sacramento county rbs reform structure and process march 2009
TRANSCRIPT
Sacramento County RBS Reform
Structure and Process
March 2009
RBS Collaborative Partners aka
RBS Reform Team County Agencies (CW, MH, Probation, DHA, Education) Group Home Providers Parents Youth Meets quarterly or on as need basis Guides policy development Reviews operations and outcomes Addresses high level problem solving and resource
development needs
Expansion to include schools and court/legal community
Sacramento County RBS Providers Quality Group Homes
Carmen Maroney, Administrator
Children’s Receiving Home of Sacramento
David Ballard, Chief Executive Officer
Martin’s Achievement Place Jim Martin, Executive Director
Sacramento County RBSOrganizational Structure
RBS Reform Team Child Welfare Mental Health Probation
RBS Project Mgt.DHA
AccessTeam
Providers County Case Mgrs.
Quality Group Homes Martin’s Achievement Place
Children’s ReceivingHome of Sacramento
•Residential Stabilization & Assessment•Family Connection & Support•Community Based Services
The Sacramento County RBS Mission and Vision
Our Mission
The Sacramento County Residentially Based Services Program is designed with the purpose of insuring that all children and youth who receive residential services are ultimately able to connect or reconnect with family, school and community so they can achieve productive adult life outcomes.
Our Vision
Our vision is that the Sacramento County RBS Demonstration Project will provide a comprehensive and coordinated array of individually tailored residential and community based services. Services will be integrated across service agencies and will allow the ongoing and consistent delivery of service and support to children and youth enrolled in RBS and their families so they can be efficiently and effectively reconnected to their families, schools and community. Eligibility for service and support will be tied to RBS enrollment, not residential placement.
The Not So Good News...We’ve hit a BUMP!
Significant County budget deficit Serious fiscal cuts for county agencies
The PROBLEM…
How to fund intensive, flexible and community based services and be cost neutral in the first year.
Target Population & Start-up Criteria
Initial Target Population
Youth ages 12-16 Assessed to need or already in
RCL 12 or above 30 slots/beds to start
Child Welfare 10
Probation 10
Mental Health 4 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
Current connection w/family or NFREM (initial start-up only)
Sacramento County RBS System Elements RBS Reform Team-Advisory Committee New!! Integrated Care Management New!! Thorough Assessment & Matching Process New!! Comprehensive Care Coordination New!! Short-term Residential Stabilization & Assessment New!! Crisis Support & Respite Care New!! Individualized Child, Youth & Family Behavioral Services New!! Intensive Permanency Services, incl.. Family Finding and
Reconnection Support New!! Community Based Services New!! Parent & Youth Involvement & Advocacy New!!
Sacramento County RBS SystemFlow Chart
Lead Agency Model
TDM
Recommendation Meeting
Authorization &Resource Mgt.
Provider Fac.CFT
Plan of Care Full Array of ServicesDischargefrom RBS
CW, MH case mgr. Identifiespotential need for group care
Probation Officer identifiespotential need for group care 9 months placement + 9 months community = 18 months RBS enrollment
90 day reviews with CANSIntegrated Arc of Care
Sacramento CountyDraft Funding Model
“Our work to date” Estimated Costs
Cost Spread Sheet
Sacramento County RBS Draft Funding Model
Funding model based on 9 months in residential, 9 months in community based care
Providers will receive Intensive Residential payment of $9438 per month when youth in residential care
Providers will receive $3056 per month when youth in community based care
Providers will receive $1666 per month for EPSDT Providers will require 90% occupancy for residential County will hold risk pool
Funding Model Draft Proposal, cont.
Additional Recommendations Annual cost reconciliation is completed annually Provider will receive 10% of any cost savings as bonus County to retain 90% of savings Provider to pay 10% of any overages
Extended Stays & Discharge from RBS Enrollment in RBS evaluated at each CFT If youth continued beyond 18 months, County & Provider
will jointly develop responsibility options RBS ends when the youth meets the individualized CFT
goals
RBS Training PlanCulture RBS Orientation Understanding RBS in Sacramento Ensuring Child & Family Voice & Ownership
Practice Effective Environmental & Treatment Interventions Effective Community Interventions & Supports Effective Aftercare Intervention and Support
Evaluation, QA and Improvement
Funding RBS
The Role of Waivers in RBS
Quality Assurance Plan
QA Tools Purpose QA Methods Frequency Person/s Responsible
YSS, YSS-F Data Report
Measure youth and family’s involvement and satisfaction with services
Provider ensures completion by youth
and family and submits results to Harder & Assoc.
Results reviewed by LIT and RBS Team
Semi-Annually and at end of RBS enrollment w/monthly LIT review and quarterly RBS Reform Team review
Provider, Harder & Assoc., RBS LIC
TDM Report Measure TDM us use and outcome/decisions
Monthly prepares TDM use report monthly and sends report to RBS LIC for LIT and RBS Reform Team review
Monthly review by LIT and Quarterly review
TDM Supervisor, RBS LIC
CANS Tool and Progress Report
Measure youth’s progress in RBS and effectiveness of RBS
Youth completes CANS. Results to Harder and Assoc. for report of collective RBS progress. Progress report reviewed by LIT and RBS Team
At intake and quarterly throughout RBS enrollment for quarterly LIT and RVS Reform Team review
Provider, Harder & Assoc., RBS LIC
Quality Insurance Plan, cont.
QA Tools Purpose QA Methods Frequency Person/s Responsible
CFT Use Measure CFT usage and youth and family involvement
Provider agency staff collect CFT use data and prepare use report to be forwarded to RBS LIC for review by RBS Reform Team
Monthly collection w/monthly review by LIT and quarterly review by RBS Reform Team
Lead provider agency, RBS LIC
RBS Contract Monitoring
Ensure quality and scope of RBS service
Review of scope with providers
Monthly RBS LIC
EPSDT Contract Monitoring
Ensure quality and scope of EPSDT service
Review of scope with providers
Monthly Mental Health Contract Monitor
What We’ve Learned & Where We’re Going
Bumps are not Sink Holes
Next Steps Providers and County agencies to work collaboratively to
explore alternative funding options Develop Funding Model Finalize VA, Funding & Waiver Proposals by 3/31/09
Presenter Contact Information
Geri Wilson Glynis Butler-StoneSacramento County Clinical ManagerLocal Implementation Coordinator Children’s Receiving Home (916) 874-2333 (916) 599-3828 of [email protected] (916) 482-2370 ext. 386
Jim Martin Dr. Mark ConroyExecutive Director PsychologistMartin’s Achievement Place, Inc. Quality Group Homes(916) 338-1001 (916) [email protected]@qualitygrouphomes.org