/2006 hearing filed by plaintiffs Katie A, Mary B. (yc, ) (Entered: 05/16/2006)
456 OBJECTIONS TO PLAINTIFFS [PROPOSED] ADDENDUM TO ORDER GRANTING MOTION for preliminary injunction 412 filed by defendants Diana Bonta. (yc, ) (Entered: 05/16/2006)
454 ORDER by Judge A. Howard Matz, regarding addendum to order granting plainitffs motion for preliminary injuction. (see file)(yc, ) (Entered: 05/15/2006)
461 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following dates: 04/24/06 Court Reporter: Leslie King (cbr, ) (Entered: 05/25/2006)
462 TRANSCRIPT filed for proceedings held on 04/24/06. Court Reporter: Leslie King. (cbr, ) (Entered: 05/25/2006)
457 Letter from to the advisory panel (yc, ) (Entered: 05/19/2006)
458 NOTICE of Change of Attorney Information: Filed by defendant Los Angeles County attorny Brandon T. Nichols(yc, ) (Entered: 05/22/2006)
459 AMENDED NOTICE OF APPEAL to 9th CCA filed by defendants Rita Saenz, Diana Bonta. Amending Appeal 428 Filed 04/12/06. Appealling Order 450 filed on: 04/24/06, entered on 04/26/06; Order 403 filed on: 03/14/06, entered on: 03/14/06; Order 454 filed On: 05/12/06, entered On: 05/12/06, and interlocutory orders that gave rise to or are subsumed within the Order Granting Plaintiffs Motion for Preliminary Injunction. cc: Sandra L. Goldsmith; Mark D. Rosenbaum; Alissa Kolek; robert D. Newman; Melinda Bird; Ira Burnim; Patrick Gardner; Gina Zaragoza−Cruz; Raymond G. Fortner. (cbr, ) Modified on 5/23/2006 (cbr, ). (Entered: 05/22/2006)
460 JOINT STATUS REPORT filed by Defendants (yc, ) (Entered: 05/25/2006)
463 AMENDED TRANSCRIPT DESIGNATION AND ORDERING FORM For Dates: 4/24/06; Court Reporter: Leslie King; Court of Appeals Case Number: 06−55559; Re: Appeal to Circuit Court, 428 (ghap, ) (Entered: 06/13/2006)
465 NOTICE of departure of counsel Gina Zaragoza−Cruz filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (yc, ) (Entered: 06/26/2006)
464 ORDER by Judge A. Howard Matz : The Court currently contemplates requiring the foregoing "observations" to be the bases for modification of the Countys Plan. The Court will hold a Status Conference on 8/16/2006 03:00 PM. Dr Vincent and other members of the Panel are encouraged to attend. By not later than 7/31/06, the parties−including the State Defendants−shall file separate responses to this Order setting forth their respective positions as to these contemplated provisions. (bg, ) (Entered: 06/19/2006)
PLACED IN FILE − NOT USED re order re motion to compel submitted by plaintiffs Katie A. (yc, ) (Entered: 06/23/2006)
471 ORDER from 9th CCA filed as to Appeal to Circuit Court, 428 filed by Diana Bonta, Rita Saenz, CCA # 06−55559. Order received in this district on 08/03/06.Appellants motion for a stay pending appeal of the order granting plaintiffs motion for preliminary injunction, and addendum thereto, and all subsequent orders affecting defendants−appellants is denied. The previously established briefing schedule remains in effect.(cbr, ) (Entered: 08/17/2006)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 52 of 92

07/31/2006 07/31/2006 07/31/2006 08/08/2006
08/11/2006
08/17/2006 08/18/2006 08/18/2006 08/18/2006 08/18/2006 09/01/2006
09/05/2006 09/05/2006 09/06/2006
09/07/2006 09/07/2006 09/08/2006

466 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D to court 6/15/2006 order re plaintiffs motion re advisory panel plan 464 (yc, ) (Entered: 08/09/2006)
467 RESPONSE to order re plaintiffs motion re advisory panel and to letter from cimh date 5/24/2006 filed by defendants Diana Bonta. (yc, ) (Entered: 08/09/2006)
468 RESPONSE of Los Angeles County to order of 6/15/2006 filed by Defendant Diana Bonta (yc, ) (Entered: 08/09/2006)
469 ORDER by Judge A. Howard Matz,, Set Hearings: Status Conference set for 8/23/2006 03:00 PM before Judge A. Howard Matz. By not later then 8/18/2006 the parties shall file a joint status report not to exceed ten pages specifying the issues and their position(yc, ) (Entered: 08/09/2006)
470 NOTICE of Change of Attorney Information: changing address and firm name to American Civil Liberties Union of Southern California for attorney Melinda Bird. Filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (bb, ) (Entered: 08/15/2006)
473 REQUEST for Continuance of Status Conference from 8/23/2006 to 9/6/2006 filed by County Defendants County of Los Angeles, Los Angeles County Department of Children and Family Services, Anita Bock. (gk, ) (Entered: 08/27/2006)
472 MINUTES IN CHAMBERS before Judge A. Howard Matz: The Court CONTINUES the 8/23/2006 Status Conference to 9/6/2006 03:00 PM.Court Reporter: Not Appearanced. (jp) (Entered: 08/21/2006)
474 JOINT STATUS REPORT filed by plaintiff and State Defendants Director of California Department of Health Services and California Department of Social Services. (lc, ) (lc, ) (Entered: 08/29/2006)
475 EX PARTE APPLICATION to Continue status conference filed by County defendants (lc, ) Modified on 8/30/2006 (lc, ). (Entered: 08/29/2006)
FAX number for Attorney Katherine Melissa Fesler is 213−687−4745. (lc, ) (Entered: 08/30/2006)
476 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : Court has just reviewed the Advisory Panel's thoughtful letters of 7/31/06 and 8/30/06. At the hearing on 9/6/06 (at which, the Court hopes, Mr. Vincent will be present), the parties, especially the County, should be prepared to respond orally to the Panel's proposals at pages 6−7 of the first letter and 1−2 of the second letter. In addition, on 9/5/06 plaintiffs and the Advisory Panel shall file with the Court any response they made to the 12/6/05 letter of Brandon Nichols to Paul Vincent. Court Reporter: Not Reported. (smo, ) (Entered: 09/01/2006)
480 NOTICE OF LODGING State defendants request for judicial notice in ninth circuit court of appeals case no. 55559 filed by State Defendants Diana Bonta. (yc, ) (Entered: 09/11/2006)
481 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry to COURT 9/1/2006 ORDER 476 (yc, ) (Entered: 09/12/2006)
484 MINUTES OF Status Conference held before Judge A. Howard Matz : The parties are to notify the court by 10/23/2006, in the form of interim reports from each side or a joint report, of the following; finding of fact and law as well as propsed candidates for the position of special master. Court Reporter: Pamela Seijas. (yc, ) (Entered: 09/27/2006)
477 RECORD ON APPEAL sent to Circuit Court re: Appeal number, 06−55559 Record consists of 32 volumes and 35 brown folders re Appeal to Circuit Court, 428 (dmap, ) (Entered: 09/07/2006)
Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals; re: Appeal to Circuit Court, 428 (lr, ) (Entered: 09/07/2006)
478 RECEIPT OF REPORTERS TRANSCRIPT of proceedings for the following date: 9/6/2006 Court Reporter: Pamela A Seijas. (kks ) (Entered: 09/08/2006)

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09/08/2006 09/15/2006 09/18/2006 10/05/2006 10/06/2006
10/18/2006
10/18/2006 10/20/2006 10/23/2006 10/24/2006
10/24/2006 10/30/2006
11/01/2006 11/01/2006 11/13/2006
11/14/2006

479 TRANSCRIPT filed for proceedings held on 9/6/2006. Court Reporter: Pamela A Seijas. (kks ) (Entered: 09/08/2006)
482 Mail Returned addressed to 3250 Ocean Park Blvd STe 300 Santa Monica re 472 In Chambers Order/Directive − no proceeding held, Set Hearings (yc, ) (Entered: 09/21/2006)
483 Mail Returned addressed to Lin Min Kong re 469 Order,, Set Hearings, (bp, ) (Entered: 09/26/2006)
487 Mail Returned addressed to Lin Min Kong re 484 Status Conference, (pj, ) (Entered: 10/25/2006)
485 MINUTESIN CHAMBERS ORDER Regarding Status Conference before Judge A. Howard Matz: A Status Conference was held on 9/6/2006. Also present was Paul Vincent, Chair of the Katie A. Advisory Panel. The parties informed the court that oral argument on the expedited appeal is to be heard on 10/24/2006 at 09:00 AM. The Court ORDERS that the Advisory panel Letters dated Jul6y 28, 2006 and August 30, 2006 be filed. Accordingly, they are attached to this Order, as Exhibits A and B, respectively (see document for further details). Court Reporter: Not Reported. (jp) (Entered: 10/10/2006)
486 ORDER by Judge A. Howard Matz, Bood cause appearing, County Defendants and Plaintiffs stipulation for a continuance of the deadline to file joint finding of fact and conclusions of law form 10/23/2006 to 10/30/2006 to file their joint statement of facts and conclusion of law in hereby granted. (yc, ) (Entered: 10/19/2006)
497 STIPULATION to Continue of the deadline to file joint findings of fact and conclusione of law filed by County Defendants Diana Bonta. Lodged PROPOSED ORDER. (yc, ) (Entered: 11/16/2006)
488 NOTICE of order to continue the deadline to file joint finding of fact and conclusion of law. filed by County Defendants Diana Bonta. (yc, ) (Entered: 11/03/2006)
489 Joint report regardng proposed special master candidates filed by Plaintiffs Katie A, Mary B. (yc, ) (Entered: 11/03/2006)
490 NOTICE OF MOTION AND MOTION FOR clarification and /or corrections of minute order dated 10/6/2006 and entered 10/10/2006; Memorandum of points and authorities in support. filed by defendants Diana Bonta. Motion set for hearing on 11/27/2006 at 10:00 AM before Judge A. Howard Matz. Lodged PROPOSED ORDER. (yc, ) (Entered: 11/03/2006)
491 DECLARATION of Sandra L. Goldsmith re MOTION to Certify 490 filed by defendants Diana Bonta. (yc, ) (Entered: 11/03/2006)
496 JOINT SUBMISSION BY PLAINTIFFS AND COUJNTRY REGARDING THE PROPOSED FINDINGS OF FACT AND CONCLUSIONS OF LAW AS TO COUNTY DEFENDANTS COMPLIANCE WIHT ESETTLEMENT AGREEMENT. (yc, ) (Entered: 11/16/2006)
492 Mail Returned addressed to 3250 Ocean Park Blvd, Ste 300, Santa Moncia Ca 90405−3219 re 485 In Chambers Order/Directive − no proceeding held,,, Set Hearings,, (yc, ) (Entered: 11/13/2006)
493 Mail Returned addressed to 3250 Ocean Park Blvd, Ste 300, Santa Monica CA 90405 re 486 Order, (yc, ) (Entered: 11/13/2006)
494 JOINT STIPULATION AND ORDER by Judge A. Howard Matz Regarding Minute Order 485 dated 10/6/2006 (see document for further details.) FURTHER ORDERED that the Hearing on State Defendants MOTION 490 set for 11/27/2006 is hereby TAKEN OFF CALENDAR.(jp) (Entered: 11/14/2006)
495 JOINT STIPULATION AND ORDER by Judge A. Howard Matz : regarding proposed findings of fact and conclusion of law. THE PARTIES HEREBY STIPULATE THAT THE DATE OF 11/15/2006 be deleted from paragraphs 130 and 135 and language requiring the county to report within one week of the court's ruling on the proposed finding be substituted in its place. (see document)(yc, ) (Entered: 11/16/2006)

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11/16/2006
11/20/2006 11/27/2006 11/30/2006 12/01/2006 01/17/2007 02/01/2007
02/06/2007 02/20/2007
02/20/2007 02/20/2007 02/20/2007 02/20/2007 02/26/2007
02/26/2007 02/26/2007

498 MINUTES re amended order re status conference before Judge A. Howard Matz :(see minutes). Consel for the State defendants are hereby ORDERED to notify counsel for the defendant in Emily Q. v. Bonta et al No CR98−4181 AHW (AJWX) of every scheduled hearing in this case. Counsel in the Emily Q. case have been ordered to attend every such hearing. Court Reporter: Not reported. (yc, ) (Entered: 11/20/2006)
499 FINDINGS OF FACT AND CONCLUSIONS OF LAW signed by A. Howard Matz. re settlement agreement between plaintiffs and county; order thereon. (see file)(yc, ) (Entered: 11/21/2006)
502 STATEMENT time required for plan amendment. filed by Defendant Diana Bonta (yc, ) (Entered: 12/11/2006)
501 OBJECTIONS re Minute order dated 11/16/2006 nunc pro tunc as of 10/6/2006. filed by Defendant Diana Bonta. (yc, ) (Entered: 12/11/2006)
500 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : The State Defendants' nonsensical "objections" to the Court's 11/16/06 Order are noted. Counsel for those State Defendants shall comply with that Order notwithstanding their objections.Court Reporter: Not Reported. (smo, ) (Entered: 12/04/2006)
503 MINUTES held before Judge A. Howard Matz : for the reasons set forth in the attached letter, the advisory panel may delay issuance of its next report to 2/28/2007.Court Reporter: Not Available. (yc, ) (Entered: 01/19/2007)
504 STIPULATION ON FEES MOTION AND ORDER by Judge A. Howard Matz: The Court retains jurisdiction to determine whether Plaintiffs are entitled to recover reasonable attorneys fees, costs, and expenses incurred in connection with the MOTION to Compel Compliance 398 filed 2/13/06. If the parties are unable to otherwise reach an agreement, Plaintiffs counsel may file a motion addressing this issue by no later than 4/15/07. (mg, ) (Entered: 02/02/2007)
505 PROOF OF MAIL SERVICE filed by County defendants Rita Saenz, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services,e proposed Stipulation and Order, 504 , was served on 2/6/07. (lc, ) (Entered: 02/13/2007)
506 NOTICE of Change of Attorney Information: Attorney Ben Wizner will no longer receive service of documents from the Clerks Office for the reason indicated in the G−06 Notice.Ben Wizner is no longer attorney of record in this case for the reason indicated in the G−06 Notice. Filed by plaintiffs Katie A, Mary B, Janet C, Henry D (bb, ) (Entered: 02/22/2007)
507 NOTICE of Change of Attorney Information: changing address to ACLU Foundation of Southern California, 1616 Beverly Boulevard, Los Angeles, CA 90026, changing email to mbird@aclu−sc.org. for attorney Melinda Bird. Filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (ak, ) (Entered: 02/27/2007)
FAX number for Attorney Melinda R Bird is 213−250−3919. (ak, ) (Entered: 02/27/2007)
508 Mail Returned addressed to 1616 Beverly Blvd. P.O. Box 26907, Los Angeles Ca 90026−5752 re 504 Stipulation and Order, (yc, ) (Entered: 02/27/2007)
509 Mail Returned addressed to 1616 Beverly Blvd, P.O. box 26907, Los Angles Ca 90026−5752 re 504 Stipulation and Order, (yc, ) (Entered: 02/27/2007)
511 NOTICE OF MOTION AND MOTION in support of motion for enforcement and/or modification of the Preliminary Injunction :Declaration of Robert D. Newman. filed by plaintiffs Katie A, Mary B, Janet C, Henry D. Motion set for hearing on 3/19/2007 at 10:00 AM before Judge A. Howard Matz. Lodged ORDER. (yc, ) (Entered: 03/08/2007)
512 MEMORANDUM of points and authorities in Support of MOTION for enforcement and/or modification of the r Preliminary Injunction 511 filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 03/08/2007)
513 PROOF OF SERVICE filed by plaintiffs Katie A, Mary B, Janet C, Henry D, re Memorandum in Support of Motion 512 , MOTION to Enforce MOTION for

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03/01/2007 03/02/2007 03/05/2007
03/06/2007 03/12/2007 03/19/2007
03/22/2007 03/26/2007 03/26/2007 03/28/2007 04/16/2007 04/24/2007 05/14/2007 05/15/2007

Preliminary Injunction MOTION for Preliminary Injunction 511 , was served on 2/26/2007. (yc, ) (Entered: 03/08/2007)
514 NOTICE OF ERRATA filed by Plaintiffs Katie A, Mary B, Janet C, Henry D. correcting MOTION to Enforce MOTION for Preliminary Injunction MOTION for Preliminary Injunction 511 (yc, ) (Entered: 03/08/2007)
510 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : The Court GRANTS the request of the Panel to file its next report on or before 3/30/07.Court Reporter: Not reported. (bg, ) (Entered: 03/05/2007)
517 OPPOSITION to plaintiffs MOTION to Enforcement and/or modification of The Preliminary injunction: 511 Declaration of Karen Ackerson−Brazille. filed by defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (yc, ) (Entered: 03/21/2007)
515 NOTICE OF ERRATA filed by Defendants re exhibits to defendants opposition to plaintiffs MOTION for enforcement and/or modification of the Preliminary Injunction 511 (yc, ) (Entered: 03/08/2007)
518 REPLY in support of MOTION to Enforcement and/or modification of the preliminary injunction: supplemental 511 : Declaraton of Roberet D. Newman. filed by plaintiffs Katie A, Mary B, Janet C, Henry D. (yc, ) (Entered: 03/21/2007)
516 MINUTES Plaintiff motion for enforcement and/or modification of the preliminary injuction [filed 2/26/2007] before Judge A. Howard Matz :, RE: MOTION to Enforce MOTION for Preliminary Injunction MOTION for Preliminary Injunction 511 is GRANTED (as to item one only)in part and DENIED in part. Counsel for plaintiff is ordered to lodge a proposed order as to (I) the first item of relief with explicit assurance relating to confidentiality and (II)the State shall within 7 days of the date of the order, a statement specifically identifying whether there are any services mentioned in the Preliminary Injunction, including the references to appendices A and B that the State concluded are Medicaid−required and Medi−Cal eligible service. Court Reporter: Leslie A. King. (yc, ) (Entered: 03/20/2007)
519 ORDER by Judge A. Howard Matz,granting in part and denying in part plaintiff's motin for enforcement and/or modification of the preliminary injunction. (see document for details)(yc, ) (Entered: 03/26/2007)
520 TRANSCRIPT filed for proceedings held on 3/19/07. Court Reporter: Leslie A. King. (lom) (Entered: 03/27/2007)
PLACED IN FILE − NOT USED re [PROPOSED] ORDER granting plaintiffs motion for enforcement and or modification on the preliminary injunction submitted by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (et) (Entered: 04/09/2007)
521 SUPPLEMENTAL to Statement regarding time required for plan amendment 502 , filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services. (et) (Entered: 04/09/2007)
522 MANDATE of 9th CCA filed as to Appeal to Circuit Court 428 , CCA # 06−5559. The appeal is reversed and remanded. Mandate received in this district on 4/18/07 (dmap. ) (Entered: 04/24/2007)
524 APPEAL RECORD RETURNED from 9th CCA Received: Volume(s): 1 thru 32; Transcripts(s): 13, and 35 voluminous folders; RE: Appeal Record Sent to USCA (A−26) 477 (cbr, ) (Entered: 05/21/2007)
525 REQUEST for Status Conference and Proposals for Discussion at the Status Conference, filed by plaintiffs Katie A. et al., (cs) (Entered: 05/30/2007)
523 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : The parties shall attend a Status Conference on June 6, 2007 at 3:00 p.m. before Judge A. Howard Matz. The Court would welcome the presence of Dr. Vincent or other members of the Advisory Panel. By not later than noon, June 1, 2007, each party shall file its own (separate) "Statement Re June 6, 2007 Status Conference" setting forth its respective views and proposals. See document for details. The Court GRANTS the

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05/29/2007 06/01/2007 06/01/2007
06/01/2007 06/01/2007 06/01/2007 06/06/2007 06/06/2007
06/11/2007
06/18/2007 09/28/2007 10/12/2007 11/02/2007 11/16/2007
11/16/2007 11/16/2007

County's March 28, 2007 request to submit its final plan to the Board of Supervisors by June 30, 2007. But the Court is extremely unlikely to allow additional time. Court Reporter: Not Reported. (smo, ) (Entered: 05/15/2007)
528 Mail Returned addressed to Erik S Pitchal re Minutes dated 5/15/07 523 . Not Deliverable as Addressed. Unable to Forward. (ad) (Entered: 06/20/2007)
529 STATEMENT re June 6, 2007 Status Conference filed by Defendant Los Angeles County (sbu) (Entered: 06/22/2007)
531 DECLARATION of Sandra L Goldsmith in support of State Defendants' Statement re: June 6, 2007 Status Conference filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County Department of Children and Family Services. (sbu) (Entered: 06/22/2007)
532 STATE DEFENDANTS' STATEMENT Re: June 6, 2007 Status Conference filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County Department of Children and Family Services (sbu) (Entered: 06/22/2007)
533 STATEMENT Re June 6, 2007 Status Conference filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (sbu) (Entered: 06/22/2007)
534 PROOF OF SERVICE filed by plaintiff Katie A, Mary B, Janet C, Henry D, Gary E, re plaintiff Statement re June 6, 2007 status confrence 533 served on Plaintiff Statement. (sbu) (Entered: 06/22/2007)
530 DECLARATION of Robert D. Newman and Joshua Bobrowsky re Mr Bobrowsky's work as a Law Clerk at Western Center on Law and Poverty filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (sbu) (Entered: 06/22/2007)
535 MINUTES OF Status Conference held before Judge A. Howard Matz : Court invites the parties to submit an amended proposed order re: mental health data which should be reconfigured as a stipulation and order. Court reopens bilateral factual discovery for 13 weeks and authorizes the parties to enlarge the deposition and interrogatory limits. Plaintiffs may initiate supplemental discovery. See document for details. Court Reporter: Leslie A. King.(smo) (Entered: 06/26/2007)
526 STIPULATION AND ORDER by Judge A. Howard Matz : This order shall remain in effect for 24 month from the date of this order or until such time as the county DMH develops the necessary management information system to collect such data regarding class members known to or served by DCFS, whichever is longer. (yc) (Entered: 06/12/2007)
527 TRANSCRIPT filed for proceedings held on 6/6/07. Court Reporter: Miriam V. Baird. (dbu) (Entered: 06/18/2007)
536 MINUTES OF IN CHAMBERS ORDER issued by Judge A. Howard Matz : The Court grants the Advisory Panel's request to submit its Seventh Progress Report by 10/19/07.(esa) (Entered: 10/01/2007)
537 ADVISORY PANEL SEVENTH REPORT to the Court filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (jp) (Entered: 10/15/2007)
538 NOTICE Unavailability of State Defendants' Counsel filed by State Defendants Rita Saenz, Diana Bonta. (smo) (Entered: 11/15/2007)
539 NOTICE OF MOTION AND PLAINTIFFS' MOTION to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees filed by Plaintiffs Mary B, Janet C, Henry D, Gary E.Motion set for hearing on 12/10/2007 at 02:00 PM before Judge Stephen Hillman. (vh) Modified on 1/23/2008 (smo, ). (Entered: 11/20/2007)
540 DECLARATION of Robert D. Newman and Kim Lewis in Support of Joint Stipulation re Plaintiffs' MOTION to Compel re 539 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (vh) (Entered: 11/20/2007)
541 JOINT STIPULATION Re Plaintiffs' Motion to Compel re 539 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (vh) (Entered: 11/20/2007)

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11/16/2007
11/20/2007
11/20/2007 11/20/2007 11/21/2007
11/21/2007
11/26/2007 12/03/2007
12/04/2007 12/04/2007 12/07/2007 12/07/2007 12/11/2007 12/11/2007

542 PROOF OF SERVICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E, re MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 , Joint Stipulation re Discovery Motion 541 , Declaration (Motion related) 540 served on 11/16/07. (vh) (Entered: 11/20/2007)
545 DECLARATION of Sandra Goldsmith in support of State Defenant's opposition MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 filed by Defendants Rita Saenz, Diana Bonta. (sbu) (Entered: 11/28/2007)
546 DECLARATION of Stan Rosenstein in support of State Defendants' opposition to plaintiff Motion to Compel filed by Defendants Rita Saenz, Diana Bonta. (sbu) (Entered: 11/28/2007)
547 Proof of Service OF SERVICE filed by defendant Rita Saenz, Diana Bonta, re Declaration (non−motion) 546 , Declaration (Motion related), Declaration (Motion related) 545 served on 11/5/2007. (sbu) (Entered: 11/28/2007)
543 MINUTES OF IN CHAMBERS ORDER held before Judge Stephen J. Hillman : re: MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 . Motion will be heard on December 10, 2007 at 10:00a.m. (sbu) (Entered: 11/27/2007)
548 PLAINTIFFS SUBMISSION OF DECLARATION INADVERTENTLY OMITTED FROM MOVING PAPERS IN SUPPORT OF Motion to Compel Further Responses by Defendants Shewry and Wagner to Document Requests and Interrogatores, re 539 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (vh) (Entered: 11/29/2007)
544 SUPPLEMENTAL MEMORANDUM IN SUPPORT to MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (sbu) (Entered: 11/27/2007)
550 SUPPLEMENTAL Declaration of Sandra L. Goldsmith in support of state defendant opposition to Plaintiffs Motion to compel and state defendant objections to document and evidence sumitted by plantiffs Motion to compel and state defendant objections and evidence submitted by plaintiffs in support of plaintiffs motion to compel; MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 filed by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (mb) (Entered: 12/06/2007)
549 MINUTES OF IN CHAMBERS ORDER held before Judge Stephen J. Hillman : Defendant shall lodge in camera all documents listed on the privelege log Exhibits G ( pages 465 thru 479) forthwith. (sbu) (Entered: 12/04/2007)
551 STATE DEFENDANTS' OBJECTIONS TO Documents and Evidence Submitted by Plaintiffs in Support of Plaintiffs' Motion to Compel, re 539 filed by Defendants Rita Saenz, Diana Bonta. (vh) (Entered: 12/07/2007)
552 MINUTES OF IN CHAMBERS ORDER held before Judge Stephen J. Hillman : (sbu) (Entered: 12/07/2007)
553 NOTICE OF LODGING document under seal for in camera inspection pursuant to court order filed by defendant Rita Saenz, Diana Bonta. (sbu) (Entered: 12/11/2007)
558 NOTICE of Change of Attorney Information: changing e−mail to rrothschild@wclp.org. for attorney Richard A. Rothschild. Filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (cbr) (Entered: 12/18/2007)
560 NOTICE of Change of Attorney Information:, changing email to klewis@wclp.org. for attorney Kimberly Lewis. Filed by plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E (ak) (Entered: 12/19/2007)

