Transcript Orientation course materials. - The Center for Human Services, UC

May 29, 2013
10:00 am - 3:00 pm
Pasadena, CA
HOUSEKEEPING
DEBORAH LOWERY
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REGIONAL HOST
COMMENTS
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Overview & Purpose
 Regional Orientation Meetings Objectives
 Inclusion of the Family Voice
 Review the Information and Guidance Set Forth in the CPM &
Medi-Cal Manual
 Dialogue on Training and Support
 Review FAQs and Responses
 Obtain and Provide Feedback on Technical Assistance, Local
Implementation Needs, and Future Meetings
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Abbreviations
 CDSS
 CPM
 CFT
 DHCS
 ICC
 IHBS
 TBS
 TCM
 TFC
California Department of Social Services
Core Practice Model
Child and Family Team
Department of Health Care Services
Intensive Care Coordination
Intensive Home Based Services
Therapeutic Behavioral Services
Targeted Case Management
Therapeutic Foster Care
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Katie A. et al v. Bonta Settlement
In July 2002, a class action lawsuit was filed to obtain
Wraparound and Therapeutic Foster Care services for
children in or at risk of placement in foster care or group
homes. In December 2011, the final settlement was
approved.
The Core Practice Model (CPM) Guide and the Medi-Cal
Manual were developed as a part of the Settlement
Agreement.
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Who is Katie A?
 A 14 year old girl at the time lawsuit was filed.
 Placed in foster care for 10 years.
 Moved through 37 different placements.
 Early assessment indicated services needed, but did not
receive trauma treatment or individualized mental health
services.
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Katie A. Settlement Agreement
Supporting
 The facilitation of an array services that are delivered in a
coordinated, comprehensive, and community-based fashion
 The development and delivery of a service that are guided by the
values and principles of the Core Practice Model.
 Establishing effective and sustainable standards and methods to
achieve quality-based oversight along with training and education
that support the practice and fiscal models.
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Katie A Settlement Agreement
Addressing
 the need for subclass members to receive medically
necessary mental health services:
 in their own home
 a family setting
 the most homelike setting appropriate to their needs
To facilitate reunification and to meet their needs for safety,
permanence, and well-being.
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Why Not Wraparound?
 Focus of lawsuit was on Early and Periodic Screening,
Diagnostic and Treatment (EPSDT)
 Services for EPSDT are more targeted and must be
aligned with medical necessity
 Wraparound is a larger process that includes both
activities and services that may or may not meet
medical necessity
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Negotiation
Process
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Therapeutic Foster Care
 State Update
 State Plan Amendment
 Update to the Medi-Cal Manual
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Katie A. Class and Subclass Members
 Who are the members of the Class and Subclass?
 What guidance is provided on member eligibility
consideration?
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Class Members
(Appendix D, Page 51 of CPM)
 Children at risk of placement in foster care
 Children w/ a mental health condition
 Children in need of individualized mental health services
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Subclass Members
(Chapter 2, Page 3, Medi-Cal Manual)
 Full-scope Medi-Cal (Title XIX) eligible
 Have an open child welfare services case
AND
 Meet the medical necessity criteria for Specialty Mental
Health Services (SMHS) as set forth in CCR Title 9
Section 1830.205 or Section 1830.210. (Medi-Cal
Manual, Glossary, Appendix A)
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Subclass Eligibility
(Chapter 3, Page 2, Medi-Cal Manual)
“In addition to the above criteria, the child and youth are
currently in or being considered for other services such
as..”
 Wraparound, Therapeutic Foster Care, Specialized care
rates due to behavioral health needs or other intensive
EPSDT services
OR
 Group home placement (RCL 10 or above), psychiatric
hospital or 24-hour mental health treatment facility or
experienced 3 or more placements within 24 months
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Open Child Welfare Case Defined
A child with an open child welfare is defined as any of
the following:
a) Child is in foster care
b) Child has a family maintenance case (pre or post,
returning home, in foster or relative placement),
including both court ordered and by voluntary
agreement
It does not include cases in which emergency response
referral are only made.
(CPM Guide Appendix C, pg 49 and Medi-Cal Manual Appendix A, pg. 17)
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Status of Child Welfare Case
Open Child Welfare Case
Closed Child Welfare Case
Intensive Care Coordination
Intensive Home Based Services
Specialty Mental health Services
Targeted Case Management
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Relationship of Services
IHBS
CPM
ICC
Subclass
Katie A Class
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Serving the Class and Subclass
Class
Subclass
• Core Practice Model Approach and • Core Practice Model Approach and
Activities
Activities
• Intensive Care Coordination
• Intensive Home Based Services
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Values and Principles
 Children protected from abuse and neglect
 Services are needs driven & strengths based
 Services are individualized for each child and family
 Services are delivered through a multi-agency approach
 Parent/Family voice and choice
 Services are a blend of formal & informal resources
 Services are culturally respectful of the child and family
 Services are provided in family’s community
 Children have permanency & stability
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Family Voice
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Core Practice Model Guide
The Core Practice Model Guide (CPM) describes a
significant shift in the way that systems and individual
service providers are expected to address the mental health
needs of children/youth and families in the child welfare
system.
