1. San Bernardino County RBS Demonstration RBS Forum Sacramento, CA September 4/5, 2008

2. Overall Approach Transform the child and family experience for children placed in RCL-14, out of state, and in psychiatric hospitals so the Voice and choice for the child and family is present Continuity of care exists throughout the trajectory of care (no hand-offs, no drop-offs) Continuum of care is planned, managed and reviewed regularly Outcome focus of the demonstration is achieved Sept., 4/5, 2008San Bernardino County RBS Demonstration2 County, Provider, and Community Partnership

3. Mission, Vision, Values Mission Working together to safely build and sustain positive, successful family connections and children’s futures. Vision The transformed system will provide resources specifically designed to facilitate the ongoing movement of children and youth who have complex emotional and behavioral needs toward more enduring and positive connection or reconnection with their families, schools and communities. The transformed system will create effective partnership and collaboration across systems in the interest of better outcomes for those youth and their families. Values Stability, permanency and safety focus Flexibility Integration across systems Continuous planning and evaluation across the arc of enrollment Continuity of care Partnership and engagement Sept., 4/5, 2008San Bernardino County RBS Demonstration3 Family Driven - Youth Guided

4. Cornerstone Innovations Family Passport Care Coordination Team Wrap approach throughout trajectory of care ITFC-like foster care consistent with RBS Sept., 4/5, 2008San Bernardino County RBS Demonstration4 A Continuum of Care with No Handoffs

5. Primary Outcome Focus Sept., 4/5, 2008San Bernardino County RBS Demonstration5 1.Reduced Length of Stay 1.Reduced level of care including out of state 2.Reduced Hospitalizations 3.Reduced AWOL incidents 4.Improved Permanency a.Stable placement b.Increased pro-social behavior c.Life long connections Stakeholder-Driven

6. Baseline Sample Demographics* Frequency% Male1539% Female2361% Black1129% Latino616% Native American13% White2053% * Sample of 38 youth who had at least one RCL-14 placement day in 2007

7. Outcome Baselines Sept., 4/5, 2008San Bernardino County RBS Demonstration7 PERMANENCYBL Avg. current GH stay7.7 mos 2 in foster home, LOS0.9 mos 1 at home, length of stay3.8 mos Avg. Time in Foster Care6.2 yrs Avg. # of prior placements3.0 Reentry in to foster caretbd Exits to permanencytbd #of supportive connectionstbd WELL BEING:BL Avg. time in GH care24.5 mos Avg. # days AWOL24.8 days Avg. # of AWOL episodes3.2 Avg. # days in hospital40.8

8. Cost Baseline Sept., 4/5, 2008San Bernardino County RBS Demonstration8 COSTBL Total cost of FC (sample) $7.5M GH Cost$5.6M Out of state costs$1.6M Non Tx foster home costs$30K FFA costs$206K Other small family homes$90K Hospitalization cost$760K Total 3-yr cost $8.2M Reflects costs over 2004 to 2007 for baseline sample Average cost of $72,000 per yr per child

9. “Rachel” - A candidate for RBS (16.8 yrs old) Sept., 4/5, 2008San Bernardino County RBS Demonstration9 1995 - 19992000 - 2003 200420052006 1995-98 - six unsubstantiated abuse/neglect referrals concerning younger sister 1996 – BM incarcerated 20 months; children w/GM 1999 – 1 referral concerning all 3 children 1995-98 - six unsubstantiated abuse/neglect referrals concerning younger sister 1996 – BM incarcerated 20 months; children w/GM 1999 – 1 referral concerning all 3 children No activity Apr – Substantiated physical abuse by step parent; removal to FFA May-Dec 4 GH placements Dec Home under FM (Wrap) Respite GH #5 1 st hospitalization GH #6 Apr – Substantiated physical abuse by step parent; removal to FFA May-Dec 4 GH placements Dec Home under FM (Wrap) Respite GH #5 1 st hospitalization GH #6 Jan Home under FM (Wrap) School and AWOL incident BM requests removal Back to GH #6 May AWOL from GH #6 FBM and GM return to DCS GH #7, AWOL GH #4, AWOL Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF Sep-Oct GH #8, pregnant AWOL (Las Vegas) Return by BM to temp. FFA AWOL x2, returns to GH #8 Oct-Dec AWOL in LA w/boy friend and GM Jan Home under FM (Wrap) School and AWOL incident BM requests removal Back to GH #6 May AWOL from GH #6 FBM and GM return to DCS GH #7, AWOL GH #4, AWOL Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF Sep-Oct GH #8, pregnant AWOL (Las Vegas) Return by BM to temp. FFA AWOL x2, returns to GH #8 Oct-Dec AWOL in LA w/boy friend and GM Jan-Jun Still AWOL, rape, miscarriage Jul-Oct FFA #3 AWOL (Back to GM) Oct-Dec 2 nd hospitalization Conservatorship Dec-Present Placed out of state (RCL- 14) Jan-Jun Still AWOL, rape, miscarriage Jul-Oct FFA #3 AWOL (Back to GM) Oct-Dec 2 nd hospitalization Conservatorship Dec-Present Placed out of state (RCL- 14) 2 abuse/neglect referrals 12 GH placements in 9 GHs 5 FFA placements in 3 FFAs 2 psych hospitalizations 12 AWOL incidents 2 Wrap failures 1 rape 2 pregnancies, 2 miscarriages 2 abuse/neglect referrals 12 GH placements in 9 GHs 5 FFA placements in 3 FFAs 2 psych hospitalizations 12 AWOL incidents 2 Wrap failures 1 rape 2 pregnancies, 2 miscarriages Motivated to be with family Maintains family contact Searches for extended family Stable out of state for 2 years Engages in goal setting Survival skills Motivated to be with family Maintains family contact Searches for extended family Stable out of state for 2 years Engages in goal setting Survival skills

10. Sept., 4/5, 2008San Bernardino County RBS Demonstration10 Designing a New System for Rachel Rachel

11. Proposed Funding Model “Success First Wrap” MHSA – Funds Care Coordination Team across arc of enrollment for 12 slots – Approximately $3,000/mo/child SB 163 Wrap takes over when MHSA ends Rate for Facility Based Services - TBD Sept., 4/5, 2008San Bernardino County RBS Demonstration11

12. Potential Waiver Requests Still under consideration Waivers need to be provider driven Sept., 4/5, 2008San Bernardino County RBS Demonstration12

13. Current Status One provider tentatively selected with both Wrap and residential beds Funding streams identified and model under construction High level System Design complete Facility based service model under construction Sept., 4/5, 2008San Bernardino County RBS Demonstration13

14. Concerns/Issues/Requests for Help Models will evolve during implementation Sept., 4/5, 2008San Bernardino County RBS Demonstration14