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12/12/2007 12/13/2007
12/13/2007 12/13/2007 12/13/2007 12/14/2007 12/20/2007 01/03/2008
01/04/2008 01/04/2008
01/11/2008

557 EXPARTE APPLICATION for Order enlarging Time to File supplemental memorandum;Memorandum of points and authorities; and declaration of Jennifer M. Kim filed by defendant Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. Lodged order.(mb) (Entered: 12/17/2007)
554 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: The Court has reviewed the Advisory Panels Seventh Report, dated September 28, 2007, and ORDERS that it be filed. By now, the November 30, 2007 estimated completion date has passed. In its Seventh Report 537 the Panel advised that the parties agree that the original county plan and the Corrective Action Plan taken together do not fulfill the Countys obligations under the Settlement Agreement... [but] have agreed to develop a strategic planning framework document.... The Court looks forward to hearing from the parties and reviewing their proposal. (jp) (Entered: 12/14/2007)
555 ORDER that State Defendants file their supplemental memorandum opposing Plaintiffs; motion to compel by 1/15/2008. NO FURTHER EXTENSION by Judge Stephen J. Hillman, (sbu) (Entered: 12/14/2007)
556 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: The Court has received letters from one Patricia Hill, who evidently attended the class certification hearing held on June 9, 2003. Those letters request legal advice from the Court. The Court is not entitled to provide such advice and will not do so. This Order will be sent to Ms. Hill, to impart that principle. (jp) (Entered: 12/14/2007)
559 MEMORANDUM of Points and Authorities in Opposition to state defendants exparte application for order enlarging time to file supplemental memorandum; declaration of Robert D. Newman filed by Plaintiff Katie A, Mary B, Henry D, Gary E.557] (mb) (Entered: 12/18/2007)
561 NOTICE of Change of Attorney Information:, changing e−mail to rnewman@wclp.org. Filed by Plaintiff Katie A (vh) (Entered: 12/20/2007)
562 NOTICE OF UNAVAILABILITY OF STATE DEFENDANTS COUNSEL that Deputy Attorney General Sandra L. Goldsmith will be unavailable for any purpose in this matter until January 8, 2008 filed by defendants Rita Saenz, Diana Bonta, Los Angeles County Department of Children and Family Services. (jp) (Entered: 12/30/2007)
563 EX PARTE APPLICATION to Exceed Page Limitation For Leave to File Memorandum of Points and Authorities in Excess of Twenty−Five Pages filed by plaintiffs Katie A. (Attachments: # 1 Memorandum of Points and Authorities in support of Ex Parte Application for Leave to File Memorandum in Excess of Twenty−Five Pages# 2 Declaration Declarations of Robert D. Newman and Kimberly Lewis in Support of Plaintiffs' Ex Parte Application for Leave to File Memorandum in Excess of Twenty−Five Pages# 3 Proposed Order [Proposed] Order Granting Plaintiffs' Ex Parte Application for Leave to File Memorandum of Points and Authorities in Excess of Twenty−Five Pages)(Hornbeck, Kirk) (Entered: 01/03/2008)
564 STATE DEFTS MEMO OF P&A'S IN OPPOSITION TO PLFS EX PARTE APPLICATION FOR LEAVE TO FILE OF SERVICE filed by STATE DEFENDANTS Diana Bonta, Plaintiffs, et al. served on January 4, 2008. (Kubota, Erin) (Entered: 01/04/2008)
565 ORDER by Judge A. Howard Matz GRANTING EX PARTE APPLICATION to Exceed Page Limitation For Leave to File Memorandum of Points and Authorities in Excess of Twenty−Five Pages 563 , but not to exceed twenty−eight (28) pages; and the State Defendants are granted leave to file a memorandum of points and authorities in support of their Opposition to plaintiffs Motion for Preliminary Injunction exceeding twenty−five (25) pages, but not exceed twenty−eight (28) pages; Based upon the showing made that the necessary arguments cannot be made within the stated twenty−five (25) page limit. (jp) (Entered: 01/07/2008)
566 NOTICE OF MOTION AND MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E.Motion set for hearing on 2/4/2008 at 10:00 AM before Judge A. Howard Matz. (Attachments: # 1 Memo of P&As in Support of Motion for Preliminary Injunction# 2 Newman

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01/11/2008 01/11/2008 01/11/2008 01/15/2008 01/15/2008 01/18/2008 01/23/2008
02/01/2008 02/04/2008 02/13/2008 02/19/2008 02/21/2008

Signature Page to Memo of P&As# 3 Notice of Manual Filing# 4 Proof of Service)(Hornbeck, Kirk) (Entered: 01/11/2008)
567 PROOF (BY HAND DELIVERY) OF SERVICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E, re MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 served on 1/11/2008. (Hornbeck, Kirk) (Entered: 01/11/2008)
568 DECLARATIONS in support of MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 (VOLUME 1 OF II (DECLS. 1−18) filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (VOLUMINOUS FOLDER). (jp) (Entered: 01/15/2008)
569 DECLARATIONS in support of MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 (VOLUME II OF II (DECLS. 19−23), filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (VOLUMINOUS FOLDER LOCATED NEXT TO FILE). (jp) (Entered: 01/15/2008)
570 SUPPLEMENT MEMORANDUM OF POINTS AND AUTHORITIES IN OPPOSITION TO PLAINTIFFS' MOTION TO COMPEL PRODUCTION OF DOCUMENTS filed by Defendant Diana Bonta. (Kim, Jennifer) (Entered: 01/15/2008)
571 SUPPLEMENT MEMORANDUM OF POINTS AND AUTHORITIES IN OPPOSITION TO PLAINTIFFS' MOTION TO COMPEL PRODUCTION OF DOCUMENTS filed by Defendant Diana Bonta. (Attachments: # 1 Exhibit A# 2 Exhibit B)(Kim, Jennifer) (Entered: 01/15/2008)
572 Joint STIPULATION for Preliminary Injunction as to and Briefing Schedule for State Defendants' Opposition, Plaintiffs' Reply and Hearing Date re Plaintiffs' Motion for Preliminary Injuction filed by Defendants Diana Bonta. (Attachments: # 1 Proposed Order)(Kim, Jennifer) (Entered: 01/18/2008)
573 ORDER by Judge A. Howard Matz, re Stipulation for Preliminary Injunction, 572 : The Court hereby makes the following Order with regard to the pending Notice of Motion and Motion for Preliminary Injunction filed January 11, 2008:State Defendants shall file and personally serve their Opposition to Plaintiffs Motion for Preliminary Injunction no later than March 17, 2008; Plaintiffs shall file and personally serve their Reply papers no later than March 31, 2008; Hearing date shall be April 7, 2008 at 10:00 a.m. before Judge A. Howard Matz. (smo) (Entered: 01/23/2008)
574 MINUTES OF Telephone Conference held before Judge Stephen J. Hillman on Tentative Ruling on Plaintiff's Motion to Compel:Tape #: 08−3. (sbu) (Entered: 02/05/2008)
575 MINUTES OF IN CHAMBERS ORDER held before Judge Stephen J. Hillman : re: MOTION for Order for to Compel Further Responses by Defendants Shewry and Wagner to Plaintiff Henry D's Document Requests and Interrogatores and to Award Attorney Fees 539 . Oral argument on plaintiffs motion to compel was heard on February 1, 2008.The Court now rules (sbu) (Entered: 02/05/2008)
576 Joint STIPULATION for Order filed by Defendant Katie A. (Attachments: # 1 Proposed Order Stipulation Re Appointment of Advisory Panel)(Nichols, Brandon) (Entered: 02/13/2008)
577 NOTICE of Errata filed by Plaintiffs Katie A, Mary B. , Janet C., Henry D., and Gary E., (Attachments: # 1 Exhibit Exhibits to Notice of Errata)(Hornbeck, Kirk) (Entered: 02/19/2008)
578 MINUTES OF IN CHAMBERS ORDER RE ELECTRONIC FILING by Judge A. Howard Matz: Effective January 1, 2008, electronic filing has been mandatory for all new and pending civil cases. All documents which are required to be filed in an electronic format pursuant to General Order No. 08−02 must be filed electronically no later than midnight on the date due, unless otherwise ordered by the Court. Documents filed late may be stricken by the Court. The Court will not accept documents which were filed electronically. Courtesy Paper Copies. Unless otherwise ordered, courtesy paper copies of all electronically filed documents must be delivered to the courtesy box outside chambers no later than 12:00 noon the following business day. The

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03/17/2008
03/17/2008 03/17/2008 03/17/2008 03/18/2008 03/18/2008 03/18/2008 03/18/2008
03/31/2008 03/31/2008 04/01/2008

courtesy paper copies must comply with Local Rule 11−3, i.e., blue backed, font size, page numbering, tabbed exhibits, etc., unless otherwise directed. The courtesy paper copy must be prominently labeled COURTESY COPY on the face page (see document for further details). (jp) (Entered: 02/21/2008)
579 STATE DEFENDANTS' OPPPOSITION TO PLAINTIFF'S MOTION FOR PRELIMINARY INJUNCTION re MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 filed by Defendants Rita Saenz, Does, Marjorie Kelly, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock. (Ackerson−Brazille, Karen) (Entered: 03/17/2008)
580 NOTICE of Manual Filing filed by Defendants Rita Saenz, Does, Marjorie Kelly, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock of DECLARATIONS AND EXHIBITS. (Ackerson−Brazille, Karen) (Entered: 03/17/2008)
583 DECLARATION in support of opposition to plaintiffs MOTION for Preliminary Injunction 566 VOLUME II OF II filed by State Defendants Rita Saenz, Diana Bonta. (pj) (Entered: 03/20/2008)
586 DECLARATION of Karen Ackerson−Brazille in support of opposition to MOTION for Preliminary Injunction 566 filed by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (kbr) (Entered: 03/20/2008)
581 CERTIFICATE OF SERVICE filed by Defendants Rita Saenz, Does, Marjorie Kelly, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock, re Notice of Manual Filing (G−92), Notice of Manual Filing (G−92) 580 , Motion Related Document, 579 served on 03/18/2008. (Ackerson−Brazille, Karen) (Entered: 03/18/2008)
582 CERTIFICATE OF SERVICE filed by Defendants Rita Saenz, Does, Marjorie Kelly, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock, re Proof of Service (subsequent documents), Proof of Service (subsequent documents) 581 served on 03/18/2008. (Ackerson−Brazille, Karen) (Entered: 03/18/2008)
584 NOTICE OF DOCUMENT DISCREPANCIES AND ORDER by Judge A. Howard Matz, ORDERING Declaration in Support of Opposition to Plaintiffs' Motion for Preliminary Injunction (Volume I of II) received 3/17/08 be filed. (kbr) (Entered: 03/20/2008)
585 NOTICE OF DOCUMENT DISCREPANCIES AND ORDER by Judge A. Howard Matz ORDERING State Defendants' Declarations in Support of Opposition to Plaintiffs' Motion for Preliminary Injunction submitted by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services received on March 17, 2008, to be filed and processed; filed date to be the date the document was stamped Received but not Filed with the Clerk. (kbr) (Entered: 03/20/2008)
587 RESPONSE IN SUPPORT of MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 Plaintiffs' Reply in Support of Motion for Preliminary Injunction filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Notice of Manual Filing# 2 Proof of Service)(Hornbeck, Kirk) (Entered: 03/31/2008)
588 ADDITIONAL DECLARATIONS in support of their MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (jp) (Entered: 04/01/2008)
589 AMENDED PROOF OF SERVICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E, re Response in Support of Motion, 587 , Motion Related Document, 588 served on April 1, 2008. (Hornbeck, Kirk) (Entered: 04/01/2008)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 61 of 92

04/02/2008
04/03/2008
04/03/2008
04/03/2008 04/04/2008
04/07/2008
04/07/2008 04/08/2008 04/09/2008 04/18/2008 04/18/2008 04/30/2008 04/30/2008 04/30/2008

590 NOTICE of Manual Filing filed by Defendant Diana Bonta of NOTICE OF MANUAL FILING AND STATE DEFENDANT'S DEPOSITION TRANSCRIPTS AND DECLARATIONS IN SUPPORT OF STATE DEFENDANTS' PRIOR OPPOSITION TO PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION. (Attachments: # 1)(Kim, Jennifer) (Entered: 04/02/2008)
591 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz : On the Courts own motion, the Court hereby takes OFF−CALENDAR plaintiffs NOTICE OF MOTION AND MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 . The parties will be notified of the new hearing date. (smo) (Entered: 04/03/2008)
592 STATE DEFENDANTS DEPOSITION TRANSCRIPTS AND DECLARATIONS in support of State Defendants Prior Opposition to Plaintiffs MOTION for Preliminary Injunction 566 filed by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (jp) (Entered: 04/04/2008)
593 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: The Court GRANTS the Advisory Panel's request for additional time to file its Eighth Report. (se) (Entered: 04/04/2008)
597 ORDER by Judge A. Howard Matz GRANTING Stipulation Re Appointment of Advisory Panel 596 : Court orders that 1) the appointment of the Advisory Panel shall continue, with the same functions and responsibilities as set forth in the Settlement Agreement, until 6/30/09, and 2) appoint Ed Walker, the designee of the County Defendants is appointed as the sixth member of the Advisory Panel. (se) (Entered: 04/08/2008)
594 NOTICE of Change of Attorney Information for attorney Brandon T Nichols counsel for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services. Filed by defendant County of Los Angeles, Los Angeles County Department of Children and Family Services, David Sanders (Nichols, Brandon) (Entered: 04/07/2008)
595 NOTICE NOTICE OF UNAVAILABILITY OF STATE DEFENDANTS COUNSEL filed by Defendants Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 04/07/2008)
596 STIPULATION for Order Re: Appointment of Advisory Panel filed by defendant Los Angeles County. (Attachments: # 1 Proposed Order)(Nichols, Brandon) (Entered: 04/08/2008)
598 PROOF OF SERVICE filed by Plaintiffs Katie A, Mary B, on Plaintifs' Proposed Findings of Fact and Conclusions of Law Re Motion for Preliminary Injunction served on April 9, 2008. (Hornbeck, Kirk) (Entered: 04/09/2008)
599 NOTICE of Change of Attorney Information for attorney Melinda R Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Changing address to 1313 W. 8th Street, Los Angeles, CA 90017. Changing fax to 213−977−5297. Filed by Plaintiff ACLU Foundation of Southern California (Bird, Melinda) (Entered: 04/18/2008)
600 NOTICE STATE DEFENDANTS REQUEST FOR ORAL ARGUMENT ON PLAINTIFFS MOTION FOR PRELIMINARY INJUNCTION filed by Defendants Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 04/18/2008)
601 NOTICE of Change of Attorney Information Filed on Behalf of Fiza Quraishi filed by Plaintiffs Katie A. , et al. (Hornbeck, Kirk) (Entered: 04/30/2008)
602 REQUEST FOR JUDICIAL NOTICE by State Defendants filed by Defendants Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 04/30/2008)
603 OBJECTIONS State Defendants' Objections to Plaintiffs' Proposed Findings of Fact and Conclusions of Law re: MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 filed by Defendant Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 04/30/2008)

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04/30/2008 05/02/2008
05/07/2008 06/05/2008 06/12/2008 07/14/2008 07/16/2008
07/23/2008 07/23/2008 08/06/2008 08/12/2008
08/13/2008 08/13/2008 08/14/2008 08/14/2008 08/14/2008

604 SUPPLEMENT to MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 State Defendants' (Proposed) Findings of Fact and Conclusions of Law filed by Defendant Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 04/30/2008)
605 NOTICE OF ERRATA TO STATE DEFENDANTS' OBJECTIONS TO PLAINTIFFS' PROPOSED FINDINGS OF FACT AND CONCLUSIONS OF LAW, AND TO STATE DEFENDANTS' PROPOSED FINDINGS OF FACT AND CONCLUSIONS OF LAW filed by Defendants Diana Bonta. (Carmen D. Snuggs) (Ackerson−Brazille, Karen) (Entered: 05/02/2008)
606 OBJECTIONS to Request for Judicial Notice 602 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Lewis, Kimberly) (Entered: 05/07/2008)
607 NOTICE OF CHANGE OF RESPONSIBILITY FOR REPRESENTATION FOR ALL DEFENDANTS filed by Defendants Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 06/05/2008)
608 (Attachments: # 1 Advisory Panel 8th Report to Court Part 1, # 2 Advisory Panel 8th Report to Court Part 2)(Lewis, Kimberly) (Entered: 06/12/2008)
609 REQUEST FOR JUDICIAL NOTICE of Section 7001(a) of Public Law filed by plaintiff Katie A. (Attachments: # 1 Supplement)(Lewis, Kimberly) (Entered: 07/14/2008)
610 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: The Court GRANTS Plaintiffs Request for Judicial Notice of Section 7001(a) of Public Law 110−252 (H.R. 2642) 609 , Supplemental Appropriations Act 2008. The Court ORDERS that each party file a statement setting forth his or her respective position as to how (if at all) this newly enacted law affects Plaintiffs' pending motion for preliminary injunction. The parties shall file these statements, not to exceed five pages, by no later than 7/23/2008. (jp) (Entered: 07/17/2008)
611 Plaintiffs' Supplemental Briefing Regarding Section 7001(a), etc filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E Plaintiffs' Supplemental Briefing re Section 7001(a), etc. (Lewis, Kimberly) (Entered: 07/23/2008)
612 STATEMENT RE: SECTION 7001(A) OF PUBLIC LAW 110−252 (H.R. 2642), SUPPLEMENTAL APPROPRIATIONS ACT 2008 filed by Defendant Diana Bonta re: Miscellaneous Document 611 . (Ackerson−Brazille, Karen) (Entered: 07/23/2008)
613 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: Status Conference set for 8/14/2008 at 03:00 PM before Judge A. Howard Matz. (se) (Entered: 08/06/2008)
614 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: The Court has scheduled a hearing on Plaintiffs renewed motion for a preliminary injunction, to be held on August 14, 2008. Counsel should be prepared to address the following questions at the hearing.... See document for details. (smo) (Entered: 08/12/2008)
615 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: The Court has read the Advisory Panels Eighth Report, dated April 18, 2008 and responds as follows:First, the Court again thanks the Panel for its salutary contributions.... (See document for details). (smo) (Entered: 08/13/2008)
617 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: Supplemental Questions for 8/14/08 Hearing (se) (Entered: 08/14/2008)
616 RESPONSE filed by Plaintiff Katie Ato Supplement(Motion related), Supplement(Motion related) 604 (Lewis, Kimberly) (Entered: 08/14/2008)
618 SUPPLEMENT STATE DEFENDANTS RESPONSE TO QUESTIONS RAISED BY THE COURT IN ITS AUGUST 12, 2008 MINUTE ORDER filed by Defendant Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 08/14/2008)
619 SUPPLEMENT STATE DEFENDANTS RESPONSE TO SUPPLEMENTAL QUESTIONS RAISED BY THE COURT IN ITS AUGUST 14, 2008 MINUTE ORDER filed by Defendant Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 08/14/2008)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 63 of 92

08/14/2008 08/20/2008 08/20/2008 08/20/2008 08/20/2008 08/20/2008 08/27/2008
08/27/2008
09/04/2008 09/22/2008 09/23/2008

620 MINUTES OF Status Conference held before Judge A. Howard Matz: Cause called; appearances made. Court questions counsel and orders additional documents to be filed by not later than 8/20/2008. MOTION for Preliminary Injunction 566 will remain under submission. Parties ordered to split the cost and obtain a transcript of this hearing. Court Reporter: Cindy Nirenberg. (jp) (Entered: 08/18/2008)
621 NOTICE of Manual Filing filed by Plaintiff Katie A of Plaintiffs Submission of Additional docs re PI Motion. (Lewis, Kimberly) (Entered: 08/20/2008)
622 REQUEST FOR JUDICIAL NOTICE OF CAL BLUE RIBBON COMM REPORT filed by Plaintiff Katie A. (Attachments: # 1 Exhibit California Blue Ribbon Comm Report)(Lewis, Kimberly) (Entered: 08/20/2008)
623 RESPONSE filed by Plaintiff Katie A To Court Order Dated Aug 12 and 13 2008 (Lewis, Kimberly) (Entered: 08/20/2008)
624 SUPPLEMENT BRIEF OF STATE DEFENDANTS' IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER filed by Defendant Diana Bonta. (Attachments: # 1 Declaration OF RICHARD HILDEBRAND)(Ackerson−Brazille, Karen) (Entered: 08/20/2008)
625 Plaintiffs' Submission of Additional Documents re Motion for Preliminary Injunction 566 (Attachments: # 1 Continuation of Exhibit A, # 2 Continuation of Exhibit E, # 3 LA Dept of Mental Health Part I, # 4 LA Dept of Mental Health Part II, # 5 LA Dept of Mental Health Part III, # 6 Mental Health Plan Part I, # 7 Mental Health Plan Part II, # 8 Mental Health Plan Part III)(kbr) (Entered: 08/21/2008)
626 REQUEST FOR JUDICIAL NOTICE RE: FURTHER SUBMISSION OF ADDITIONAL DOCUMENTS RE STATE DEFENDANTS OPPOSITION TO PLAINTIFFS MOTION FOR PRELIMINARY INJUNCTION (Attachments: # 1 Exhibit A− PAGES, 59−89 TO STATE DEFENDANTS REQUEST FOR JUDICIAL NOTICE RE: FURTHER SUBMISSION OF ADDITIONAL DOCUMENTS, # 2 Exhibit B− PAGES, 90−113 TO STATE DEFENDANTS REQUEST FOR JUDICIAL NOTICE RE: FURTHER SUBMISSION OF ADDITIONAL DOCUMENTS)(Ackerson−Brazille, Karen) (Entered: 08/27/2008)
627 SUPPLEMENT STATE DEFENDANTS FURTHER SUBMISSION OF SUPPLEMENTAL INFORMATION ON EPSDT SERVICES PROVIDED BY STATE IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER filed by Defendant Diana Bonta. (Attachments: # 1 Exhibit EXHIBIT 1− PAGES, 4−53 TO STATE DEFENDANTS FURTHER SUBMISSION OF SUPPLEMENTAL INFORMATION ON EPSDT SERVICES PROVIDED BY STATE IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER, # 2 Exhibit EXHIBIT 1− PAGES, 54−103 TO STATE DEFENDANTS FURTHER SUBMISSION OF SUPPLEMENTAL INFORMATION ON EPSDT SERVICES PROVIDED BY STATE IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER, # 3 Exhibit EXHIBIT 2− PAGES, 104−156 TO STATE DEFENDANTS FURTHER SUBMISSION OF SUPPLEMENTAL INFORMATION ON EPSDT SERVICES PROVIDED BY STATE IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER, # 4 Exhibit EXHIBIT 2− PAGES, 157−215 TO STATE DEFENDANTS FURTHER SUBMISSION OF SUPPLEMENTAL INFORMATION ON EPSDT SERVICES PROVIDED BY STATE IN RESPONSE TO THE COURTS AUGUST 14, 2008 ORDER)(Ackerson−Brazille, Karen) (Entered: 08/27/2008)
628 (Attachments: # 1 Exhibit Exhibits 190 and 191)(Lewis, Kimberly) (Entered: 09/04/2008)
629 ORDER ON PLAINTIFFS' RENEWED MOTION FOR A PRELIMINARY INJUNCTION by Judge A. Howard Matz: The Court TAKES UNDER SUBMISSION MOTION for Preliminary Injunction re: Wrap around services and TFC for class members and meet and confer and appointment of Special Master 566 . (se) (Entered: 09/22/2008)
630 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: Court directs counsel for the ACLU to file declarations in each case confirming that Ms. Orihuela will be fully "walled off" from both such cases. The declaration for the Emily Q. case shall append this order to it. (jp) (Entered: 09/24/2008)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 64 of 92

09/26/2008 10/17/2008 10/29/2008 10/30/2008 10/30/2008
11/15/2008
11/17/2008 11/17/2008 11/17/2008
11/25/2008
11/26/2008 11/26/2008

