Care Management Entity Quality Collaborative

Technical Assistance Webinar Series

CME Engagement and Work

with Judges and the Court

March 1, 2012, 1:00 – 2:30 p.m., ET

For audio and to participate, dial: (800) 273-7043

Passcode: 596413

In case of technical difficulties, call (609) 528-8400

This document was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid

Services. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume

endorsement by the Federal Government.

.

2

CHCS Priorities

Our work with state and federal agencies, Medicaid health

plans, providers, and consumers focuses on:

2

Integrating Care for People with

Complex and Special Needs

Improving Quality and

Reducing Racial and Ethnic Disparities

Building Medicaid Leadership and Capacity

Enhancing Access to Coverage and Services

Maryland, Georgia and Wyoming Collaborative CHIPRA Grant Project

Goal: Improving the health and social outcomes

for children with serious behavioral health

needs.

Implement and/or expand a Care Management

Entity (CME) provider model to improve the

quality - and better control the cost - of care for

children with serious behavioral health

challenges who are enrolled in Medicaid or the

Children’s Health Insurance Program.

3

Care Management Entity Quality Collaborative

Technical Assistance Webinar Series

CME Engagement and Work

with Judges and the Court

.

Care Management Entity Quality

Collaborative Technical Assistance Webinar

Series

How Wraparound Milwaukee Interacts

with the Courts & Judges

March 1, 2012 Presented By:

Bruce Kamradt, Director,

Wraparound Milwaukee

Honorable, Thomas Donegan

Milwaukee County Children’s Court

What is Wraparound Milwaukee

A system of care organized to provide comprehensive services and supports to children and adolescents with serious emotional and mental health needs and their families

Organized as a special managed care entity, publically operated by Milwaukee County Behavioral Health Division under the 1915a provisions of the Social Security Act, which allows it to function as a type of HMO for a distinct Medicaid population within a specific geographical area (Milwaukee County)

Current enrollment is approximately 900 youth/families with 1400 families served annually

Criteria for Enrollment in Wraparound

Milwaukee

DSM-IV diagnosis with a more chronic mental health, emotional or behavior condition likely to require services for a year or more

Currently or recently served by two or more child serving systems i.e. Child Welfare, Juvenile Justice, mental health or special education

At imminent risk of placement in a:

Residential treatment center

Juvenile Correctional facility

Psychiatric inpatient facility

Status of Youth at Time of Enrollment

in Wraparound Milwaukee

•46% adjudicated delinquent and referred through County Probation Dept. (Delinquency & Court Services Division)

•20% Children in Need of Protection or Services (CHIPS) referred through Child Welfare System and under court jurisdiction

•6% Juvenile in Need of Protection and Services (JIPS – status offenders)

•28% voluntary (but could be deferred prosecution or alternative to formal court processing)

Programs Wraparound Milwaukee Operates

in Conjunction with the Courts

Wraparound – youth enter Wraparound Milwaukee under a CHIPs or Delinquency order (600 youth)

FOCUS – alternative to commitment to the State Corrections System under a “Stayed Order” (42 boys)

Re-Entry – youth with SED transitioning from the Dept. of Corrections State facility (20 youth)

Family Intervention and Support Services (FISS) – voluntary diversion program open to families with children who are chronically AWOL from home or uncontrollable in the home who were otherwise seeking court intervention (60 families)

How Enrollment in Wraparound

Involves Court System

CHIPS (Child in Need of Protection or Services):

Youth in foster care is identified with a serious emotional or mental health need placing them at risk of placement in a residential treatment center, group home or hospital

Child Welfare Central Staffing Committee reviews request for a “higher level of care” placement and recommends assessment by Wraparound Milwaukee if they meet criteria for imminent risk of institutional placement

Wrap Screener/Assessment Worker conducts assessment for eligibility and appropriateness of enrollment in Wraparound

How Enrollment in Wraparound

Involves Court System – cont’d

CHIPS (cont.)

Wraparound Assessment Worker presents recommendation to Children’s Court Judge in court (usually with concurrence of Child Welfare); Judge makes CHIPS finding and order

A Separate order is written for participation in Wraparound: “Care & Treatment Services that may include residential treatment placement to be arranged or provided by Wraparound Milwaukee…”

Court orders usually written for one year but maybe reviewed earlier

How Enrollment in Wraparound

Involves Court System – cont’d

Delinquent:

County probation worker and supervisor review adjudicated delinquent with identified mental health issues or needing further mental health assessment and who is deemed at risk for placement in a RTC or commitment to Dept. of Corrections for placement in a State correctional facility and who maybe appropriate for enrollment in Wraparound Milwaukee

Referred by Probation or Judge, Wraparound Milwaukee Screener then assesses for eligibility and appropriateness; and makes recommendation in writing and testifies in Court (assessment is always based on review of juvenile’s record, psychologist report, and interview with child and family)

How Enrollment in Wraparound

Involves Court System – cont’d

Delinquent (cont.):

Judge makes delinquency finding and order for participation in Wraparound Milwaukee (i.e. “…Care and Treatment services that may include placement in a residential treatment center to be arranged or provided by Wraparound Milwaukee…”)

OR

Based on seriousness of offense or offense history, Judge commits youth to the State Dept. of Corrections but “Stays the Order” and instead orders placement in the FOCUS Program which includes short-term residential stay and concurrent enrollment in Wraparound Milwaukee

Confidentiality

Single Release of Information Form for youth enrolled in Wraparound Milwaukee approved by Children's Court Judges

Authorizes Wraparound Milwaukee, its contracted care coordination agencies and its mobile urgent treatment teams to exchange information related to diagnosis, prognosis and treatment and care planning with Milwaukee County Children's Court and Delinquency services, Medicaid, Bureau of Milwaukee Child Welfare.

