Transcript Regional Provider Forum

Level of Care Tool
Utilization
A Multi-County Initiative
And
A Single County Initiative
Southwest Ohio
Regional Collaborative
Butler, Clermont, Hamilton, Montgomery,
Preble, Warren
Summit County
Children Services
SORC Background
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Sept 2008, Butler Co. Commissioners
Suggested topics:
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Regional recruitment of foster/adoptive
homes
Private foster care agency reviews
Regional contractual rates
Integrated software pilot
Public/key audience education
Disaster/emergency cooperation
SORC: Initial Perceptions….
SORC: Identified Opportunities
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Given the current and future economic climate
we, collectively, realized we could not continue
to operate in the same manner
Opportunity to work together to provide the best
care to the children and families we serve
Opportunity to better serve children both locally
and regionally
Improve placement stability by placing children
in the appropriate level of care to meet their
need
SORC: Level of Care Tool
Initiative
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Increase agency’s involvement in ensuring children are
placed in the least restrictive LOC
Ensure that placement decisions are driven by children’s
behavioral characteristics that will impact the demands
on the placement resource
Promote similar provider expectations/ requirements
across the region
Improve and streamline services to children while
reducing administrative burdens on counties and
providers
SORC: Placement Numbers
Children in Paid Placements
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At the end of 2008 there were roughly
2500 children in paid care throughout this
six county area
As of March 2010, there were 2409
children in paid care throughout the
collaborative area
SORC: Placement Dollars
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In 2008, the six county region was
spending in excess of $60 million dollars
for placement costs.
In 2009, the collaborative area spent
$60,101,919 for placement costs
SORC: LOC Tool Development &
Progression
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Functional Assessment Scale initially developed by Alice
Lin and a research team from UNC/Chapel Hill School of
Social Work under a contract with NC Department of
Social Services –”N.C. F.A.S.”
Tested for reliability and validity from 1996 through 1997
In Ohio, the scale went through local modifications in
urban counties when being field tested for inter-rater
reliability and content validity
SORC: SW Tool development &
progression
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Hamilton County Protocol was developed in 2003
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Butler County Protocol borrowed with permission
modified in 2008
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Alice Lin, LOC creator, customized the Southwest
Ohio Level of Care Tool in June 2009
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SWLOC Tool assesses for: Basic Foster Care,
Therapeutic Low, Therapeutic High, Group
Home, Residential Treatment (open and locked)
SORC: Conceptual Foundations of the
LOC tool
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Focus on functioning, not DSM diagnosis, #
medications, etc.
Consider strengths and weaknesses of the child’s
functioning
Incorporate child welfare domains with
behavioral health issues
Used in combination with assessment of family
and environmental domains
Preserve rater discretion
Use for admission and continued stay reviews
Summit County
LOC Assessment Tool
Implementation
Summit’s Background
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February 2006, Summit County Children Services
implemented The Level of Care Assessment Tool
Summit County developed contracted rates with
Providers based on The Level of Care
Prior to 2006 all rates were Provider driven
Summit’s Background (cont.)
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Prior to the Level of Care and
development of the Assessment Tool,
there was no true matching
Placements were not based on needs /
behaviors
Summit’s Initial Thoughts
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Children would be placed based on their needs /
behaviors
Ensure children would be placed in the Least
Restrictive Environment
Children would have only one placement in a
custody episode
Reduce paid placement budget
SCCS staff originally afraid it was more work
Some workers felt that they were losing control
of their case
Training for Providers, SCCS staff and Juvenile
Court staff
Summit: Placement Numbers
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In January 2006, 318 children in Paid Placement:
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In January 2007, 375 children in Paid Placement:
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189 Foster Care
38 Group Home
91 Residential
261 Foster Care
36 Group Home
78 Residential
End of 2009, 212 children in Paid Placement:
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123 Foster Care
40 Group Home
49 Residential
Summit’s Financial Impact
 2005
 2006
 2007
 2008
 2009
$15,329,511
$13,923,386
$13,066,856
$11,286,164
$10,759,766
Summit’s Level of Care Tool
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140 questions with narratives
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Tool automatically assigns a Level of Care
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Six Levels of Care
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Detail, Detail, Detail
Summit’s Impact
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Reduction in the Paid Placement Budget
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Decrease in youth placed in Temporary ER
Shelter Care
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Decrease number of youth placed in residential
care
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An On Call 24/7 Placement Manager
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Development of Resource Managers &
Placement Unit
Summit: Goals
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Continue to stay within the Paid Placement Budget
Decrease the length of stay for youth in residential
care
Ongoing collaboration with Summit County
agencies to develop plans for step downs and
emancipation plans
Continue to encourage Providers to recruit foster
homes in Summit County
SORC: Implications & Impact for
Providers
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Increased standardization, consistency and
county participation in decision-making about
level of care determination
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Having to more clearly define the services being
provided
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Greater accountability to demonstrate outcomes
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The shared challenge of developing service
alternatives to fill the gap while being cost
effective
SORC: Provider Impact (cont.)
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Additional opportunities being identified for regional
collaboration
Providers fear losing money and in some cases, a reality
Overall reduction in the use of residential care/decreased
length of stay duration in residential care settings
Providers fear losing control
Better understanding of agency financial situation and
funding streams available
SORC: Provider Impact (cont.)
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Increased competition for our business
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Opportunity for dialogue with counties
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Change is hard, for some…..and welcomed by
others
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“Unfunded Mandates” claimed by some
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Some felt the tool was a threat, until the tool
was shared with the provider group
SORC: Impact on Agency Staff
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Staff afraid they were losing discretion
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Staff afraid of more work
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Differences of opinions if being completed
by UM/UR versus Caseworkers
Fear of provider response
SORC: Challenges of
Implementing
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Bridging communication gap given variety of
names for levels of care
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Distrust in tool validity/reliability
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Financial impact on providers
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Meshing small county with large county needs
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Dealing w/ opposition
SORC: Benefits of implementing
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Uniformity from county to county
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Open dialogue between counties
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Improved dialogue w/ providers
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Reduction of costs
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Improved confidence of staff in requesting
placement type
SORC: County to County
comparison
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All six counties using now
Still some variance from county to county:
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Completed by UM/UR or Caseworker
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Scored by Supervisor, UM/UR dept, CW, FCFC
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Timing of reassessments
Ultimately, both SORC and Summit
find…
Public agencies and
private providers share
the common goal of
providing quality services
to youth.