631 DECLARATION of Melinda Bird in Compliance With Minute Order of September 23, 2008 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Bird, Melinda) (Entered: 09/26/2008)
632 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: The Court GRANTS the Advisory Panels request for an extension of time to file its next Panel report, which is due 10/17/2008 to 11/17/2008. (jp) (Entered: 10/20/2008)
633 STATUS REPORT of STATUS filed by Defendants Rita Saenz, Diana Bonta, Anita Bock, Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Ackerson−Brazille, Karen) (Entered: 10/29/2008)
634 STATE DEFENDANTS SUBMISSION OF DMH LETTER NO. 08−07 filed by Defendant Diana Bonta re: Report 633 (Ackerson−Brazille, Karen) (Entered: 10/30/2008)
635 MINUTES OF Status Conference held before Judge A. Howard Matz: Court questions counsel and orders that the appointment of the Special Master in Emily Q. is extended to December 31, 2010 with a proposed budget due some time in the first week of January. Order to issue. Status Conference in Katie A. set for 12/17/2008 at 03:00 PM before Judge A. Howard Matz; Mr. Nichols is ordered to appear. Court orders counsel to order a transcript of this hearing and to split the cost 50/50. See document for specific information and deadlines.Court Reporter: Cindy Nirenberg. (se) (Entered: 11/14/2008)
636 MINUTES OF IN CHAMBERS AMENDED ORDER RE ELECTRONIC FILING before Judge A. Howard Matz: Effective January 1, 2008, electronic filing has been mandatory for most new and pending civil cases in the United States District Court for the Central District of California. Self−represented litigants and attorneys who take appropriate steps to opt out of the system need not comply with the following requirements. All documents which are required to be filed in an electronic format pursuant to General Order No. 08−03 must be filed electronically no later than midnight on the date due, unless otherwise ordered by the Court. Documents filed late may be stricken by the Court. The Court will not accept documents which were filed electronically, but which otherwise fail to comply with filing requirements. (See document for further details). (jp) (Entered: 11/17/2008)
637 (Nichols, Brandon) (Entered: 11/17/2008)
638 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary Eto Report 633 , Miscellaneous Document 634 PLAINTIFFS' RESPONSE TO STATE DEFENDANT'S SUBMISSION OF DMH LETTER NO. 08−07 (Bird, Melinda) (Entered: 11/17/2008)
639 DECLARATION re Response (non−motion) 638 to State Defendant's Submission of DMH Letter No. 08−07 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Declaration of Laura J. Champion, MFT, # 2 Declaration of Steven Elson, Ph.D., # 3 Declaration of Lyn Farr, # 4 Supplement Declaration of Robert Friedman, # 5 Supplement Declaration of Dr. Charles Huffine, # 6 Declaration of Debbie Manners, # 7 Supplement Declaration of Linda Huff Redman, # 8 Declaration Bruce Saltzer, # 9 Supplement Declaration of Carroll J. Schroeder)(Bird, Melinda) (Entered: 11/17/2008)
640 TRANSCRIPT for proceedings held on 8/14/08 3:07 pm. Court Reporter Cindy Nirenberg, cindycsr@gmail.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 12/16/2008. Redacted Transcript Deadline set for 12/26/2008. Release of Transcript Restriction set for 2/23/2009. (Nirenberg, Cindy) (Entered: 11/25/2008)
641 (Attachments: # 1 Adivisory Panel's Ninth Report)(Lewis, Kimberly) (Entered: 11/26/2008)
642 MINUTES OF IN CHAMBERS before Judge A. Howard Matz: The Court has reviewed the Advisory Panel's Ninth Report 641 and again thanks the Panel for its salutary work. The Court invites those members of the Panel who will be in Los Angeles to attend the status conference in Court on 12/17/2008. We will discuss

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 65 of 92

12/01/2008 12/01/2008 12/02/2008 12/03/2008 12/08/2008
12/12/2008 12/17/2008 12/18/2008
12/18/2008 12/19/2008
12/19/2008

certain portions of the report at that time. (jp) (Entered: 12/01/2008)
643 STIPULATION for Extension of Time to File Stipulation for Extension for State Defendants Opposition to Plaintiffs Response to State Defendants Submission of DMH Letter No. 08−07 filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock.(Ackerson−Brazille, Karen) (Entered: 12/01/2008)
644 ORDER by Judge A. Howard Matz GRANTING Stipulation for Extension of Time to File Response/Reply, 643 : State Defendants shall file and serve their Opposition to Plaintiffs Response to State Defendants Submission of DMH Letter No. 08−07 no later than December 8, 2008. Hearing date shall remain December 17, 2008 at 3:00 p.m. (se) (Entered: 12/02/2008)
645 Notice of Unavailability of County Defendants' Counsel (Nichols, Brandon) (Entered: 12/02/2008)
646 NOTICE OF FILING TRANSCRIPT filed for proceedings 8/14/08 3:07 pm (Nirenberg, Cindy) (Entered: 12/03/2008)
647 OBJECTIONS to Response (non−motion) 638 , Declaration (non−motion), Declaration (non−motion), Declaration (non−motion) 639 filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services. (Attachments: # 1 Declaration DECLARATIONS OF SOPHIE CABRERA AND KARY YOSHIZUKA, PAGES, 28−50, # 2 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 51−100, # 3 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 101−150, # 4 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 151−200, # 5 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 201−250, # 6 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 251−300, # 7 Declaration DECLARATION OF CHERYL TREADWELL− PAGES, 301−333)(Ackerson−Brazille, Karen) (Entered: 12/08/2008)
648 COUNTY RESPONSE TO THE NINTH REPORT TO COURT filed by Defendant Los Angeles County (Attachments: # 1 County Strategic Plan − Part 1 of 2, # 2 County Strategic Plan − Part 2 of 2)(Nichols, Brandon) (Entered: 12/12/2008)
653 MINUTES OF Status Conference held before Judge A. Howard Matz: Cause called; appearances made. Also present is Richard Saletta. Court and counsel confer regarding status of case, role of a special master and the advisory board. (See document for further details). Court is not denying plaintiffs' motion for preliminary injunction, the Court is vacating as moot said motion without prejudice of renewing the motion at a later time. Court Reporter: Pam Seijas. (jp) (Entered: 12/24/2008)
649 TRANSCRIPT for proceedings held on 11/17/08; 11:33 a.m.. Court Reporter/Electronic Court Recorder: Pamela A. Seijas, phone number www.pamelaseijas.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 1/8/2009. Redacted Transcript Deadline set for 1/18/2009. Release of Transcript Restriction set for 3/18/2009. (Seijas, Pamela) (Entered: 12/18/2008)
650 NOTICE OF CLERICAL ERROR: Due to clerical error Re: Transcript (CV), Transcript (CV), Transcript (CV) 649 (Seijas, Pamela) (Entered: 12/18/2008)
651 TRANSCRIPT for proceedings held on 12/17/08; 2:38 p.m.. Court Reporter/Electronic Court Recorder: Pamela A. Seijas, phone number www.pamelaseijas.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 1/9/2009. Redacted Transcript Deadline set for 1/19/2009. Release of Transcript Restriction set for 3/19/2009. (Seijas, Pamela) (Entered: 12/19/2008)
652 NOTICE OF FILING TRANSCRIPT filed for proceedings 12/17/08; 2:38 p.m. (Seijas, Pamela) (Entered: 12/19/2008)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 66 of 92

12/31/2008 01/16/2009
01/16/2009 01/20/2009 02/09/2009 02/09/2009 02/09/2009 02/09/2009 02/10/2009
02/17/2009
02/17/2009 02/23/2009 02/23/2009 02/23/2009 03/02/2009

654 SPECIAL MANAGEMENT ORDER by Judge A. Howard Matz (se) (Entered: 12/31/2008)
657 NOTICE of Change of Attorney Information for attorney Michael J Stortz counsel for Plaintiff Katie A. Filed by PLAINTIFF MICHAEL STORTZ (Attachments: # 1 Supplement G−06 NOTICE CHANGE OF ATTORNEY INFO Holle, # 2 Supplement G−06 NOTICE CHANGE OF ATTORNEY INFO Mudryk, # 3 Supplement G−06 NOTICE CHANGE OF ATTORNEY INFO Stortz.pdf)(Stortz, Michael) (Entered: 01/16/2009)
658 NOTICE NOTICE OF NAME CHANGE FROM PROTECTION & ADVOCACY, INC. TO DISABILITY RIGHTS CALIFORNIA filed by PLAINTIFF Katie A. STORTZ, MICHAEL (Stortz, Michael) (Entered: 01/16/2009)
659 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: Copies of correspondence between Court and Katie A. Advisory Panel attached. (se) (Entered: 01/21/2009)
661 NOTICE OF MOTION AND MOTION to Appoint Special Master filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 3/2/2009 at 10:00 AM before Judge A. Howard Matz. (Bird, Melinda) (Entered: 02/09/2009)
662 MEMORANDUM in Support of MOTION to Appoint Special Master 661 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Proposed Order APPOINTING RICHARD SALETTA AS SPECIAL MASTER)(Bird, Melinda) (Entered: 02/09/2009)
663 DECLARATION of Robert D. Newman in support of MOTION to Appoint Special Master 661 and Exhibits filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Exhibit 1, # 2 Exhibit 2, # 3 Exhibit 3)(Bird, Melinda) (Entered: 02/09/2009)
664 REQUEST FOR JUDICIAL NOTICE re MOTION to Appoint Special Master 661 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Bird, Melinda) (Entered: 02/09/2009)
665 NOTICE OF ERRATA filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. correcting Memorandum in Support of Motion 662 , Request for Judicial Notice, Request for Relief 664 (Attachments: # 1 Request for Judicial Notice, # 2 Proposed Order Appointing Richard Saletta as Special Master)(Bird, Melinda) (Entered: 02/10/2009)
666 Opposition STATE DEFENDANTS OPPOSITION TO PLAINTIFFS MOTION FOR APPOINTMENT OF A SPECIAL MASTER re: MOTION to Appoint Special Master 661 filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock. (Attachments: # 1 Exhibit Letter (January 22, 2009))(Ackerson−Brazille, Karen) (Entered: 02/17/2009)
667 NOTICE NOTICE OF UNAVAILABILITY OF STATE DEFENDANTS COUNSEL filed by Defendants Rita Saenz, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock. (Ackerson−Brazille, Karen) (Entered: 02/17/2009)
668 REPLY support MOTION to Appoint Special Master 661 filed by Plaintiff Katie A. (Newman, Robert) (Entered: 02/23/2009)
669 RESPONSE IN SUPPORT of MOTION to Appoint Special Master 661 filed by Plaintiff Katie A. (Newman, Robert) (Entered: 02/23/2009)
670 REPLY support MOTION to Appoint Special Master 661 filed by Plaintiff Katie A. (Newman, Robert) (Entered: 02/23/2009)
673 MINUTES OF Motion to Appoint Special Master held before Judge A. Howard Matz: For reasons and findings stated on the record, the Court grants plaintiffs motion to appoint a special master. Order to issue. Pending finalization of the order appointing Special Master, Richard Saletta, the Court orders Mr. Saletta to submit a proposed budget and work−plan by March 23, 2009. The Court also orders the state defendants to respond to the two communicationsfrom plaintiffs regarding the policy letter by not later than March 9, 2009.Court Reporter: Cindy Nirenberg. (se) (Entered: 03/04/2009)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 67 of 92

03/03/2009
03/04/2009 03/19/2009 03/23/2009 03/23/2009 04/03/2009 04/09/2009 05/08/2009 05/10/2009
05/21/2009 06/30/2009 07/01/2009 07/21/2009 07/22/2009
08/10/2009 08/24/2009

671 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: Attached is an edited and amended Order that the Court has prepared to appoint Richard Saletta as Special Master. The Court will enter the Order after it receives the Proposed Budget and Work Plan from Mr. Saletta. If Mr. Saletta has questions about the Order, he may raise them directly with the Court, by telephone. (se) (Entered: 03/03/2009)
672 SUPPLEMENT to MOTION to Appoint Special Master 661 filed by Plaintiff Katie A. (Newman, Robert) (Entered: 03/04/2009)
674 STATE DEFENDANTS' OBJECTIONS IN OPPOSITION re: MOTION to Appoint Special Master 661 AND OPPOSITION TO PLAINTIFFS' SUPPLEMENTAL BRIEF RE ORDER APPOINTING RICHARD SALETTA AS SPECIAL MASTER filed by Defendant Diana Bonta. (Ackerson−Brazille, Karen) (Entered: 03/19/2009)
675 Special Master's Proposed Budget and Work Plan in Response to Court's Order Appointing Special Master March 3, 2009 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E re: Motion Hearing,, 673 (Bird, Melinda) (Entered: 03/23/2009)
676 OPPOSITION Plaintiffs' Response to State Defendants' Objections and Motion to Modify Order Appointing Special Master and Opposition to Plaintiffs' Supplemental Brief re Order Appointing Richard Saletta as Special Master; Declaration of Robert D. Newman filed by Plaintiff Katie A. (Newman, Robert) (Entered: 03/23/2009)
677 ORDER by Judge A. Howard Matz APPOINTING Richard Saletta s Special Master. (See attached Order for further details). (jp) (Entered: 04/06/2009)
680 DECLARATION of Richard Saletta re Order 677 Declaration of Richard Saletta re Appointment as Special Master filed by Plaintiff Katie A. (Newman, Robert) (Entered: 04/09/2009)
683 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz. The Court GRANTS the request of the Katie A. Panel to extend the time by which its next report shall be submitted. The new date is July 3, 2009. (kbr) (Entered: 05/11/2009)
682 TRANSCRIPT for proceedings held on 3/2/09 10:30am. Court Reporter: Cindy Nirenberg, www.cindynirenberg.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 5/31/2009. Redacted Transcript Deadline set for 6/10/2009. Release of Transcript Restriction set for 8/8/2009. (Nirenberg, Cindy) (Entered: 05/10/2009)
684 NOTICE OF FILING TRANSCRIPT filed for proceedings 3/2/09 10:30a (Nirenberg, Cindy) (Entered: 05/21/2009)
685 SPECIAL MASTERS REVISED TRAVEL BUDGET filed by Defendants Rita Saenz, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services (Ackerson−Brazille, Karen) (Entered: 06/30/2009)
686 ORDER RE SPECIAL MASTER'S REVISED TRAVEL BUDGET by Judge A. Howard Matz 685 . (se) (Entered: 07/01/2009)
687 STATUS REPORT ADVISORY PANEL TENTH REPORT TO THE COURT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Lewis, Kimberly) (Entered: 07/21/2009)
688 Stipulation Re Approval of County Strategic Plan and Extension of Advisory Panel; [Proposed] Order filed by Defendant Los Angeles County (Attachments: # 1 Proposed Order, # 2 Exhibit A − Part 1 of 2, # 3 Exhibit A − Part 2 of 2, # 4 Exhibit B, # 5 Exhibit C − Part 1 of 2, # 6 Exhibit C − Part 2 of 2)(Nichols, Brandon) (Entered: 07/22/2009)
689 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz GRANTING Stipulation between Plaintiffs and County Defendants 688 . (se) (Entered: 08/10/2009)
690 MINUTES IN CHAMBERS by Judge A. Howard Matz: The Special Master reports that the Katie A workgroup continues to meet in Step One, Foundation Building, for

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 68 of 92

09/01/2009 09/01/2009 09/03/2009 09/25/2009 12/24/2009 12/29/2009
01/14/2010 02/01/2010

purposes of determining whether the parties are able to narrow their differences and thereby establish the foundation to reach agreements on the issues listed in paragraph 12, sub−section a. and b. of the Court Order Appointing Richard Saletta as Special Master dated 4/3/2009. The Special Master requests additional time for Step One, Foundation Building. The Special Master requests an extension to 10/16/2009. The Court GRANTS his request. (jp) (Entered: 08/25/2009)
691 NOTICE of Change of Attorney Information for attorney Melinda R Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Changing firm name to Disability Rights California. Changing e−mail to melinda.bird@disabilityrightsca.org. Filed by plaintiff Katie A., et al. (Bird, Melinda) (Entered: 09/01/2009)
692 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents. The following error(s) was found: Signature/date omitted RE: Notice of Change of Attorney Information (G−06), Notice of Change of Attorney Information (G−06) 691 . In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. (ak) (Entered: 09/03/2009)
693 NOTICE of Change of Attorney Information for attorney Melinda R Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Changing firm name to Disability Rights California. Changing e−mail to melinda.bird@disabilityrightsca.org. Filed by plaintiff Katie A., et al. (Bird, Melinda) (Entered: 09/03/2009)
694 Pursuant to Court Order 206 , the court ORDERS all the parties and the advisory panel to serve their respective filing relating to the panel's third report on David Ambroz, at the following new address: David Ambroz, 6521 Willoughby Avenue, Los Angeles, CA 90038. (se) (Entered: 09/25/2009)
695 SPECIAL MASTERS REVISED BUDGET filed by Defendants Rita Saenz, Does, Marjorie Kelly, David − Sanders, Diana Bonta, Los Angeles County, Los Angeles County Department of Children and Family Services, Anita Bock (Attachments: # 1 Proposed Order PROPOSED] ORDER RE SPECIAL MASTERS REVISED BUDGET)(Ackerson−Brazille, Karen) (Entered: 12/24/2009)
696 ORDER RE SPECIAL MASTER'S REVISED BUDGET by Judge A. Howard Matz: GOOD CAUSE APPEARING, The Court hereby makes the following Order with regard to the Special Master's Revised Budget 695 : This budget amendment will augment the existing Special Masters Budget approved by the Court on 4/3/2009. This amendment is required to complete the second step of the special masters proposed Two Step plan submitted to the Court on 3/22/2009. State Defendants shall pay to the Special Master, Rick Saletta, for the period of 12/1/2009 through 3/31/2010 as follows: (1) $54,600.00 to augment the special masters existing budget. The special master will be reimbursed at $150.00 per hour and consultants reimbursed at $85.00 per hour. (a) $50,000.00 for the Special Master and Consultants for the following activities (see attached Order for further details). (b) $4,600.00 for travel and incidental costs based on the following (see attached Order for further details). (jp) (Entered: 12/29/2009)
697 STATUS REPORT ADVISORY PANEL ELEVENTH [REVISED] REPORT TO THE COURT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Lewis, Kimberly) (Entered: 01/14/2010)
698 MINUTES IN CHAMBERS by Judge A. Howard Matz: The Court thanks the Advisory Panel for the Revised Eleventh Panel Report. A few observations: (1) Training and Coaching (pp. 4 and 11): Can the County, with the aid of the Panel, elicit a grant from a benefactor orfoundation to provide for paid weekend seminars, so that staffers can perform their regular, demanding workday responsibilities and still receive compensated training? Could facilities (and trainers) be made available, gratis, by academic institutions?(2) New Core Practice Model (p. 11): The Court looks forward to the Countys explanation in the next Panel report.(3) The Court does recognize and commend the five members of the County Board of Supervisors for their continuing financial support for the implementation of the Settlement Agreement, and has no objection to counsel for the County so informing them. (4) The Court believes that it would be constructive for the Panel to quantify the "lower financial costs" for Wraparound graduates, in the next Panel Report. (jp) (Entered: 02/01/2010)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 69 of 92

02/04/2010 02/04/2010 03/26/2010 05/28/2010 05/28/2010 05/28/2010 06/15/2010
06/15/2010
06/24/2010 07/19/2010 07/29/2010
07/29/2010 08/06/2010 08/09/2010
09/24/2010

699 Notice of Change of Attorney Information filed by Defendant Los Angeles County (Fesler, Katherine) (Entered: 02/04/2010)
700 Attorney Information Update Form filed by Defendant Los Angeles County (Fesler, Katherine) (Entered: 02/04/2010)
701 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz. The Court on its own motion extends until not later than May 28, 2010 the time forSpecial Master Saletta to file the report previously required for submission this month. (kbr) (Entered: 03/26/2010)
702 STATUS REPORT of REPORT PURSUANT TO COURTS ORDER APPOINTING SPECIAL MASTER APRIL 3, 2009 filed by Defendant Diana Bonta. (Snuggs, Carmen) (Entered: 05/28/2010)
703 MINUTES IN CHAMBERS by Judge A. Howard Matz: The Court GRANTS the Special Master's request (and that of the parties) for a Status Conference to be held on 6/15/2010 at 3:00 PM. (jp) (Entered: 05/28/2010)
704 Notice of Change of Attorney Information filed by Defendant Diana Bonta , Director of Department of Health Care Services and Director ofDepartment of Social Services (Martinez, Ernest) (Entered: 05/28/2010)
705 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz re: ORDER EXTENDING APPOINTMENT OF RICHARD SALETTA AS SPECIAL MASTER AND PROVIDING ADDITIONAL MEASURES. The Court extends the Special Masters appointment to November 1, 2010 on the same terms and with the same provisions that are in the initial appointment. (kbr) (Entered: 06/21/2010)
706 MINUTES OF Status Conference held before Judge A. Howard Matz. Counsel inform the Court that their mutual intent is to pursue the path that could lead to a settlement agreement. Court orally approves the Special Master's Report, and approves the proposed budget. See today's separately filed order. Counsel shall share equally in the cost of today's transcript. Court Reporter: Cindy Nirenberg. (kbr) (Entered: 06/21/2010)
707 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: Re Report 702 : The Court withdraws paragraph 1 of its 6/15/10 Order. (se) (Entered: 06/24/2010)
708 MINUTES OF IN CHAMBERS ORDER held before Judge A. Howard Matz: The Court GRANTS the Advisory Panels request to extend to the week of August 20, 2010 the time for filing of its next report. (se) (Entered: 07/20/2010)
709 TRANSCRIPT for proceedings held on 6/15/10 3:20 pm. Court Reporter: Cindy Nirenberg, www.cindynirenberg.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the court reporter or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 8/19/2010. Redacted Transcript Deadline set for 8/29/2010. Release of Transcript Restriction set for 10/27/2010. (Nirenberg, Cindy) (Entered: 07/29/2010)
710 NOTICE OF FILING TRANSCRIPT filed for proceedings 6/15/10 3:20 pm (Nirenberg, Cindy) (Entered: 07/29/2010)
711 Special Master Proposal RE: Contracting with Consultant(s) To Special Master Work Group filed by Defendant Diana Bonta (Snuggs, Carmen) (Entered: 08/06/2010)
712 ORDER RE: SPECIAL MASTER PROPOSAL FOR CONSULTANTS TO WORK GROUP by Judge A. Howard Matz, re Special Master Proposal 711 . The Court hereby approves the proposal, including the proposed budget, and authorizes the Special Master to contract with the Consultant(s) as set forth in the proposal. (kbr) (Entered: 08/09/2010)
713 STATUS REPORT ADVISORY PANEL TWELFTH REPORT TO THE COURT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Lewis, Kimberly) (Entered: 09/24/2010)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 70 of 92

10/25/2010 10/29/2010
12/17/2010
01/10/2011 01/18/2011 01/18/2011 01/25/2011 02/08/2011 02/25/2011 03/01/2011
03/07/2011

714 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz re: Twelfth Report from Advisory panel. (kbr) (Entered: 10/26/2010)
715 MINUTE IN CHAMBERS by Judge A. Howard Matz: The Court hereby extends indefinitely the appointment of Richard Saletta as Special Master. The Special Master shall, by not later than 12/20/1010 present a proposed budget to the Court for its approval, to continue his duties as needed pursuant to the ongoing appointment. The Court approval of the Special Master ongoing appointment results from the Court expectation that, on or 12/3/2010 By no later than 12 17/2010, the Special Master shall file with the Court a report (see attached Minute Order for further information). (jp) (Entered: 11/01/2010)
716 MINUTE IN CHAMBERS by Judge A. Howard Matz: Yesterday the Court met with Special Master Richard Saletta and his assistant, Steve Korosec. As a result of information they provided, and for good cause, the Court ORDERS as follows: (1) the Order of 10/29/2010 is superseded in the following respects: (a) By not later than 2/25/2011 (not 12/27/2010), the parties shall execute and file the the Court a written agreement containing the terms of settlement they have evidently reached. (b) By not later than 2/25/2011 the Special Master shall evaluate the settlement agreement and make recommendations to the Court about it, with special reference to whether it fairly and meaningfully addresses the alleged rights and needs of the class that has been certified. (2) By not later than he shall present a proposed budget to the Court, and he may seek retroactive authorization to be compensated for duties performed before that date. The dates specified above are "last dates." The Court encourages the parties to proceed faster and complete earlier their commendable efforts to resolve this difficult case. (jp) (Entered: 12/17/2010)
717 NOTICE of Change of Attorney Information for attorney Kimberly Lewis counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Filed by Plaintiff Kimberly Lewis (Lewis, Kimberly) (Entered: 01/10/2011)
718 MINUTE IN CHAMBERS by Judge A. Howard Matz: NOTICE TO COUNSEL. The Court received a letter from Patricia Hills requesting information about a baby born to her in 1987 and, apparently, soon thereafter placed in foster care. The Court responded with the attached letter (the address having been redacted). (jp) (Entered: 01/18/2011)
719 County Response to Order of October 25, 2010 filed by Defendant Los Angeles County (Nichols, Brandon) (Entered: 01/18/2011)
720 MINUTE IN CHAMBERS by Judge A. Howard Matz: NOTICE TO COUNSEL. The Court GRANTS the 1/18/2011 letter−request of the Katie A. Advisory Panel to extend the date by which the next report is due from 2/19/2011 to 3/25/2011. (jp) (Entered: 01/25/2011)
721 NOTICE of Change of Attorney Information for attorney Robert D Newman counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Alison Barkoff will no longer receive service of documents from the Clerks Office for the reason indicated in the G−06 Notice.Alison Barkoff is no longer attorney of record for the aforementioned party in this case for the reason indicated in the G−06 Notice. Filed by Plaintifff Alison Barkoff (Newman, Robert) (Entered: 02/08/2011)
722 SPECIAL MASTER REPORT PURSUANT TO THE COURT'S DECEMBER 17, 2010 ORDER REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 02/25/2011)
723 MINUTE IN CHAMBERS by Judge A. Howard Matz: Notwithstanding my previous Court Order, the Court now approves the Special Master recommendation concerning settlement negotiations and deadlines. Accordingly, (1) The parties will negotiate the one substantive matter, to be resolved no later than 3/11/2011. If the parties are unable to resolve that issue by that date, the Special Master will complete his independent fact−finding effort, and make his own separate recommendations to the Court. (2) If the parties are able to resolve the issue described in paragraph 1 above, the parties will continue negotiations regarding plaintiffs attorney feesdemand, with that negotiation to be resolved no later than 4/26/2011. (jp) (Entered: 03/01/2011)
724 NOTICE of Change of Attorney Information for attorney Antionette D Dozier counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Filed by Plaintiff Katie A.; Mary B.; Janet C.; Henry D.; and Gary E. (Dozier, Antionette) (Entered: 03/07/2011)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 71 of 92

03/10/2011 03/10/2011 03/10/2011 04/11/2011 04/14/2011 04/15/2011 04/22/2011 05/09/2011
05/13/2011 05/13/2011 05/13/2011 05/17/2011 05/17/2011
05/17/2011
05/18/2011

