sacramento county rbs reform collaborative reform in progress
TRANSCRIPT
Sacramento County RBS Reform
Collaborative Reform in Progress
Who are we?
County Agencies (CW, MH, Probation, DHA, Education)
Group Home Providers Parents Youth
Our Vision, Mission, Values & Guiding Principles
“Roots to Grow, Wings to Fly”
Vision Reconnecting children, families & community
Mission Insure that all children and youth who receive residential services
are ultimately able to connect or reconnect with family, school & community so they can achieve productive adult life outcomes
Statement of Shared Principles & Core Values
RBS reform is critical to improving the ability of children and families in Sacramento County to get the right services, at the right time and the right location.
Residentially Based Services should:
√Demonstrate respect for the culture, individuality and humanity of children, youth and families
√Provide and use thorough assessments to drive services
that are tailored to individual, youth and families
√Help children and youth in placement quickly return to and
remain safe within their families, successful in their schools and integrate into their communities
√Hold all providers and systems accountable for actions and
outcomes
RBS Outcome Goals Increased % of children and youth discharged to
permanency Improved placement stability for children and youth in
group care Decreased % of children and youth re-entering after
discharge from group care Shortened length of career stay for children and youth
in group care Decreased % of children and youth placed in out of
county group care
Target Population & Start-up Criteria
Initial Target Population
CW, MH, Prob youth ages 12-16
Assessed to need or already in RCL 12 or above
30 slots/beds to start Child Welfare 12 Probation 12 Mental Health 6 2-3 providers w/plan to
increase number of youth & providers annually
Referral Criteria
Presents safety issues for self or others that requires 24 hours supervision and needs cannot be met in family setting or lower level of care
Not currently receiving Wrap Unmet mental health needs
present and likely to continue for extended time without RBS, and
for Initial Start-Up Only Current connection w/family or
NFREM
Service Inputs→ Should produce these outputs→ Which should result in these improved outcomes:
Thorough assessment Good fit: right level, right services Placement stability, and matching shorter LOS Parent and youth Active participation in case Increased ownership engagement planning process w/case plan: process placement stability: shorter LOS Intensive short-term Stabilization, safety; improved Continuity of family residential stabilization ability to cope; pro-social skills; and community and assessment pro-social competence connection: increase
in # of kids discharged to perm
On-going family in-home Improved family functioning Kids have needs met services at home; decrease # children returning to OH care
Our Theory of Change
Our Theory of ChangeService Inputs→ Should produce these outputs→ Which should result in these improved outcomes: Individual child and family Improved family functioning: “right Decrease in psych. Services in or out of services, right time, right place” hospitalizations and Of placement across continuum of care and juvenile hall episodes; relationships decreased re-entry into CWS or Juv Justice Educational engagement Educational continuity Academic achievement, and enrichment svcs placement and enrichment svcs stability Comprehensive care Integrated services delivered All coordination under a single case plan Non-traditional support Informal support network Decrease # children services strengthened; culturally re-entering care appropriate services delivered Intensive permanency Reconnection/Strengthening All services family ties, or finding alt permanency
The RBS Service Array
1. Comprehensive Care Coordination
2. Family Engagement & Empowerment
3. Intensive Short-term Residential Stabilization &
Assessment
4. Intensive Permanency
5. Ongoing Family Support
6. Education Engagement & Enrichment
7. Individualized child, Youth & Family Behavioral
8. Non-traditional Support & Assistance
9. Other Innovative Options & Approaches
The RBS Program Design
Service Array→ Service Options→ Program Model
Assessment & MatchingPlan of Care
Facility Based ServicesCommunity Based Services
Permanency Services
What’s new that will make the difference?
Assessment & Matching
Enhanced TDM Use of CANS as standardized assessment tool Child, youth & family participation Includes placement matching Provider presence Begins resource management process
Child/youth enrolled in RBS, not “placed” “CFT like” Team to develop and coordinate plan of
care Facilitated by RBS provider…Fred
√ Facilitate√ Reunify√ Engage√ Discharge
Plan updates at 30 day & quarterly intervals Continues after residential discharge Cross system collaboration
Plan of Care
Facility Based Services
Family membership in facility treatment team Integrated facility & community based staff for continuity of
connections, relationships, service delivery Individualized treatment Recruitment & retention of talented staff Flexible services that promote & provide for individualized interest Enrichment opportunities that anchor child in community and family Normalization w/safety contingencies Alignment of county caseworker with residential staff Active participation of caseworkers in CFT
Permanency Services
No “old step down”, only step toward permanency Strengthening and developing child/youth’s ties to
community Finding, developing & supporting family connections Build knowledge, skill & expertise of county and provider
RBS staff Youth advocacy
Coordinated by CFT Blend of parallel and aftercare Family & youth focused Comprehensive
-treatment
-respite
-educational
-recreational
Community Based Services
Lead Agency Model
Authorization& Resource
Mgt.
