1. An Introduction to Choices, Inc.

2. Afternoon Agenda Introduction to Choices – Provider networks – Family involvement – Outcomes and success stories Impetus, vision, and goals of the Pilot Breakout sessions / facilitated discussions

3. Choices, Inc. Non profit care management organization created in 1997 Developed around a community need: “high cost youth out of state” Blended system of care principles with wraparound values and managed care technology.

4. Choices Care Management More than 200 employees $50 million annual budget More than 1350 youth served in child and family teams daily Working across ALL child serving systems – 60% child welfare Indiana Choices – Since 1997 Ohio Choices – 2002 - 2011 Maryland Choices – Since 2005 DC Choices – Since 2008 Louisiana Choices - 2012

5. Choices OS Systems of Care Principles (clinical) – Family Centered Involvement – Wraparound Process – Multi-system Coordinated Care Care Management technologies (fiscal) – Capitated or Case Rates – Outcome Based – Flexible Funding Technology blending clinical & fiscal – Real Time Data – Data driven decision making

6. Care Coordination PLAN Case Manager School Family Juv Probation Child Welfare Mental Health/ Substance Abuse Care Coordinator Case RateProvider Network

7. Community Provider Networks Build upon the existing service system in a community Add organizations who aren’t typically involved as service providers (churches, African American organizations – after school, respite, mentoring) Individuals, solo practitioners, small groups from across the community have an opportunity to grow with the network

9. Community Provider Network Behavioral Health Behavior management Crisis intervention Day treatment Evaluation Family assessment Family preservation Family therapy Group therapy Individual therapy Parenting/family skills training Substance abuse therapy, individual and group Special therapy Psychiatric Assessment Medication follow-up/psychiatric review Nursing services Mentor Community case management/case aide Clinical mentor Educational mentor Life coach/independent living skills mentor Parent and family mentor Recreational/social mentor Supported work environment Tutor Community supervision

10. Community Provider Network Placement Acute hospitalization Foster care Therapeutic foster care Group home care Relative placement Residential treatment Shelter care Crisis residential Supported independent living Respite Crisis respite Planned respite Residential respite Care Coordination Case management Service coordination Intensive case management Other Camp Team meeting Consultation with other professionals Guardian ad litem Transportation Interpretive services Discretionary Activities Automobile repair Childcare/supervision Clothing Educational expenses Furnishings/appliances Housing (rent, security deposits) Medical Monitoring equipment Paid roommate Supplies/groceries Utilities Incentive money

11. Enhancing Your System of Care New Challenges and Opportunities

12. Are You a System of Care Enhancer In a Strengths Based Culture?

13. Strength Based Culture Wraparound Values Phrases That Pay Strength Based Care Strength Based Supervision

14. Phrases That Pay and Make a Difference LISTEN, LISTEN, and then LISTEN! Enhancers as well as other team members are expected to listen to the messages that are delivered by families, as well as one another. When the messages are heard, enhancers have a better understanding of how to get to Know Parents. Change Agents Change First – Enhancers are challenged from a strength based approach that in order to help families transition to change, everyone must be willing to adapt.

15. Phrases That Pay and Make a Difference Needs Aren’t Services – Enhancers are educated by child and family teams to focus on the needs of families and not force another service in their lives. Incremental not Instantaneous – Enhancers are challenged to support the belief that change comes over time and from hard work and commitment.

18. What is a SOC Enhancer? What is a SOC Enhancer Qualities of an Enhancer What to Expect

22. SOC Enhancers…. Empower youth and families Understand the System of Care Values and Phrases That Pay Know how to work themselves out of a person’s life Understand the strength of a Child and Family Team View themselves as Pioneers for Change Know how to challenge youth and families to use their strengths

23. SOC Enhancers… Know how to help families learn how to be self-sufficient Know how to establish boundaries for themselves Know when to share information with the Care Coordinator and Child and Family Team Understand the treatment team goals and the expectation from the Child and Family Team.