725 Extension of Advisory Panel; [Proposed Order] (Attachments: # 1 Proposed Order)(Nichols, Brandon) (Entered: 03/10/2011)
726 EXTENSION OF ADVISORY PANEL; ORDER by Judge A. Howard Matz that the appointment of the Advisory panel shall continue, with the same functions and responsibilities as set forth in the Settlement Agreement, until 12/31/2013 725 . (jp) (Entered: 03/10/2011)
729 ORDER on Extension of Advisory Panel by Judge A. Howard Matz, re Miscellaneous Document 725 : the appointment of the Advisory Panel shall continue, with the same functions and responsibilities as set forth in the Settlement Agreement, until December 31, 2013. (se) (Entered: 04/15/2011)
727 SPECIAL MASTER'S REVISED BUDGET REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 04/11/2011)
728 ADVISORY PANEL REPORT of Report to the Court, First Reporting Period of 2011, March 26, 2011 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Dozier, Antionette) (Entered: 04/14/2011)
730 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: Court approves the Special Masters Revised Budget which was filed on April 11, 2011 (Docket No. 727). (se) (Entered: 04/15/2011)
731 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: The Court extends until May 11, 2011 the time within which Special Master Richard Saletta must file his next report.(se) (Entered: 04/22/2011)
732 MINUTE IN CHAMBERS by Judge A. Howard Matz:The parties are ORDERED to appear for a Status Conference set for 5/17/2011 at 3:00 PM. The parties are ORDERED to appear for a 5/13/2011 they separately shall file a status report describing the current status of the case and any issues that thus far have precluded a complete settlement or resolution of this case. Those status reports may be filed under seal if desired. (jp) (Entered: 05/09/2011)
733 NOTICE Notice of Manual Filing filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) (Entered: 05/13/2011)
734 STATEMENT Plaintiffs' Statement Re May 17, 2011 Status Conference (Newman, Robert) (Entered: 05/13/2011)
735 STATUS REPORT Pursuant to the Court's May 9, 2011 Order filed by Defendants Diana Bonta, Rita Saenz. (Snuggs, Carmen) (Entered: 05/13/2011)
736 STATEMENT Plaintiffs' Supplemental Statement Re May 17, 2011 Status Conference re: Statement 734 . (Newman, Robert) (Entered: 05/17/2011)
737 MINUTE IN CHAMBERS by Judge A. Howard Matz: The Court thanks the Katie A. Advisory Panel for its Report (dated 3/26/2011) for the "First Reporting Period of 2011." The Court is gratified that there are several areas of demonstrated progress and in that regard the Court commends the leadership of the management teams of DCFS and DMH. The Court also concurs in the Panel's Recommendations, particularly that the County "start something" to provide meaningful and extensive training and coaching. (See pp.4−5). (jp) (Entered: 05/17/2011)
741 MINUTES OF Status Conference held before Judge A. Howard Matz: Court and counsel discuss various possible mediation procedures to resolve the outstanding attorney's fees issue. The parties agree, subject to obtaining their respective clients approval, to have the Court mediate the attorneys fees issue only and if there is a future attorney's fees motion, then that motion will be referred to another judge. The parties are to notify the Court of their clients decision and depending on their decision, the Court will issue a separate minute order setting a mediation hearing date of (proposed) 6/15/2011 at 9:30 AM. Court Reporter: Victoria Valine. (jp) (Entered: 05/23/2011)
738 MINUTE IN CHAMBERS by Judge A. Howard Matz: The Court extends until 6/27/2011 the time by which Special Master Saletta must file his next report. (jp) (Entered: 05/18/2011)

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05/19/2011 05/20/2011 06/09/2011
06/13/2011 06/13/2011 06/13/2011 06/14/2011 06/14/2011 06/14/2011 06/15/2011 07/05/2011
07/22/2011 08/12/2011 08/15/2011
09/02/2011

739 NOTICE TO THE COURT AND THE PLAINTIFFS FOLLOWING THE MAY 17, 2011 STATUS CONFERENCE filed by State Defendants Diana Bonta. (Snuggs, Carmen) (Entered: 05/19/2011)
740 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. Pursuant to the approach explored at the May 17, 2011 conference, the Court will conduct a mediation on June 15, 2011 starting at 9:30 a.m. Next week the Court will issue an order requesting certain filings before then. (kbr) (Entered: 05/20/2011)
742 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court directs each side to file a Confidential Statement setting forth the information (tailored to the unique features of this case) that the Court needs to have in order to be of assistance. See, 5(b) of the Court's Order Regarding Settlement Conference Before this Court. Such Confidential Statements shall be filed under seal, with chambers copies made available to the Court, by 4:00 p.m. on Monday, June 13, 2011. (kbr) (Entered: 06/09/2011)
743 NOTICE Notice of Manual Filing filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) (Entered: 06/13/2011)
744 NOTICE OF MANUAL FILING OF STATE DEFENDANTS' CONFIDENTIAL STATEMENT FILED UNDER SEAL PURSUANT TO THE COURT'S JUNE 9, 2011 ORDER filed by Defendant Diana Bonta (Snuggs, Carmen) (Entered: 06/13/2011)
746 SEALED DOCUMENT− Plaintiffs' Settlement Conference Statement. (mat) (Entered: 06/15/2011)
745 NOTICE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) (Entered: 06/14/2011)
747 SEALED DOCUMENT− Notice of Errata Re: Plaintiffs' Settlement Conference Statement. (mat) (Entered: 06/15/2011)
748 SEALED DOCUMENT− State Defendants' Confidential Statement Filed Under Seal Pursuant to the Court's June 9, 2011 Order. (mat) (Entered: 06/15/2011)
749 MINUTES OF MEDIATION (non−evidentiary) before Judge A. Howard Matz: The ground rules for the mediation are placed on the record and the mediation is held. For reasons stated on the record, the Court seals the transcript of the mediation. Court Reporter: Cindy Nirenberg. (jp) (Entered: 06/16/2011)
750 MINUTE IN CHAMBERS by Judge A. Howard Matz: On 7/1/2011, the parties separately informed the Court that they have accepted the Court's proposal for resolution of the attorneys' fees dispute. Accordingly, the Court now ORDERS the following. By not later than 7/22/2011 the Special Master shall file his evaluation of the substantive settlement agreement and make recommendations to the Court about it, with special reference to whether it fairly and meaningfully addresses the alleged rights and needs of the class that has been certified. (see attached Minute Order for further information). The parties should not expect to receive further orders from the Court until aroundmid−August 2011. (jp) (Entered: 07/06/2011)
751 SPECIAL MASTER'S REPORT of Pursuant to Agreement That Would Lead to Resolution of The Katie A. Case filed by Defendant Diana Bonta. (Martinez, Ernest) (Entered: 07/22/2011)
752 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: the Court has read the Special Masters's Report 751 and issues Order. (se) (Entered: 08/12/2011)
753 MINUTE IN CHAMBERS by Judge A. Howard Matz: ORDER MODIFYING SCHEDULE. GOOD CAUSE having been shown, the Court modifies its last order in the following respects: (1) Plaintiffs shall file their motion for Preliminary Approval on or before 9/2/2011 (not 8/26/2011). (2) State Defendants shall file their response on or before September 9/12/2011 (not 8/30/2011). (jp) (Entered: 08/15/2011)
754 NOTICE OF MOTION AND MOTION for Settlement Approval of Class Action Settlement filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 9/27/2011 at 02:00 PM before Judge A. Howard Matz. (Attachments: # 1 Memorandum of Points and Authorities I Support of Motion for Preliminary

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 73 of 92

09/06/2011 09/12/2011 09/19/2011 09/26/2011 09/27/2011 09/28/2011 09/29/2011
09/30/2011 10/06/2011
10/28/2011 11/02/2011

Approval of Class Action Settlement, # 2 Declaration of Robert D. Newman In Support of Motion for Preliminary Approval of Class Action Settlement, # 3 Declaration of Kimberly Lewis In Support of Motion for Preliminary Approval of Class Action Settlement, # 4 Declaration of Patrick Gardner In Support of Motion for Preliminary Approval of Class Action Settlement, # 5 Declaration of Melinda Bird In Support of Motion for Preliminary Approval of Class Action Settlement, # 6 Declaration of Ira A. Burnim In Support of Motion for Preliminary Approval of Class Action Settlement, # 7 Declaration of Mark D. Rosenbaum, # 8 [Proposed] Order Granting Preliminary Approval of Class Action Settlement)(Dozier, Antionette) (Entered: 09/02/2011)
755 Amendment to MOTION for Settlement Approval of Class Action Settlement 754 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Dozier, Antionette) (Entered: 09/06/2011)
756 STATEMENT of Re: Plaintiffs' Motion for Preliminary Approval of Class Action Settlement; Declaration of Carmen D. Snuggs MOTION for Settlement Approval of Class Action Settlement 754 filed by Defendant Diana Bonta. (Snuggs, Carmen) (Entered: 09/12/2011)
757 REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 09/19/2011)
758 STATEMENT of STATE DEFENDANTS' SUPPLEMENTAL STATEMENT RE: PLAINTIFFS' MOTION FOR PRELIMINARY APPROVAL OF CLASS ACTION SETTLEMENT MOTION for Settlement Approval of Class Action Settlement 754 filed by Defendant Diana Bonta. (Snuggs, Carmen) (Entered: 09/26/2011)
762 MINUTES OF Motion fo Preliminary Approval of the Proposed Settlement Agreement 754 Hearing held before Judge A. Howard Matz: The Court grants the motion forpreliminary approval of the proposed settlement. The Court sets a fairness hearing date 12/1/2011 at 2:00 PM. Order to issue. Court Reporter: Cindy Nirenberg. (jp) (Entered: 10/04/2011)
759 [Proposed] Order Granting Preliminary Approval of Class Action Settlement re: Amendment (Motion related) 755 (Newman, Robert) (Entered: 09/28/2011)
760 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Miscellaneous Document [PROPOSED] Order 759 . The following error(s) was found: Incorrect event selected. The correct event is: Notice of Lodging − under Category − NOTICES. Other error(s) with document(s): This document tendered for the judge's approval should have been submitted as a separate PDF attachment to the Notice of Lodging and e−mailed to a Judge Matz generic email addresses a WordPerfect or Microsoft Word version of the document. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (jp) (Entered: 09/29/2011)
761 ORDER by Judge A. Howard Matz: granting 754 Motion for Preliminary Approval of Class Action Settlement. (se) (Entered: 10/03/2011)
763 MINUTE IN CHAMBERS by Judge A. Howard Matz: On 9/27/2011, the Court held a hearing in this case on Plaintiffs' Motion for Preliminary Approval of the Proposed Settlement Agreement. For the reasons stated on the record at that hearing, the Court approves Special Master Richard Saletta's Proposed Work Plan and Budget, which was filed on 9/19/2011. The Court hereby sets a Status Conference for 1/19/2012 at 2:00 PM. (jp) (Entered: 10/06/2011)
764 REPORT of Advisory Panel's Report to the Court − Second Reporting Period 2011, October 19, 2011 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Dozier, Antionette) (Entered: 10/28/2011)
765 NOTICE OF MOTION AND MOTION for Settlement Approval of Class Action Settlement filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 12/1/2011 at 02:00 PM before Judge A. Howard Matz. (Attachments: # 1 Memorandum Plaintiffs' Memorandum of Points and Authorities Re Final Approval

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 74 of 92

11/03/2011
11/07/2011
11/07/2011
11/07/2011 11/07/2011 11/18/2011 11/23/2011 11/23/2011

of Class Action Settlement, # 2 Declaration Supplemental Declaration of Robert D. Newman)(Newman, Robert) (Entered: 11/02/2011)
766 NOTICE OF MOTION AND MOTION for Attorney Fees filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Motion set for hearing on 12/1/2011 at 02:00 PM before Judge A. Howard Matz. (Attachments: # 1 Memorandum Memorandum of Points and Authorities In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 2 Declaration Declaration of Richard A. Rothschild In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 3 Declaration Declaration of Barrett S. Litt, Exhs. A−C In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 4 Declaration Declaration of Barrett S. Litt, Exhs. D−F In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 5 Declaration Declaration of Barrett S. Litt, Exhs. G−H In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 6 Declaration Declaration of Carol A. Sobel, Exhs. 1−5 In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 7 Declaration Declaration of Carol A. Sobel, Exh. 6 In Support of Motion for Approval of The Fee Portion of the Settlement Agreement, # 8 Declaration Declaration of Carol A. Sobel, Exhs. 7−11 In Support of Motion for Approval of The Fee Portion of the Settlement Agreement)(Newman, Robert) (Entered: 11/03/2011)
767 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: NOTICE OF MOTION AND MOTION for Settlement Approval of Class Action Settlement 765 . The following error(s) was found: (1) Hearing information is incorrect. (2) Proposed not submitted pursuant to Local Rule 52−4.1. Other error(s) with document(s): Civil Motions for Judge Matz are to be heard on Mondays, at 10:00 AM. Please consult Judges' Procedures, Schedules and Motion Calendar located on Court's website. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (jp) (Entered: 11/07/2011)
768 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: NOTICE AND MOTION AND MOTION for Attorney Fees 766 . The following error(s) was found: (1) Hearing information is incorrect. (2) Proposed Order not submitted pursuant to Local Rule 52−4.1. Other error(s) with document(s): Civil Motions for Judge Matz are to be heard on Mondays, at 10:00 AM. Please consult Judges' Procedures, Schedules and Motion Calendar located on Court's website. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (jp) (Entered: 11/07/2011)
769 RESPONSE BY THE COURT TO NOTICE TO FILER OF DEFICIENCIES IN ELECTRONICALLY FILED DOCUMENTS by Clerk of Court: In accordance with the Notice to Filer Of Deficiencies In Electronically Filed Documents REGARDING: Notice of Motion and Motion for Settlement Approval 765 is ACCEPTED as filed; The hearing date has been RESCHEDULED to Motion for Attorney Fees 766 is 12/5/2011 at 10:00 AM. (jp) (Entered: 11/07/2011)
770 NOTICE OF CLERICAL ERROR: Due to clerical error Re: Response By Court to Notice of Deficiencies (G−112B) 769 , Hearing date for MOTION for Attorney Fees 766 was incorrectly rescheduled for 12/5/2011; hearing date remains set for 12/1/2011 at 2:00 PM. (jp) (Entered: 11/07/2011)
771 CLASS ACTION COMMENTS OF THE UNITED STATES in support of Final Approval of the Proposed Settlement Agreement 765 . (jp) (Entered: 11/22/2011)
772 REPLY In Support MOTION for Attorney Fees 766 , MOTION for Settlement Approval of Class Action Settlement 765 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Declaration Further Supplemental Declaration of Robert D. Newman)(Newman, Robert) (Entered: 11/23/2011)
773 Stipulation Regarding Exit Conditions filed by Defendant Los Angeles County (Attachments: # 1 Proposed Order)(Nichols, Brandon) (Entered: 11/23/2011)

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11/23/2011 11/23/2011
12/01/2011 12/01/2011
12/02/2011 12/05/2011
12/05/2011 12/05/2011 12/05/2011

774 RESPONSE IN SUPPORT STATE DEFENDANTS' RESPONSE TO PLAINTIFFS' MOTION FOR APPROVAL OF THE ATTORNEYS' FEES PORTION ON THE SETTLEMENT AGREEMENT filed by Defendant Diana Bonta. (Martinez, Ernest) (Entered: 11/23/2011)
775 RESPONSE filed by Defendant Diana Bontato Response in Support of Motion 774 State Defendants Statement In Response To Plaintiffs Memorandum of Points and Authorities Re: Final Approval of Class Action Settlement (Attachments: # 1 Declaration Declaration of John Krause In Support of State Defendants Statement In Response To Plaintiffs Memorandum of Points And Authorities Re: Final Approval of Class Action Settlement, # 2 Declaration Declaration of Mary Sheppard In Support of State Defendants Statement In Response To Plaintiffs Memorandum of Points And Authorities Re: Final Approval of Class Action Settlement, # 3 Declaration Declaration of Sean Tracy In Support of State Defendants Statement In Response To Plaintiffs Memorandum Of Points And Authorities Re: Final Approval Of Class Action Settlement)(Snuggs, Carmen) (Entered: 11/23/2011)
776 ORDER TO STIPULATION REGARDING EXIT CONDITIONS by Judge A. Howard Matz, re Stipulation 773 . IT IS HEREBY ORDERED that the exit conditions attached hereto as Exhibit "A" are approved and adopted. (kbr) (Entered: 12/01/2011)
784 MINUTES OF (1) Fairness Hearing on Motion for Final Approval of the Proposed Settlement Agreement 754 ; (2) plaintiffs' Motion for Settlement approval of Class Action Settlement 765 ; (3) Plaintiffs' Motion for Attorney Fees 766 ; (4) Plaintiffs' Motion for Settlement Approval 777 (non evidentiary) before Judge A. Howard Matz: For reasons and findings stated on the record, the Court grants the proposed settlement agreement 754 , the settlement of the class action 765 , and the motion for attorneys fees 766 . Order and judgment to issue. The parties are to submit a proposed stipulated judgment by tomorrow, 12/2/2011. Court grants Mr. Saletta's request to continue the 1/19/2012 Status Conference to 2/17/2012 at 2:00 PM. The corresponding status report must be filed by 2/10/2012. Court Reporter: Cindy Nirenberg. (jp) (Entered: 12/06/2011)
777 [PROPOSED] STIPULATED Judgment Pursuant to Class Action Settlement Agreementfiled by Plaintiff Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) Modified on 12/5/2011 (jp). (Entered: 12/02/2011)
778 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: MOTION for Settlement Approval of [Proposed] Stipulated Judgment Pursuant to Class Action Settlement Agreement event is: Notice of Lodging − under Category − NOTICES. Other error(s) with document(s): Clerk has terminated the Motion event created by document 777. The docket text has been corrected by Clerk to reflect the caption document. In the future, please use the SEARCH feature on the CM/ECF Menu Bar if you are unsure of the events to use. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (jp) (Entered: 12/05/2011)
779 STIPULATED JUDGMENT PURSUANT TO CLASS ACTION SETTLEMENT AGREEMENT granting Approval of [Proposed] Stipulated Judgment Pursuant to Class Action Settlement Agreement MOTION for Judgment 777 . (se) (Entered: 12/05/2011)
780 NOTICE OF LODGING Proposed Pretrial Conference Order Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. [Proposed] Order Awarding Attorneys' Fees, Costs and Expenses Pursuant to Settlement Agreement (Newman, Robert) (Entered: 12/05/2011)
781 TRANSCRIPT for proceedings held on 9/27/11 2:15 pm. Court Reporter: Cindy Nirenberg, www.cindynirenberg.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the COURT REPORTER, www.cindynirenberg.com, or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 12/26/2011. Redacted Transcript Deadline set for 1/5/2012. Release of Transcript Restriction set for 3/4/2012. (Nirenberg, Cindy) (Entered: 12/05/2011)

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12/05/2011 12/06/2011 12/06/2011 12/20/2011 02/10/2012 02/16/2012 02/16/2012 02/17/2012
02/28/2012
03/01/2012 03/01/2012

782 MINUTE IN CHAMBER SORDER MODIFYING SCHEDULE by Judge A. Howard Matz: Pursuant to the now−approved Stipulated Judgment and Class Action Settlement, the Court hereby dismisses the claims against the State Defendants. The Court retains jurisdiction over the implementation of the Settlement Agreement. (jp) Modified on 2/14/2012 (smo). (Entered: 12/05/2011)
783 NOTICE OF FILING TRANSCRIPT filed for proceedings 9/27/11 2:15 pm (Nirenberg, Cindy) (Entered: 12/06/2011)
785 ORDER AWARDING ATTORNEYS' FEES, COSTS AND EXPENSES PURSUANT TO SETTLEMENT AGREEMENT by Judge A. Howard Matz. The Court orders State Defendants to pay to Plaintiffs' counsel $3.75 million. Pursuant to 37 of the Settlement Agreement 779 , interest shall accrue on this amount at the rate of 7% beginning December 6, 2011. (kbr) (Entered: 12/07/2011)
786 County's Response to the Katie A. Advisory Panel's Report to the Court for the Second Reporting Period of 2011 filed by Defendant Los Angeles County (Nichols, Brandon) (Entered: 12/20/2011)
787 STATUS REPORT of Special Master's Report on Progress Toward Completition Of The Katie A. Implementation Plan. filed by Special Master Richard Saletta. (Martinez, Ernest) (Entered: 02/10/2012)
788 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court ORDERS counsel for the Los Angeles County Defendants and those counsel for Plaintiffs who are responsible for monitoring implementation of the County Settlement to attend and be prepared to participate in the status conference scheduled for February 17, 2012 at 2:00 p.m. (kbr) (Entered: 02/16/2012)
789 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court has now reviewed the Advisory Panels October 19, 2011 Report and the County's December 20, 2011 Response to it. Instead of ordering further information at this time, the Court will await the next Panel Report and County Response. (kbr) (Entered: 02/16/2012)
790 MINUTES OF STATUS CONFERENCE (non−evidentiary) before Judge A. Howard Matz: Court sets a further Status Conference date of 4/30/2012 at 2:00 PM. The parties are to meet and confer with Mr. Saletta on Tuesday, 2/21/2012 to obtain a consensus on the proposed dates for the final implementation report hearing and the corresponding deadlines. The Court now adopts the schedule set forth below. 4/30/2012 (2 p.m.): Status Conference (already confirmed by the Court) 6/15/2012: Deadline for Special Master to provide a draft of the report to the Court re Implementation Plan 6/29/2012: Deadline for Special Master to file final report to the Court re Implementation Plan (with Implementation Plan filed as attachment) July 9, 2012: Deadline for the parties to file a response to the Special Master's report re Implementation Plan July 13, 2012 (2 p.m.): Court Hearing date re Special Master Report and Implementation Plan Court Reporter: Cindy Nirenberg. (jp) (Entered: 02/23/2012)
791 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: Court approves and adopts the recommendations that Special Master Richard made in his most recent report as follows: 1. CDSS and DHCS shall file an Interim Joint Leadership Plan, and provide a copy to the Special Master, by no later than March 6, 2012. 2. The Court authorizes the Special Master to contract with an outside consultant to elicit assistance for the Negotiation Workgroup in determiningMedi−Cal coverage and models for JFC. Mr. Saletta shall, however, first obtain approval from the Court before entering into any specific contract.3. The Negotiation Workgroup is directed to continue developing the Implementation Plan. (se) (Entered: 02/28/2012)
792 JOINT STATE LEADERSHIP PLAN FOR KATIE A PLANNING AND IMPLEMENTATION filed by Defendant Diana Bonta re: Report 787 , Minutes of In Chambers Order/Directive − no proceeding held, R&R − Accepting Report and Recommendations,,,, 791 (Martinez, Ernest) (Entered: 03/01/2012)
793 TRANSCRIPT for proceedings held on 12/01/11 2:10pm. Court Reporter/Electronic Court Recorder: CINDY L. NIRENBERG, website: w w w. c i n d y n i r e n b e r g. c o m. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of

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03/01/2012 03/02/2012 03/27/2012 03/28/2012
04/23/2012 04/24/2012 04/30/2012
04/30/2012 05/02/2012
05/04/2012
05/18/2012 05/24/2012
05/24/2012

Intent to Redact due within 7 days of this date. Redaction Request due 3/22/2012. Redacted Transcript Deadline set for 4/1/2012. Release of Transcript Restriction set for 5/30/2012. (ml) (Entered: 03/01/2012)
794 NOTICE OF FILING TRANSCRIPT filed for proceedings 12/01/11 2:10pm (ml) (Entered: 03/01/2012)
795 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court views the Joint State Leadership Plan For Katie A. Planning And Implementation, Dkt. 792 , as a promising development. The Court invites the Special Master to respond to it, but he is not required to do so. (kbr) (Entered: 03/02/2012)
796 NOTICE of Change of Attorney Information for attorney Melinda Ruth Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D. Changing address to 350 South Bixel Street, Suite 290, Los Angeles, CA 90017. Changing fax number to 213−213−8001. Filed by plaintiff Katie A., et al. (Bird, Melinda) (Entered: 03/27/2012)
797 NOTICE of Change of Attorney Information for attorney Marilyn L Holle counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Changing address to 350 South Bixel Street, Suite 290, Los Angeles, CA 90017. Changing fax number to 213−213−8001. Filed by plaintiff Katie A., et al. (Holle, Marilyn) (Entered: 03/28/2012)
798 SPECIAL MASTER'S REPORT of ON PROGRESS TOWARD COMPLETION OF THE KATIE A. IMPLEMENTATION PLAN filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 04/23/2012)
799 Notice of Change of Attorney Information filed by Defendant Los Angeles County (Hinojosa Quinonez, Laura) (Entered: 04/24/2012)
TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz. The Status Conference previously scheduled for 4/30/12 at 2:00 p.m. has been taken off calendar, to be rescheduled at a later date. The parties will be notified of the new hearing date and time. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(kbr) TEXT ONLY ENTRY (Entered: 04/30/2012)
800 MINUTE IN CHAMBERS by Judge A. Howard Matz: The Court approves both the Special Master's 2011−2012 Revised Budget attached as Exhibit 2 to his recent report (Dkt. 798 , filed on April 23, 2012) and his Fiscal year 2012−13 Budget, attached as Exhibit 3. (jp) (Entered: 04/30/2012)
801 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Miscellaneous Document 799 . The following error(s) was found: Incorrect event selected. The correct event is: Change of Attorney Information G−06. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (lom) (Entered: 05/02/2012)
802 RESPONSE BY THE COURT TO NOTICE TO FILER OF DEFICIENCIES IN ELECTRONICALLY FILED DOCUMENTS by Clerk of Court to Judge A. Howard Matz: In accordance with the Notice to Filer Of Deficiencies In Electronically Filed Documents REGARDING: Notice of Change of Attorney Information 799 . The document is accepted as filed (jp) (Entered: 05/04/2012)
803 REPORT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Dozier, Antionette) (Entered: 05/18/2012)
804 NOTICE of Change of Attorney Information for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Adding Lauren M. Black as attorney as counsel of record for Los Angeles County for the reason indicated in the G−06 Notice. Filed by defendant Los Angeles County (Quinonez, Laura) (Entered: 05/24/2012)
805 NOTICE of Change of Attorney Information for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Catherine Joan Pratt will no longer receive service of documents from the Clerks Office for the reason indicated in the G−06 Notice.Catherine Joan Pratt is no longer attorney of record for the

