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Support and Stabilization Guidance

Interim guidance on support and stabilization providers during COVID-19.

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Support and Stabilization Guidance

March 23, 2020
The Department of Children and Families (the Department) and its Support & Stabilization (S&S) service providers are facing unprecedented circumstances due to the COVID-19 outbreak. Child protection is a critical function of state government and the Department will continue, with your partnership, to fulfill its mission of keeping the Commonwealth’s children safe.


Isolation of children and families, a concern even when there is not a major public health issue, is now heightened. The Department is committed to reconfiguring daily operations to mitigate the spread of COVID-19 while continuing to assess the safety of children, and support staff and service providers in the process.


The Department requests that S&S providers collaborate with us to reach out to families and children on your caseloads while taking recommended health and safety measures to prevent virus spread.


It is important to note, that Governor Baker’s March 23, 2020 Emergency Order does not apply to your service provision. The link to the Emergency Order can be found
here: https://www.mass.gov/doc/covid-19-essential-services


Health and Safety Guidance
Following is guidance from the Massachusetts Department of Health (DPH) and the Department to assist with planning how to conduct work in the COVID-19 environment.

  1. The Department’s March 18 Interim Guidance on Prioritizing Child Safety and Conducting Visits During COVID-19 Outbreak is in Appendix A.
  2. DPH’s COVID-19 guidance for “Agency In-Home Caregivers” and “Community Day Programs” [This is the guidance for S&S providers delivering services in a community based location] is available at: https://www.mass.gov/info-details/covid-19-guidance-and-directives#caregivers-

Requests to DCF S&S Providers
Using the guidance sources listed above, the Department requests that your agency:

  1. Assess Capacity to Deliver Contracted S&S Service
  2. Assess Capacity to Connect with Families via Technology
  3. Communicate with DCF about Contract Issues
  4. Use the “Agency In-Home Care” or “Community Day Program” Checklist Tools

Assess Capacity
The Department understands that to slow the spread of coronavirus emergency orders to temporarily close child care programs, suspend public and private elementary and secondary education (K-12) as well as accommodations for employees at high risk, emergency modifications to services, and other factors may decrease your agency’s capacity to deliver your contracted S&S service.


The Department needs you to assess your agency’s service-delivery capacity so you can communicate with the Area Office for which you provide services. Your contact at the Area Office will be the Area Lead Agency Director or other Lead Agency staff. If Lead Agency staff are not available, you may connect with the Area Resource Coordinator (ARC) or Area Clinical Manager (ACM).
   
The expectation is that you will connect with the Area Office to initially triage cases no later than 7 calendar days from the issue date of this Interim Guidance, which is Monday, March 31. Your Area Office contacts will discuss the level of risk in the family with you and collaborate on determining which of your services will best meet the family’s needs. Cases with high risk levels will receive the highest level of service you are able to deliver in the current environment. Cases with lower risk levels are more appropriate for alternative services designed to meet the requirements of working in the midst of the COVID-19 environment.


Assess Capacity to Connect with Families via Technology
COVID-19 requires relying on technology to do our work in ways we have not in the past. FaceTime or similar technology, or even telephone contact, can help us stay connected with families and children when we cannot see them in person.
Assess your agency’s ability to equip staff with access to technology that will allow them to stay in contact with families and children when concerns about COVID-19 transmission interfere with seeing them in person. If tele-contact is being substituted for an in-home visit or a community-based service, APPENDIX B provides suggested topics to cover during the tele-contact.


Communicate with DCF about Contract Issues

  • The Department understands that services may look different and be delivered in alternative ways due to following health and safety guidelines. This is a time that requires flexibility.
  • Should circumstances change so dramatically that your agency is no longer able to provide any services that match your S&S contracted service, please communicate this change in an email to both:
    • Tara D’Orio-Thomas tara.diorio-thomas@massmail.state.ma.us and Andrea Cosgrove andrea.cosgrove@massmail.state.ma.us
  • Include in the email:
    • Name of the S&S service
    • Person submitting information
    • Title of person submitting information
    • Phone number of person submitting information
    • S&S contracted service not being provided – title and brief description
    • Title and brief description of the Alternative S&S service that will be substituted for contracted service
    • If the substituted service will be telehealth, covering the topics listed in APPENDIX B, write “telehealth”
    • If the substituted service will be something other than telehealth, provide a brief description.
    • While service modifications are required to limit the spread of COVID-19, the Department is collaborating with the Executive Office of Health and Human Services to ensure payments for alternative services. Details will be forthcoming.

