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

Los Angeles CountyRBS Demonstration

RBS ForumSacramento, CA

March 4/5, 2009

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, 2009 Los Angeles County RBS Demonstration 2

Mission, Vision, ValuesWorking 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.


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


Provider Demographics and Plans


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


Cornerstone Innovations Continued

RCL-12 and RCL-14 RBS- One level of care

- Single rate plus a “patch”

- Streamlined referral process


Eligibility CriteriaNecessary:

– 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)


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


Page - 10

Baseline Data

Notes:1. Exit cohort data FY 07/08, CWS/CMS2. N = 980 children

Mar., 4/5, 2009 Los Angeles County RBS Demonstration

Outcomes - Dashboard


SAFETY

PERMANENCY

WELL BEING

SATISFACTION

FIDELITY

COST

Instruments

YSS, YSS-F

WFI

CANS

CAFAS


RBS Organization

March 4/5, 2009 13Los Angeles County RBS Demonstration

Initial Referral & Enrollment


Level of

Care?

Level of

Care?

CSWCSW

RCL-14 Screening

Committee

RCL-14 Screening

Committee

NO

Provider LiaisonProvider Liaison

PlacementPlacementPlacementPlacement

BeginBeginBeginBegin1

2-72-7

1-71-7

??

?? Wait and queue time in days

1-71-7

DMH AB Case Mgr.

Reg. Collocated StaffAssessment StaffMonitoring Staff

RUMUnitRUMUnit

2

3

?

1-71-7

YES

Benefits Coord/TransitionUtilization Mgmt

Utilization ReviewCare Management

AdministrationFunding (payment)

QA/QI

Benefits Coord/TransitionUtilization Mgmt

Utilization ReviewCare Management

AdministrationFunding (payment)

QA/QI

ISCProvider

Assignment

ISCProvider

Assignment

DCFS WraparoundAdministration

6

RBS RMP/TDMScreening

Assessment (CANS)Placement and

assignment Decision


Assessment (CANS)Placement and

assignment Decision

5

4

Other placement

Existing Provider Pop.•Unit conversion•Expedited County and provider process


1-141-14

Appropriate RBS BedAvailable


YES

RCL-14NO

RCL-12 & 14

RCL-14Pre-screening

&Prep

RCL-14Pre-screening

&Prep

??

RBS

Streamlined Referral & Enrollment


CSWCSW

Provider LiaisonProvider Liaison

BeginBeginBeginBegin1

2-72-7

?? Wait and queue time in days

DMH AB Case Mgr.

Reg. Collocated StaffAssessment StaffMonitoring Staff

RUMUnitRUMUnit

2

4

1-71-7RBS RMP/TDM

ScreeningAssessment (CANS)Placement Decision

Provider AssignmentWrap Enrollment


Assessment (CANS)Placement Decision

Provider AssignmentWrap Enrollment

3

Other placement





YES

NO

??

Res Tx

PlacementPlacementPlacementPlacement

RBS

RBS

Proposed Funding ModelRBS 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


Waiver Requests

1. RCL

2. Replace RCL point system with new staffing and treatment model

3. Other - TBD


Status and Plan

• Provider selection Completed

• Voluntary Agreement and Funding Model Due 3/23

• Wrap contract amendment with RBS May

• Training and culture change May-Jul

• Unit conversion Aug-Sep


Open Questions

1. Bridge care

2. Unit design (CCL implications)

3. Culture change and training


Documents

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