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05/24/2012 05/24/2012 06/29/2012
07/10/2012
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07/13/2012 07/13/2012 07/13/2012 07/17/2012

aforementioned party in this case for the reason indicated in the G−06 Notice. Filed by defendant Los Angeles County (Quinonez, Laura) (Entered: 05/24/2012)
806 NOTICE of Change of Attorney Information for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Gerald M. Custis will no longer receive service of documents from the Clerks Office for the reason indicated in the G−06 Notice.Gerald M. Custis is no longer attorney of record for the aforementioned party in this case for the reason indicated in the G−06 Notice. Filed by defendant Los Angeles County (Quinonez, Laura) (Entered: 05/24/2012)
807 NOTICE of Change of Attorney Information for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Brandon T. Nichols will no longer receive service of documents from the Clerks Office for the reason indicated in the G−06 Notice.Brandon T. Nichols is no longer attorney of record for the aforementioned party in this case for the reason indicated in the G−06 Notice. Filed by defendant Los Angeles County (Quinonez, Laura) (Entered: 05/24/2012)
808 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: The Court has authorized Special Master Richard Saletta to postpone the filing of the report that was otherwise due today. Instead, Mr. Saletta will continue to work with the parties and he will inform the Court as to the realistic timetable necessary for him to file a written proposal recommending a short term implementation plan as to someaspects of the judgment and a long term plan as to the remaining ones. Unless otherwise ordered, that written proposal must be filed no later than 9/7/2012 and a hearing will be conducted on 9/13/2012. Meanwhile, however, unless otherwiseordered the 7/13/2012 hearing will be held. (jp) (Entered: 06/29/2012)
809 TRANSCRIPT for proceedings held on 2/17/12 2:20 pm. Court Reporter: C. Nirenberg, website: www.msfedreporter.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through C. Nirenberg, website: www.msfedreporter.com or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 7/31/2012. Redacted Transcript Deadline set for 8/10/2012. Release of Transcript Restriction set for 10/8/2012. (Nirenberg, Cindy) (Entered: 07/10/2012)
810 NOTICE OF FILING TRANSCRIPT filed for proceedings 2/17/12 2:20 pm re Transcript 809 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(Nirenberg, Cindy) TEXT ONLY ENTRY (Entered: 07/10/2012)
811 TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz: The previously scheduled Status Conference for 7/13/2012 at 2:00 PM has been rescheduled. The Status Conference will now be a telephonic status conference set for 7/13/2012 at 4:00 PM before Judge A. Howard Matz. Counsel are to coordinate a single conference call. Once all of the parties are on the line, Counsel are to call the Court at (213) 894−5290. The status conference will be to review the status of the case. No status reports are required. If you have any questions, please contact Stephen Montes, Courtroom Deputy Clerk by email at stephen_montes@cacd.uscourts.gov.THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(smo) TEXT ONLY ENTRY (Entered: 07/11/2012)
812 TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz previously scheduled telephonic status conference for 7/13/2012 at 4:00 PM has been terminated. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(smo) TEXT ONLY ENTRY (Entered: 07/13/2012)
813 INTERIM REPORT of Pursuant to Court's Approving Special Master Hiring a Medicaid Consultant February 28, 2012 filed by Defendant Diana Bonta. (Martinez, Ernest) (Entered: 07/13/2012)
814 INTERIM REPORT of Pursuant to Court's Approving Special Master Hiring A Medicaid Consultant February 28, 2012 filed by Defendant Diana Bonta. (Martinez, Ernest) (Entered: 07/13/2012)
815 MINUTE IN CHAMBERS by Judge A. Howard Matz: On or before 8/28/2012, the Special Master shall file his next Report and it shall include the Implementation Plan[s] for both Phase I and Phase II. On or before 9/7/2012, the parties shall

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09/11/2012 09/11/2012 09/13/2012
09/13/2012

separately file their respective responses to the Special Masters August 28th report. The Court will conduct a hearing on 9/14/2012 at 3:00 PM. On or before 12/31/2012, the DHCS must have completed all steps necessary to ensure that Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS) are available to sub−class members and can be claimed by county MentalHealth Plans. The Court will conduct a hearing on 12/13/2012 at 3:00 PM., atwhich it will review the status of the Implementation Plans and of the requirements of item 4, above. The Court is not pleased with the fact that it has been compelled to accept the above−described delays, although it is not in any way faulting the States honorable lawyers. The Court is mainly concerned about whether the 36 month extension of supervision is realistic and fair. In any event, the parties may respond to this order by not later than 7/27/2012 (although they are not required to). (jp) (Entered: 07/17/2012)
816 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Special Master has informed the Court that there may be a need to clarify the "New Requirements" section of the Court's July 17, 2012 Order. This Order will do so. See Order for additional information. (kbr) (Entered: 07/23/2012)
817 NOTICE of Change of Attorney Information for attorney Sara Ugaz counsel for Defendant Diana Bonta. Filed by Defendant DIANA BONTA (Ugaz, Sara) (Entered: 07/23/2012)
818 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court approves the budgets the Special Master proposed for the services of consultants Linda Redman, Ph.D and Marylou Sanders, M.A. 813 , 814 . This approval covers the period beginning May 1, 2012 and ending June 30, 2013. (kbr) (Entered: 08/03/2012)
819 SPECIAL MASTER'S REPORT ON PROGRESS TOWARD COMPLETION OF THE KATIE A IMPLEMENTATION PLAN REPORT filed by Defendant Diana Bonta. (Attachments: # 1 Exhibit 1 THROUGH 5 TO SPECIAL MASTER'S REPORT ON PROGRESS TOWARD COMPLETION OF THE KATIE A IMPLEMENTATION PLAN)(Snuggs, Carmen) (Entered: 08/28/2012)
820 TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz: Due to the Court's unavailability on September 14, 2012, the STATUS CONFERENCE re: Special Master Report and Implementation Plan previously scheduled for Friday, 9/14/2012 at 3:00 PM has been rescheduled. The Status Conference is now set for Thursday, 9/13/2012 at 3:00 PM before Judge A. Howard Matz. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(smo) TEXT ONLY ENTRY (Entered: 09/04/2012)
821 NOTICE of Change of Attorney Information for attorney Patrick H Gardner counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Changing firm name and address to Young Minds Advocacy Corp., 115 Haight Street, Menlo Park, CA 94025. Changing e−mail to patrick@youngmindsadvocacy.org. Filed by plaintiff Katie A (Gardner, Patrick) (Entered: 09/11/2012)
822 NOTICE filed by defendants Los Angeles County. Notification of Resignation of William Jones; Stipulation Re no Appointment of Replacement Panel Member; and Request for Commendation of William Jones; [Proposed] Order (Quinonez, Laura) (Entered: 09/11/2012)
823 ORDER by Judge A. Howard Matz, re Notification of Resignation of William Jones 822 . IT IS HEREBY ORDERED that the Advisory Panel is permitted to continue with the same functions and responsibilities as set forth in the Settlement Agreement, until December 31, 2013, without replacing William Jones on the Panel, unless the Parties and Panel mutually agree that a replacement is needed, in which case the Court will be advised of said request for an appointment. (kbr) (Entered: 09/13/2012)
824 MINUTES OF Status Conference held before Judge A. Howard Matz. The Court accepts Mr. Saletta's recommendation and suggestions. The parties are ordered to meet and confer and then propose a schedule so that the Court is provided with another Special Master's Report by December 6, 2012. At the forthcoming December 13, 2012 hearing (at 3:00 p.m.), the Court will hear the parties respective positions on adjusting the expectation timeline for the completion of the Implementation Plan Phase II details. Court Reporter: Cindy Nirenberg. (kbr) (Entered: 09/17/2012)

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09/24/2012 10/11/2012
10/11/2012 11/29/2012 12/06/2012 12/06/2012 12/07/2012 12/13/2012
12/17/2012
12/17/2012 12/20/2012

825 Mail Returned Undeliverable addressed to Renee M Wohlenhaus re Order 823 (jp) (Entered: 09/24/2012)
826 TRANSCRIPT for proceedings held on 9/13/12 3:12 pm. Court Reporter/Electronic Court Recorder: C. Nirenberg, www.msfedreporter.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter www.msfedreporter.com or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 11/1/2012. Redacted Transcript Deadline set for 11/11/2012. Release of Transcript Restriction set for 1/9/2013. (Nirenberg, Cindy) (Entered: 10/11/2012)
827 NOTICE OF FILING TRANSCRIPT filed for proceedings 9/13/12 3:12 pm re Transcript 826 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(Nirenberg, Cindy) TEXT ONLY ENTRY (Entered: 10/11/2012)
828 PROGRESS REPORT REPORT of TOWARD COMPLETION OF THE KATIE A. IMPLEMENTATION PLAN filed by Special Master Richard Saletta. (Attachments: # 1 Exhibit 1 to 3 to Special Master's Report on Progress Toward Completion of the Katie A. Implementation Plan)(Snuggs, Carmen) (Entered: 11/29/2012)
829 TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz: On the Court's own motion, the Court advances the time of the 12/13/2012 Status Conference from 3:00 p.m. to 2:00 p.m., before Judge A. Howard Matz. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(smo) TEXT ONLY ENTRY (Entered: 12/06/2012)
830 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary Eto Report, 828 to Special November 29, 2012 Master Report (Bird, Melinda) (Entered: 12/06/2012)
831 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. The Court has received the attached fax from the California Mental Health Directors Association. Apparently, it was not sent to counsel of record in this case. (kbr) (Entered: 12/07/2012)
834 MINUTES OF Status Conference held before Judge A. Howard Matz: Court and counsel confer about the recommendations in the Special Master's Progress Report on Progress Toward Completion of the Katie A. Implementation Plan. See document for details. Court ORDERS Mr. Saletta to report on subsequent developments involving CMHDA and CDHCS and their communications with each other, by not later than January 3, 2013. Court ORDERS the parties to obtain an expedited transcript of this hearing. The transcript must be prepared by not later than Monday, December 17, 2012. Upon receipt, Mr. Saletta must send a copy of the transcript to Patricia Ryan.Court Reporter: C. Nirenberg. (smo) (Entered: 12/20/2012)
832 TRANSCRIPT for proceedings held on 12/13/12 2:40 pm. Court Reporter: C. Nirenberg, website www.msfedreporter.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter, www.msfedreporter.com, or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 1/7/2013. Redacted Transcript Deadline set for 1/17/2013. Release of Transcript Restriction set for 3/17/2013. (Nirenberg, Cindy) (Entered: 12/17/2012)
833 NOTICE OF FILING TRANSCRIPT filed for proceedings 12/13/12 2:40 pm re Transcript 832 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(Nirenberg, Cindy) TEXT ONLY ENTRY (Entered: 12/17/2012)
835 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz: This Order reflects the Court's findings and rulings at, and following, the hearing that was held on December 13, 2012. See document for details. If the deadlines forrelease of the Documentation Plan and Core Practices Model Guide are bothextended to February 1, 2013, and the Special Master determines that thosedeadlines cannot be met and there has not been substantial progresswarranting yet another extension to March 1, 2013, the Special Master shallfile a status report by not later than February 11, 2013 stating the reasons forthe delay and recommending how to overcome them. (smo) (Entered: 12/20/2012)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 81 of 92

01/07/2013
02/20/2013
02/21/2013 03/01/2013 03/04/2013 03/04/2013 03/11/2013 03/13/2013 03/19/2013 03/20/2013
03/25/2013

836 ADVISORY PANEL REPORT of The Court's Second Reporting Period 2012, December 15, 2012 filed by Plaintiff Katie A. (Attachments: # 1 Appendix Katie A−Appendix 1 to Advisory Panel Report, # 2 Appendix Katie A−Appendix 2 to Advisory Panel Report, # 3 Appendix Katie A−Appendix 3 to Advisory Panel Report, # 4 Appendix Katie A−Appendix 4 to Advisory Panel Report, # 5 Appendix Katie A−Appendix 5 to Advisory Panel Report, # 6 Appendix Katie A−Appendix 6 to Advisory Panel Report)(Dozier, Antionette) (Entered: 01/07/2013)
837 MINUTE ORDER IN CHAMBERS by Judge A. Howard Matz. (1) Their best estimate as to when the objectives and provisions of the Settlement Agreement will at last be achieved; Their view as to the efficacy of the Advisory Panel; Their requests or recommendations as to the most efficient and effective manner in which Judge Kronstadt may and should assume the task of overseeing implementation of the Settlement Agreement; Any other matter[s] they deem relevant or appropriate. (kbr) (Entered: 02/20/2013)
838 TEXT ONLY ENTRY (IN CHAMBERS) by Judge A. Howard Matz re: Settlement Agreement with the State Defendants 837 . Status Conference set for 3/13/2013 at 3:00 PM before Judge A. Howard Matz. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(smo) TEXT ONLY ENTRY (Entered: 02/21/2013)
839 SPECIAL MASTER'S SUPPLEMENTAL PROGRESS REPORT of ON THE IMPLEMENTATION OF THE KATIE A. PLAN filed by Defendant Diana Bonta. (Snuggs, Carmen) (Entered: 03/01/2013)
840 STATUS REPORT JOINT STATUS REPORT PURSUANT TO COURT'S FEBRUARY 20, 2013 ORDER filed by Defendant Los Angeles County. (Quinonez, Laura) (Entered: 03/04/2013)
841 PLAINTIFFS' CLARIFICATION REPORT of TO THE SPECIAL MASTER'S SUPPLEMENTAL PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A. PLAN filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) (Entered: 03/04/2013)
842 RESPONSE filed by Defendant Diana Bontato Report 839 STATE DEFENDANTS' RESPONSE TO SPECIAL MASTER'S SUPPLEMENTAL PROGRESS REPORT FILED MARCH 1, 2013 (Martinez, Ernest) (Entered: 03/11/2013)
843 MINUTES OF Status Conference held before Judge A. Howard Matz. Court and counsel confer about the Settlement Agreement with the State Defendants. The Court approves and adopts the Proposed Modification of Implementation Plan Timelines, Exhibit 1 to this Order. Court Reporter: Cindy Nirenberg. (kbr) (Entered: 03/14/2013)
844 ORDER TRANSFERRING CIVIL ACTION pursuant to Section 3.1 of General Order 08−05. ORDER case transferred from Judge A. Howard Matz to the calendar of Judge John A. Kronstadt for all further proceedings. The case number will now reflect the initials of the transferee Judge CV 02−05662 JAK(SHx). Signed by Judge A. Howard Matz. (rn) (Entered: 03/19/2013)
845 (IN CHAMBERS) ORDER REGARDING TRANSFER OF CASE TO JUDGE JOHN A. KRONSTADT by Judge John A. Kronstadt: This action has been reassigned to the Honorable John A. Kronstadt, United States District Judge. The Magistrate Judge previously assigned to this matter will continue. The case number will now read: LA CV02−05662 JAK (SHx). Because all pleadings are routed using the judge's initials, please be sure to use the initials JAK in place of the initials AHM on all future filings. Judge Kronstadt's Courtroom Deputy Clerk, Andrea Keifer, can be reached at 213.894.2156 or at andrea_keifer@cacd.uscourts.gov. 844 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(ake) TEXT ONLY ENTRY (Entered: 03/20/2013)
846 MINUTE:(IN CHAMBERS) ORDER SETTING STATUS CONFERENCE: The Court sets a Status Conference in this matter for June 6, 2013 at 1:30 p.m. in Courtroom 750. Thepurpose of the Status Conference is to discuss and consider developments with respect to those matters considered during the March 13, 2013 hearing, including the status of the implementation of the orders that were issued following that hearing. In addition, the Status Conference will provide an opportunity for a discussion of the Special Master's Proposed Budget for Fiscal Year 2013−14. In connection with the Status Conference, the Special Master shall file a Progress Report

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 82 of 92

04/10/2013
04/10/2013 05/24/2013 05/24/2013 05/29/2013
06/27/2013 07/26/2013 07/26/2013 07/26/2013
07/26/2013 08/01/2013

and Budget Proposal on or before May 24, 2013. The Court does not anticipate the need to have any party file a statement prior to the Status Conference because it expects that the parties and the Special Master will have conferred about the matters addressed in his Progress Report and Budget Proposal prior to its filing IT IS SO ORDERED Judge John A. Kronstadt. (ir) (Entered: 03/26/2013)
847 TRANSCRIPT for proceedings held on 3/13/13 3:05 PM. Court Reporter: C. Nirenberg, www.msfedreporter.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through Court Reporter: C. Nirenberg, www.msfedreporter.com, or PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 5/1/2013. Redacted Transcript Deadline set for 5/11/2013. Release of Transcript Restriction set for 7/9/2013. (Nirenberg, Cindy) (Entered: 04/10/2013)
848 NOTICE OF FILING TRANSCRIPT filed for proceedings 3/13/13 3:05 PM re Transcript 847 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY.(Nirenberg, Cindy) TEXT ONLY ENTRY (Entered: 04/10/2013)
849 SPECIAL MASTER'S PROPOSED BUDGET FISCAL YEAR 2013−14 PURSUANT TO THE COURT'S MARCH 26, 2013 ORDER REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 05/24/2013)
850 NOTICE OF ERRATA filed by Special Master Richard Saletta. correcting Report 849 (Attachments: # 1 SPECIAL MASTER'S PROPOSED BUDGET FISCAL YEAR 2013−14 PURSUANT TO THE COURT'S MARCH 26, 2013 ORDER)(Snuggs, Carmen) (Entered: 05/24/2013)
851 MINUTE IN CHAMBERS ORDER GRANTING SPECIAL MASTERS REQUEST TO CONTINUE JUNE 6, 2013 STATUS CONFERENCE by Judge John A. Kronstadt: The request for a continuance of the June 6, 2013 Status Conference is GRANTED. The Status Conference is continued to August 8, 2013 at 1:30 p.m. in Courtroom 750 in the Roybal Building. On or before July 29, 2013, the Special Master shall submit to the Court an updated report with respect to progress in the case, including with respect to those matters described in the Letter and in its five−page exhibit and proposed further dates for implementation and a status conference with respect to such efforts. On or before August 1, 2013, the parties shall file a joint report in which their collective and/or respective views arepresented with respect to the Special Masters July 29, 2013 report, including as to what future dates should be set in this matter with respect to the implementation of the settlement agreement. (Attachments: # 1 Exhibit) (shb) (Entered: 05/30/2013)
852 MINUTE ORDER IN CHAMBERS by Judge John A. Kronstadt: re Approving Special Master's Proposed Budget Fiscal Year 2013−14. (rne) (Entered: 06/27/2013)
DOCUMENT number 853, In Chambers Order Re Pilot Program for Under Seal Documents deleted for the following reason: No document was attached to the docket entry.(cbr) (Entered: 07/26/2013)
853 NOTICE OF CLERICAL ERROR: Previous docket entry (#853) did not have attached form order. (im) (Entered: 07/26/2013)
854 (IN CHAMBERS) ORDER RE PILOT PROGRAM FOR UNDER SEAL DOCUMENTS by Judge John A. Kronstadt. This Court is participating in a pilot program regarding the submission of sealed documents. Effective July 8, 2013, all proposed sealed documents must be submitted via email to the Judges Chambers email at: jak_chambers@cacd.uscourts.gov consistent with this Order. (im) (Entered: 07/26/2013)
855 SPECIAL MASTER'S PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A PLAN REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 07/26/2013)
856 PLAINTIFFS' AND STATE DEFENDANTS' JOINT REPORT of RE SPECIAL MASTER'S PROGRESS REPORT FILED JULY 26, 2013 ON THE IMPLEMENTATION OF THE KATIE A. PLAN filed by Defendant Diana Bonta. (Martinez, Ernest) (Entered: 08/01/2013)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 83 of 92

08/08/2013 08/26/2013
08/26/2013 08/26/2013
08/30/2013 09/03/2013 09/05/2013 09/25/2013 11/04/2013 11/13/2013 11/15/2013

857 MINUTES OF STATUS CONFERENCE: Status Conference held before Judge John A. Kronstadt: The Court grants the parties request and sets a Status Conference for November 18, 2013 at 3:00 p.m. (See order for details)Court Reporter: Alex Joko. (shb) (Entered: 08/09/2013)
858 TRANSCRIPT for proceedings held on AUGUST 8, 2013, 2:00 PM. Court Reporter/Electronic Court Recorder: ALEXANDER T. JOKO, CSR NO. 12272, AJ_CSR@YAHOO.COM. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 9/16/2013. Redacted Transcript Deadline set for 9/26/2013. Release of Transcript Restriction set for 11/24/2013. (mw) (Entered: 08/26/2013)
859 NOTICE OF FILING TRANSCRIPT filed for proceedings AUGUST 8, 2013, 2:00 PM re Transcript 858 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (mw) TEXT ONLY ENTRY (Entered: 08/26/2013)
860 MINUTE IN CHAMBERS ORDER AMENDING SCHEDULE RE COURTS AUGUST 8, 2013 ORDER (Dkt. 857) by Judge John A. Kronstadt: On August 23, 2013, Richard Saletta, the Special Master, reported that the parties have made significant progress in reaching an agreement with respect to the matters discussed at the August 8, 2013 Status Conference before the Court. Dkt. 857. However, certain issues have arisen that need to be addressed with respect to the State and County Mental Health Plan Contract and State Control Agency. Until the entities with responsibility for such matters respond to pending inquiries, the parties cannot complete their efforts to reach an agreement on the final language. Accordingly, the Court GRANTS the parties request for an extension until August 30, 2013 of the August 23, 2013 deadline for the submission of agreed upon language −− or a report as to any remaining disagreements −− pursuant to the Courts August 8, 2013 Order. If an agreement cannot be reached, the parties shall submit a joint filing, including a red−line showing their competing positions together with a brief statement by each as to the reasons for its respective, proposed language. The Special Master shall file any comments on or before September 6, 2013 with respect to any disputed language. (shb) (Entered: 08/26/2013)
861 STIPULATION for Order Regarding Modifications to Special Master's Revised Recommendations of His Progress Report Filed July 26, 2013 on the Implementation of the Katie A. Plan filed by Defendants Diana Bonta. (Attachments: # 1 Proposed Order Regarding Modifications to Special Master's Revised Recommendations of His Progress Report Filed July 26, 2013 on the Implementation of the Katie A. Plan)(Martinez, Ernest) (Entered: 08/30/2013)
862 ORDER by Judge John A. Kronstadt, GRANTING Stipulation to modify Special Master's Revised Recommendations of his Progress Report filed 7/26/13 on the Implementation of the Katie A. Plan 861 . (ir) (Entered: 09/04/2013)
863 ADVISORY PANEL REPORT TO THE COURT − FIRST REPORTING PERIOD OF 2013, AUGUST 24, 2013 REPORT filed by Plaintiff Katie A. (Dozier, Antionette) (Entered: 09/05/2013)
864 Mail Returned addressed to KATHLEEN R WOLFE re Minutes of In Chambers Order/Directive − no proceeding held,,,,, 860 (rne) (Entered: 09/26/2013)
865 SPECIAL MASTER'S NOVEMBER 4, 2013 PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A. PLAN REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 11/04/2013)
866 SPECIAL MASTER'S NOVEMBER 13, 2013 REVISED PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A PLAN REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 11/13/2013)
867 RESPONSE filed by Defendant Diana Bontato Report 866 STATE DEFENDANTS' RESPONSE TO SPECIAL MASTER'S NOVEMBER 13, 2013 REVISED REPORT ON THE IMPLEMENTATION OF THE KATIE A. PLAN (Attachments: # 1 Exhibit Part 1 of 2, # 2 Exhibit Part 2 of 2)(Snuggs, Carmen) (Entered: 11/15/2013)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 84 of 92

11/18/2013 11/18/2013
11/19/2013
11/21/2013
11/21/2013 11/25/2013 11/26/2013 11/27/2013 11/27/2013 12/03/2013

869 MINUTES: STATUS CONFERENCE: The status conference is held. The Court sets a further Status Conference for February 3, 2014 at 1:30 p.m. Counsel shall file joint progress reports on November 27, 2013, January 16, 2014, and February 6, 2014. The Court directs the parties to lodge a proposed order that shall set forth the details of this hearing no later than November 25, 2013. IT IS SO ORDERED by Judge John A. Kronstadt Court Reporter: Alex Joko. (ir) (Entered: 11/20/2013)
872 AMENDED MINUTES 869 : STATUS CONFERENCE: The status conference is held. The Court confers with the parties regarding the progress that has been made since the August 8, 2013 hearing (Dkt. 857) and the four recommendations proposed by the Special Master in the Revised Report. Dkt. 866. Counsel and parties address the Court with respect to the tentative views and goals expressed by the Court. The Court sets a further Status Conference for February 13, 2014 at 1:30 p.m. The Special Master shall confer with the parties and prepare joint progress reports on November 27, 2013, January 16, 2014, and February 6, 2014. The Court directs the parties to lodge a proposed order that shall set forth the details of this hearing no later than November 25, 2013 IT IS SO ORDERED Judge John A. Kronstadt. (ir) (Entered: 11/22/2013)
868 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Response (non−motion) 867 . The following error was found: Case number is incorrect or missing. Incorrect judge's initials. The correct case number is 2:02−cv−05662−JAK (SHx). Please make sure all future documents have the correct case number on them. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (ir) (Entered: 11/19/2013)
870 TRANSCRIPT for proceedings held on 11/18/13 3:30 p.m.. Court Reporter: ALEXANDER T. JOKO, CSR, phone number AJ_CSR@YAHOO.COM. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 12/12/2013. Redacted Transcript Deadline set for 12/22/2013. Release of Transcript Restriction set for 2/19/2014. (ha) (Entered: 11/21/2013)
871 NOTICE OF FILING TRANSCRIPT filed for proceedings 11/18/13 3:30 p.m. re Transcript 870 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (ha) TEXT ONLY ENTRY (Entered: 11/21/2013)
873 NOTICE OF LODGING filed Proposed Order Re: November 18, 2013, Status Conference re Amended Minutes,,, 872 (Attachments: # 1 Proposed Order Regarding November 18, 2013, Status Conference and The Special Master's Recommendations fo His Revised Progress Report Filed November 13, 2013 on the Implementation of the Katie A. Plan)(Snuggs, Carmen) (Entered: 11/25/2013)
874 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Notice of Lodging, 873 . The following error(s) was found: Caption of document is incorrect. In response to this notice the court may order (1) an amended or correct document to be filed (2) the document stricken or (3) take other action as the court deems appropriate. You need not take any action in response to this notice unless and until the court directs you to do so. (rne) (Entered: 11/26/2013)
875 REVISED RECOMMENDATION ONE TO THE SPECIALS MASTER'S NOVEMBER 13, 2013 REVISED PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A. PLAN REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 11/27/2013)
876 ORDER re Notice of Lodging 873 by Judge John A. Kronstadt. The document is accepted as filed. (lom) (Entered: 11/27/2013)
877 ORDER Regarding 11/18/2013 Status Conference and the Special Master's Recommendations for his Revised Progress Report Filed 11/13/2013 on the Implementation of the Katie A. Plan by Judge John A. Kronstadt. Status Conference set for 2/13/2014 01:30 PM before Judge John A. Kronstadt. (rne) (Entered: 12/03/2013)

