1. An Integrated System in Vermont What is the Agency of Human Services Doing? Agency of Human Services Melissa Bailey, MA, LCMHC Director of Integrated Family Services

2. It is easier to build a child than repair an adult (p araphrased from Frederick Douglass, social reformer, writer and statesman 1818-1895)

3. Overview: Integrating Systems Integrated Family Services (IFS) History: Child/family treatment and support services span six AHS departments and over 11 different divisions. Separate and distinct children’s programs were created using separate Medicaid state plan options, Medicaid waivers, procedures and rules for managing sub- specialty populations within various programs. Goal: To create a seamless continuum of local services for families (prenatal to 22 years old) from health promotion, prevention and early intervention to intensive treatment and long term family support. The integrated system is also designed to provide services and supports to the family unit, not just the child. Hypothesis: Providing families with early support, education and intervention will produce more favorable outcomes at a lower cost than the current practice of waiting until circumstances are bad enough and provide better care for children and families. Regulatory Framework: Federal Medicaid EPSDT mandate requires coordination with all services (Maternal and Child Health; Title V; Title IV-E and IDEA part B and part C as well as other social programs). Global Commitment provides for one regulatory and managed care framework across all children’s programs and more readily aligns with holistic care required by EPSDT. 3

4. Core Elements Across the System Family systems, strength based & informed decision making by families Intervene earlier Functional needs considered Common and consistent intake, screening, assessments with multi-disciplinary teams with one plan of care Unified AHS guidelines, criteria & common documentation

5. Core Elements Across All Service Delivery Identified lead service coordinator Integrated funding with unified and simplified reimbursement & oversight Outcome based contracts Modern IT structures to share information & reduce redundancies Contracts will be combined and eliminate duplicative requirements.

6. Connection to Blueprint and Healthcare Reform Re-design will provide services in a similar manner as Blueprint and Healthcare Reform – prevention, early intervention and integrated care are key There will be integration with the mental health, substance abuse and developmental services provided for children and their families and coordinated or integrated with the medical/health home and community health teams Provide early intervention, prevention and specialty care Family Based Approach – work with families from the beginning not just when there is a problem

7. Overview: CMMI Round Two Grant Opportunity 6/11/20137 Grant Priorities: Models that improve care for populations with specialized needs. Priorities include: children in foster care, adolescents in crisis, persons with serious behavioral health needs or requiring long term care, high cost pediatric populations. Models that improve the health of populations (defined geographically, clinically, or by socioeconomic class), through activities focused on prevention, wellness, and comprehensive care that extend beyond the clinical service delivery setting and addresses the social determinants of health, and integrate behavioral and primary care. Models that are designed to rapidly reduce costs. Priorities areas are diagnostic services, outpatient radiology, high cost physician administered medications, home based services, therapeutic services and post -acute services. Models that test approaches for specific provider types to transform their financial and clinical models. Priority areas are models designed for physician specialty and sub-specialty and for pediatric providers who provide services for children with multiple medical conditions, behavioral health issues, congenital condition and complex social issues, and that include shared decision making mechanisms to engage beneficiaries and their families/caregivers in treatment choices.

8. Our Grant Application Align and integrate the way providers organize and deliver care to children and families to promote a seamless continuum of EPSDT services from enhanced prenatal care, early screening, intervention and family wellness through age 21. Create incentives for communities to address social determinants of health and reduce the likelihood of adverse childhood experience and thus reduce negative health outcomes. Decrease risk factors and improve health for children in state custody by providing immediate and early intervention to address trauma. Integrate medical homes with providers in home and community based settings. Infuse population based health promotion and prevention activities for mental health, early development and family wellness in every delivery system statewide. Reduce the utilization of intensive and more costly Medicaid/CHIP services and share demonstrated savings with local regions to support family wellness and early care.

9. The VFBA in the Grant Application Paradigm shift for promotion of wellness, mental health and treatment of emotional and behavioral problems from a family perspective. The goals are to: (1) keep families well, (2) protect at risk families from developing emotional and behavioral problems and (3) effectively treat those who already experience problems. Parents play a central role in facilitating their children’s development, therefore it makes sense to consider the entire family to be the target of prevention and treatment, contrary to current fee for service payment models that require one identified patient. The broader early childhood, developmental and mental health workforce will receive training in the family wellness model, applicable to every family. For those who are already experience problems, psychiatry staff, under the direction of Dr. James Hudziak, will provide specialized consultation and if needed treatment for families experiencing the most complex of social, emotional or behavioral issues, including substance abuse.

10. Our Partners in the System Change Process Vermont Center for Children Youth and Families – Dr. Jim Hudziak Designated Agencies – Community Mental Health and Developmental Service Agencies Specialized Service Agencies Parent Child Centers Local Schools and the Agency of Education Families and Family Advocacy Organizations Primary Care And if you don’t fall in one of the above categories now… it includes YOU!!

11. Time for BOLD Action Expectations for change from the community providers to the state leaders and state leaders to the community providers! We must push each other to implement the changes in practice based on the research You have access to the children and families We can’t rely on someone else to make these changes – We have to!

12. Next Steps Six month follow ups in the health service areas (HSA) We will be connecting with you regarding these follow up planning sessions Invite us to meet with your practice or community group prior to the 6 months if you are ready to start planning Contact information: Priscilla White will be point for this effort 802-769-6329 or priscilla.white@state.vt.us