Sacramento County RBS Reform

1. Sacramento County RBS Reform Structure and Process March 2009

2. RBS Collaborative Partners akaRBS 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

3. 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

4. Sacramento County RBSOrganizational Structure RBS Reform Team Child Welfare Mental Health Probation RBS Project Mgt. Access Team DHA Providers County Case Mgrs. • Residential Stabilization • & Assessment • Family Connection & Support • Community Based Services Quality Group Homes Martin’s Achievement Place Children’s Receiving Home of Sacramento

5. 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.

6. 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.

7. 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) Target Population & Start-up Criteria

8. 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!!

9. Sacramento County RBS SystemFlow Chart Lead Agency Model Integrated Arc of Care CW, MH case mgr. Identifies potential need for group care 90 day reviews with CANS TDM Plan of Care Full Array of Services Authorization & Resource Mgt. Provider Fac. CFT Discharge from RBS Recommendation Meeting Probation Officer identifies potential need for group care 9 months placement + 9 months community = 18 months RBS enrollment

10. Sacramento CountyDraft Funding Model “Our work to date” • Estimated Costs • Cost Spread Sheet

11. 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

12. 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

13. RBS Training Plan Culture • 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

14. Quality Assurance Plan

15. Quality Insurance Plan, cont.

16. 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

17. Presenter Contact InformationGeri Wilson Glynis Butler-StoneSacramento County Clinical ManagerLocal Implementation Coordinator Children’s Receiving Home (916) 874-2333 (916) 599-3828 of Sacramentowilsoga@saccounty.net (916) 482-2370 ext. 386 gbutler-stone@crhkids.orgJim Martin Dr. Mark ConroyExecutive Director PsychologistMartin’s Achievement Place, Inc. Quality Group Homes(916) 338-1001 (916) 609-6300j_martin@mapinc.net Mark@qualitygrouphomes.org