CPM should be a guide for implementation of the
expectations of practice, the required elements for fidelity
practice to the model and approaches to implementation.
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CPM Guide
 Overview of Child Welfare and Mental Health
 Values and Principles
 Teaming
 Trauma Informed Practice
 Practice Components
 Implementation
 Appendices
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CPM Guide
 Values and Principles
 Trauma Informed Practice
 Integration within the guide
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Child and Family Team
The Child and Family Team (CFT )is a team that shares a
vision with the family and is working to advance that vision
while a team meeting is how the members communicate. No
single individual, agency, or service provider works
independently. Working as part of team involves a different
way of decision making.
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Child and Family Team
Child/Youth, Family and Extended Family
Informal
Supports
Formal
Supports
• Friends
• Coaches
• Faith-Based Connections
•
•
•
•
•
Educational Professionals
Mental Health
Child Welfare
Probation Officers
Representatives from other agencies
providing services to child/youth and family
• Regional Center Case Managers
• Substance Use Disorder Specialists
• Health Care Professionals
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CPM Values and Principles
Service Delivery Components
Engagement
Transition
Monitoring and
Adapting
Child,
Youth,
and
Family
Screening
(CWS)
Assessment
(MH)
Service Planning
and
Implementation
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Screening & Assessment
 Child Welfare Service assessment activities include
screening for mental health needs
 Child welfare is responsible for seeing that a MH screening
tool is completed for all children in open cases at intake and
at least annually
 Mental Health assessment is more formal and completed
by a MH professional
 MH worker communicates the results of the assessment to
the child and family and reviews what part of the
assessment, if any, must be shared w/CW and what parts the
family wants to share.
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Elements of a Successful Team
A process of a group
of people coming
together who are
committed to a
common purpose
Mutual respect
between team
members and
recognizing their
value to the team
Meeting schedules
and locations are
guided by the
family’s needs and
preferences
Membership must
include child and
family, CWS and MH
and others identified
by the family
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CPM Appendices
 California Child Welfare System
Appendix A
 Practice Standards and Activities Matrix Appendix B
 Glossary of Acronyms and Terms
Appendix C
 Katie A. Settlement Background
Appendix D
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LUNCH
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Family Voice
Child and Family
Team
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Medi-Cal Manual
(Chapter 5, pg. 7)
Intensive Care Coordination (ICC) and
Intensive Home Based Services (IHBS)
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ICC and IHBS
 Community, family, and youth involvement are essential
 ICC and IHBS are guided by the CPM
 All new Subclass members must receive ICC services
 The CFT is the Essential element to implementation
 Provider requirements for ICC and IHBS are included in
Appendix G of the Medi-Cal Manual
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Medi-Cal Manual Highlights
ICC and IHBS
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ICC Service Components and Activities
ICC Coordinator
ICC Service Setting, Activities, and Components
Claiming Multiple Staff
IHBS Services, Descriptions and Goals
Claiming and Reimbursement
Appendices
 Service Reference Charts
Appendix D
 Sample of Progress Notes
Appendix E
 Medical Necessity Criteria
Appendix F
 Provider Qualifications*
Appendix G
 Non-reimbursable Activities
Appendix H
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ICC: Service Components and Activities
 Services and supports are guided by the needs of the youth
 Involve a facilitated and collaborative relationship among
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youth, family, and involved child-serving systems
Support the parent or caregiver in meeting youth’s needs
Must be delivered using a CFT to develop and guide the
planning and service delivery process.
Similar to the activities routinely provided as Targeted Case
Management (TCM)
Involve comprehensive assessment and periodic reassessment
Involve periodic revision of planning
Referral monitoring and follow-up
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ICC Coordinator
 Must be mental health provider/practitioner
 Responsible for working within the CFT
 Ensures plans are integrated to comprehensively address
the identified goals and objectives
 Ensures service activities are coordinated to support and
ensure successful and enduring change
 Is a “bridge” between program outcomes, CFT, and plan
development process. ICC Coordinator helps to ensure the
integrated experience of children and families.
