RBS : Out of the Box

2. RBS: Out of the Box

3. Connect the dots by drawing four straight, continuous lines, without lifting the pencil from the paper. Nine Dot Challenge:

4. CDSS Review Process Fiscal RBS Steering Committee Legal CCL Foster Care Rates & Eligibility Fiscal Fiscal Foster Care Program ? Dept of Mental Health

7. TransformingBay Area Residential Services Mark Lane Bay Area Consortium RBS Local Implementation Coordinator

8. Planning Process 5 Counties x 3 Departments = Chaos

9. Developing consensus(July 11 TA meeting) • How are we going to work together? • Lead County vs. Shared Coordination vs. Shared Purchase …. • Who decides? • What approach makes sense? • Mission: To work together to help the children and families in our target populations build and sustain whole lives.

10. Guiding Principles • Service-based, rather than place-based • Families will be part of the team and the decision-making process • Locally provided continuity of care and services • Culturally competent and strength-based services • Minimal disruptions in connections for youth and families • Focus on safe, stable, permanent living environment • Services customized to meet the family’s unique situation

11. DEVELOPING THE MOU • Nature of the Relationship • Vision • Shared expectations • Roles and Responsibilities

12. ENGAGING THE PROVIDERSTHROUGH AN RFQ • Refining the Target Population • Restating the Guiding Principles • Outlining the Program Design • Defining the Criteria to Deliver Services

13. KEY INNOVATIONS forTRANSFORMING BAY AREARESIDENTIAL SERVICES

14. Provider Innovations • Flexible use of staff resources • Flexible use of facility-based interventions • Increased trend of community-based interventions • Ongoing and flexible decision-making • Balance between place-based and community-based activities

15. Funder Innovations • Building contracts with an assumption of trust and based on anticipated transactions throughout the duration of the project. • Family involvement as a key business practice. • Process-based contracting in which key actions are outlined, agreed-upon, and monitored.

16. County Worker Innovations • RBS is seen as an affirmative choice • Use of RBS should be a decision of first resort, rather than last resort

17. Next Steps • Issue the RFQ • Engage the qualified providers • Complete the funding model • Outline the Waiver Requests • Plan for Implementation

18. Target Populations Bay Area Consortium Residentially Based Services Lois Rutten, Contra Costa County

19. Who Are These Youth?

20. Phase 1 Target Populations • Family Reattachment • Younger children who are in placement due to a combination of family disruption, abuse and/or dangerous behaviors that can’t be managed in other settings • Pathways to Permanency • Children and youth who are growing up in placement and do not have a permanent plan

21. Phase 2 Target Populations • Bridge to Success and Safety • Youth with complex needs who are mandated to out of home placement in the juvenile justice system but are currently in detention • Reconnecting and Reconstructing • Sexually exploited girls who are unable to stay in placement using current approaches

22. How Many Youth? • All youth/children in this pilot must be: • A dependent or ward of the court described in section 300 or 602 of the Welfare & Institutions Code and/or, • Receiving services under AB 3632 • Family Reattachment – 100 • Pathways to Permanence – 600

23. Statistical case review – CWS/CMS Individual case review – look for common characteristics Optimal volume to sustain population? Is there an existing cross-system partnership? Can a program be regionally implemented? Criteria for Determining Target Population

24. Common Characteristics • Age and Gender • Male • 12-16 years old • Ethnicity • African American • Average length of placement in group care • More than 2 years • Average number of placements • 5-7 • Out of county • Minimal family and community connections • Multiple psychotropic medications • Multiple assessments/evaluations for treatment • Diagnosis?

25. Next Steps • RFQ response • Intake & referral process • Project entry/exit/capacity • Training • Providers • Staff • Community • Measure results

26. Residentially Based Services Proposed Funding Streams BAY AREA CONSORTIUM Presented by: Liz Crudo, San Fransisco County and Ellen Bucci, San Mateo County

28. Objective • To provide an overview of potential funding streams; • Discuss potential funding model; • Next steps.

29. Current funding sources • Residential stay • AFDC-FC • Medi-cal / EPSDT • Community stay • AB 163 Wraparound Funding • Medi-cal / EPSDT

30. Potential Funding Streams • EPSDT • Case mgmt • Medication support • Therapy • SB 163 Wraparound • AFDC Residential Rate • Monthly bed rate board and care • In house stabilization

31. Potential Funding Streams (con’t) • Other Wrap Dollars • New or unused slots • Wrap Savings • Mental Health Services Act (MHSA) • PSSF / CAPIT / STOP / TANF/Family Preservation/TCM/CALWORKS • County General Fund

