1. Los Angeles County RBS Demonstration RBS Forum Sacramento, CA March 4/5, 2009

2. Lessons Learned From RBS Process ResWrap in 2004 – “RBS will be easy” Without culture/system change no transformation Unforeseen contracting difficulties in order to support innovation intended RBS has become the foundation for future care Reduction in out-of-home care caseload Understanding that Residential and Wrap is a partnership and Res Tx milieu is different Mar., 4/5, 2009Los Angeles County RBS Demonstration2

3. Mission, Vision, Values Working Mission The Los Angeles RBS Demonstration Project will support the transformation of residential care within the child welfare system to empower families, have community focus and achieve permanency. Working Vision The creation of a strength-based, family-centered, needs-driven system of care that transforms group homes from long-term placements to short-term family driven interventions, which are not place-based, concurrently provide for seamless transitions to continuing care, and support the safety, permanency and well- being of youth and their families. Mar., 4/5, 2009Los Angeles County RBS Demonstration3

4. Demonstration Profile Children in or at risk of RCL – 12/14 placement 48-54 bed demonstration Approximately 200 children to be served in 2 years Three providers Mar., 4/5, 2009Los Angeles County RBS Demonstration4

5. Provider Demographics and Plans Mar., 4/5, 2009Los Angeles County RBS Demonstration5

6. Cornerstone Innovations Wraparound-based Child and Family Teams during residential treatment Family finding, engagement, preparation and support during residential treatment Residential therapeutic milieu infused with Wraparound principles Portability of intensive treatment interventions across settings Mar., 4/5, 2009Los Angeles County RBS Demonstration6

7. Cornerstone Innovations Continued RCL-12 and RCL-14  RBS -One level of care -Single rate plus a “patch” -Streamlined referral process Mar., 4/5, 2009Los Angeles County RBS Demonstration7

8. Eligibility Criteria Necessary: – Projected need for 24 hour care at least 50% of the time – Need for intensive community development And/Or – Need for intensive family development Sufficient but not necessary: – Will need intensive services after residential discharge to maintain permanency – Would benefit from a therapeutic community and peer interaction – Meets minimum threshold of therapeutic need (DMH/CANS) Mar., 4/5, 2009Los Angeles County RBS Demonstration8

9. Service Elements Facilitated planning process - Child and Family Teams Continuity of care across all environments Unified Plan of care Family finding and engagement Family connections Respite Crisis stabilization Staff roles Exploring evidenced-based practices Mar., 4/5, 2009Los Angeles County RBS Demonstration9

10. Page - 10 Baseline Data Notes: 1.Exit cohort data FY 07/08, CWS/CMS 2.N = 980 children Mar., 4/5, 2009 Los Angeles County RBS Demonstration

11. Outcomes - Dashboard Mar., 4/5, 2009Los Angeles County RBS Demonstration11 SAFETY PERMANENCY WELL BEING SATISFACTION FIDELITY COST

12. Instruments YSS, YSS-F WFI CANS CAFAS Mar., 4/5, 2009Los Angeles County RBS Demonstration12

13. RBS Organization March 4/5, 200913Los Angeles County RBS Demonstration

14. Initial Referral & Enrollment Mar., 4/5, 2009Los Angeles County RBS Demonstration14 Level of Care? Level of Care? CSW RCL-14 Screening Committee RCL-14 Screening Committee NO Provider Liaison PlacementPlacement BeginBegin 1 2-7 1-7 ? ? ? ? Wait and queue time in days 1-7 DMH AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff RUM Unit RUM Unit 2 3 ? 1-7 YES Benefits Coord/Transition Utilization Mgmt Utilization Review Care Management Administration Funding (payment) QA/QI Benefits Coord/Transition Utilization Mgmt Utilization Review Care Management Administration Funding (payment) QA/QI ISC Provider Assignment ISC Provider Assignment DCFS Wraparound Administration 6 RBS RMP/TDM Screening Assessment ( CANS ) Placement and assignment Decision RBS RMP/TDM Screening Assessment ( CANS ) Placement and assignment Decision 5 4 Other placement Existing Provider Pop. Unit conversion Expedited County and provider process Existing Provider Pop. Unit conversion Expedited County and provider process 1-14 Appropriate RBS Bed Available Appropriate RBS Bed Available YES RCL-14 NO RCL-12 RCL-12 & 14 RCL-14 Pre-screening & Prep RCL-14 Pre-screening & Prep ? ? RBS

15. Streamlined Referral & Enrollment Mar., 4/5, 2009Los Angeles County RBS Demonstration15 CSW Provider Liaison BeginBegin 1 2-7 ? ? Wait and queue time in days DMH AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff RUM Unit RUM Unit 2 4 1-7 RBS RMP/TDM Screening Assessment ( CANS ) Placement Decision Provider Assignment Wrap Enrollment RBS RMP/TDM Screening Assessment ( CANS ) Placement Decision Provider Assignment Wrap Enrollment 3 Other placement Existing Provider Pop. Unit conversion Expedited County and provider process Existing Provider Pop. Unit conversion Expedited County and provider process Appropriate RBS Bed Available Appropriate RBS Bed Available YES NO ? ? Res Tx PlacementPlacement RBS

16. Proposed Funding Model RBS Rate -Residential treatment -Family finding, engagement, preparation and support (flexible use) -Child and Family Team -Risk Pool -Payment for 1st 9 mos -Extended LOS -Respite -Unanticipated costs -Set aside per month per child for 1st 9 months of care - TBD -Access rules – TBD Residential -9 mos -Single rate + Patch Wraparound -12 months -Wrap rate = $4,184, excluding placement costs Cost reconciliation -Annually -Share risk and benefit – methodology TBD Mar., 4/5, 2009Los Angeles County RBS Demonstration16

17. Waiver Requests 1.RCL 2.Replace RCL point system with new staffing and treatment model 3.Other - TBD Mar., 4/5, 2009Los Angeles County RBS Demonstration17

18. Status and Plan Provider selection Completed Voluntary Agreement and Funding Model Due 3/23 Wrap contract amendment with RBSMay Training and culture changeMay-Jul Unit conversionAug-Sep Mar., 4/5, 2009Los Angeles County RBS Demonstration18

19. Open Questions 1.Bridge care 2.Unit design (CCL implications) 3.Culture change and training Mar., 4/5, 2009Los Angeles County RBS Demonstration19