Sacramento County RBS Reform

Structure and Process

March 2009



RBS Collaborative Partners aka RBS Reform Team

County Agencies (CW, MH, Probation, DHA, Education)     Group Home Providers Parents Youth Meets quarterly or on as need basis   Guides policy development Reviews operations and outcomes  Addresses high level problem solving and resource development needs Expansion to include schools and court/legal community

Sacramento County RBS Providers



Quality Group Homes

Carmen Maroney, Administrator 

Children’s Receiving Home of Sacramento

David Ballard, Chief Executive Officer 

Martin’s Achievement Place

Jim Martin, Executive Director

RBS Reform Team

Sacramento County RBS Organizational Structure

Child Welfare Mental Health Probation

Access Team •Residential Stabilization & Assessment •Family Connection & Support •Community Based Services

Providers Quality Group Homes Children’s Receiving Home of Sacramento RBS Project Mgt

.

Martin’s Achievement Place

DHA

County Case Mgrs

.

The Sacramento County RBS Mission and Vision

Our Mission

The Sacramento County Residentially Based Services Program is designed with the purpose of insuring that all children and youth who receive residential services are ultimately able to connect or reconnect with family, school and community so they can achieve productive adult life outcomes.

Our Vision

Our vision is that the Sacramento County RBS Demonstration Project will provide a comprehensive and coordinated array of individually tailored residential and community based services. Services will be integrated across service agencies and will allow the ongoing and consistent delivery of service and support to children and youth enrolled in RBS and their families so they can be efficiently and effectively reconnected to their families, schools and community. Eligibility for service and support will be tied to RBS enrollment, not residential placement.

The Not So Good News...

We’ve hit a BUMP!

 Significant County budget deficit  Serious fiscal cuts for county agencies The PROBLEM…

How to fund intensive, flexible and community based services and be cost neutral in the first year.

Target Population & Start-up Criteria

Initial Target Population

    Youth ages 12-16 Assessed to need or already in RCL 12 or above 30 slots/beds to start

Child Welfare 10 Probation 10 Mental Health 4

3 providers w/plan to increase number of youth & providers annually

Referral Criteria

    Presents safety issues for self or others that requires 24 hours supervision and needs cannot be met in family setting or lower level of care Not currently receiving Wrap Unmet mental health needs present and likely to continue for extended time without RBS Current connection w/family or NFREM (

initial start-up only

)

Sacramento County RBS System Elements

          RBS Reform Team-Advisory Committee

New!!

Integrated Care Management

New!!

Thorough Assessment & Matching Process

New!!

Comprehensive Care Coordination

New!!

Short-term Residential Stabilization & Assessment

New!!

Crisis Support & Respite Care

New!!

Individualized Child, Youth & Family Behavioral Services

New!!

Intensive Permanency Services, incl.. Family Finding and Reconnection Support

New!!

Community Based Services

New!!

Parent & Youth Involvement & Advocacy

New!!

Sacramento County RBS System Flow Chart

Lead Agency Model

Integrated Arc of Care

CW, MH case mgr. Identifies potential need for group care 90 day reviews with CANS TDM Recommendation Meeting Authorization & Resource Mgt.

Probation Officer identifies potential need for group care Provider Fac.

CFT Plan of Care

Full Array of Services

Discharge from RBS 9 months placement + 9 months community = 18 months RBS enrollment

Sacramento County Draft Funding Model

“Our work to date”



Estimated Costs



Cost Spread Sheet

Sacramento County RBS Draft Funding Model

      Funding model based on 9 months in residential, 9 months in community based care Providers will receive Intensive Residential payment of $9438 per month when youth in residential care Providers will receive $3056 per month when youth in community based care Providers will receive $1666 per month for EPSDT Providers will require 90% occupancy for residential County will hold risk pool

Funding Model Draft Proposal, cont.

Additional Recommendations   Annual cost reconciliation is completed annually Provider will receive 10% of any cost savings as bonus   County to retain 90% of savings Provider to pay 10% of any overages Extended Stays & Discharge from RBS  Enrollment in RBS evaluated at each CFT   If youth continued beyond 18 months, County & Provider will jointly develop responsibility options RBS ends when the youth meets the individualized CFT goals

RBS Training Plan

   Culture RBS Orientation Understanding RBS in Sacramento Ensuring Child & Family Voice & Ownership    Practice Effective Environmental & Treatment Interventions Effective Community Interventions & Supports Effective Aftercare Intervention and Support Evaluation, QA and Improvement Funding RBS The Role of Waivers in RBS

Quality Assurance Plan

QA Tools

YSS, YSS-F Data Report CANS Tool and Progress Report

Purpose

Measure youth and family’s involvement and satisfaction with services use and outcome/decisions Measure youth’s progress in RBS and effectiveness of RBS

QA Methods

Provider ensures completion by youth and family and submits results to Harder & Assoc. Results reviewed by LIT and RBS Team monthly and sends report to RBS LIC for LIT and RBS Reform CANS. Results to Harder and Assoc. for report of collective RBS progress. Progress report reviewed by LIT and RBS Team

Frequency

Semi-Annually and at end of RBS enrollment w/monthly LIT RBS Reform Team review review At intake and quarterly throughout RBS enrollment for quarterly LIT and RVS Reform Team review

Person/s Responsible

Provider, Harder & Assoc., RBS LIC TDM Supervisor, RBS LIC Provider, Harder & Assoc., RBS LIC

Quality Insurance Plan, cont.

QA Tools

CFT Use RBS Contract Monitoring EPSDT Contract Monitoring

Purpose

Measure CFT usage and youth and family involvement Ensure quality and scope of RBS service Ensure quality and scope of EPSDT service

QA Methods

Provider agency staff collect CFT use data and prepare use report to be forwarded to RBS LIC for review by RBS Reform Team Review of scope with providers Review of scope with providers

Frequency

Monthly collection w/monthly review by LIT and quarterly review by RBS Reform Team Monthly Monthly

Person/s Responsible

Lead provider agency, RBS LIC RBS LIC Mental Health Contract Monitor

What We’ve Learned & Where We’re Going



Bumps are not Sink Holes

Next Steps  Providers and County agencies to work collaboratively to explore alternative funding options   Develop Funding Model Finalize VA, Funding & Waiver Proposals by 3/31/09

Presenter Contact Information

Geri Wilson Sacramento County Local Implementation Coordinator (916) 874-2333 (916) 599-3828 [email protected]

Glynis Butler-Stone Clinical Manager Children’s Receiving Home of Sacramento (916) 482-2370 ext. 386 [email protected]

Jim Martin Executive Director Martin’s Achievement Place, Inc.

(916) 338-1001 [email protected]

Dr. Mark Conroy Psychologist Quality Group Homes (916) 609-6300 [email protected]