 

  • Reminder
    • To communicate about specific cases, be in touch with the Lead Agency Director or designee in the DCF Area Office where the case is being managed.
    • To communicate about changes to contracted services that will affect all cases, regardless of Region or Area Office, send an email to tara.diorio- thomas@massmail.state.ma.us and andrea.cosgrove@massmail.state.ma.us

Supervised Visitation and Community and Home-Based Services
Following the Governor’s recent order regarding state agency operations, the Department‘s services focused on emergency child protection responses for a two day period as we began to prepare for new operating procedures required in the COVID-19 environment. While additional services were limited in this period, with your help, DCF will operate a wide range of services going forward. The Department continues to need your partnership and your valuable services to meet the needs of the children and families we both serve.


We appreciate that many of you are investigating ways to use technology to connect children and families when face-to--face visits are not possible. The Department will depend on you to continue face- to-face supervised visits and develop alternatives as necessary.


Using the “Agency In-Home Care” or “Community Day Program” Checklist Tools
The current guidance documents at https://www.mass.gov/info-details/covid-19-guidance-and- recommendations#for-in-home-caregivers- include a Checklist Tool to assist with planning for emergency modifications. Please use the Checklist Tool that is the best match for your agency to supplement planning that is already occurring in your organization.


APPENDIX A
Interim Guidance on Prioritizing Child Safety and Conducting Visits During COVID-19 Outbreak

3/18/2020


The novel coronavirus, COVID-19, poses an unprecedented challenge to the Department of Children and Families’ operations. There are crucial functions we must carry out to fulfill our responsibility to keep children safe, especially at a time when they are less visible in the community and therefore, more vulnerable. In order to prevent and mitigate the spread of COVID-19 while maintaining our core operations, we must prioritize our responsibilities and collaborate to accomplish critical agency functions and roles.


While information about COVID-19 is emerging, the CDC has identified that older adults and those with underlying health conditions or a weakened immune system are at higher risk for developing complications from COVID-19. We recognize that you may fall in to one of these high-risk categories and recommend that you work with your Supervisor and Manager to develop alternative plans for making in-person visits. Most importantly, if you are sick or have a fever you should not come to work.


Contacting Children and Families
With schools and childcare centers closing and parents experiencing higher levels of stress for a variety of reasons, including potential loss of work, it is increasingly important for us to remain in contact with our children and families to assess safety and address imminent needs they may have.


Make Contact on Your Assigned Cases
Please check in with the children, young adults, parents, and foster parents you are assigned to, either by phone or by using FaceTime. This is a very stressful time for children and families and our work is assessing how they are doing, including determining any safety or risk factors that may be present or increased because of new circumstances. If you identify any emergency situations, talk to your supervisor and manager immediately about next steps.

Meet with Your Supervisor to Prioritize Cases

After you have made contact with your families, plan to meet with your supervisor to discuss your cases and any imminent situations that require follow up. This meeting does not have to occur in person and can be done by phone or WebEx. In discussing your cases, you and your supervisor should discuss the following:

  • Age of the children, including sibling groups
  • Date of last face-to-face contact with children
  • Level of risk identified in the Risk Assessment tool
  • Any contributing factors present in the case, including substance use, mental health concerns and domestic violence
  • Any urgent needs the family may have, like childcare, medical care, medication availability or financial stressors.

During this process, if you identify any imminent situations that necessitate a face-to- face contact, you and your supervisor should discuss next steps with your manager. Together you, your supervisor, and manager can make a plan for making safe, face- to-face contact.


Conducting Safe Visits in the Field
Visits with children, families and foster/kin caregivers are a critical part of DCF’s responsibility to protect children and ensure their safety. The following guidelines should be utilized when conducting home visits during responses, visits for ongoing cases and to foster homes/group homes/congregate care facilities.

