Transcript Los Angeles County RBS Demonstration

San Bernardino County
RBS Demonstration
Implementation
RBS Forum
Sacramento, CA
March 4/5, 2009
Approach and Innovations
• Transform the child/family experience placed for
RCL-14, out of state, and hospitalized children
• Expedited enrollment parallel to RCL-14 cert.
• Same portable Care Coordination Team across
treatment settings
• Shared treatment staff across settings
• Trauma informed care (Risking Connections)
• ITFC foster care consistent with RBS
• Joint County/provider training
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Values
Tailored Flexibility
Permanency Focus
No Handoff, No Drop Off
Family-driven, Youth-Guided
Trauma Informed Stabilization
Partnership and Integration Across Systems
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RBS Organization
DCS/DBH/Probation
Senior Leadership
RBS Oversight
Committee
Subcommittees
Executive Champions
RBS Steering Committee
Evaluation
Liaison
Probation
Liaison
-Program
-Training
-Contracting & Finance
-Foster Family Care
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Primary Outcome Focus
(Dashboard)
Improvement
1.
Ratio of Res Tx : Community Tx
2.
Out of state placements
3.
Hospitalizations
4.
AWOL incidents
5.
Permanency
a.
b.
c.
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Stable placement
Increased pro-social behavior
Life long connections
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RBS System Design
Child/Family Plan of Care
POC
Goals
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Enrollment
Begin
1
Referral
2
CSW
?
CPU
RBS
?
1a
TDM/IE
P
AB
Case
Mgr
Placement
RBS Enrollment Meeting
including
Collecting and Analyzing Child and Family Data
(Case Mining)
Provider
Accept
Child?
NO
YES
?
NO
?
Other
Other
Placement
Wait and queue time in days
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Information
3
IPC
(RCL-14
Cert?)
PO
?
Information
?
YES
Initial Care
Coordination
Team Meeting
Enrollment in
RBS
Complete
Placement
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Placement
Placement
6
?
4
9
?
Res Tx
Youth
Stabilized
Community
Care
Yes
Initial Care
Coordination
Team Meeting
5
8
?
?
Bed
Available
Yes
Enrollment in
RBS
Complete
7
No
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?
Tailored
RBS Care
Coordination
In Current
Setting
San Bernardino County RBS Demonstration
Bed
Now
Available
No
Res Tx
Still
Needed
?
8
Enrollment Highlights
• Three points of entry
• Created new, parallel Enrollment Meeting
– Family & provider present
– Case mining and packet prep for RCL-14 cert. (IPC)
– Leave meeting with enrollment decision made
• Care Coordination plan initiated
• Facility placement plan initiated if bed available
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Placement Highlights
Care Coordination
• If bed unavailable, care coordination and stabilization occurs in
current placement
• If stabilized in current placement, no move (still enrolled in RBS)
• Care Coordination Team sets pace, duration and frequency
Residential Treatment
•
•
•
•
Intensive Tx interventions (parallel child, family, community)
Trauma informed care
Close integration with Care Coordination Team
Concurrent family finding
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Community Care Highlights
Care Coordination
• Team assesses stabilization and family readiness
• Same core team coordinates in the community
Community Treatment
• Continue Intensive Tx interventions (parallel child, family,
community)
• Trauma informed care
• Respite available
• Develop natural supports for eventual exit
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Implementation Details Under
Discussion
• RBS exit process
• Streamlined documentation
• Joint training plan
• Integrated QA/QI
• Local evaluation process
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Funding Model*
Residential Treatment
(estimated 12 mos)
• RCL-14 Rate
$6,694/mo
• Full Service Partnership (FSP)
– MHSA “Success First Wrap”
– EPSDT (typical)
$3,000/mo
$5,600/mo
*Plan to model out year savings and decide on reinvestment strategies at annual
review.
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Funding Model Continued
Community Based Care
(estimated 6 months)
• ITFC Rate (steps down)
• Full Service Partnership (FSP)
– MHSA “Success First Wrap”
– EPSDT (typical)
$4,476/mo
$3,000/mo
$5,600/mo
• SB 163 Wrap if/when MHSA period ends
– AFDC
– EPSDT
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$1,847/mo
$ 800/mo
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Waivers – None
• Standard State/County systems
• RCL system (Points under discussion)
• Tailored CCL and QA/QI surveillance for RBS
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Current Status and Plans
• Provider selected
• New residential site selection underway
• ITFC RFP process begun
• Initial State onsite review and comment of plan complete – follow-up under
way
• Voluntary Agreement and Funding model submitted
• System Design complete
• Documentation underway
• Training design and development started (Title IV-E funding planned)
• First clients tentatively identified – first child planned for August
• Out year reinvestment strategy with respect to savings and sustainability
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