ProviderFacilitated
CFTPlan of Care
Integrated Arc of Care
Full Array ofServices
TDMDischargefrom RBS
County Worker Identifies Need for Group Care
Enhanced
Partnership Roles & Responsibilities Collaborative Process Staffing Model QA Mechanism Preliminary Training Plan Provider Selection for Next Steps...
Operational Design
Total Cost of Care and outcome components: All clients who have left care during 2006 and 2007 From RCL 12-14 Placed by Child Welfare, Mental Health, or Probation Federal and Non-federal (to be utilized to estimate correct ratio of FED : NONFED
AFDC Costs) Dollar totals are for each time span of placement during these 2 years With Lifetime cost listed as an additional column WRAP payments are also listed and are not included in the Lifetime Cost Mental Health Treatment Costs, EPSDT and/or 26.5 Non-AFDC Costs for out of state placements and hospitalization Permanency Outcomes data Age of Clients Client Gender Distance of Provider from Sacramento Metropolitan Statistical Area Only consider Clients with Group Home placements of 90 days or longer
Identifying Necessary Data Elements
Multiple Databases contain relevant information Requires collaboration across DHA, County
CMS/CWS Workers, Children’s Mental Health Manually combining information from databases Multiple refinements of Data Requests from each
database Large data set of approx. 850 clients
Challenges
Average Placement Cost* $133,401 in AFDC Payments + WRAP
$17,471 = $150,872** Fed/Non-Fed 71.5% / 28.5% Male/Female 60% / 40% Average Age 16.4 years
*Does not include additional payments for Mental Health, 26.5, Out of state, and/or Hospitalization.
**Preliminary figures, rough, not yet reliable!
Results
Service Areas Responsibilities to carry out components of
each service Expected Funding Sources for each
component within the service
Provider Estimates of RBS Services
1. Comprehensive Care Coordination 2. Family Engagement & Empowerment 3. Intensive Short-term Residential Stabilization &
Assessment 4. Intensive Permanency 5. Ongoing Family Support 6. Education Engagement & Enrichment 7. Individualized child, Youth & Family Behavioral 8. Non-traditional Support & Assistance 9. Other Innovative Options & Approaches
The RBS Service Array
Funding Components of the RBS RateProvider Cost 156,489
Monthly 8,694
EPSDT 2,906 33.4%
AFDC 3,645 41.9%
AFDC/Flex 2,142 24.6%
8,694
Next Steps
Continue to Refine reliability of Data Adjust Funding Shares as necessary Determine Payment Strategy Determine Risk Pool Strategy
Regulatory Interpretation-”Strict Liability” be replaced with a “Standards of Care” or “Prudent Parent” standard-AWOL “violations” be replaced with “Standards of Care for AWOL Behavior”
Licensed Capacity- 84068.1(c)(1), 84088(a)1-Request waiver for regs to accommodate emergency placements when not in conflict with fire clearance or use permits
Facility-84065.2(d),(e)1&2-Personnel Duties-Request flexible use of staff-Request waiver to be able use logical and natural consequences
as determined by the treatment team Training Requirements- 84065(3)
-Allow expansion of approved trainings to prepare staff to work between residential, community and home
Regulatory Waiver Overview
Fiscal Waivers
Rate Classification Level System (RCL) Section 11.402.000-Waive entire RCL system to be replaced by
provisional rate with cost settlement -Provides more flexible and efficient use of FC $$-Costs to be reported on semi-annual basis -Annual audit to follow A122 and 133 auditing standards
AFDC-FC State Share Waiver-Waiver to create funding stream specific to RBS community
based services for aftercare and parallel services-To be used for non EPSDT billable services throughout
continuum of care
What We’ve Learned & Where We’re Going
Collaboration is slow, but the way to go Vision, Mission & Values were key to moving
forward It’s hard to crawl outside the box Program and funding Model development is a dance
Next Steps Close gaps & finalize work to date Develop Operational & Evaluation Model Meet 10/3 deliverable deadline!!!
Presenter Contact Information
Jim Martin Geri WilsonExecutive Director Sacramento County
Martin’s Achievement Place RBS Reform Project Coord.(916) 338-1001 (916) 875-2-2023(916) 338-1044 fax (916) 599-3828 [email protected] [email protected]
Dan PetrieSr. Program DirectorMilhous Children’s Center(530) 265-9057(530) 215-9057 [email protected]