San Bernardino County RBS Demonstration Implementation RBS Forum Sacramento, CA March 4/5, 2009

Approach and Innovations Transform the child/family experience placed for RCL-14, out of state, and hospitalized children Expedited enrollment parallel to RCL-14 cert. Same portable Care Coordination Team across treatment settings Shared treatment staff across settings Trauma informed care (Risking Connections) ITFC foster care consistent with RBS Joint County/provider training March 4/5, 2009San Bernardino County RBS Demonstration2

Values Tailored Flexibility Permanency Focus No Handoff, No Drop Off Family-driven, Youth-Guided Trauma Informed Stabilization Partnership and Integration Across Systems March 4/5, 2009San Bernardino County RBS Demonstration3

RBS Oversight Committee -Program -Training -Contracting & Finance -Foster Family Care RBS Organization March 4/5, 20094San Bernardino County RBS Demonstration

Primary Outcome Focus (Dashboard) March 4/5, 2009San Bernardino County RBS Demonstration5 1.Ratio of Res Tx : Community Tx 2.Out of state placements 3.Hospitalizations 4.AWOL incidents 5.Permanency a.Stable placement b.Increased pro-social behavior c.Life long connections Improvement

March 4/5, 2009San Bernardino County RBS Demonstration6 RBS System Design Child/Family Plan of Care POC Goals

Enrollment March 4/5, 2009San Bernardino County RBS Demonstration7 CSW IPC (RCL-14 Cert?) NO Other Placement Initial Care Coordination Team Meeting PlacementPlacement BeginBegin 1a 1 Enrollment in RBS Complete ? ? ? ? ? ? ? ? Wait and queue time in days ? ? AB Case Mgr Placement PO Placement PO ? ? CPU RBS Enrollment Meeting including Collecting and Analyzing Child and Family Data (Case Mining) 4 Provider Accept Child? RBS Other NO 2 YES Information 3 Referral YES Information TDM/IE P

Placement March 4/5, 2009San Bernardino County RBS Demonstration8 4 Initial Care Coordination Team Meeting Enrollment in RBS Complete Bed Available Bed Available Res Tx Tailored RBS Care Coordination In Current Setting Tailored RBS Care Coordination In Current Setting Res Tx Still Needed Res Tx Still Needed Yes No Placement Yes ? ? ? ? ? ? ? ? ? ? Bed Now Available Community Care Community Care Youth Stabilized No ? ?

Enrollment Highlights Three points of entry Created new, parallel Enrollment Meeting – Family & provider present – Case mining and packet prep for RCL-14 cert. (IPC) – Leave meeting with enrollment decision made Care Coordination plan initiated Facility placement plan initiated if bed available March 4/5, 2009San Bernardino County RBS Demonstration9

Placement Highlights Care Coordination If bed unavailable, care coordination and stabilization occurs in current placement If stabilized in current placement, no move (still enrolled in RBS) Care Coordination Team sets pace, duration and frequency Residential Treatment Intensive Tx interventions (parallel child, family, community) Trauma informed care Close integration with Care Coordination Team Concurrent family finding March 4/5, 2009San Bernardino County RBS Demonstration10

Community Care Highlights March 4/5, 2009San Bernardino County RBS Demonstration11 Care Coordination Team assesses stabilization and family readiness Same core team coordinates in the community Community Treatment Continue Intensive Tx interventions (parallel child, family, community) Trauma informed care Respite available Develop natural supports for eventual exit

Implementation Details Under Discussion RBS exit process Streamlined documentation Joint training plan Integrated QA/QI Local evaluation process March 4/5, 2009San Bernardino County RBS Demonstration12

Funding Model* Residential Treatment (estimated 12 mos) RCL-14 Rate $6,694/mo Full Service Partnership (FSP) – MHSA “Success First Wrap” $3,000/mo – EPSDT (typical) $5,600/mo *Plan to model out year savings and decide on reinvestment strategies at annual review. March 4/5, 2009San Bernardino County RBS Demonstration13

Funding Model Continued Community Based Care (estimated 6 months) ITFC Rate (steps down) $4,476/mo Full Service Partnership (FSP) – MHSA “Success First Wrap” $3,000/mo – EPSDT (typical) $5,600/mo SB 163 Wrap if/when MHSA period ends – AFDC $1,847/mo – EPSDT $ 800/mo March 4/5, 2009San Bernardino County RBS Demonstration14

Waivers – None Standard State/County systems RCL system (Points under discussion) Tailored CCL and QA/QI surveillance for RBS March 4/5, 2009San Bernardino County RBS Demonstration15

Current Status and Plans Provider selected New residential site selection underway ITFC RFP process begun Initial State onsite review and comment of plan complete – follow-up under way Voluntary Agreement and Funding model submitted System Design complete Documentation underway Training design and development started (Title IV-E funding planned) First clients tentatively identified – first child planned for August Out year reinvestment strategy with respect to savings and sustainability March 4/5, 2009San Bernardino County RBS Demonstration16