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ICC Coordinator vs. CFT Facilitator
 ICC Coordinator must be mental health provider
 ICC Coordinator is a member of the CFT
 CFT Facilitator can be any member of CFT
 CFT Facilitator can be a Youth, Family Member
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ICC Service Settings
 Home (biological, foster or adoptive)
 Community Settings
For the purposes of coordinating placement on discharge 30
days or less
 Psychiatric Facilities
 Group Home
 Hospital Settings
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ICC: Service Components
Assessing
Transition
ICC
Service
Planning
Implementation
Monitoring
and
Adapting
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Assessing Example 2, John, Page 9
John’s parents talked about the different circumstances that
were going on when he became so anxious he could not
handle remaining in the location, including someone
touching him or lots of noise and activity from the younger
children in the house. The ICC Coordinator and Parent
Partner assisted John’s Parents and John to identify what
circumstances were going on when he seemed calmer and
more in control: morning seems better than later in the day;
fewer people seem better; talking is better than touching
when giving feedback.
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Assessing
 Assessing client and family’s needs and strengths
 Assessing the adequacy and availability of resources
 Reviewing information from family and other sources
 Evaluating effectiveness of previous interventions and
activities
Assessing Example 1: John, pg. 9
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Service Planning and Implementation
 Developing a plan with specific goals, activities, and
objectives
 Ensuring the active participation of client and individuals,
and clarifying the roles and the individuals involved
 Identifying the interventions/course of action targeted at the
client and family’s assessed needs
Service Planning & Implementation Example 1: John, pg. 10
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Monitoring and Adapting
 Monitoring to ensure that identified services and activities
are progressing appropriately
 Changing and redirecting actions targeted at the client’s
and family’s assessed needs, not less than every 90 days
Monitoring and Adapting Example 1: Susie, pg. 10
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Transition
Developing a transition plan for the client and family’s longterm stability including the effective use of natural supports
and community resources.
Transition Example 1: Susie, pg. 10
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ICC: Claiming Multiple Staff pg. 12
 Each staff may claim ICC for the CFT meeting clearly
linked to the mental health client plan goals and/or the
information gleaned during the meeting that contributed to
the formulation of the mental health client plan or
revisions
 Medi-Cal reimbursement must be based on Staff time (e,g.
a single staff member who participates in the CFT meeting
cannot claim for more time than the length of the meeting
plus any documentation and travel time)
 Progress notes must include evidence of incorporation of
CPM elements described in the CPM guide.
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Intensive Home Based Services
Activities
Supporting
Educating
Improving
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Intensive Home Based Services (IHBS)
 Delivered through an individualized treatment plan
 Care planning team develops goals and objectives for all
life domains:
 Family life, community life, education, vocation, and
independent living
 Subclass who are receiving IHBS are eligible for
medically necessary specialty services mental health
modes of service, consistent with identified needs meeting
medical necessity criteria
 Specific goals and objectives are developed
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IHBS Descriptions
 Individualized
 Strength-based interventions
 Designed to ameliorate mental health conditions that interfere
with a child functioning
 Interventions aim at building skills for youth to successfully
function in the home and community,
 Interventions aim at improving the families’ ability to assist
youth in building and maintaining skills to function in the
home and community
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IHBS Goals
 Community participation
 Independent functioning
 Building social, communication, behavioral, and basic
living skills
 Child is engaged in community activities in order to work
towards the completion of identified goals and objectives
in a natural setting
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ICC and IHBS Claiming & Reimbursement
Claiming: Appendix F
 California Code of Regulations (CCR) Title 9,
Division 1 Chapter 11
 Procedure code T1017 HK
 Medical Necessity Criteria
Reimbursement
 ICC same rate as Targeted Case Management Services
 IHBS same rate as Specialty Mental health Services
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Information on Claiming and Reimbursement
For cost report and provider certification purposes, ICC will be identified
using Mode of Service 15 and Service Function Code 07, and IHBS will be
identified using Mode of Service 15, Service Function Code 57. The following
table lists this mode and procedure mapping:
Service
Mode of
Service
Service
Code
Procedure
Code
Procedure
Modifier
Intensive Care
Coordination (ICC)
15
07
T1017
HK
Intensive Home Based
Services (IHBS)
15
57
H2015
HK
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Claiming and Reimbursement
 In order to identify all specialty mental health services
provided to subclass members, MHPs shall identify all
claims for services provided to clients identified as
subclass members by supplying the Loop 2300 REFDemonstration Project Identifier (DPI) segment with the
value “KTA” as the Demonstration Project Identifier (data
element REF02).
 At this time, use of the DPI is not a requirement to claim
for FFP reimbursement, however, MHP’s are strongly
encouraged to submit this indicator as soon as possible so
that all services to subclass members may be reported.
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Training and Support
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CPM Training Support
 A multi-disciplinary subcommittee of the Statewide
Training and Education Committee (STEC) convened to
make recommendations for training and staff development
.