32. New Funding Model Assumptions • No new moneys; • Impact of State budget; • Providers will need to be Medi-cal certified for billing and leverage purposes; • Will require waivers and utilization of multiple funding streams;

33. New Funding Model Assumptions (con’t) • Need to build service model first, then funding structure (What do we want to achieve, rather than how much money do we have?); • Providers need to be WRAP eligible; and • Counties will need to apply for additional WRAP slots. • Counties would each need to contract with the provider for Medi-cal

34. New Funding Model Questions to be answered • Service Model needs to be discussed and explored with Providers (Providers have knowledge re:making funding work); • Need cost information from Providers; • Cost per individual youth will vary greatly? • Price Point? (average fair price) • Existing staff to be utilized or new staff? • How will youth without Medi-Cal be served?

35. Next Steps • Complete RFQ; • Hold discussions with providers; • Create funding model.

37. Los Angeles CountyProposed RBS Demonstration Project RBS Forum Sacramento, CA September 4/5, 2008

38. Mission, Vision, Collaboration Mission The Los Angeles RBS Demonstration will transform intensive mental health services within the child welfare system to empower families and achieve permanency for youth. Vision The creation of a strength-based, family-centered, needs-driven system of care that transforms group homes from long-term placements to short-term interventions, which are not place-based, which provide for seamless transitions to continuing care, and which support the safety and permanency needs of youth and their families LA RBS Collaborative In November of 2007, the RBS Collaborative design group was formed and is composed of county, provider and community stakeholders. Sept., 4/5, 2008 Los Angeles County RBS Demonstration 38

39. LAC Group Home Trend Data

40. Target Population • Children in or approved for RCL 12 or 14 placements • CANS will be the assessment tool • Approximately 200 DCFS children will be served • Over 24 mos • Using up to 64 RCL 12 or 14 beds and 192 Wrap slots • Average age – 15.8 years Sept., 4/5, 2008 Los Angeles County RBS Demonstration 40

41. Baseline Data: RCL-12 Children All RCL 12 FY 2006-07 Exit Cohort Data 50% 80% 90% Page - 41

42. Baseline Data Continued(collaborative profile applied)

43. LOS Data Analysis Notes: For RCL 12, 24 mo. analysis captures ~90% of population For ‘Collaborative Profile’ - 24 mo. analysis captures ~80% of population Page - 43

44. Proposed Outcomes SAFETY Safety in placement Safety in home-based settings PERMANENCY Shortened timelines to permanency for youth Limited, shortened length of stay in RCL 12 and 14 placements Stability in home-based settings WELL BEING Family and youth satisfaction with RBS services Family identification and connection for disconnected youth Culturally and linguistically sensitive family involvement (visitation, participation in and ratification of planning process, agency contact, connectedness) Educational improvement (attendance, stability, GPA) Socio-behavioral improvement (evidenced by CANS) COST Cost neutrality Sept., 4/5, 2008 Los Angeles County RBS Demonstration 44

45. Wraparound and Group Home Enrollment (FY 2003 – 2007)

46. Cornerstone Innovations Wraparound-based Child and Family Teams during residential tx. Family finding, engagement, preparation and support during residential tx. Residential therapeutic milieu influenced by Wraparound principles Shared risk/benefit between County and providers Sept., 4/5, 2008 Los Angeles County RBS Demonstration 46

47. System Design Sept., 4/5, 2008 Los Angeles County RBS Demonstration 47

48. Proposed Funding Model • Augmented residential rate for facility based services • RCL-12 = $5,891+ $2,300 RBS rate • RCL-14 = $6,694 + $2,300 RBS rate • Modeled at 9 months • RBS Rate covers • Family finding, engagement, preparation and support • Child and Family Team • Flex funds • LAC Wrap rate for community based services ($4,184 excluding placement costs) • Risk pool • Could possibly be used for • Extended LOS • Respite • Unanticipated costs • Placement costs during Wraparound • $1,000 set aside per month per child for 1st 12 months of care • Cost reconciliation • Either annually or semi-annually • Share risk and benefit Sept., 4/5, 2008 Los Angeles County RBS Demonstration 48

49. Potential Waiver Requests RCL and related point systems No new placement agreement for respite Sept., 4/5, 2008 Los Angeles County RBS Demonstration 49

50. Current Status Request for interest letter to be issued mid-Sept. Provider selection by end of Sept. Contract negotiations to follow Sept., 4/5, 2008 Los Angeles County RBS Demonstration 50