Case: 2:02-cv-05662-JAK-AJW As of: 03/20/2019 07:50 AM PDT 85 of 92

01/15/2014 01/27/2014 01/31/2014 02/06/2014 02/11/2014
03/04/2014 03/04/2014 03/14/2014 03/19/2014

878 REPORT of SPECIAL MASTER'S REPORT ON THE PROGRESS OF THE STATE'S REVIEW AND ANALYSIS OF THE COUNTIES' SEMI−ANNUAL REPORTS AND THE PARTIES' AGREEMENT ON ACCOMPLISHING THE OBJECTIVES OF AMENDED RECOMMENDATION 1. filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 01/15/2014)
879 STIPULATION for Extension of Time to File OF FIVE DAYS FOR THE STATE TO COMPLETE AND POST THE PLAN REQUIRED BY REVISED RECOMMENDATION NUMBER ONE OF THE SPECIAL MASTER'S NOVEMBER 13, 2013, REVISED REPORT filed by STATE DEFENDANTS Diana Bonta. (Attachments: # 1 Proposed Order)(Snuggs, Carmen) (Entered: 01/27/2014)
880 ORDER by Judge John A. Kronstadt, granting Stipulation for Extension of Five Days for the State to Complete and Post the Plan Required by Revised Recommendation Number One of the Special Master's November 13, 20913 Report, 879 . the parties hereby stipulate that the State be provided an extension of time of five (5) days, until February 6, 2014, to develop and post its action plan described in Amended Recommendation 1. (shb) (Entered: 01/31/2014)
881 REPORT of SPECIAL MASTER'S FEBRUARY 6, 2014 REPORT ON PROGRESS OF THE STATE'S KATIE A. WORK PLAN filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 02/06/2014)
882 (IN CHAMBERS) ORDER CONTINUING FEBRUARY 13, 2014 STATUS CONFERENCE by Judge John A Kronstadt: The Court has reviewed the Special Master's February 6, 2014 Report of Progress of the State's Katie A. Work Plaint (Dkt. 881) and grants the request to continue the Status Conference to March 6, 2014 at 1:30 p.m. and continue the due date for the filing and website posting from February 6, 2014 to February 27, 2014. The Special Master shall provide an updated report to the Court by 12:00 p.m. on March 4, 2016 as to the progress made by the parties in reaching an agreement on the Action Plans required by Amended Recommendation 1 and progress on Recommendation 3. If full agreement is reached, and if the Special Master recommends that the March 6, 2014 hearing is unnecessary, the Court may take the hearing off calendar. However, there will be no further continuances of the March 6, 2014 date conference if disputes remain as of March 4, 2014. 881 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (ake) TEXT ONLY ENTRY (Entered: 02/11/2014)
883 REPORT of SPECIAL MASTER'S MARCH 4, 2014 REPORT ON PROGRESS OF THE STATE'S KATIE A. WORK PLAN filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 03/04/2014)
884 (IN CHAMBERS) ORDER TAKING MARCH 6, 2013 STATUS CONFERENCE OFF CALENDAR by Judge John A Kronstadt: The Court is in receipt of the Special Master's March 4, 2014 Report on Progress of The State's Katie A. Work Plan and takes the March 6, 2014 Status Conference off calendar. A separate order will issue notifying counsel of the continued date for the status conference. 883 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (ake) TEXT ONLY ENTRY (Entered: 03/04/2014)
885 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary Eto Report 883 PLAINTIFFS' RESPONSE TO SPECIAL MASTER REPORT DATED MARCH 14, 2014 (Newman, Robert) (Entered: 03/14/2014)
887 MINUTE ORDER IN CHAMBERS by Judge John A. Kronstadt RE SPECIAL MASTERS REPORT (DKT. 883) AND RESCHEDULING STATUS CONFERENCE (DKT. 884). Based on its review of the Report, by this Order, the Court approves and adopts the following portions of its recommendations: 1. Recommendations 1 and 2: The March 6, 2014 Status Conference will be continued to June 19, 2014, with the conference to proceed at 1:30 p.m. The Court is not persuaded that it would be efficient or is necessary to have a prior status conference in April 2014; 2. Recommendation 3: Each of the parties may respond to the Report and each may file a replyto any response by another party, with any response due on or before March 14, and any reply due on or before March 21, 2014; 3. Recommendation 4: The Special Master shall file an updated status report on or before June 3, 2014, and any party may file a response to that report on or before June 13, 2014. 4. Recommendation 5: The Special Master shall file monthly updates with the Court with respect to the

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03/21/2014 03/26/2014 03/31/2014 03/31/2014 04/01/2014
04/02/2014 04/11/2014
04/15/2014 04/21/2014 05/14/2014 05/21/2014

deliverables described in the Report (Dkt. 883 at 7:28−8:4), as well as with respect to any other material and significant developments, whether encouraging or discouraging, that relate to the progress in the implementation of the overall plan. The Court acknowledges and applauds the parties ongoing collaborative efforts and the work of theSpecial Master. The Court recognizes that the parties are not in complete agreement as to certain matters, but anticipates both continued collaborative efforts by the parties over the coming weeks as well as a productive session with the Court on June 19, 2014. (shb) (Entered: 03/24/2014)
886 REPLY filed by Defendant Diana Bonta to Response (non−motion) 885 STATE DEFENDANTS' REPLY TO PLAINTIFFS' RESPONSE TO SPECIAL MASTER'S REPORT DATED MARCH 4, 2014 (Snuggs, Carmen) (Entered: 03/21/2014)
888 STIPULATION RE EXTENSION OF ADVISORY PANEL AND QUALITATIVE SERVICE REVIEW PARTICIPATION filed by Defendant Los Angeles County (Attachments: # 1 Proposed Order Proposed Order)(Quinonez, Laura) (Entered: 03/26/2014)
889 ORDER by Judge John A. Kronstadt, re EXTENSION OF ADVISORY PANEL AND QUALITATIVE SERVICE REVIEW PARTICIPATION 888 (shb) (Entered: 04/01/2014)
890 [DOCUMENT STRICKEN − SEE DKT.891] PERMANENT INJUNCTION AND JUDGMENT filed by Judge John A. Kronstadt against Defendants (See order for details). (MD JS−6, Case Terminated) (shb) Modified on 4/1/2014 (ake). (Entered: 04/01/2014)
891 NOTICE OF CLERICAL ERROR: Due to clerical error Re: Permanent Injunction, Judgment, 890 . This document has been stricken. Documents docketed in incorrect case should have been docketed in case 13−cv−05012 JAK (PLAx). This case has been re−opened and the Permanent Injunction and Judgment will be docketed in the correct case. (shb) Modified on 4/1/2014 (shb). Modified on 4/1/2014 (ake). (Entered: 04/01/2014)
892 SPECIAL MASTER'S MONTHLY UPDATE ON IMPLEMENTATION OF THE KATIE A. SERVICE DELIVERY ACTION PLAN − MARCH 2014 REPORT filed by Special Master Richard Saletta. (Attachments: # 1 Exhibit A thru E to Special Master's Monthly Update)(Snuggs, Carmen) (Entered: 04/02/2014)
893 MINUTE IN CHAMBERS ORDER RE SPECIAL MASTERS MONTHLY UPDATE AND EXHBITS (DKT. 892) by Judge John A. Kronstadt. Certain statements pertinent to this action and the present timelines were made in the December 6, 2013 letter from the Executive Directors of the California State Association of Counties (CSAC) and the County Mental Health Directors Association (CMHDA) (Dkt. 892, Ex. D) and in the March 18, 2014 Memorandum from the Executive Director of the CMHDA (id. Ex. E). There has been no written filing in this action that sets forth any official positions of the State of California −− through counsel in this action from the Office of the Attorney General −− about those statements.Therefore, to ensure transparency and to facilitate a comprehensive and coherent discussion of all issues at the June 19, 2014 Status Conference in this matter, the State of California, through its counsel in this matter, shall file a statement, on or before April 21, 2014. (See order for further details) (shb) (Entered: 04/11/2014)
894 Notice of Appearance or Withdrawal of Counsel: for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Filed by Defendant Los Angeles County. (Quinonez, Laura) (Entered: 04/15/2014)
895 STATEMENT IN RESPONSE TO THE COURT'S APRIL 11, 2014 ORDER filed by Defendant Diana Bonta re: Minutes of In Chambers Order/Directive−form only−no proceeding held,,, 893 . (Snuggs, Carmen) (Entered: 04/21/2014)
896 SPECIAL MASTER'S MONTHLY UPDATE ON IMPLEMENTATION OF THE KATIE A. SERVICE DELIVERY ACTION PLAN − APRIL, 2014 REPORT filed by Special Master Richard Saletta. (Snuggs, Carmen) (Entered: 05/14/2014)
897 (IN CHAMBERS) ORDER CONTINUING JUNE 19, 2014 STATUS CONFERENCE by Judge John A Kronstadt: The Court, on its own motion, continues the Status

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06/20/2014
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Conference from June 19, 2014 to July 2, 2014 at 2:00 p.m., with the Court to confer with the Special Master in advance of the hearing at 1:00 p.m. The Court directs the Special Master to file his report on or before June 16, 2014, with any responses to be filed no later than June 26, 2014. 887 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (ake) TEXT ONLY ENTRY (Entered: 05/21/2014)
898 REPORT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Attachments: # 1 Advisory Panel's Report to the Court − Second Reporting Period of 2013, April 25, 2014)(Newman, Robert) (Entered: 06/03/2014)
899 REPORT of SPECIAL MASTER'S JUNE 2014 PROGRESS REPORT ON THE IMPLEMENTATIN OF THE KATIE A. PLAN filed by Special Master Richard Saletta. (Attachments: # 1 Exhibit 1 and Exhibit 1.1, # 2 Exhibit 1.2, Exhibit 1.3, Exhibit 1.4, # 3 Exhibit 1.5 and Exhibit 2, # 4 Exhibit 3, Exhibit 4, and Exhibit 5, # 5 Exhibit 6, Exhibit 7.1, Exhibit 7.2 and Exhibit 8)(Snuggs, Carmen) (Entered: 06/16/2014)
900 (IN CHAMBERS) ORDER CONTINUING JULY 2, 2014 MEETING WITH THE SPECIAL MASTER AND STATUS CONFERENCE by Judge John A. Kronstadt: At the request of the parties, the Court approves the continuance of the meeting with the Special Master and Status Conference, presently scheduled for July 2, 2014, to July 18, 2014 at 1:00pm and 2:00pm, respectively. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jaklc2, ) TEXT ONLY ENTRY (Entered: 06/20/2014)
901 (IN CHAMBERS) AMENDED ORDER CONTINUING JULY 2, 2014 MEETING WITH THE SPECIAL MASTER AND STATUS CONFERENCE by Judge John A. Kronstadt: At the request of the parties, the Court approves the continuance of the meeting with the Special Master and Status Conference, presently scheduled for July 2, 2014, to July 18, 2014 at 1:00pm and 2:00pm, respectively. All materials associated with the July 18, 2014 status conference shall be filed on or before July 11, 2014. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jaklc2, ) TEXT ONLY ENTRY (Entered: 06/20/2014)
902 RESPONSE filed by Defendant Diana Bontato Report, 899 (Attachments: # 1 Exhibit A − Part 1 − Bates Nos. 0029−0054, # 2 Exhibit A − Part 2 − Bates Nos. 0055−0085, # 3 Exhibit B, C − Bates Nos. 0086 − 0152, # 4 Exhibit D, Batres 0153−0195)(Snuggs, Carmen) (Entered: 07/11/2014)
903 EXHIBIT Filed filed by Defendant Diana Bonta. EXHIBITS TO STATE DEFENDANTS' RESPONSE TO THE SPECIAL MASTER'S JUNE 16, 2014 REPORT as to Response (non−motion), 902 . (Attachments: # 1 Exhibit J,K,L,M,N − Bates Nos. 0248−0297, # 2 Exhibit O,P,Q,R,S,T,U,V − Bates 0298−0355, # 3 Exhibit W,X,Y,Z,AA − Bates 0356 −0395)(Snuggs, Carmen) (Entered: 07/11/2014)
904 EXHIBIT Filed filed by Defendant Diana Bonta. EXHIBITS TO STATE DEFENDANTS' RESPONSE TO THE SPECIAL MASTER'S JUNE 16, 2014 REPORT as to Response (non−motion), 902 . (Attachments: # 1 Exhibit BB, Part 2, Bates 0414−0431, # 2 Exhibit CC − Bates 0432−0445, # 3 Exhibit DD,EE,FF,GG,HH − Bates 0446−0503)(Snuggs, Carmen) (Entered: 07/11/2014)
905 EXHIBIT Filed filed by Defendant Diana Bonta. EXHIBITS TO STATE DEFENDANTS' RESPONSE TO THE SPECIAL MASTER'S JUNE 16, 2014 REPORT as to Response (non−motion), 902 . (Attachments: # 1 Exhibit II, Part 2, Bates 0529−0552, # 2 Exhibit JJ, KK, Bates 0553−0612)(Snuggs, Carmen) (Entered: 07/11/2014)
906 RESPONSE filed by Defendant Diana Bontato Report, 899 PLAINTIFFS' AND STATE DEFENDANTS' JOINT RESPONSE TO THE SPECIAL MASTER'S JUNE 16, 2014 REPORT (Snuggs, Carmen) (Entered: 07/14/2014)
907 (IN CHAMBERS) ORDER CONTINUING JULY 18, 2014 MEETING WITH THE SPECIAL MASTER AND STATUS CONFERENCE by Judge John A. Kronstadt: The Court, on its own motion, continues the July 18, 2014 Status Conference to July 31, 2014 at 1:30 p.m., with the Court to confer with the Special Master in advance of the hearing at 12:30 p.m. The Special Master shall email the Clerk with a list of parties

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who will be appearing by telephone and in person on or before July 25, 2014. 900 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (ake) TEXT ONLY ENTRY (Entered: 07/15/2014)
908 EXHIBIT Filed filed by Defendant Diana Bonta. EXHIBIT CC to State Defendants' Response to Special Master's June 16, 2014 Report as to Exhibit (non−trial), 904 . (Snuggs, Carmen) (Entered: 07/16/2014)
909 DIAL IN INFORMATION FOR JULY 31, 2014 TELEPHONIC STATUS CONFERENCE by Melissa Kunig, Relief Courtroom Deputy Clerk to Judge John A Kronstadt: Counsel who will appear telephonically at the July 31, 2014 status conference shall call in no later than 1:15 p.m. using the following information: Call In Number 213.894.3669; Password 129663#. Please note that cell phones and speaker phones are not permitted. 907 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (mku) TEXT ONLY ENTRY (Entered: 07/28/2014)
912 MINUTES OF STATUS CONFERENCE: Status Conference held before Judge John A. Kronstadt: The Court confers with all parties and the Special Master as to the areas of agreement and dispute. The Court expresses optimism that agreement may be reached as to some, if not all, of the remaining issues through further discussions between and among the parties and the Special Master. In in the interest of judicial and party economy, as well as to serve the need to take steps that will ensure the timely compliance with the terms of the settlement agreement, the Court concludes that the next steps in the process will be as follows: 1. The parties and the Special Master shall meet and confer forthwith as to the language in any remaining disputed recommendations. On or before August 15, 2014, the parties and Special Master shall submit a then up−to−date version(s) of the recommendations. The submission shall use a red−line format to illustrate any remaining disputes as to language between or among the parties and the Special Master. 2. At the same time that the parties and Special Counsel submit the aforementioned document, each of the three Plaintiffs, Defendants, and the Special Master shall submit a brief, not toexceed 10 pages, setting forth their respective or collective positions as to why the disputed language and resulting approach that each recommends is both appropriate and consistent with the requirements of the settlement agreement. The Court notes that a reiteration of what is in the parties briefs that preceded this hearing would not be particularly useful because that information is already before the Court. Instead, the parties should add to that information by focusing on the practical issues that relate to a successful and timely implementation of the terms of the settlement agreement so that the affected minors will receive the needed services in accordance with the schedule anticipated by the settlement agreement. Descriptions of meaningful, proposed timelines will also be helpful. 3. The Court sets a further status conference for August 28, 2014 at 11:00 a.m. to discuss and seek to resolve any remaining disputes as to the recommendations, and to set any furtherappropriate deadlines and hearings in this matter. The Court sets a meeting with the Special Master in advance of the hearing on August 28, 2014 at 10:00 a.m. The Special Master shall email the Clerk with a list of parties who will be appearing by telephone and in person on or before August 21, 2014. Court Reporter: Alex Joko. (shb) (Entered: 08/05/2014)
910 TRANSCRIPT for proceedings held on 7/31/14, 1:45 PM. Court Reporter/Electronic Court Recorder: Alex Joko, phone number aj_csr@yahoo.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 8/25/2014. Redacted Transcript Deadline set for 9/4/2014. Release of Transcript Restriction set for 11/2/2014. (Joko, Alexander) (Entered: 08/04/2014)
911 NOTICE OF FILING TRANSCRIPT filed for proceedings 7/31/14, 1:45 PM re Transcript 910 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (Joko, Alexander) TEXT ONLY ENTRY (Entered: 08/04/2014)
913 STATEMENT Plaintiffs, State Defendants', and Special Master's Statement of Agreement on Selected Recommendations filed by Defendant Diana Bonta (Martinez, Ernest) (Entered: 08/15/2014)

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08/19/2014
09/29/2014 10/09/2014 10/09/2014 10/16/2014
10/28/2014 10/30/2014 10/30/2014 11/10/2014

914 MINUTE ORDER IN CHAMBERS by Judge John A. Kronstadt: re: Statement 913 . Due to the agreements reached, the Status Conference previously set for August 28, 2014, is taken off calendar. The Court proposes the further status conference on progress, consistent with the terms of Recommendation 10, for October 16, 2014, at 1:30 p.m. The Court requests that the Special Master confer with counsel for the parties to determine if this time and date is convenient. The Special Mastershall advise the Courts Clerk if October 16 is convenient, or propose other dates to the Court that are convenient to all counsel and the Special Master. The Special Master shall make that report to the CourtsClerk on or before September 5, 2014. Consistent with Recommendation 10, the parties and the Special Master shall file the materials described on the dates specified; provided, however, in order to permit the parties and the Special Master additional time to confer, discuss and seek to resolve any disputed areas, the parties' response shall be due on or before October 9, 2014, rather than on October 3, 2014. Counsel and the Special Master are encouraged to engage in the same collaborative efforts that led to the Statement of Agreement as they discuss issues in advance of the October 16, 2014 Status Conference. (shb) (Entered: 08/19/2014)
915 REPORT of SPECIAL MASTER'S OCTOBER 2014 PROGRESS REPORT ON THE IMPLEMENTATION OF THE KATIE A. PLAN filed by Special Master Richard Saletta. (Attachments: # 1 Exhibit 1 to Special Master's October 2014 Progress Report, # 2 Exhibit 2 to Special Master's October 2014 Progress Report)(Snuggs, Carmen) (Entered: 09/29/2014)
916 RESPONSE filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary Eto Report, 915 PLAINTIFFS' RESPONSE TO SPECIAL MASTER'S OCTOBER 2014 PROGRESS REPORT (Newman, Robert) (Entered: 10/09/2014)
917 RESPONSE filed by Defendant Diana Bontato Report, 915 STATE DEFENDANTS' RESPONSE TO SPECIAL MASTER'S SEPTEMBER 29, 2014 REPORT (Snuggs, Carmen) (Entered: 10/09/2014)
918 MINUTES OF STATUS CONFERENCE: Status Conference held before Judge John A. Kronstadt: The Court confers with the parties and the Special Master concerning the areas of agreement and dispute since the Special Masters last status report filed on September 29, 2014. The parties are ordered to meet and confer with the Special Master and submit to the Court by no later than October 28, 2014, an updated version of the proposed recommendations. The submission shalluse a red−line format to illustrate any disputes as to language between or among the parties and the Special Master. To the extent there was an agreement as to a recommendation prior to the hearing, the parties shall file by no later than October 28, 2014, a stipulation and proposed order as to such language.The Court continues the matter for a final status conference on November 24, 2014, at 3:00 p.m. The Special Master shall file a status report by no later than November 20, 2014. The Court suggests that a discussion of the manner of post−jurisdiction collaboration be presented in light of the structure of therelevant State, County, private organization and federal operations in this field. The Court notes that leadership and collaboration are central to continued growth of the progress made to date. Court Reporter: Alex Joko. (shb) (Entered: 10/20/2014)
919 STATEMENT OF AGREEMENT ON RECOMMENDATIONS 1−4 BY PLAINTIFFS, STATE DEFENDANTS' AND SPECIAL MASTER'S (Martinez, Ernest) (Entered: 10/28/2014)
920 TRANSCRIPT for proceedings held on 10/16/14, 2:00 PM. Court Reporter/Electronic Court Recorder: Alex Joko, phone number aj_csr@yahoo.com. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Electronic Court Recorder before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Notice of Intent to Redact due within 7 days of this date. Redaction Request due 11/20/2014. Redacted Transcript Deadline set for 11/30/2014. Release of Transcript Restriction set for 1/28/2015. (Joko, Alexander) (Entered: 10/30/2014)
921 NOTICE OF FILING TRANSCRIPT filed for proceedings 10/16/14, 2:00 PM re Transcript 920 THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (Joko, Alexander) TEXT ONLY ENTRY (Entered: 10/30/2014)
922 MINUTE IN CHAMBERS ORDER REQUESTING ATTORNEY JOHN F. OTOOLE CONSENT TO E−SERVICE OF DOCUMENTS by Judge John A. Kronstadt: Mr.

