Los Angeles County RBS Demonstration RBS Forum Sacramento

Los Angeles County RBS Demonstration RBS Forum Sacramento, CA March 4/5, 2009

Lessons Learned From RBS Process • Res. Wrap in 2004 – “RBS will be easy” • Without culture/system change no transformation • Unforeseen contracting difficulties in order to support innovation intended • RBS has become the foundation for future care • Reduction in out-of-home care caseload • Understanding that Residential and Wrap is a partnership and Res Tx milieu is different Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 2

Mission, Vision, Values Working Mission The Los Angeles RBS Demonstration Project will support the transformation of residential care within the child welfare system to empower families, have community focus and achieve permanency. Working 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 family driven interventions, which are not place-based, concurrently provide for seamless transitions to continuing care, and support the safety, permanency and wellbeing of youth and their families. Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 3

Demonstration Profile • Children in or at risk of RCL – 12/14 placement • 48 -54 bed demonstration • Approximately 200 children to be served in 2 years • Three providers Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 4

Provider Demographics and Plans Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 5

Cornerstone Innovations • Wraparound-based Child and Family Teams during residential treatment • Family finding, engagement, preparation and support during residential treatment • Residential therapeutic milieu infused with Wraparound principles • Portability of intensive treatment interventions across settings Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 6

Cornerstone Innovations Continued RCL-12 and RCL-14 RBS - One level of care - Single rate plus a “patch” - Streamlined referral process Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 7

Eligibility Criteria Necessary: – Projected need for 24 hour care at least 50% of the time – Need for intensive community development And/Or – Need for intensive family development Sufficient but not necessary: – Will need intensive services after residential discharge to maintain permanency – Would benefit from a therapeutic community and peer interaction – Meets minimum threshold of therapeutic need (DMH/CANS) Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 8

Service Elements • Facilitated planning process - Child and Family Teams • Continuity of care across all environments • Unified Plan of care • Family finding and engagement • Family connections • Respite • Crisis stabilization • Staff roles • Exploring evidenced-based practices Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 9

Baseline Data RCL 12/14 Combined Total FC Total GH Curr GH Avg Age Career Episode (years) (mos) 60. 1 20. 2 8. 3 15. 2 RCL-12 58. 3 18. 4 7. 7 15. 2 RCL-14 80. 0 40. 1 15. 0 15. 5 63. 2 32. 4 21. 5 12. 5 Five Acres 61. 5 34. 5 22. 0 11. 4 Hathaway Sycamores 63. 0 28. 7 18. 3 14. 9 Hillsides 71. 4 29. 0 24. 7 13. 3 Demonstration Providers Notes: 1. Exit cohort data FY 07/08, CWS/CMS 2. N = 980 children Mar. , 4/5, 2009 Page - 10 Los Angeles County RBS Demonstration

Outcomes - Dashboard SAFETY PERMANENCY WELL BEING SATISFACTION FIDELITY COST Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 11

Instruments YSS, YSS-F WFI CANS CAFAS Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 12

RBS Organization DCFS/DMH Wraparound Administration RBS Roundtable - Parent representative - DCFS (Wrap, Group home) - DMH (Child Welfare Division) - Providers - Education - Other community partners Implementation Team March 4/5, 2009 RBS Evaluation Team RBS QA/QI Los Angeles County RBS Demonstration RBS Training Team 13

Initial Referral & Enrollment Provider Liaison 2 1 Begin Appropriate RBS Bed Available RBS YES NO RUM Unit RBS RMP/TDM Screening Assessment (CANS) Placement and assignment Decision 3 Other placement 2 -7 Level of Care? 4 CSW 5 ? 1 -14 1 -7 RCL-14 Screening Committee AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff • Unit conversion • Expedited County and provider process YES NO ? ISC Provider Assignment Benefits Coord/Transition Utilization Mgmt Utilization Review Care Management Administration Funding (payment) QA/QI ? RCL-12 & 14 ? Wait and queue time in days Mar. , 4/5, 2009 6 DCFS Wraparound Administration Existing Provider Pop. DMH RCL-12 RCL-14 Pre-screening & Prep 1 -7 Placement Los Angeles County RBS Demonstration 14

Streamlined Referral & Enrollment Provider Liaison 2 RBS RMP/TDM 1 Begin YES Appropriate RBS Bed Available Res Tx NO RUM Unit Screening Assessment (CANS) Placement Decision Provider Assignment Wrap Enrollment 1 -7 RBS Other placement 4 2 -7 Placement CSW 3 Existing Provider Pop. DMH AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff • Unit conversion • Expedited County and provider process RBS ? ? Wait and queue time in days Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 15

Proposed Funding Model RBS Rate - Residential treatment - Family finding, engagement, preparation and support (flexible use) - Child and Family Team - Risk Pool - Payment for 1 st 9 mos - Extended LOS - Respite - Unanticipated costs - Set aside per month per child for 1 st 9 months of care - TBD - Access rules – TBD Residential - 9 mos - Single rate + Patch Wraparound - 12 months - Wrap rate = $4, 184, excluding placement costs Cost reconciliation - Annually - Share risk and benefit – methodology TBD Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 16

Waiver Requests 1. RCL 2. Replace RCL point system with new staffing and treatment model 3. Other - TBD Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 17

Status and Plan • Provider selection Completed • Voluntary Agreement and Funding Model • Wrap contract amendment with RBS Due 3/23 May • Training and culture change May-Jul • Unit conversion Aug-Sep Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 18

Open Questions 1. Bridge care 2. Unit design (CCL implications) 3. Culture change and training Mar. , 4/5, 2009 Los Angeles County RBS Demonstration 19