24. SOC Enhancers Believe… That they are the System of Care. That the System of Care is exclusive to their locality. That they are the true pioneers for change. That the value they bring is essential to the success of the System of Care.

25. Reciprocity… SOC Enhancers believe that assisting families is “Just the right thing to do.” SOC Enhancers allow families to contact them for “life.” Many providers have been called upon by families who were in need of a “booster shot.” How do SOC Enhancers give back?

26. Reciprocity… Faith-based Enhancers have been known to remain in the lives of families far after the funding is gone. They offer lifetime support. Faith-based Enhancers have been known to practice Servant Leadership. They assist families selflessly. How do Faith-based Enhancers give back?

27. Qualities of SOC Enhancers… People who show strong compassion for mankind. People who do not perceive themselves as heroes. People who do not mind getting in the “trenches” with families. People who truly believe that it takes a village.

28. What to Expect? Shared Ownership Togetherness Shared Accountability Shared Values Shared Practice Model Family Involvement Continuous Learning Reciprocity

29. You represent the SOC in your community SOC ENHANCER STRENGTH BASED PRACTICE WRAPAROUND STRENGTH BASED SUPERVISION

31. Definition of Family Driven Care Families have a primary decision making role in the care of their own children, as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. Federation of Families for Children’s Mental Health

32. Indiana Families Reaching for Rainbows est. in 1999 as part of the Marion County, IN SAMHSA grant. Advocates for families of children with behavioral and mental health needs Marion County Chapter of the Federation of Families for Children’s Mental Health Provider of services: Peer to peer support Community supervision Parenting Classes

33. Louisiana Partner with a statewide organization called Ekhaya Provides a Parent Support and Training Specialist to work directly with the caregiver in a variety of ways including household budgeting, helping to schedule and follow through with appointments, teaching parenting skills. They also provide a Peer Support Specialist who works as a mentor for the youth.

34. Maryland Partner with Maryland Coalition of Families for Children’s Mental Health & Montgomery County Federation of Families for Children’s Mental Health Both provide family navigation: one-to-one support to families. A Family Navigator is a parent who has cared for a child with special needs and has been trained to help other families. Navigators know about the services in Maryland and in their community, and how to apply for them. A Family Navigator can listen to concerns, attend meetings, when possible, assist with completing forms, explain rights, make connections to appropriate services. All families in Maryland can access this service.

35. Outcomes & Successes Hypotheses – Serve more youth in the community – Reduce expenses for out-of-home placements – Improve outcomes for youth – Save money

36. Methodology Time period: November 2008 through January 2010 Data obtained: – Indiana Department of Child Services (DCS) monthly indicator reports from Region 10 – The Clinical Manager (TCM) – Child and Adolescent Needs and Strengths Assessment (CANS)

37. Methodology Compared outcomes between youth that received services from Choices and those that did not Note that DCS data includes Choices youth Average monthly census – Choices 122 youth – DCS 3022 youth enrolled as CHINS

38. Results

41. Clinical Outcomes

43. Fiscal Outcome Service Cost per day for DCSLOS (Days) Total Cost Per Youth Episode Residential $ 293.24270 $ 79,174.80 Choices Tier 3 $ 126.94341 $ 43,286.54 In 2009, there were 102 youth referred by DCS that were not in RTC at enrollment. Of those 85 youth remained out of residential treatment. Savings per Youth= $79,174.80 (cost of residential treatment episode) - $43,286.54 (cost of a Choices episode) = $35,888.26 Savings to DCS = $35,888.26 * 85 youth = $3,050,502.10 Choices saves DCS approximately 3 million dollars for every 100 youth they divert from residential treatment.

44. Results Intensive care coordination models can be used to: Serve more youth in the community Reduce expenses for out-of-home placements Improve outcomes for youth Save money

45. Questions? www.ChoicesTeam.org Choices, Inc. 4701 N. Keystone Ave. Suite 150 Indianapolis, IN 46205 (317) 726-2121