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01/21/2015 04/20/2015 04/20/2015
07/10/2015 08/03/2015 08/12/2015 07/13/2016

OToole is requested to file a response by November 17, 2014, indicating whether he will consent toe−service of filed documents. Attached hereto are the instructions for communicating consent. If needed, assistance is available at the website provided in the instructions. (shb) (Entered: 11/10/2014)
923 REPORT of Special Master November 2014 Progress Report on the Implementation of the Katie A. Plan filed by Defendant Anita Bock. (Attachments: # 1 Exhibit Exhibit 1−2 to Special Master Report, # 2 Exhibit Exhibit 2 Cont'd to Special Master Report)(Snuggs, Carmen) (Entered: 11/20/2014)
924 RESPONSE filed by Defendant Diana Bonta State Defendants' Response to Special Master's November 20, 2014 Report (Snuggs, Carmen) (Entered: 11/20/2014)
925 RESPONSE filed by Defendant Diana Bontato Report, 923 State Defendants' Response to Special Master's November 20, 2014 Report (Snuggs, Carmen) (Entered: 11/20/2014)
926 RESPONSE filed by Plaintiff Katie A (Lewis, Kimberly) (Entered: 11/24/2014)
927 MINUTES OF Status Conference held before Judge John A. Kronstadt: The status conference is held. The Court confers with the parties and the Special Master concerning theprogress the parties have made to date and the parties proposals for the implementation of the Katie A.Plan after the conclusion of the Courts jurisdiction. The Court commends each partys advocacy, andtheir collective efforts to advance the welfare of the class−members. Counsel for the parties make similarremarks. The Court makes suggestions about how to continue on that path, and encourages the partiesto continue to work collaboratively and efficiently. The Court applauds the exceptional work of the SpecialMaster. The Court also acknowledges the central role played by Judge Matz throughout the time periodwhen he presided over the case. The Court suggests that the parties consider the use of a private neutralto assist in dispute resolution in the future. The Court inquires whether there are any issues with respectto any outstanding fees payable to the Special Master. Each side states that there are no such issues,and for that reason, there is no need to extend the Courts jurisdiction so that such issues could beaddressed.Court Reporter: Alex Joko. (bp) (Entered: 12/03/2014)
928 STATUS REPORT of Advisory Panel's First Reporting Period of 2014 filed by Plaintiff Katie A. (Dozier, Antionette) (Entered: 01/21/2015)
DOCUMENT number 929, Notice of Reassignment deleted for the following reason: NEF wasn't generated, document wasn't attached.(stsh) (Entered: 04/20/2015)
929 NOTICE OF REASSIGNMENT OF CASE due to Unavailability of Judicial Officer filed. The previously assigned Magistrate Judge is no longer available. Pursuant to directive of the Chief Magistrate Judge and in accordance with the rules of this Court, the case has been returned to the Clerk for reassignment. This case has been reassigned to Magistrate Judge Andrew J. Wistrich for any discovery and/or post−judgment matters that may be referred. Case number will now read as CV02−05662 JAK (AJWx). (mg) (Entered: 04/20/2015)
930 REPORT filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Dozier, Antionette) (Entered: 07/10/2015)
931 Notice of Appearance or Withdrawal of Counsel: for attorney Melinda Ruth Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Michael J. Stortz is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G−123 Notice. Filed by plaintiff Melinda Bird. (Bird, Melinda) (Entered: 08/03/2015)
932 MINUTE ORDER IN CHAMBERS by Judge John A. Kronstadt: Counsel shall continue to file reports consistent with the implementation of the Plan. However, consistent with the prior orders, for administrative purposes, this matter is deemed closed. Made JS−6. (pso) (Entered: 08/13/2015)
933 STATUS REPORT of ADVISORY PANEL'S REPORT TO THE COURT−ANNUAL REPORT FOR 2015, JULY 5, 2016 filed by Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. (Newman, Robert) (Entered: 07/13/2016)

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12/13/2016 12/14/2016 08/31/2017 09/01/2017
09/07/2017 09/13/2017 10/10/2017 10/11/2017 01/23/2019 01/28/2019 02/25/2019
02/25/2019

934 Stipulation Regarding Extension of Advisory Panel; [Proposed] Order (Attachments: # 1 Proposed Order)(Quinonez, Laura) (Entered: 12/13/2016)
935 ORDER GRANTING STIPULATION REGARDING EXTENSION OF ADVISORY PANEL 934 by Judge John A. Kronstadt: The appointment of the advisory panel ("Panel") shall continue until December 31, 2018. (ah) (Entered: 12/15/2016)
936 (STRICKEN PURSUANT TO DKT. 938 )Notice of Appearance or Withdrawal of Counsel: for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Adding Vicki Kozikoujekian as counsel of record for County of Los Angeles for the reason indicated in the G−123 Notice. Filed by Defendants Los Angeles County. (Quinonez, Laura) Modified on 9/7/2017 (ah). (Entered: 08/31/2017)
937 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Notice of Appearance or Withdrawal of Counsel (G−123), 936 . The following error(s) was/were found: Incomplete document attached In response to this notice, the Court may: (1) order an amended or correct document to be filed; (2) order the document stricken; or (3) take other action as the Court deems appropriate. You need not take any action in response to this notice unless and until the Court directs you to do so. (ak) (Entered: 09/01/2017)
938 ORDER TO STRIKE ELECTRONICALLY FILED DOCUMENTS by Judge John A. Kronstadt: the following document(s) be STRICKEN for failure to comply with the Local Rules, General Order and/or the Courts Case Management Order: Notice of Appearance or Withdrawal of Counsel (G−123), 936 . The document is blank. Counsel shall re−file the document with the required information. (ah) (Entered: 09/07/2017)
939 Notice of Appearance or Withdrawal of Counsel: for attorney Laura Elizabeth Hinoj Quinonez counsel for Defendant Los Angeles County. Adding Vicki Kozikoujekian as counsel of record for Los Angeles County for the reason indicated in the G−123 Notice. Filed by Attorney for County Defendants Laura Quinonez. (Quinonez, Laura) (Entered: 09/13/2017)
940 REPORT filed by Plaintiffs Katie A, Mary B, Janet C. (Newman, Robert) (Entered: 10/10/2017)
941 Notice of Appearance or Withdrawal of Counsel: for attorney Melinda Ruth Bird counsel for Plaintiffs Katie A, Mary B, Janet C, Henry D, Gary E. Andrew Marc Mudryk is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G−123 Notice. Filed by plaintiff Melinda Bird. (Bird, Melinda) (Entered: 10/11/2017)
942 ANNUAL REPORT of ADVISORY PANEL=S REPORT TO THE COURT ANNUAL REPORT FOR 2017, DECEMBER 21, 2018 filed by Plaintiff Katie A. (Dozier, Antionette) (Entered: 01/23/2019)
943 Notice of Electronic Filing re Report 942 e−mailed to Fiza A. Quraishi bounced due to invalid email address. The primary e−mail address associated with the attorney record has been deleted. Pursuant to Local Rules it is the attorneys obligation to maintain all personal contact information including e−mail address in the CM/ECF system. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (rrey) TEXT ONLY ENTRY (Entered: 01/28/2019)
944 Notice of Appearance or Withdrawal of Counsel: for attorney Louis R Miller counsel for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, David − Sanders. Adding Louis R. Miller as counsel of record for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders for the reason indicated in the G−123 Notice. Filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders. (Attorney Louis R Miller added to party Los Angeles County(pty:dft), Attorney Louis R Miller added to party Los Angeles County Department of Children and Family Services(pty:dft), Attorney Louis R Miller added to party David − Sanders(pty:dft))(Miller, Louis) (Entered: 02/25/2019)
945 Notice of Appearance or Withdrawal of Counsel: for attorney Brian Procel counsel for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, David − Sanders. Adding Brian A. Procel as counsel of record for

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02/25/2019
02/25/2019 03/13/2019 03/18/2019 03/18/2019

Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders for the reason indicated in the G−123 Notice. Filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders. (Attorney Brian Procel added to party Los Angeles County(pty:dft), Attorney Brian Procel added to party Los Angeles County Department of Children and Family Services(pty:dft), Attorney Brian Procel added to party David − Sanders(pty:dft))(Procel, Brian) (Entered: 02/25/2019)
946 Notice of Appearance or Withdrawal of Counsel: for attorney David W Schecter counsel for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, David − Sanders. Adding David W. Schecter as counsel of record for Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders for the reason indicated in the G−123 Notice. Filed by Defendants Los Angeles County, Los Angeles County Department of Children and Family Services, and David Sanders. (Attorney David W Schecter added to party Los Angeles County(pty:dft), Attorney David W Schecter added to party Los Angeles County Department of Children and Family Services(pty:dft), Attorney David W Schecter added to party David − Sanders(pty:dft))(Schecter, David) (Entered: 02/25/2019)
947 NOTICE of Association of Counsel associating attorney Louis R. Miller, Brian A. Procel, and David W. Schecter on behalf of Defendants Los Angeles County, David − Sanders. Filed by Defendants Los Angeles County, David − Sanders (Procel, Brian) (Entered: 02/25/2019)
948 [DOCUMENT STRICKEN PER ORDER ON 3/18/2019, SEE DOCKET ENTRY NO. 949] REQUEST to Withdraw filed by Plaintiff Katie A. (Attachments: # 1 Proposed Order Proposed Order on Request to Withdraw) (Gardner, Patrick) Modified on 3/18/2019 (jp). (Entered: 03/13/2019)
949 ORDER TO STRIKE ELECTRONICALLY FILED DOCUMENTS by Judge John A. Kronstadt: the following document(s) be STRICKEN for failure to comply with the Local Rules, General Order and/or the Courts Case Management Order: REQUEST to Withdraw 948 , for the following reasons: Counsel shall refile the form using the Court's Form G−123. (jp) (Entered: 03/18/2019)
950 Notice of Appearance or Withdrawal of Counsel: for attorney Patrick H Gardner counsel for Plaintiff Katie A. Patrick Gardner is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G−123 Notice. Filed by plaintiff Patrick Gardner. (Gardner, Patrick) (Entered: 03/18/2019)

 </s> FOR PUBLICATION
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT

KATIE A., by & through her next friend Michael Ludin; MARY B., by & through her next friend
Robert Jacobs; JANFf c., by &
through her next friend Dolores Johnson; HENRY D., by & through his next friend Gillian Brown; GARY E., by & through his next friend Michael Ludin, individually & on behalf of others similarly situated,
Plain tifft-Appellees,
v.
Los ANGELES COUNTY; Los ANGELES COUNTY DEPARTMENT OF CHILDREN AND FAMILY SERVICES; DOES, I thru 100 inclusive; DAVID SANDERS,
Defendants,
and
DIANA BONTA, Director of CA Dept of Health Services; RITA SAENZ, Director of CA Dept of Social Services,
Defendants-Appellants.

No. 06-55559
D.C. No. CV 02-05662 AHM
OPINION

Appeal from the United States District Court for the Central District of California
A. Howard Matz, District Judge, Presiding
Argued and Submitted October 24, 2006-Pasadena, California
3387

KATIE A. v. BONTA Filed March 23, 2007
Before: Eugene E. Siler, Jr., * A. Wallace Tashima, and
Carlos T. Bea, Circuit Judges. Opinion by Judge Tashima
*The Honorable ~ugene E. Siler, Jr., Senior United States Circuit Judge for the Sixth Circuit, sitting by designation.

3390

KATIE A. v. BONTA

COUNSEL
Sandra L. Goldsmith, Deputy Attorney General, Los Angeles, California, for the defendants-appellants.

KATIE A. v. BONTA

3391

Robert D. Newman, Esq., Western Center for Law and Poverty, Los Angeles, California, for the plaintiffs-appellees.

OPINION
TASHIMA, Circuit Judge:
Defendants, the Director of the California Depa11ment of Health Services ("DHS") and the Director of the California Department of Social Services ("DSS"), appeal from the district court's grant of a preliminary injunction ordering them to screen members of a statewide class of foster children1 and, where medically necessary, provide the children with the forms of mental health care lmown as wraparound services and therapeutic foster care. The district court found that "the early and periodic screening, diagnostic, and treatment services" ("EPSDT") provisions of the Medicaid Act obligate the State of California ("State") to provide wraparound services and therapeutic foster care to Medicaid-eligible children under 21, and that the State does not currently provide those forms of assistance, "as such."
On appeal, defendants argue that the district court abused its discretion in granting a preliminary injunction against them and in denying their motion for reconsideration. Specifically, . they contend that the court: (1) failed to make findings of fact and conclusions of law, as required by Federal Rule of Civil Procedure 52(a); (2) committed clear error in its factual findings; (3) applied the wrong legal standard both as to the standard for issuance of a mandatory preliminary injunction against a state agency and as to the underlying legal questions; and (4) failed to comply with Federal Rule of Civil Procedure 65(d)' s requirement that an injunction be specific in its tenus. We have jurisdiction to review the district court's order
1The class also includes children at imminent risk of foster care placement.

3392

KATIE A. v. BONTA

granting the preliminary injunction and the court's denial of the motion for reconsideration under 28 U.S.C. § 1292(a)(I).

Because the district court applied an erroneous interpretation of the Medicaid Act, we reverse and remand. We reject defendants' remaining contentions of error regarding the factual findings and legal standard relied on by the district court.

BACKGROUND

I. The Katie A. Class Action

In July 2002, a class of children who were in Los Angeles County foster care or at risk of being placed into foster care (Katie A., et al.) filed a complaint seeking declaratory and injunctive relief against the Director of DRS and the Director of DSS,' as well as Los Angeles County, the Los Angeles County Department of Children and Family Services ("DCFS"), and the Director of DCFS ("LA County Defendants"). The complaint alleged that the class was entitled to and had not received "medically necessary mental health services in a home-like setting." Separate claims were alleged under 42 U.S.C. § 1983, based on violations of the children's rights under the Medicaid Act, 42 U.S.C. § 1396 et seq., and the Due Process Clause of the federal Constitution; under the Americans with Disabilities Act and the Rehabilitation Act; under the Due Process Clause of the California Constitution; and under California statutory law.

The complaint was later amended to include a state-wide class of children in foster care or at risk of being placed in foster care. The district court certified the class under Federal Rule of Civil Procedure 23(b)(2),' and approved a settlement

2DHS is the State agency responsible for administering Medicaid health services in California. California's Medicaid program is called "MediCal." DSS is the State agency responsible for supervising the administration of child welfare services in California,
3The class was defined as:
Children in California who (a) are in foster care or at imminent

KATIE A. v. BONTA

3393

agreement between the plaintiff class and LA County Defendants.

Plaintiffs then moved for a preliminary injunction to require the Director of DHS and the Director of DSS ("defendants") to provide wraparound services ("wraparound") and therapeutic foster care ("TFC") to members of the class. Plaintiffs described wraparound and TFC as highly effective "integrated community-based interventions for children with emotional, behavioral, and mental health disorders." Plaintiffs argued that the EPSDT provisions obligate the State to provide wraparound and TFC to them. In particular, they alleged that MediCal policies impeding access to wraparound services or TFC violated the Medicaid statute. They alleged that MediCal covered only some components of wraparound and TFC, and that State policies made it difficult to access either type of care.

Defendants argued that the Medicaid statute does not require them to provide services in the wraparound or TFC forms demanded by plaintiffs: and that MediCal provides all required services. They characterized wraparound and TFC as processes or approaches, rather than services, and argued that

risk of foster care placement; and (b) have a mental illness or condition that has been documented or, had an assessment already been conducted, would have been documented; and (c) who need individualized mental health services, including but not limited to professionally acceptable assessments, behavioral support and case management services, family support, crisis support, therapeutic foster care and other necessary services in the home or in a home-like setting, to treat or ameliorate their illness or condition,
4Both plaintiffs and defendants, as well as the district court, have used the phrase "as such" to modify the phrase "wraparound and TFC" throughout the case, as a shorthand way of expressing the idea of "wraparound and TFC as distinct programs" or as "separately covered packages of services under Medi-Cal." As discussed below, this modifier was crucial to the district court's understanding and analysis of the case.

3394

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the Medicaid Act does not create obligations to provide either. Defendants also disputed plaintiffs' contention that all of the components of wraparound and TFC are health care services properly covered by Medicaid.

On March 14, 2006, the district court entered an order granting a mandatory preliminary injunction against defendants, ordering them to provide medically necessary wraparound services' and TFC' to class members 'on a consistent,
statewide basis within 120 days of the order's entry. Stating that defendants did not dispute that they did not provide wraparound and TFC as such, the court found that "wraparound services and therapeutic foster care fall within the EPSDT obligations of Medicaid-participating states.'" The court also

5The court relied on plaintiffs' description of wraparound services, which was as follows:
Providers of wraparound care services: (a) engage in a unique assessment and treatment planning process that is characterized by the formation of a child, family, and multi-agency team, (b) marshal community and natural supports through intensive case management, and (c) make available an array of therapeutic interventions, which may include behavioral support services, crisis planning and intervention, parent coaching and education, mobile therapy, and medication monitoring.
6The court also incorporated plaintiffs' description ofTFC as programs that:
(a) place a child singly, or at most in pairs, with a foster parent who is carefully selected, trained, and supervised and matched with the child's needs; (b) create, through a team approach, an individualized treatment plan that builds on the child's strengths; (c) empower the therapeutic foster parent to act as a central agent in implementing the child's treatment plan; (d) provide intensive oversight of the child's treatment, often through daily contact with the foster parent; (e) make available an array of therapeutic interventions to the child, the child's family, and the foster family ... ; and (I) enable the child to successfully tran,ition from therapeutic foster care to placement with the child's family or alternative family placement by continuing to provide therapeutic interventions.
7As a preliminary matter, the court held that plaintiffs properly relied on the private right of action contained in 42 U.S.C. § 1983 to enforce the

KATIE A. v. BONTA

3395

cited what it described as plaintiffs' undisputed evidence that wraparound and TFC are medically necessary for children with serious mental health needs. On this basis, the court concluded that plaintiffs had shown a strong likelihood of succeeding on the merits of their Medicaid Act claim. The court also described the potential for irreparable harm to plaintiffs in the fonn of unnecessary institutionalization and unmet mental health needs, if the injunction were not issued.

The court denied defendants' motions for clarification and reconsideration, but subsequently issued an Addendum to the order, which contained short answers to defendants' questions from their motion for clarification. The Addendum also contained appendices ("Appendices A and B") listing the components of wraparound and TFC for purposes of compliance with the order.

II. The Medicaid Framework and the EPSDT Obligation

Medicaid is a cooperative federal-state program that directs federal funding to states to assist them in providing medical assistance to low-income individuals. 42 U.S.C. § 1396. States choose whether to participate in Medicaid. Once a state enters the program, the state must comply with the Medicaid Act and its implementing regulations. Alexander v. Choate, 469 U.S. 287, 289 n.1 (1985); see generally 42 U.S.C. § 1396 et seq. California has chosen to participate in Medicaid.

To participate in Medicaid, a state must submit and have approved by the Secretary of Health and Human Resources a state plan for medical assistance. 42 U.S.C. § 1396. The Medicaid Act requires that each state plan "provide for making medical assistance available, including at least the care and

right toEPSDT services created by 42 U.S.C. § 1396a(a)(I0), citing Walson v. Weeks, 436 F.3d 1152 (9th CiL), cerl. denied, 127 S.Ct. 598 (2006). Defendants have not disputed that ruling on appeal.

3396

KATIE A. v. BONTA

services listed in paragraphs (1) through (5), (17) and (21) of section 1396d(a) of this title, to all individuals [listed under certain statutory provisions]." 42 U.S.C. § 1396a(a)(10). "[E]arJy and periodic screening, diagnostic, and treatment services ... for individuals who are eligible under the plan and are under the age of 21" are among the mandatory categories of medical assistance. 42 U.S.C. § 1396d(a)(4)(B).'

Thus, California, like all other states participating in Medicaid, is required to provide EPSDT care to eligible children under the age of 21.9 EPSDT services are defined in § 1396d(r). The EPSDT services at issue in this case, wraparound and TFC, are claimed to fall under subsection (r)(5) as "[s]uch other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan." 42 U.S.C. § J396d(r)(5).

Under § 1396d(r)(5), states must "cover every type of health care or service necessary for EPSDT corrective or ameliorative purposes that is allowable under § J396d(a)." S.D. ex reI. Dixon v. Hood, 391 F.3d 581,590 (5th Cir. 2004) (citing Collins v. Hamilton, 349 F.3d 371 (7th Cir. 2003»; Pediatric Specialty Care, Inc. v. Ark. Dep't ofHuman Servs., 293 F.3d
472 (8th Cir. 2002); Pittman v. Sec y, Fla. Dep't ofHealth &
Rehab., 998 F.2d 887 (11th Cir. 1993); Pereira v. Kozlowski, 996 F.2d 723 (4th Cir. 1993».10 Although states have the

8All subsequent references to statutory sections are to sections of Title 42 of the United States Code, unless otherwise noted.
9A large subset of the plaintiffs are eligible for Medicaid as foster children receiving federal assistance under Title IV-E of the Social Security Act, and others may be eligible on other grounds. See 42 U.S.C. § 1396a(a)(10)(A)(i)(I). The district court's order cOVers only MediCal eligible children.
10This is subject to certain limits; for example, a state need not pay for experimental medical procedures. See Miller v. Whitburn, 10 F.3d 1315, 1318 (7th Cif. 1993); McLaughlin v. Williams, 801 F. Supp. 633, 637-38 (S.D. Fla. 1992).

KATIE A. v. BONTA

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option of not providing certain "optional" services listed in § 1396d(a) to other populations, they must provide all of the services listed in § 1396d(a) to eligible children when such services are found to be medically necessary. Section 1396d(a) contains a list of 28 categories of care or services; these categories are fairly general, including descriptions such as "inpatient hospital services" and "private duty nursing services." 42 U.S.C. § 1396d(a)(l)-(8).

The EPSDT obligation is thus extremely broad. The federal agency charged with administering the Medicaid Act, the Centers for Medicare and Medicaid Services ("CMS"), has described EPSDT as a "comprehensive child health program of prevention and treatment." CMS, U.S. Dep't of Health & Human Servs., Pub. No. 45, State Medicaid Manual § 5010(B) (hereinafter "State Medicaid Manual")."

STANDARD OF REVIEW

We review the district court's grant or denial of a preliminary injunction for abuse of discretion. Earth Island Inst. v.
u.s, Forest Serv., 442 F.3d 1147, 1156 (9th Cir. 2006). "The
district court necessarily abuses its discretion when it bases its decision on an erroneous legal standard or on clearly erroneous findings of fact." Radde v. Bont, 357 F.3d 988, 994 (9th Cir. 2004) (citations and internal quotation marks omitted); see also Stanley v. Univ. 01S, Cal., 13 F.3d 1313,1319 (9th Cir. 1994) ("An order [granting a preliminary injunction] is reversible for legal error if the court did not apply the correct preliminary injunction standard, or if the court misapprehended the law with respect to the underlying issues in litiga-

11Courts have accorded eMS' interpretations of the Medicaid Act, such as that found in the State Medicaid Manual, "respectful consideration" based on the agency's expertise, the statute's complexity and technical nature, and the broad authority delegated to the Secretary of Health and Human Services under the Act. S.D. ex rei. Dixon, 391 F.3d at 590 n.6; see also Wis. Dep't ~f Health & Family Servs. V. Blumer, 534 U.S. 473, 497 (2002).

KATIE A. v. BONTA
tion.") (citation and internal quotation marks omitted)." Where an injunction is issued against state officials, a district court will "be deemed to have committed an abuse of discretion . . . if its injunction requires any more of state officers than demanded by federal constitutional or statutory law." Clark v. Coye, 60 F.3d 600, 604 (9th Cir. 1995) (citation omitted).
DISCUSSION
I. The District Court's Factual Findings
Defendants argue that the district comt clearly en-ed in a number of its findings of fact. We review a district court's factual findings for clear error, and this court will not reverse "if the district court's findings are plausible in light of the record viewed in its entirety . . . even if it is convinced it would have found differently." Husain v. Olympic Airways, 316 FJd 829, 835 (9th Cir. 2002), aff'd, 540 U.S. 644 (2004).
First, defendants argue that the court erred in stating that "Defendants do not dispute that cun-ently they are not providing these forms of assistance [wraparound and TFC), as such, to members of the plaintiff class." However, defendants immediately follow this contention with this statement: " 'Wraparound services' and 'therapeutic foster care' are not
"Citing Thomas v. County of Los Angeles, 978 F.2d 504 (9th Cir. 1992), defendants argue that a heightened standard of appellate review applies to preliminary injunctions against state agencies. Thomas, however, employed «more rigorous" review only in the sense that the court checked to see whether the district court properly applied the rule that requires a showing of "an intentional and pervasive pattern of misconduct" by officials before a federal court may enjoin a state or local law enforcement agency. See id. at 508 (citing Rizzo v. Goode, 423 U.S. 362, 375 (1976». Therefore, Thomas does not alter the general standard of appellate review for preliminary injunctions against state or local agencies. Cf Radde, 357 F.3d at 994-95 (applying normal standard of appellate review to a preliminary injunction issued against the County of Los Angeles under the Americans with Disabilities Act).

KATm A. v. BONTA

3399

Medicaid-covered services as such and are therefore not covered as such under the Medi-Cal program." (Emphasis added.) This statement coincides almost exactly with the district court's (jescription of defendants' position. It is therefore difficult to see how defendants can argue that the court's finding was clearly erroneous, while essentially reiterating that finding as their position in their next sentence."

Defendants also argue that the court overlooked or mischaracterized several of their legal arguments (whether they disputed plaintiffs' categorization of which statutory provisions encompass the components of wraparound and TFC, and the nature of their contentions regarding the coverage of § 1396d(a». The district court's characterizations of the parties' legal arguments, however, are not factual findings; because we do not rely on or defer to them, we need not review them for clear error."

Defendants fnrther argue that the court erred in finding that other states fund wraparound and TFC programs under Medicaid. The district court cited those states' practices as support for its conclusion that wraparound and TFC are Medicaidcovered services. Evidence in the record supports the court's

13Defendants attempt to qualify their agreement with the district court's finding by asserting that any component of wraparound or TFC that is covered under Medicaid is already covered under MediCaL The district court did not make any factual findings on this issue, however, because the court found that the Medicaid Act requires the State to provide wraparound and TFC "as such." The State could apparently not meet this obligation by funding only individual components of those types of care. Therefore, given the court's legal conclusion, there was no reason for the COUlt to make findings regarding the State's provision of the components.
14Defendants' contention that the court committed clear error in characterizing wraparound services and TFC as "services" is similarly misplaced, because that was not a pure factual finding, but an application of a statutory tenn. The court's finding was specifically directed to the question of whether those types of care are "early and periodic screening, diagnostic, and treatment services" falling under § 1396d(r)(5) - which must be resolved as a matter of statutory interpretation. See Part IILB, infra.

3400

KATIE A. v. BONTA

findings, and defendants have not presented any strong evidence to the contrary. For example, evidence that some states' programs use blended funding is not inconsistent with. the fact that such programs use Medicaid funding. Nor did defendants point to any specific evidence that other states are only able to fund wraparound and TFC through waivers allowing them to offer services not otherwise covered by Medicaid.

II. The Mandatory Preliminary Injunction

[I) Defendants contend that the district court failed to apply the appropriate legal standard for issuance of a mandatory preliminary injunction. We disagree. First, the district court correctly described the applicable test for the granting of a preliminary injunction, see Rodde, 357 F.3d at 994 (describing test), as well as the heightened standard that applies to mandatory injunctive relief, see Stanley, 13 F.3d at 1320 (stating that, when issuing a mandatory preliminary injunction, the court must find that the "facts and law clearly favor" plaintiffs).

[2) Second, in concluding that plaintiffs were entitled to a mandatory preliminary injunction, the district court correctly applied these tests. The court found that plaintiffs had a strong likelihood of success on the merits of their Medicaid Act claims. It also discussed the possibility that plaintiffs would face unnecessary institutionalization without the preliminary injunction, recognized that such harms were "grave," and rejected defendants' arguments that plaintiffs failed to show that they faced irreparable harm. It is evident that the court concluded that plaintiffs faced the potential for irreparable injury without the injunction. This is sufficient to meet the general requirement of "probable success on the merits and the possibility of irreparable injury" for preliminary injunctive relief. Rodde, 357 F.3d at 994. The court's finding of a strong likelihood that plaintiffs would succeed on the merits of their claims also evidences a conclusion that the law and facts clearly favor plaintiffs, meeting the requirement for issuance

KATIE A. v. BONTA

3401

of a mandatory preliminary injunction. Stanley, 13 F.3d at 1320.

Defendants also argue that the district court did not make any explicit findings showing that it considered the federalism principles that require federal comts to grant each state "the widest latitude in the dispatch of its own internal affairs" and to find "a threat of immediate and irreparable harm" before enjoining a state agency's operations. See Rizzo, 423 U.S. at 378-79; Gomez v. Vernon, 255 F.3d 1118, 1128 (9th Cir. 2001); Hodgers-Durgin v. de la Vina, 199 F.3d 1037, 1042 (9th Cir. 1999). The district court, however, did describe plaintiffs' vulnerability, complex needs, and ongoing "unmet mental health needs and the harms of unnecessary institutionalization." That description suffices to show that the court found a threat of immediate and irreparable harm to plaintiffs. As for the deference accorded to state agencies in their internal affairs, the court appropriately allowed defendants an opportunity jointly to develop the remedial plan needed to implement the injunction. No further deference was required; the order itself required only that defendants supply the services that the comt found to be required under federal law. It did not mandate detailed or burdensome procedmes for compliance. See Clark, 60 F.3d at 604.

III. The Medicaid Act

The district court's determination that the EPSDT provisions of the Medicaid Act require the State to provide wraparound and TFC was the foundation for its ruling that plaintiffs have a strong likelihood of success on the merits. Whether the district court correctly interpreted the EPSDT provisions of the Medicaid Act is a question of statutory interpretation that we review de novo. Bay Area Addiction Research & Treatment, Inc. v. City ofAntioch, 179 F.3d 725, 730 (9th Cir. 1999).

