lps conservatorship cfts

CFTs for LPS Conserved Clients?


Sacramento county raised this unique issue of “CFTs” for LPS Conservatorship during the Joint Hearing on the LANTERMAN-PETRIS-SHORT ACT by the Assembly Health And Judiciary on December 15, 2021.
 
What was said during the meeting:
“I’d also encourage that we look at the LPS law... one of the things Sacramento county is doing which is really unique is we do basically Child and family team meetings. CFTs are in the dependency system, child family therapy or child family team meetings, those are
meetings that the department calls where the [family] sits in the center of the room and everybody surrounds the family and puts their heads together about what they need to do to
support that youth [or permanency placement] planning. We're doing that for LPS conservatees. We have our LPS Conserved client come to the table and [hold a CFT]. We [get] the public defender, county council, public guardian, case managers... we get together with the providers and say what do we need to do to make help you successfully engage in treatment”. Edited for clarity
 
At this time there is very little information about how LPS Conservatorship “CFTs” are conducted. To better conceptualize how CFTs may be implemented for LPS clients, below are is a sample guidelines for LPS CFTs adapted from current CFTs structure in the dependency system.
 
A very important note:
CFTs are already tricky to schedule in the dependency realm despite entire trainings and departments dedicated for CFTs. With how little funding there is for LPS, actual implementation for CFTs for LPS clients can pose to be a contentious issue as public guardians, public defenders, and treatment staff are very very busy. This guideline below is to be just that…. A simple guideline based on dependency practice. If other counties are to adopt CFTs for LPS clients, very very careful consideration needs to be made for everyone’s time.
 
Additionally, CFTs in the dependency realm are often filled with heightened emotions and sometimes conflict. Parents can yell, cry, or get into protracted arguments about case planning. With LPS clients, it would be unrealistic to expect that they would always present calmly or never be emotionally upset by an outcome. A facilitator would need to be trained in mental health de-escalation and mental illness sensitivity training to ensure that the meeting runs smoothly.
 
 
The CFT or child family team meeting one is a meeting process for families to provide input to social services and by extension the juvenile court. Topics of discussion center around how well case plan services are progressing for the parents, current placement, the youth’s health needs, and upcoming critical court dates. CFTs are an important process for everyone involved with child welfare to progress through a case plan that may have stagnated due to poor communication or inability to complete court ordered services.
CFT meetings are both formal and informal as they result in reports submitted to the court at the next review court date; but informal in that there are no bench officers present.
 
The goal of a CFT meeting is to practice shared decision making where the patient, case manager, medical providers, third party support, and/or legal representatives are present and all have input into the safety, placement options, case plan development, and outcome of the patient’s case.
 
All CFTs include:
• Explanation of the purpose of a CFT for all members.
• A shared agenda drafted and distributed prior to the meeting with input from all the members.
• Group agreements regarding privacy and rules.
• If necessary, the team shall review previous plans and changed circumstances.
• The group shall discuss patient’s progress and/or barriers to meeting treatment goals.
• Scheduling for the next CFT.
• For the entirety of the meeting always remembering to bear in mind the patient and family’s cultural and unique needs.
 
 
CFTs required for open LPS cases:
• Within the first 6 months of establishment of a permanent conservatorship, a CFT may be scheduled to ensure treatment goals are being met and if not how to change treatment planning to ensure that they are, and how the patient can work with the treatment team to transition to a lower level of placement as soon as possible.
• Evaluation of current and future placement needs including current restriction, patient’s desired changes in placement, and medication planning.
• The team shall evaluate or draft an ongoing case plan that every member of the team shall have input into with reevaluation every ___ months.
• Discussion around current psychotropic medication regimen.
• Discussion of side effects, complaints, patient desires to change or stay on certain medications and insight into choices.
  
 
 
Other important meetings topics may include (as applicable to case circumstances):
• Assessment of current placement in the least restrictive setting and review of treatment team notes to determine if patient is unable to maintain in the current setting.
• Assessment of third party relative and friends to determine if they are able to help meet the needs of the conservatee including ongoing treatment compliance, housing, assistance with food, clothing, and shelter.
for respite care.
• To develop a relapse preservation strategy so that conservatee does not need to return to a higher level of care
• Assessment of potential future placements such as group homes, board and cares, or residential facilities.
o If at any time the team’s placement recommendation is for more restrictive placement the patient’s legal representative and the public conservator representative shall present all the less restrictive options, why they would be unworkable, and all relevant legal guidelines supporting such a move.
• Planning for out of facility visits and potential family and friend visitation.
 
Attorneys in CFTs: LPS clients should be encouraged to consult with their attorneys for a CFT
 
CFTs in the dependency system are not legal proceedings but they may involve the parent’s counsel or legal representative. The department may have county counsel on the phone but not always due to high case loads. The same should apply for LPS Conservatorship CFTs as patients should have a legal representative or patient’s rights present at the CFT to ensure that their legal rights are retained.
 
•A patient’s attorney does not typically attend CFTs but they often request their attorney investigator’s presence at CFTMs.
•Notice is given to all team members when a new person will be present due to confidentiality rules.
 
•The attorney will be given the same information regarding the purpose, rules, and agenda of the CFT.
• All parties should know that CFTs are not for legal purposes of gaining “judicial advantage” or asking questions that relate to legal fact-finding that may impact court purposes. This needs to be done via formal discovery procedures.
•When attending, attorneys or investigators need to agree to the CFT confidentiality agreement
 
 
 
Scheduling a CFT
•CFTs shall be facilitated by a certain contracted facilitator who is trained in mental health and the needs of mental health patients.
•It should be either the public guardian or the treatment facility’s responsibility to schedule meetings and submit requests for facilitators giving all parties enough time to arrange their schedules.
 
 
NOTE: LPS clients should by statue be required to receive all information relating to the CFT. However, a client should retain the right to request that their information not be shared with certain members such as friends or relatives.
 
Confidentiality
•All mandated reporting laws shall be in effect, and if abuse is disclosed, this
information may be used to submit the appropriate referral.
 
Notifying and inviting essential and non essential CFT participants
•The CFT Facilitator is responsible for providing notification dates and invitations to each
member as part of meeting preparation.
•If a required member declines to attend the meeting, the CFT Facilitator should encourage them to attend and if they are unable to, document the reason for absence.
•All participants other than the public guardian, treatment team member, and patient should be approved by the patient and public guardian.
•Prior to inviting other members, the facilitator shall inform the patient of the proposed person’s role in the meeting and ask if they have an objection.
 
Notifying and inviting CFT participants (cont.)
•Before each meeting begins, the CFT Facilitator should meet briefly with the conservatee and confirm key information and address any new concerns or safety issues with placement.
•If there are concerns with patients being violent or acting inappropriately, then the CFT facilitator should not “cut” the patient out of the process. They should strive to see what is making the patient agitated and if they are unable to resolve the issue possibly arrange for a different date or for the patient to “call in” instead.