 Curricula resources that may be relevant have been
collected and analyzed to inform curricula development
and training.
 Recommendations for staging curricula development,
training and support have been approved by STEC and
submitted to CDSS for review.
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CPM Training Support
 Will use an Implementation Framework to spread, sustain
and train the Core Practice Model across all levels of the
child welfare and mental health workforces.[see CPM
Guide Chap 3]
 Will use a Learning Collaborative process as one of
several methods to inform the implementation curriculum,
which is initially aimed leadership and management.
 Learning Collaborative will be comprised of interested
counties from all CA regions, selected by CDSS & DHCS in
consultation with CMHDA & CWDA.
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CPM Training Support
 The Learning Collaborative counties will provide feedback for
the development of statewide, multidisciplinary training and
coaching materials for supervisory and line-worker staff.
 Multi-disciplinary training and coaching materials will be
incorporated into revisions currently being made to CWS
Common Core Curricula, and Title IV-E pre-service
educational curricula and shared with training entities for
mental health
 The contributions from the Learning Collaborative will serve
as a basis to inform planning for broader training across all
California counties.
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Available Assistance from the
Regional Training Academies (RTAs)
 Assistance with completing the Readiness Assessments.
 Participation and assistance with implementation teams
and work groups.
 Support of Learning Collaborative activities.
 Assistance with development and provision of countyspecific training and staff development activities.
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Next Steps
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State/local Accountability, Communication and
Oversight (ACO) Taskforce: FYI
 The Agreement requires DHCS and MHPs to conduct
specific activities related to data, accountability, quality
assurance and oversight, including the establishment of a
joint State/local Accountability, Communication and
Oversight (ACO) Taskforce.
 MHPs may participate in or provide input to the ACO
Task Force that will be forming to address these issues.
 The Agreement also requires a statewide data-informed
system of accountability, communication and oversight
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State/local Accountability, Communication and
Oversight (ACO) Taskforce :FYI
 Improves data exchange and matching among California Department of
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Social Services (CDSS), DHCS, MHPs and county child welfare services
(CWS) agencies;
Uses existing data collection and baseline and performance benchmarks to
the greatest extent feasible
Determines what will be measured to evaluate progress in implementing
and providing access to ICC and IHBS
Establishes a method to track the use of ICC and IHBS
Develops requirements and a general plan for the collection of data and
information about children in the class (beginning with sub-class and
extending to entire class at a future date) who receive mental health services
to evaluate utilization patterns including types, frequency, and intensity of
services, and timely access to care.
First meeting – June 1, 2013
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Joint Management Structure
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Technical Assistance
 Weekly Technical Assistance Conference Calls on
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Information and Needs Related to Implementation
Initiating STEC Learning Collaboratives to Ensure the
Exchange of Successful Implementation Practice
Approaches and Identify TA & Training Needs
Focused TA on Finance Related to Implementation
and Sustainability
Regional and Local Technical Assistance and
Information Exchange
On-going FAQs and Responses
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Announcements
Future Regional Trainings:
 May 30, Anaheim
 June 5, Riverside
Additional Training Venues:
 Institute (Formerly Wraparound Institute), June 2014
 Resource Center for Family Focused Practice Website
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Readiness Assessment and Service Delivery Plan
 Email to DHCS by on later than May 15, 2013
 Technical Assistance is available
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Questions and Feedback
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Frequently Asked Questions & Responses
Question #1: If a Subclass member no longer has an open child welfare case
and, subsequently, does not meet subclass eligibility criteria, is the child/youth
still eligible to receive ICC and/or IHBS?
Question #2: If a child/youth is receiving ICC and IHBS and it is determined
that ICC is too intensive for the child/youth’s needs, can the treatment plan be
modified to include TCM in place of ICC?
Question #3: Are there new documentation requirements for ICC and IHBS?
Question #4: Can a subclass member receive IHBS and Therapeutic
Behavioral Services (TBS) at the same time?
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Lessons Learned from Orientations
 Comparison tables will be created:
 ICC/Wraparound/Targeted Case Management
 IHBS/Wraparound/Therapeutic Behavioral Services
 FAQs
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Acknowledgements
 Parent Partners, Youth, and Families
 Members of the Core Practice Model and Medi-Cal
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Manual Subgroups
Regional Training Academies
Counties, Providers, and the Resource Center for FamilyFocused Practice
California Mental Health Directors Association
California Welfare Directors Association
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California Department of Health Care Services
California Department of Social Services
Contact Information
 California Department of Health Care Services
 Email: [email protected]
 Website: dhcs.ca.govKatieAImplementation
 California Department of Social Services
 Email: [email protected]
 Website: http://www.childsworld.ca.gov/PG1320.htm
Thank you!
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