Defendants contend that the district court erred in determining that the EPSDT provisions of the Medicaid Act require

3402

KATIE A. v. BONTA

the State to provide wraparound and TFC. They argue that, even assuming all the components are covered under § 1396d(a), federal law does not require the State to offer the components as a "bundle" of services. They also dispute the court's conclusion that all the component services included within wraparound and TFC fall under § 1396d(a).

We conclude that the district court applied an erroneous legal standard in concluding that the EPSDT provisions require the State to provide wraparound and TFC. The district court mistakenly assumed that if all the components of wraparound and TFC fall within categories listed in § 1396d(a), and that wraparound and TFC can be deemed health care "services" in themselves, then the package of components must be offered in the form of wraparound or TFC. This assumption was flawed, for reasons that we explain below.

In general, the EPSDT provisions require only that the individual services listed in § 1396d(a) be provided, without specifying that they be provided in any particular form."

A. The district court's approach

The district court first determined that wraparound and TFC are mental health "services," rather than simply processes, approaches, or philosophies. The court then noted that a service may fall under one of the 28 categories of § 1396d(a) without being expressly listed as one of those cate. gories. Relying on plaintiffs' breakdown of wraparound and TFC into component services, and their listing of specific provisions of § 1396d(a) which would cover each component, the

151t is possible that if the State fails adequately to provide the compo~ nent services, and the effectiveness of those services requires their coordinated delivery, it may be appropriate to require the State to provide services packaged together in a particular form, such as wraparound or TPC. Because, however, the predicate is unmet in this case, we need not address that possibility.

KATIE A. v. BONTA

3403

court concluded that each component likely falls under one or more of the § 1396d(a) categories listed by plaintiffs. For example, the court found that one component of wraparound, "engagement of the child and family," likely falls under § 1396d(a)(19) as "case management." After stating that all the components of both wraparound and TFC would fall under the State's EPSDT obligations, the court concluded that, as a result, wraparound and TFC are themselves within the State's EPSDT obligations.

The court did not explore the possibility that the State might only have an obligation to fund the component services of wraparound and TFC, rather than to offer the coordinated complex of services in a single package. This is clear from the way that the court addressed whether the State was violating its EPSDT obligations - which is to say that the court did not address the question beyond stating that defendants did not dispute that they were not providing wraparound and TFC "as such" to members of the plaintiff class.

But defendants had stated in their opposition to plaintiffs' motion for a preliminary injmlction that "Medi-Cal already covers the services that Plaintiffs are entitled to illlder Medicaid" and that plaintiffs were seeking a "bundled rate."" There was also evidence in the record that MediCal currently reimburses providers for at least some components of wraparoillld and TFC. Therefore, the court should have examined whether all required component services under § 1396d(a) were already being supplied. If all mandated services under § 1396d(a) are being supplied effectively, the State is not obliged to go further and package the services as wraparound and TFC.

161t should be noted that defendants also disputed whether the components of wraparound and TFC were actually covered under the Medicaid statute.

3404

KATIE A. v. BONTA

B. The EPSDT provisions require that a specified set of health services be provided in an effective manner to eligible children

[3] As stated above, under the EPSDT provisions, states have an obligation to cover every type of health care or service necessary for EPSDT corrective or ameliorative purposes that is allowable under § 1396d(a). The states also have an obligation to see that the services are provided when screening reveals that they are medically necessary for a child. This obligation is created by § 1396a(a)(43)(C), which states that a state plan must provide for arranging, directly or through referral, necessary corrective treatment under the EPSDT obligation. See § 1396a(a)(43)(C); Clark v. Richman, 339 F. Supp. 2d 631, 646-67 (M.D. Pa. 2004) ("[state's] obligations with respect to EPSDT services require more proactive steps, such as actual provision of services"); Chisholm v. Hood, 110 F. Supp. 2d 499,507 (E.D. La. 2000) ("states are further obligated to actively arrange for corrective treatment" under § 1396a(a)(43)(C»; Salazar v. Dist. of Columbia, 954 F. Supp. 278, 330 (D.D.C. 1996) (finding that District ofColumbia's failure to ensure that EPSDT-eligible children receive diagnosis and treatment for health problems detected during screening violated § 1396a(a)(43)(C»; State Medicaid Manual § 5310 (states must "[d]esign and employ methods to assure that children receive ... treatment for all conditions identified as a result of examination or diagnosis"). Even if a state delegates the responsibility to provide treatment to other entities such as local agencies or managed care organizations, the ultimate responsibility to ensure treatment remains with the state. See, e.g., John B. v. Menke, 176 F. Supp. 2d 786, 801 (M.D. Tenn. 2001) (state cannot "disclaim responsibility for the ultimate provision of EPSDT-compliant services by a once-removed provider").

[4] States also must ensure that the EPSDT services provided are reasonably effective. Thus, the State Medicaid Manual states at several points that EPSDT services must be

KATIE A. v. BONTA

3405

sufficient "to achieve their purpose." See State Medicaid Manual § 511 0 ("Services provided under EPSDT must be sufficient in amount, duration, or scope to reasonably achieve their purpose."); id. § 5123 (while "42 C.F.R. 440.230 allows [states] to establish the amount, duration and scope of services provided under the EPSDT benefit ... services must be sufficient to achieve their purpose (within the context of serving the needs of individuals under age 21 )"). Other statutory provisions and regulations under the Medicaid Act reinforce this obligation. See, e.g., 42 U.S.C. § 1396a(a)(8) (stating that all medical assistance, including EPSDT, must be furnished with "reasonable promptness"); 42 C.F.R. § 441.61(b) (providing that state must make available a variety of qualified providers willing to provide EPSDT).

[5) Federal courts have scrutinized state Medicaid systems to be sure that those systems are adequately designed to provide EPSDT services. See, e.g., Chisholm v. Hood ("Chisholm If'), 133 F. Supp. 2d 894, 899-901 (E.D. La. 2001) (stating that in not allowing psychologists directly to enroll as Medicaid providers and not providing alternative avenues of care, system foreclosed access to necessary psychological services for EPSDT-eligible children); John B., 176 F. Supp. 2d at 791-92, 800-05 (finding that the structure of the Tennessee Medicaid managed care system "makes it impossible to fully comply with federal mandates" including EPSDT).

C. As long as a State provides all EPSDT services in an effective manner, the Medicaid statute does not dictate that services must be "bundled"

[6) While the states must live up to their obligations to provide all EPSDT services, the statute and regulations afford them discretion as to how to do so. There is nothing in the EPSDT statutory provisions or regulations that indicates that the state must generally design its Medicaid system to fund "packages" of EPSDT services." The legislative history of the

"Section 1396d(r)(5) obligates the states to provide "necessary health care, diagnostic services, treatment, and other measures" and references

3406

KATIE A. v. BONTA

EPSDT provisions simply indicates a Congressional purpose to provide a broad program of healtb care to poor children, one that would include all the forms ofcare listed in § 1396d(a).18

In a number of cases, courts have held that particular types of health services must be provided to Medicaid-eligible children under a state's EPSDT obligations. Those cases, however, did not require a state to fund distinct services covered under separate categories of § 1396d(a) as a single package of services. See S.D. ex reI. Dixon, 391 F.3d at 597 (incontinence underwear falls under § 1396d(a)(7) as "home health care services"); Collins, 349 F.3d at 374-76 (long-term care at psychiatric res{dential treatment facility falls under § 1396d(a)(l6)

§ J396d(a)'s description of 28 general categories of health cafe services. The EPSDT regulations do not state whether services must be provided in a single package, or can be covered as separate services. There are regulations providing further definition of specific categories within § 1396d(a). 42 C.F.R. §§ 440.1-440.185. CMS has never promulgated final regulations interpreting § 1396d(r)(5) since it was added by Congress in 1989. See Medicaid Program; Early and Periodic Screening, Diagnosis, and Treatment Services Defined, 58 Fed. Reg. 51,288 (proposed Oct. I, 1993) (proposed regulations).
18Congress established the EPSDT program in 1967. See Stanton v. Bond, 504 F.2d 1246, 1247 (7th Cir. 1974) (describing establishment of program), Until 1989, states had substantial discretion regarding the services that they would provide as part of the EPSDT benefit. In 1989, Congress revised the EPSDT provisions to mandate broad coverage of medically necessary health services for eligible children under 21. See Omnibus Budget Reconciliation Act of 1989, Pub. L. 101-239, § 6403 (codified in part and as amended at 42 U.S.C. § 1396d(r»; H.R. Rep. No. 101-386, at 453 (1989) (Conf. Rep.), reprinted in 1989 U.S.C.C.A.N. 3018,3056. See also 135 Congo Rec. SI3,233-34 (Oct. 12, 1989) (Sen. Fin. Comm. Report) (explaining, as background to EPSDT amendments, that "while states have always had the option to do so, many still do not provide to children participating in EPSDT all care and services allowable under federal law, even if otherwise not included in the state's plan.... The Committee amendment would require that states provide to children all treatment items and services that are allowed under federal law and that are determined to be necessary....H).

KATIE A. v. BONTA

3407

as "inpatient psychiatric hospital services"); Pediatric Specialty Care, Inc., 293 F3d at 480-81 (early intervention day treatment services fall under § 1396d(a)(13) as "other diagnostic, screening, preventive, and rehabilitative services"); Chisholm II, 133 F. Supp. 2d at 897-98 (behavioral and psychological services for the autistic fall under both § 1396d(a)(6) as "any other type of remedial care recognized under State law" and § 1396d(a)(13) as "other preventive, and rehabilitative services").

The issue of whether the state must provide "bundled" EPSDT services was raised in a recent case quite similar to this one in Massachusetts, in which a class of children with serious emotional distnrbances claimed a right under the EPSDT provisions to "intensive home-based services," which would have included components falling under various categories of § 1396d(a). The district court avoided ruling on the question of whether EPSDT required the state to provide "intensive home-based services" to the children. Instead it "looked behind the phrase to the array of actual clinical interventions that constitute, in the terms of the Medicaid statute, 'medically necessary' services for class members." Rosie D. v. Romney, 410 F. Supp. 2d 18, 30 (D. Mass. 2006).19 On that basis, the court concluded that comprehensive assessment of the children's clinical needs, ongoing case management and monitoring, and adequate in-home behavioral support services were each required EPSDT services which the state had failed to provide. Id. at 52-53. We believe that that analytic approach was correct, insofar as it required the State to supply the substantive EPSDT services described in § 1396d(a) without curtailing the state's administrative discretion as to how to do so.

19The court noted that the phrase "intensive home-based services" had "generated an unhelpful~ time-consuming, and largely irrelevant dispute over whether the phrase describes a discrete clinical intervention (i.e" an actual fonn of treatment) or merely one method or system for delivering medical treatment." 410 F. Supp. 2d at 30.

3408

KATIE A. v. BONTA

[7] The conclusion that as a general rule, states may fund
or provide medically necessary EPSDT services as separate components is consistent with the overall structure and principles of the Medicaid program. Medicaid is a cooperative federal-state program. Wilder v. Va. Hasp. Ass 'n, 496 U.S. 498, 502 (1990). While the states must meet the substantive obligations of the Medicaid Act, they nonetheless retain the discretion to design and administer their Medicaid systems as they wish. Frew v. Hawkins, 540 U.S. 431, 439 (2004) (noting that consent decree at issue represented one choice among "various ways that a State could implement the Medicaid Act" to comply with the "general EPSDT statute"); John B., 176 F. Supp. 2d at 800 ("The State has discretion with respect to the provision of [EPSDT] services, so long as the plan 'complies satisfactorily' with federal law.") (citing Chisholm I); Chisholm I, 11 0 F. Supp. 2d at 506 ("Exactly how and in what fashion the state provides [EPSDT] services is left up to the state, as long as the state's plan to provide EPSDT services 'complies satisfactorily' with the requirements of federal law.") (citing Mitchell v. Johnston, 701 F.2d 337, 343 (5th Cir.1983)); see also Blumer, 534 U.S. at 495 (stating "that the leeway for state choices urged by both Wisconsin and the United States is characteristic of Medicaid"); Alaska Dep't ofHealth & Soc. Servs. v. Ctrs. for Medicare & Medicaid Servs., 424 F.3d 931,935 (9th Cir. 2005) ("Assuming that its plan meets federal requirements, a state has considerable discretion in administering its Medicaid program.").

IV. The Approach on Remand

Here, the district court assumed that if each component of a given type of care falls within the State's EPSDT obligations, this necessarily implies that that form of care itself must be funded and provided by the State as a single package."

2°Plaintiffs themselves did not make this assumption; their motion for a preliminary injunction cited exarnples of states that provide wraparound
and TFC by funding the individual components (while asserting that it is "highly preferable" for providers to bill wraparound and TFC as "a bun~ dIed package of services").

KATIE A. v. BONTA

3409

Under that assumption, because MediCal does not fund wraparound or TFC as distinct types of care, the district court concluded that the State was violating this obligation.

[8] In analyzing the issue in this way, the court conflated a two-step analysis into one; as a result, it applied a legal interpretation of the Medicaid Act that is too sweeping. The court should have first detennined whether the State is meeting its legal obligation under the EPSDT provisions to provide all individual health services that fall under the categories listed in § 1396d(a). Then, if it found that the State is failing to provide the individual health services effectively, the court should have determined whether the failure could only be remedied by ordering the State to fund the individual services as a single "bundle." Rather !ban applying a legal rule that requires the State always to fund a coordinated bundle of services if the individual components fall under § 1396d(a), the court should have applied a legal rule that would allow the State to exercise its discretion as to how to meet its EPSDT obligation effectively to provide all the component services that fall under § 1396d(a). On remand, the district court should analyze plaintiffs' likelihood of success on their Medicaid Act claims in this manner.

V. Other Claims of Error

[9] We reject defendants' remaining contentions of error." First, defendants contend that the injunction against DSS is "absolutely baseless." We conclude that the district court did

21Defendants also contend that they were "extremely prejudiced" by several of the district court's rulings that preceded the preliminary injunction, and by plaintiffs' alleged failure to comply with a discovery order.
Because defendants provide no elaboration or legal argument regarding
the coures supposed errors or the nature of any prejudice to them, we treat these contentions as having been waived. See lndep. Towers of Wash. v. Washington, 350 F.3d 925, 929 (9th Cir. 2003) (holding that court will consider "only issues which are argued specifically and distinctly in a
party's opening brief').

3410

KATIE A. v. BONTA

not err in enjoining DSS, even though DSS does not administer the State MediCal program and the complaint did not specify DSS as a defendant to the Medicaid Act claims. Under the Federal Rules of Civil Procedure, every injunction "is binding only upon the parties to the action, their officers, agents, servants, employees, and attorneys, and upon those persons in active concert or participation with them who receive actual notice of the order by personal service or otherwise." Fed. R. Civ. P. 65(d). DSS had actual notice of both the motion for the preliminary injunction and of the order. Further, DSS supervises the State child welfare system that is charged with foster children's care and can influence whether they will receive needed mental health services or not - qualifying them as "persons in active concert" with the DRS with regard to the class members' receipt of health care through MediCal."

[10) Defendants also contend that the district court errone-

ously required that they provide services to class members,

rather than simply make such services available. The order

required the State to screen class members and provide wrap-

around and TFC to members where medically necessary.

Requiring the State actually to provide EPSDT services that

have been found to be medically necessary is consistent with

the language of the Medicaid Act, which requires that each

state plan "provide for ... arranging for (directly or through

referral to appropriate agencies, organizations, or individuals)

corrective treatment the need for which is disclosed by such

child health screening services.

" 42 U.S.C.

§ 1396a(a)(43).

Finally, in their reply brief, defendants argue that plaintiffs'

22That DSS has the power to affect foster care children's receipt ofmental health services is demonstrated by its administration of both the State's non-MediCal wraparound services pilot project ("SB 163" project), which uses State and county foster care funds to provide wraparound, and a federal child welfare demonstration project providing wraparound services ("Title IV-E Waiver" project).

KATIE A. v. BONTA

3411

first amended complaint fails to cite the actual provision of the Medicaid Act which creates the EPSDT entitlement enforceable under § 1983. Defendants did not make this argument in their opening brief. An appellate court "will not ordinarily consider matters on appeal that are not specifically and distinctly argued in appellant's opening brief." Koerner v. Grigas, 328 F.3d 1039, 1048 (9th Cir. 2003) (citation omitted); see also Indep. Towers of Wash., 350 F.3d at 929. Exceptions apply when (I) there is good cause for the omission or manifest injustice may result if the issue is not considered; (2) the issue was raised in appellee's brief; or (3) the omission did not prejudice the opposing party's defense. Koerner, 328 F.3d at 1048-49. None of those exceptions applies here.

In any event, it is clear that defendants had fair notice of the nature of plaintiffs' claims. See Conley v. Gibson, 355
U.S. 41, 47 (1957) (defendant must have fair notice of the nature of plaintiff's claim); see also Crull v. GEM Ins. Co., 58 F.3d 1386, 1391 (9th Cir. 1995) ("The pleadings need not identify any particular legal theory under which recovery is sought.").

Because we vacate the preliminary injunction, we need not address defendants' contentions that the form of the order violated Federal Rules of Civil Procedure 52(a) and 65(d). We do note that on remand, in order to comply with Rule 52(a) and to facilitate appellate review, the district court should first make separate determinations as to (1) whether each component service of wraparound and TFC falls under a particular provision of § 1396d(a), and (2) whether defendants have effectively provided each mandated component service, before applying the standard discussed above to determine whether the State should be required to provide the required services in another manner which will render such services effective, or proceed directly to wraparound and TFC. See Fed. R. Civ. P. 52(a).

3412

KATIE A. v. BONTA CONCLUSION

The district court abused its discretion by relying on an erroneous legal interpretation of the federal Medicaid statute in granting plaintiffs' motion for a preliminary injunction. The preliminary injunction is reversed and the case is remanded for further proceedings consistent with this opinion.

REVERSED and REMANDED.


[CONTENT] the Central District | California | July 18, 2002 | Los Angeles County Department of Children and Family Services ||| County | State | California ||| State | Los Angeles County | the Medicaid Act | Periodic Screening | 42 | 1396 | the U.S. Constitution | Article I, section 7(a | the California Constitution | Americans | 42 | Section 504 of the Rehabilitation Act | 29 | 701 | California Government Code § | 11135 ||| ACLU | Southern California, Center for Public Interest | Western Center for Law and Poverty | Youth Law Center | Bazelon Center for Mental Health Law ||| March 2003 | Plaintiffs | L.A. County ||| June 19, 2003 | United States | A. Howard Matz | July 16, 2003 | Court ||| four | 1 | 2 | 3 | 4 ||| six | County ||| Panel | Court ||| August 2005 | Panel | two-year ||| September 15, 2005 ||| Matz | March 14, 2006 | State | thousands | Medi-Cal ||| approximately 85,000 | California |||  ||| February 16, 2006 | Plaintiffs | the Settlement Agreement | LA County ||| November 2006 | Matz ||| The State of California | the U.S. Court of Appeals | the Ninth Circuit ||| March 23, 2007 | the Ninth Circuit | the March 14th, 2006 | Matz | Periodic Screening | Diagnostic | the Medicaid Act | State | TFC ||| Katie A. v. | 481 | 1150 | 9th Cir. | 2007 ||| Plaintiffs | another Motion for Preliminary Injunction | January 11, 2008 ||| Court | Medi-Cal ||| March 2009 ||| December 2011 ||| $3.75 million ||| two | Implementation Plan ||| August 28, 2012 | the District Court | Implementation Plan | Court | September 13, 2012 ||| Advisory Panel | the Implementation Plan ||| the District Court's | December 2014 | September 26, 2014 ||| Court | November 20, 2014 ||| State ||| November 24, 2014 ||| John A. Kronstadt ||| August of 2015 | Kronstadt | a minute ||| October 19, 2017 | L.A. County's | December 31, 2018 ||| December 21, 2018 | Panel | 2017 ||| January 23, 2019 ||| 2017 | County | County | the Shared Core Practice Model ||| Panel | County | County ||| County | the Shared Core Practice Model | every eighteen months | 19 | 3 ||| Panel | the Shared Core Practice Model | County | first | Panel ||| Bloomberg [SUMMARY] This lawsuit was filed in the Central District of California on July 18, 2002, by the class of children and young adults who (a) are in the custody of Los Angeles County Department of Children and Family Services; (b) have a behavioral, emotional, or psychiatric impairment; and (c) need individualized mental health services.  The suit is against County and State agencies for neglecting their responsibilities to provide mental health care services to foster children in California.  Plaintiffs sought declaratory and injunctive relief from the State and Los Angeles County under provisions of the Medicaid Act, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), 42 U.S.C. § 1396; the Substantive Due Process clause of the 14th Amendment to the U.S. Constitution; Article I, section 7(a) of the California Constitution; the Americans with Disabilities Act, 42 U.S.C. § 12132; Section 504 of the Rehabilitation Act, 29 U.S.C. § 701; and California Government Code § 11135.   Plaintiffs are represented by the ACLU of Southern California, Center for Public Interest, Western Center for Law and Poverty, Protection & Advocacy, Inc., Youth Law Center, and Bazelon Center for Mental Health Law. 

In March 2003, Plaintiffs and L.A. County began settlement negotiations.  On June 19, 2003, United States District Judge A. Howard Matz certified class status, and on July 16, 2003, the Court approved a jointly submitted settlement agreement as fair, reasonable, and adequate.  The settlement agreement has four objectives: (1) to facilitate a provision of services delivered in a coordinated, comprehensive, community-based fashion; (2) to support the development and delivery of a service structure and fiscal system that supports core practices and services model; (3) to support an effective and sustainable solution that will involve standards and methods to achieve quality-based oversight; and (4) to address the need for certain class members with more intensive needs to receive medically necessary mental health services in their own home, a family settings, or the most homelike setting appropriate to their needs, in order to facilitate reunification, and to meet their needs for safety, permanence, and well-being. 

Pursuant to the Agreement, the parties to the settlement appointed a six-member expert advisory panel to determine whether the County met the objectives set forth and implemented the plans. The Panel was required to make regular written reports to the parties and Court of its findings and recommendations. In August 2005, the Panel issued a two-year report finding that the County had not complied with the terms of the Agreement. 

Because the state agencies did not participate in the settlement, plaintiffs moved for a preliminary injunction against them on September 15, 2005. Judge Matz granted the motion on March 14, 2006, ordering the State to provide "wraparound services" and "therapeutic foster care," to thousands of Medi-Cal eligible children who are in foster care or at risk of foster care placement. There are approximately 85,000 children in foster care in California and an even greater number of children served by the child welfare system in their own homes. The court's order extends to both groups of children.  

(In the meantime, on February 16, 2006, Plaintiffs filed a Motion to Compel Compliance with the Settlement Agreement against LA County. In November 2006, Judge Matz ordered the County to address deficiencies in its implementation plan.)

The State of California appealed to the U.S. Court of Appeals for the Ninth Circuit. On March 23, 2007, the Ninth Circuit vacated the March 14th, 2006, preliminary injunction, holding that Judge Matz had erroneously interpreted the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions of the Medicaid Act by not "explor[ing] the possibility that the State might only have an obligation to fund the component services of wraparound and TFC, rather than to offer the coordinated complex of services in a single package." Katie A. v. Bonta, 481 F.3d 1150 (9th Cir. 2007).

After further discovery, Plaintiffs filed another Motion for Preliminary Injunction against the state defendants on January 11, 2008. In response, the Court ruled that wraparound services are Medi-Cal eligible and ordered the parties to address how to provide and bill for those services. A Special Master was appointed in March 2009 to facilitate a settlement between the parties.

The parties reached a settlement agreement in December 2011, which included the development of an Implementation Plan to be evaluated by the Special Master. The agreement included a payment of $3.75 million in attorneys' fees, including costs and expenses, to plaintiffs' counsel. The parties developed a two-phase Implementation Plan. On August 28, 2012, the Special Master informed the District Court that he found the Implementation Plan reasonably and sufficiently calculated to meet the objectives of the agreement, and the Court accepted his recommendations on September 13, 2012. 

The Special Master and Advisory Panel continued to monitor and report on the completion of the Implementation Plan. 

In light of the fact that the District Court's jurisdiction was scheduled to end in December 2014, the Special Master put forth a set of recommendations in his report on September 26, 2014 to sustain the growth in the development and delivery of the intensive services agreed to by the parties. The Special Master submitted a final report to the Court on November 20, 2014. The report identified areas of progress and growth, but also found that there remained significant unfinished deliverables from the settlement agreement and identified the key activities the State should begin or continue implementing.

A status conference was held on November 24, 2014. Judge John A. Kronstadt determined that there was no need for the court to extend its jurisdiction at that time. Subsequently, in August of 2015, Judge Kronstadt issued a minute order stating that while the parties should continue to file reports consistent with the implementation of the settlement, the matter was considered closed. As of October 19, 2017, the parties had stipulated, with approval from the court, that the Panel monitoring L.A. County's progress toward implementation of the settlement agreement should continue to operate through December 31, 2018.

On December 21, 2018, the Panel issued its report for 2017. The plaintiff then filed this report with the court on January 23, 2019. The 2017 report identified major continuing concerns regarding the County's slow progress in implementing the settlement and uncertainty that County strategies would succeed in implementing the Shared Core Practice Model, which the report identified as a key strategy for compliance. The Panel noted its hope that the County's work would have developed data indicators that reflected progress towards full implementation, but because the County has concluded its data systems will not support those tasks, other strategies would be needed to improve performance. Among other things, the report was particularly troubled by the County's decision to change from using an Immersion Process, in which the Shared Core Practice Model would be fully implanted in only a few offices every eighteen months, to instead deciding to use a countywide approach in an attempt to reform all 19 offices and 3 specialized units simultaneously. The Panel report expressed doubt that this approach would bring the County any closer to full implementation of the Shared Core Practice Model, and disapproved of the County's decision to make this change without first notifying the parties or Panel, both of which had treated the immersion approach as a part of the strategic plan. 

According to Bloomberg, the case is now closed. 