Los Angeles CountyProposed RBS

Demonstration ProjectRBS Forum

Sacramento, CA

September 4/5, 2008

Mission, Vision, Collaboration

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 2

MissionThe Los Angeles RBS Demonstration will transform intensive mental health services within the child welfare system to empower families and achieve permanency for youth.

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 interventions, which are not place-based, which provide for seamless transitions to continuing care, and which support the safety and permanency needs of youth and their families

LA RBS CollaborativeIn November of 2007, the RBS Collaborative design group was formed and is composed of county, provider and community stakeholders.

LAC Group Home Trend Data

LA DCFS Children in Group Homes Trend 2004-Present

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RCL 14 RCL 12 RCL 11 RCL 10 RCL 9 RCL 8 RCL 7 RCL 6 RCL 5 RCL 4

Target Population

• Children in or approved for RCL 12 or 14 placements– CANS will be the assessment tool

• Approximately 200 DCFS children will be served– Over 24 mos– Using up to 64 RCL 12 or 14 beds and 192 Wrap slots

• Average age – 15.8 years

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 4

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Baseline Data: RCL-12 Children

Total Time in Current GH (36 mo view)

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# of Children x PeriodTotal # of ChildrenTrend

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n50%

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All RCL 12 FY 2006-07 Exit Cohort Data

Baseline Data Continued(collaborative profile applied)

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LOS Data Analysis

Notes:1.For RCL 12, 24 mo. analysis captures ~90% of

population2.For ‘Collaborative Profile’ - 24 mo. analysis captures

~80% of population

Proposed Outcomes

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 8

SAFETY• Safety in placement• Safety in home-based settings

PERMANENCY• Shortened timelines to permanency for youth• Limited, shortened length of stay in RCL 12 and 14 placements• Stability in home-based settings

WELL BEING• Family and youth satisfaction with RBS services• Family identification and connection for disconnected youth• Culturally and linguistically sensitive family involvement (visitation, participation in

and ratification of planning process, agency contact, connectedness)• Educational improvement (attendance, stability, GPA)• Socio-behavioral improvement (evidenced by CANS)

COST• Cost neutrality

Wraparound and Group Home Enrollment (FY 2003 – 2007)

Wraparound vs. Group Home Enrollment 2003 - 2007

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799

575528490406368327

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165218361873

205320532184

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Wraparound Enrollment Group Home Enrollment (RCL 4 - 14)

Cornerstone Innovations• Wraparound-based Child and Family

Teams during residential tx.

• Family finding, engagement, preparation and support during residential tx.

• Residential therapeutic milieu influenced by Wraparound principles

• Shared risk/benefit between County and providers

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 10

System Design

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 11

Proposed Funding Model• Augmented residential rate for facility based services

– RCL-12 = $5,891+ $2,300 RBS rate– RCL-14 = $6,694 + $2,300 RBS rate– Modeled at 9 months

• RBS Rate covers– Family finding, engagement, preparation and support– Child and Family Team– Flex funds

• LAC Wrap rate for community based services ($4,184 excluding placement costs)

• Risk pool– Could possibly be used for

• Extended LOS• Respite• Unanticipated costs• Placement costs during Wraparound

– $1,000 set aside per month per child for 1st 12 months of care

• Cost reconciliation – Either annually or semi-annually– Share risk and benefitSept., 4/5, 2008 Los Angeles County RBS Demonstration 12

Potential Waiver Requests

• RCL and related point systems

• No new placement agreement for respite

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 13

Current Status

• Request for interest letter to be issued mid-Sept.

• Provider selection by end of Sept.

• Contract negotiations to follow

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 14

Concerns/Issues/Requests for Help

• Cost neutrality calculation

• Interaction with Title IV-E Waiver

• Administration and claiming processes

• CCL implications

Sept., 4/5, 2008 Los Angeles County RBS Demonstration 15