Sacramento County RBS Reform Collaborative Reform in Progress

Who are we? County Agencies (CW, MH, Probation, DHA, Education) Group Home Providers Parents Youth

Our Vision, Mission, Values & Guiding Principles “Roots to Grow, Wings to Fly” Vision Reconnecting children, families & community Mission Insure that all children and youth who receive residential services are ultimately able to connect or reconnect with family, school & community so they can achieve productive adult life outcomes

Statement of Shared Principles & Core Values RBS reform is critical to improving the ability of children and families in Sacramento County to get the right services, at the right time and the right location. Residentially Based Services should: √Demonstrate respect for the culture, individuality and humanity of children, youth and families √Provide and use thorough assessments to drive services that are tailored to individual, youth and families √Help children and youth in placement quickly return to and remain safe within their families, successful in their schools and integrate into their communities √Hold all providers and systems accountable for actions and outcomes

RBS Outcome Goals Increased % of children and youth discharged to permanency Improved placement stability for children and youth in group care Decreased % of children and youth re-entering after discharge from group care Shortened length of career stay for children and youth in group care Decreased % of children and youth placed in out of county group care

Target Population & Start-up Criteria Initial Target Population CW, MH, Prob youth ages Assessed to need or already in RCL 12 or above 30 slots/beds to start Child Welfare 12 Probation 12 Mental Health 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, and for Initial Start-Up Only Current connection w/family or NFREM

Our Theory of Change

The RBS Service Array 1. Comprehensive Care Coordination 2. Family Engagement & Empowerment 3. Intensive Short-term Residential Stabilization & Assessment 4. Intensive Permanency 5. Ongoing Family Support 6. Education Engagement & Enrichment 7. Individualized child, Youth & Family Behavioral 8. Non-traditional Support & Assistance 9. Other Innovative Options & Approaches

The RBS Program Design Service Array→ Service Options→ Program Model Assessment & Matching Plan of Care Facility Based Services Community Based Services Permanency Services What’s new that will make the difference?

Assessment & Matching Enhanced TDM Use of CANS as standardized assessment tool Child, youth & family participation Includes placement matching Provider presence Begins resource management process

Child/youth enrolled in RBS, not “placed” “CFT like” Team to develop and coordinate plan of care  Facilitated by RBS provider…Fred √Facilitate √Reunify √Engage √Discharge Plan updates at 30 day & quarterly intervals Continues after residential discharge Cross system collaboration Plan of Care

Facility Based Services Family membership in facility treatment team Integrated facility & community based staff for continuity of connections, relationships, service delivery Individualized treatment Recruitment & retention of talented staff Flexible services that promote & provide for individualized interest Enrichment opportunities that anchor child in community and family Normalization w/safety contingencies Alignment of county caseworker with residential staff Active participation of caseworkers in CFT

Permanency Services No “old step down”, only step toward permanency Strengthening and developing child/youth’s ties to community Finding, developing & supporting family connections Build knowledge, skill & expertise of county and provider RBS staff Youth advocacy

Coordinated by CFT Blend of parallel and aftercare Family & youth focused Comprehensive -treatment -respite -educational -recreational Community Based Services

Lead Agency Model Authorization & Resource Mgt. Provider Facilitated CFT Plan of Care Integrated Arc of Care Full Array of Services TDM Discharge from RBS County Worker Identifies Need for Group Care Enhanced

Partnership Roles & Responsibilities Collaborative Process Staffing Model QA Mechanism Preliminary Training Plan Provider Selection for Next Steps... Operational Design

Total Cost of Care and outcome components: All clients who have left care during 2006 and 2007 From RCL Placed by Child Welfare, Mental Health, or Probation Federal and Non-federal (to be utilized to estimate correct ratio of FED : NONFED AFDC Costs) Dollar totals are for each time span of placement during these 2 years With Lifetime cost listed as an additional column WRAP payments are also listed and are not included in the Lifetime Cost Mental Health Treatment Costs, EPSDT and/or 26.5 Non-AFDC Costs for out of state placements and hospitalization Permanency Outcomes data Age of Clients Client Gender Distance of Provider from Sacramento Metropolitan Statistical Area Only consider Clients with Group Home placements of 90 days or longer Identifying Necessary Data Elements

Multiple Databases contain relevant information Requires collaboration across DHA, County CMS/CWS Workers, Children’s Mental Health Manually combining information from databases Multiple refinements of Data Requests from each database Large data set of approx. 850 clients Challenges

Average Placement Cost* $133,401 in AFDC Payments + WRAP $17,471 = $150,872** Fed/Non-Fed71.5% / 28.5% Male/Female60% / 40% Average Age16.4 years *Does not include additional payments for Mental Health, 26.5, Out of state, and/or Hospitalization. **Preliminary figures, rough, not yet reliable! Results

Service Areas Responsibilities to carry out components of each service Expected Funding Sources for each component within the service Provider Estimates of RBS Services

1. Comprehensive Care Coordination 2. Family Engagement & Empowerment 3. Intensive Short-term Residential Stabilization & Assessment 4. Intensive Permanency 5. Ongoing Family Support 6. Education Engagement & Enrichment 7. Individualized child, Youth & Family Behavioral 8. Non-traditional Support & Assistance 9. Other Innovative Options & Approaches The RBS Service Array

Funding Components of the RBS Rate Provider Cost156,489 Monthly8,694 EPSDT2, % AFDC3, % AFDC/Flex2, % 8,694

Next Steps Continue to Refine reliability of Data Adjust Funding Shares as necessary Determine Payment Strategy Determine Risk Pool Strategy

Regulatory Interpretation -”Strict Liability” be replaced with a “Standards of Care” or “Prudent Parent” standard -AWOL “violations” be replaced with “Standards of Care for AWOL Behavior” Licensed Capacity (c)(1), 84088(a)1 -Request waiver for regs to accommodate emergency placements when not in conflict with fire clearance or use permits Facility (d),(e)1&2-Personnel Duties -Request flexible use of staff -Request waiver to be able use logical and natural consequences as determined by the treatment team Training Requirements (3) -Allow expansion of approved trainings to prepare staff to work between residential, community and home Regulatory Waiver Overview

Fiscal Waivers Rate Classification Level System (RCL) Section Waive entire RCL system to be replaced by provisional rate with cost settlement -Provides more flexible and efficient use of FC $$ -Costs to be reported on semi-annual basis -Annual audit to follow A122 and 133 auditing standards AFDC-FC State Share Waiver -Waiver to create funding stream specific to RBS community based services for aftercare and parallel services -To be used for non EPSDT billable services throughout continuum of care

What We’ve Learned & Where We’re Going Collaboration is slow, but the way to go Vision, Mission & Values were key to moving forward It’s hard to crawl outside the box Program and funding Model development is a dance Next Steps Close gaps & finalize work to date Develop Operational & Evaluation Model Meet 10/3 deliverable deadline!!!

Presenter Contact Information Jim MartinGeri Wilson Executive DirectorSacramento County Martin’s Achievement PlaceRBS Reform Project Coord. (916) (916) (916) fax(916) cell Dan Petrie Sr. Program Director Milhous Children’s Center (530) (530) cell