CADPAAC January 2010 Quarterly Meeting COSSR Pilot Presentation San Mateo County’s Experience in Transforming Treatment and Recovery Services

COMING SOON TO COUNTIES EVERYWHERE…. “ IT’S COMPLICATED”

Produced By: San Mateo County Behavioral Health and Recovery Services Supported by: ADP COSSR Starring: Clients and Staff from Womens Recovery Association and staff from San Mateo BHRS Technical Support: Rick’s Raters

CHAOS/OPPORTUNITY Shifting substance abuse policy Changes to the health care system P=A=R=I=T=Y State “blahget” Waiver

More Chaos Demands for service UP and R esources down Demand for results UP, UP, UP, Capacity to know ??? Research says This.... and We do That EBP’s are In, at $16 hour ARE YOU KIDDING

? ? ? ? ? Are clients referred to care receiving the best treatment and support possible? Is taxpayers’ money being spent in the most efficient and effective ways?

ANSWERS NO AND NO

Per Albert E. “the definition of insanity is… You know the rest

Our Logic Improve Outcomes by Improving Services by Improving Policy and Practice by Improving How We Pay

The Terms of Engagement Provider gets Per Client Per Year Funding To focus on the care of the client Maximum flexibility in treatment planning “do whatever it takes” County gets higher quality of care administrative efficiencies greater accountability

IF YOU THINK THAT WAS GOOD Client gets: Enhanced long term recovery improvement in quality of life  mental health, family life, housing, employment, legal involvement and access to medical care

More Questions Than Answers Are outcomes facilitated by this approach? Are case rates a viable funding option? Does a case rate give the provider the flexibility to "do whatever it takes"? Does the approach improve engagement and retention?

You Gotta Be Kidding, More ??? Is it scalable to an entire system of care? How can a case rate work between multiple providers serving the same client? What actuarial data is required to determine the correct rate? What is the proper financial structure to incentivize providers?

In the Leading Role Womens Recovery Association 45-year history gender-specific responsive Complete and integrated continuum of care Committed to removing obstacles that prevent women with complex treatment issues from fully accessing, engaging and remaining in treatment NIATX since 2003

They Said “Yes”!!!! Unique opportunity to more effectively manage the continuum of care Acute episodic treatment model recovery management model Staff to think more creatively about matching the right level of care for each client Flexibility about the length of stay Full cost of treatment/recovery services

Recovery Coach Quality Improvement Committee Implementation Team Redefining Care Components Acute Stabilization Post Stabilization Recovery Management Reengagement Key Ingredients

It’s EASIER Than It Looks POTENTIAL CLIENTS REFERRED Sources: Probation, Parole, Criminal Justice/Jail, Defense Attorneys/DA, HSA, Treatment Readiness PROMISING CLIENTS SELECTED Priority population (Criminal justice, mothers with children, homeless; San Mateo County residents; ability to commit to a year of engagement SCREENING Licensed clinician completes bio- psychosocial assessment, LOCUS, determines DSM diagnosis and quadrant CLIENT IDENTIFIED AS APPROPRIATE FOR THE PILOT CLIENT CHOOSES TO PARTICIPATE ACUTE STABILIZATION PHASE Admission to Residential, Intensive Evening or Day Outpatient treatment POST STABILIZATION Transitioned to lower level of care as determined by treatment plan (i.e. Residential to Evening Outpatient) RECOVERY MANAGEMENT Aftercare; Recovery Coaching; titrating case management services and/or individual counseling REENGAGEMENT Following risk assessment, client may reenter any level of care to restabilize or reengage in recovery process Clients that are inappropriate or unwilling to commit to the pilot, will be referred to appropriate WRA service in “business as usual” model

And In The Beginning First Client Enrolled January, Clients Year 1 20 Clients Year 2

“Not to worry, says Dr. Rick, its too early and your sample size is to small.” The Envelope Please…. Treatment Outcomes

Are outcomes facilitated by this approach? Maybe Are case rates a viable funding option? Not Sure Yet Does a case rate give the provider the flexibility to "do whatever it takes"? Definitely (whew!) Does the approach improve engagement and retention? Yes (whew2) Time For Some Answers

Is it scalable to an entire system of care? Yes….and Not Sure How can a case rate work between multiple providers serving the same client? What actuarial data is required to determine the correct rate? What is the proper financial structure to incentivize providers? Time For More Answers

“Is it worth it Dr Rick?” asks Steve “Let me tell you about Maria”, says Dr Rick BeforeAfter Unsuccessful completionContinued Assessment of What Works Discharged no contactContact maintained in jail (still enrolled) Back to residentialAdvocacy to Parole Disconnected from wrap around services Individualized client centered plan Strong wrap around services

“So what happened to Maria?” Successfully transitioned to continuing recovery support Regained custody of her children Met conditions of Parole Received 3 year housing voucher Furthered her Education