Sacramento County RBS Reform Structure and Process March 2009

RBS Collaborative Partners aka RBS 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

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

Sacramento County RBS Organizational Structure RBS Reform TeamChild WelfareMental HealthProbation RBS Project Mgt. DHA Access Team ProvidersCounty Case Mgrs. Quality Group Homes Martin’s Achievement Place Children’s Receiving Home of Sacramento Residential Stabilization & Assessment Family Connection & Support Community Based Services

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.

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.

Target Population & Start-up Criteria Initial Target Population Youth ages 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)

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!!

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

Sacramento County Draft Funding Model “Our work to date” Estimated Costs Cost Spread Sheet

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

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

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

Quality Assurance Plan

Quality Insurance Plan, cont.

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

Presenter Contact Information Geri WilsonGlynis Butler-Stone Sacramento CountyClinical Manager Local Implementation CoordinatorChildren’s Receiving Home (916) (916) of Sacramento ext. 386 Jim MartinDr. Mark Conroy Executive DirectorPsychologist Martin’s Achievement Place, Inc.Quality Group Homes (916) (916)