1. Setting the Stage for Implementation Translating RBS Ideas into Action

2. Engineering Transformation From group care facilities that have associated therapeutic and family permanency services To family permanency resources that have integrated residential and therapeutic services RBS Reform Forum - 11/5/082Setting the Stage for Implementation

3. What’s Different On the County Side From sending children to a place … To enrolling them in a process From monitoring services and compliance … To tracking performance and outcomes On the Provider Side From counting heads in beds … To managing progress along an intervention pathway From selling services as commodities… To delivering responsiveness and results RBS Reform Forum - 11/5/083Setting the Stage for Implementation

4. From Design to Development As your picture of what your RBS system will look like comes into focus The task of the Local Implementation Team will be to translate good ideas into great services Each of the primary elements from AB 1453 will have a set of associated innovations And each set of innovations will have a corresponding group of functions that will have to be installed to make them happen RBS Reform Forum - 11/5/084Setting the Stage for Implementation

5. Making RBS Happen AB 1453 RequirementsTransformation IdeaImplementation Target PopulationObjective criteriaEnrollment process Arc of CareTargeted involvementPerformance incentives Residential environmentThe renewal stationCulture change plan Intensive interventionsPractice based on evidenceClinical system redesign Parallel servicesMobile milieu teamNew staff patterns & skills Follow-along supportRecovery recognitionBuilt in family backup Role of placing agenciesIntegrated utilizationEfficient gateways Child & family involvementThe reconnection engineEngagement skill sets Evaluation, QA/QIData driven operations Improvement feedback loop FundingCost neutral performanceBudgets, rates, claiming Waivers Blow up RCL/CCLRegulatory innovation RBS Reform Forum - 11/5/085Setting the Stage for Implementation

6. Coordinating Three Change Pathways The 11 core elements of the transformation required by AB 1453 can be sorted into 3 basic task clusters: Defining and delivering the resource (What are the differences between group care and RBS?) Funding and regulating the resource (How do we restructure existing funding to support our chosen innovations?) Using and managing the resource (How do we decide when to use it, and keep track of what happens while we’re using it?) These are carried out via Local Implementation Subcommittees RBS Reform Forum - 11/5/086Setting the Stage for Implementation

7. Subcommittees and Work Groups -1 Integrated utilization management – Operationalize target population criteria – Start up and ongoing client selection – Managing the arc of care – Role of the public agency case manager – Referral, screening, enrollment, transition – Track outcomes – Programmatic QA/QI – Program operations evaluation report Clarifying the overall RBS System Design RBS Reform Forum - 11/5/087Setting the Stage for Implementation

8. Subcommittees and Workgroups -2 Integrated fiscal management – Rates – Performance incentives – Risk pools – Documentation and billing – Coordinating funding streams – Cost neutrality “Nut” – Eligibility and claiming – Fiscal QA/QI – Tracking performance vs. projections – Fiscal evaluation report Establishing and operating an efficient funding model RBS Reform Forum - 11/5/088Setting the Stage for Implementation

9. Subcommittees and Workgroups -3 Integrated program management – Family input and involvement – Residential redesign – Clinical assessment and planning – Designing an alternative regulatory system – Staff training and development – Staffing arrangements and supervision – Service design and delivery – Plan of care design and implementation – Service QA/QI – Client experience and outcomes report Defining and managing the RCL/CCL alternative RBS Reform Forum - 11/5/089Setting the Stage for Implementation

10. The RBS Spiral of Inquiry What is this new resource? How do we pay for it? How do we use and manage it? The iterative movement from one phase of development in the spiral to the next is accomplished by asking questions that open up space for new ideas. RBS Reform Forum - 11/5/0810Setting the Stage for Implementation

11. Performance and Impact Performance Goals What does your RBS System DO? Use a data driven process for resource utilization and management? Provide for comprehensive, continuing and coordinated strength-based service planning and implementation? Insure active, effective, and sustained youth and family involvement? Deliver an integrated combination of therapeutically focused residential care options and parallel community-based services? Offer ongoing after care services and support for transition to any needed ongoing formal and informal services following enrollment? Outcome Targets What does your RBS system ACCOMPLISH? Children, youth and families express a sense of satisfaction with the assistance they have received and acquire hope for a positive future? Children and youth form positive, safe and sustained connections with family members or other adults who are making a lifelong commitment to them? Children and youth live in positive, safe, and stable community settings with either their families or other adults who are committed to provide ongoing care, nurture and support? Children and youth demonstrate a significant reduction in the behaviors that resulted in their being identified as needing a high level of care? Children and youth make reasonable progress in advancing grade to grade and acquiring skills for long term life success given their gifts, talents and preferences? RBS Reform Forum - 11/5/0811Setting the Stage for Implementation