Plan Your Contact/Visit
If a situation arises where face-to-face contact is needed, talk with your supervisor and manager to develop a plan for making the contact. Whenever possible before going out to a visit, call the family and ask the following screening questions regarding members of their household. If you are unable to call the family before a home visit, or it is intended to be an unannounced visit, ask these screening questions regarding all household members before you enter the home and conduct your visit:

  • Are you or anyone in your household sick with fever (Higher than 100.3 oF) or newly developed respiratory illness such as cough, sneezing, shortness of breath, or sore throat?
  • Have you traveled internationally (i.e., within the past 14 days) from a COVID-19-affected geographic area?
  • Have you had close contact with a person diagnosed with COVID-19 in the past 14 days?

If someone answers yes to one of these questions, talk with your supervisor and manager for next steps. Your manager can reach out to the DCF Medical Team to discuss the situation further. It is still important for us to assess safety and risk in the families we work with, and your supervisor, manager and the medical team can help strategize the best and safest way for us to make contact with a family.

We are encouraging foster parents to ask screening questions of any visitors to their home, so they may also ask you the same screening questions listed above.


For visits to congregate care facilities, facility staff will ask you screening questions before you are able to visit. Because the spread of COVID-19 can occur rapidly in these environments, facilities are utilizing this guidance to protect the children in their care.


Minimize Duplicative Contacts When Possible

Often, foster parents or congregate care/group care facilities care for multiple children in DCF care. When this occurs, we recommend coordinating with the workers assigned and conducting a single visit to reduce the number of visitors in homes or facilities. At this time, other visits may be conducted by phone or FaceTime when child safety considerations permit. Supervisors and Managers can work together for this to occur across units and agency functions.

Safety Precautions to Take During and After Home Visits

Whenever a DCF Worker visits a family’s home, they should take common-sense precautions to reduce their exposure to COVID-19. These include:

  • Avoid touching surfaces in the family’s home as much as possible. Use a tissue to touch a surface when needed.
  • Avoid shaking hands with family members or engaging in other forms of physical greetings.
  • Maintain a distance of six feet between yourself and family members during home visits whenever possible.
  • Clean and sanitize your hands after each home visit by washing your hands with soap and warm water or using hand sanitizer or sanitizing wipes.
  • Clean and disinfect your home, car, and workspace with alcohol or bleach-based products often.
  • Clean and disinfect your clothes often.
  • Avoid touching your face.



APPENDIX B
Phone and Telecommunication Guidance

Consumer Name:
Date:

Time:

Contact: Y/N

Communication made by what method?
• In person
• Phone
• Text
• Telecommunication

Is everyone in your family safe?
• Immediate Family
• Extended Family
• Friends

Are you worried about anyone in particular? Explain:

How is everyone feeling?
• Is anyone ill? Fever of 100.3, coughing, sneezing, shortness of breath?
• Has anyone been diagnosed with COVID-19 or been exposed?
• Any foreign travel?

Have you had contact with any of your medical providers?
• concerns about COVID-19 testing?
• other medical issues
• rescheduling a doctor’s appointment
• medication needs

Do you have enough of the current medications that are prescribed to you or your family?

What are some of the things that you are currently worried about?
• Children being home
• Finances, paying bills
• Contracting COVID-19
• Supplies
• Other? Explain:

STOP HERE! Does this family need to be escalated up due to acuity/emergency situation? If no proceed with the remaining questions.

Do you know how to access free breakfasts and lunch from your local school?


Do you want assistance with ways to reduce risk that anyone in your family will get COVID-19?
• Please take the time to educate the family on proper cleaning and disinfecting as needed.
• Social distancing
• Avoiding crowds...

Do you have any concerns about running out of supplies?
• If so what in particular? Food, water, paper products, hygiene or cleaning products
• Are there resources that we can provide or direct them to?
Do you have internet/ Wifi Access?
• Gathering information on device and apps that could be used.
• Is there a resource they can obtain access from?
Do you need assistance with your child's remote learning?
• Have them email or send you to the school website to gain understanding of what is being
asked.
• Help develop a schedule if one does not exist
• Providing them with learning resources for free time if interested

As age and developmentally appropriate, talk with children and ask them questions about their safety, their needs, and their feelings.

Anytime you connect using a video feature, ask to see all children on screen.


Review crisis plan prior to ending the call
• Do they have a contact number for your agency/point person? • 211
• MCI, ESP or Local hospital number
• Review when it appropriate to call 911.


Set up a time for the next in person, phone call/telecommunication to help maintain a schedule for you and the youth and/or families so that they are prepared to talk the following day.

 

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