Other parties must be specifically added to the consent to include: family & educational advocates, Milwaukee Public Schools, primary care physician, dentist and other.

All consents expire after 12 months and must be re-authorized and signed by parent/guardian.

Conflict Resolution Protocol

Care Coordinator & Bureau Worker

Care Coordinator & Probation

Officer

Care Coordinator Supervisor &

Bureau Supervisor

Care Coordinator Supervisor &

Probation Supervisor

Wraparound Milwaukee Liaison & Bureau Section

Manager

Wraparound Milwaukee Liaison

& Probation Program Manager

Wraparound Milwaukee Director & Director Delinquency Services or

Director Bureau of Milwaukee Child Welfare

Legal Roles of Care Coordinators

Prepare court/ report/ revision letters

Prepare and file legal change of placement notices

Submit runaway/ missing/ temporary placement reports

Attend and testify at court hearings

Utilize conflict resolution protocol

Report critical incidents

How Care Coordinators are Trained

on Legal/Court Process

Legal and court information training is part of training curriculum

required for new care coordinators

Curriculum covers:

Definition of legal terms Court orders/docket sheets

CHIPS, Delinquent, JIPS Writing court letters/reports

Legal change of placements Filing runaway/missing notices

Conflict resolution Critical incidents

Court etiquette

Supervisors must accompany new care coordinators to Court for at

least the first month on job

Number of CW Youth Served Daily in

Wraparound Milwaukee in 2011

Child Welfare:

190 of 1615 children under CHIPS orders = 10%

120 youth enrolled in diversion through REACH program

Number of Delinquent Youth Served Daily

in Wraparound Milwaukee in 2011

Targeted

Monitoring

Program (n=105)

Systems of Care

Integration Model

“Wraparound Milwaukee” (n=430)

State Juvenile

Corrections

(n=190)

Diversion

(n=200)

Average Daily Youth Under

DCSD/DOC ~ 2040

Pending or

Community

Probation

Recidivism Study

Overall recidivism rate for Wraparound Milwaukee

Recidivism Study cont’d

Re-offending rate for high risk youth in Wraparound Milwaukee

Re-Offending Pattern of All Youth in

Wraparound in the First 21 Months of

Program

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

<3 Mo 4-6 Mo 7-9 Mo 10-12 Mo 13-15 Mo 16-18 Mo 19-21 Mo

Re-offending Pattern of All Youth in Wraparound in the First 21 Months

of Program

How Judicial Role in Wraparound

Began

Frustration with existing system

Training and education on Wraparound philosophy and approach

Opportunity to design a new system from scratch

Other

Benefits of Wraparound Milwaukee to

the Court From a Judicial Perspective

Centralized resources – “it’s all in one place”

Family centered – “families actually liked something available to them”

Professional focus – “care coordinator was an expert on mental health services so the Judge did not have to assume that uncomfortable role”

Accountability – “one agency is responsible for the care and treatment of youth”

Comprehensive services – “the availability of anything the child needed”

Better outcomes including reduction in the use of institutional placement

Biggest Challenges of Wraparound

Milwaukee’s Role in the Court System

“Selling” it to judges and court personnel – comfort level in delegating authority for care and treatment services including placement

Occasional disagreement between Probation and Wraparound around needed services and placement

Addressing community safety concerns

Trying to keep all the roles straight in court- care coordinators, crisis stabilizers, mentors, etc.

Rotation system among judges means expertise, understanding and familiarity with Wraparound Milwaukee is often changing with judicial rotation every 2 years

Questions? To submit a question please use one of the following options:

•Ask a Question Online: Click the Q&A icon located in the hidden toolbar at the top of your screen.

•Ask a Question via Phone: Phone lines will now be un-muted.

Slides and a video archive of this event will be

available on our website, at www.chcs.org.

26

CME Engagement and Work with Judges - New Jersey

System of Care

Honorable Roger W. Daley (Ret.)

Middlesex County Vicinage

New Jersey .

CHIPRA Care Management Entity Quality Collaborative

Technical Assistance Webinar Series

28

Working Together

• Understanding Roles

• Acknowledging the Tension

• Advantages to Having CMO Available

Strategies to Create Synergy

• Partnership meetings (with Court personnel and DCBHS system partners)

• Use of court liaisons

• 14 day plan protocol

29

Questions? To submit a question please use one of the following options:

•Ask a Question Online: Click the Q&A icon located in the hidden toolbar at the top of your screen.

•Ask a Question via Phone: Phone lines will now be un-muted.

Slides and a video archive of this event will be

available on our website, at www.chcs.org.

30