san bernardino county rbs demonstration
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San Bernardino County RBS Demonstration. RBS Forum Sacramento, CA. September 4/5, 2008. Overall Approach. Transform the child and family experience for children placed in RCL-14, out of state, and in psychiatric hospitals so the Voice and choice for the child and family is present - PowerPoint PPT PresentationTRANSCRIPT
San Bernardino CountyRBS Demonstration
RBS ForumSacramento, CA
September 4/5, 2008
Overall ApproachTransform the child and family experience for children placed in RCL-14, out of state, and in psychiatric hospitals so the
•Voice and choice for the child and family is present
•Continuity of care exists throughout the trajectory of care (no hand-offs, no drop-offs)
•Continuum of care is planned, managed and reviewed regularly
•Outcome focus of the demonstration is achieved
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 2
County, Provider, and Community PartnershipCounty, Provider, and Community Partnership
Mission, Vision, ValuesMission
Working together to safely build and sustain positive, successful family connections and children’s futures.
VisionThe transformed system will provide resources specifically designed to facilitate
the ongoing movement of children and youth who have complex emotional and behavioral needs toward more enduring and positive connection or reconnection with their families, schools and communities. The transformed system will create effective partnership and collaboration across systems in the interest of better outcomes for those youth and their families.
ValuesStability, permanency and safety focus
FlexibilityIntegration across systems
Continuous planning and evaluation across the arc of enrollmentContinuity of care
Partnership and engagement
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 3
Family Driven - Youth GuidedFamily Driven - Youth Guided
Cornerstone Innovations• Family Passport
• Care Coordination Team
• Wrap approach throughout trajectory of care
• ITFC-like foster care consistent with RBS
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 4
A Continuum of Care with No HandoffsA Continuum of Care with No Handoffs
Primary Outcome Focus
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 5
1. Reduced Length of Stay
1. Reduced level of care including out of state
2. Reduced Hospitalizations
3. Reduced AWOL incidents
4. Improved Permanency
a. Stable placementb. Increased pro-social behaviorc. Life long connections
Stakeholder-DrivenStakeholder-Driven
Baseline Sample Demographics*
Frequency %
Male 15 39%
Female 23 61%
Black 11 29%
Latino 6 16%
Native American 1 3%
White 20 53%
* Sample of 38 youth who had at least one RCL-14 placement day in 2007
Outcome Baselines
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 7
PERMANENCY BL
Avg. current GH stay 7.7 mos
2 in foster home, LOS 0.9 mos
1 at home, length of stay 3.8 mos
Avg. Time in Foster Care 6.2 yrs
Avg. # of prior placements 3.0
Reentry in to foster care tbd
Exits to permanency tbd
#of supportive connections tbd
WELL BEING: BL
Avg. time in GH care 24.5 mos
Avg. # days AWOL 24.8 days
Avg. # of AWOL episodes 3.2
Avg. # days in hospital 40.8
Cost Baseline
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 8
COST BL
Total cost of FC (sample) $7.5M
GH Cost $5.6M
Out of state costs $1.6M
Non Tx foster home costs $30K
FFA costs $206K
Other small family homes $90K
Hospitalization cost $760K
Total 3-yr cost $8.2M
•Reflects costs over 2004 to 2007 for baseline sample•Average cost of $72,000 per yr per child
“Rachel” - A candidate for RBS (16.8 yrs old)
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 9
1995 - 1999 2000 - 2003 2004 2005 2006
1995-98 - six unsubstantiated abuse/neglect referrals concerning younger sister
1996 – BM incarcerated 20 months; children w/GM
1999 – 1 referral concerning all 3 children
1995-98 - six unsubstantiated abuse/neglect referrals concerning younger sister
1996 – BM incarcerated 20 months; children w/GM
1999 – 1 referral concerning all 3 children
No activity
No activity
Apr – Substantiated physical abuse by step parent; removal to FFA
May-Dec 4 GH placements
Dec Home under FM
(Wrap)RespiteGH #51st hospitalizationGH #6
Apr – Substantiated physical abuse by step parent; removal to FFA
May-Dec 4 GH placements
Dec Home under FM
(Wrap)RespiteGH #51st hospitalizationGH #6
Jan Home under FM (Wrap)School and AWOL incidentBM requests removalBack to GH #6
May AWOL from GH #6FBM and GM return to DCSGH #7, AWOLGH #4, AWOL
Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF
Sep-Oct GH #8, pregnantAWOL (Las Vegas)Return by BM to temp. FFAAWOL x2, returns to GH #8
Oct-Dec AWOL in LA w/boy friend and GM
Jan Home under FM (Wrap)School and AWOL incidentBM requests removalBack to GH #6
May AWOL from GH #6FBM and GM return to DCSGH #7, AWOLGH #4, AWOL
Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF
Sep-Oct GH #8, pregnantAWOL (Las Vegas)Return by BM to temp. FFAAWOL x2, returns to GH #8
Oct-Dec AWOL in LA w/boy friend and GM
Jan-JunStill AWOL, rape, miscarriage
Jul-OctFFA #3AWOL (Back to GM)
Oct-Dec 2nd hospitalizationConservatorship
Dec-PresentPlaced out of state (RCL- 14)
Jan-JunStill AWOL, rape, miscarriage
Jul-OctFFA #3AWOL (Back to GM)
Oct-Dec 2nd hospitalizationConservatorship
Dec-PresentPlaced out of state (RCL- 14)
• 2 abuse/neglect referrals• 12 GH placements in 9 GHs• 5 FFA placements in 3 FFAs• 2 psych hospitalizations• 12 AWOL incidents• 2 Wrap failures• 1 rape• 2 pregnancies, 2 miscarriages
• Motivated to be with family• Maintains family contact• Searches for extended family• Stable out of state for 2 years• Engages in goal setting• Survival skills
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 10
Designing a New System for Rachel
Rachel
Rachel
Proposed Funding Model
• “Success First Wrap” MHSA
– Funds Care Coordination Team across arc of
enrollment for 12 slots
– Approximately $3,000/mo/child
• SB 163 Wrap takes over when MHSA ends
• Rate for Facility Based Services - TBD
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 11
Potential Waiver Requests
Still under considerationWaivers need to be provider driven
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 12
Current Status
• One provider tentatively selected with both Wrap and residential beds
• Funding streams identified and model under construction
• High level System Design complete
• Facility based service model under construction
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 13
Concerns/Issues/Requests for Help
Models will evolve during implementation
Sept., 4/5, 2008 San Bernardino County RBS Demonstration 14