from the balcony and on the ground the louisiana balcony view march 4, 2014
TRANSCRIPT
From the Balcony and On the GroundThe Louisiana Balcony View
March 4, 2014
Coordinated System of Care (CSoC)
• 1915c/b(3) Waiver• Implemented in five of state’s 9 regions (1200
youth)• Wraparound Agencies• Family Support Organization• State Plan services + specialized services• Statewide expansion (2400 youth) planned for
this FY
2Louisiana Department of Health and Hospitals – Office of Behavioral Health
Louisiana CSoC Regions
Louisiana Department of Health and Hospitals 3
IMPLEMENTATIONEssential Community/System Supports
Essential Community/System Supports
• Community partnership• Collaborative action• Fiscal policies & sustainability• Access to needed services & supports• Human resource development & support• Accountability
Bruns, E. J. & Walker, J. S. (2010). The wraparound process: An overview of implementation essentials. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative.
Louisiana Department of Health and Hospitals – Office of Behavioral Health 5
Community Partnership
Strengths• Cabinet level state leadership engaged in
development• Broad-based inclusive planning processChallenges• Family/youth engagement• Geography
6Louisiana Department of Health and Hospitals – Office of Behavioral Health
Collaborative Action
Louisiana Department of Health and Hospitals 7
Strengths• Policy development led by national experts• Lead agency identified with expectation for
collaboration (Executive Order)Challenges• Concurrent move to statewide managed
behavioral healthcare• Lack of knowledge base and experience
Fiscal Policies & Sustainability
Louisiana Department of Health and Hospitals 8
Strengths• 1915b/c waivers• Braided fundingChallenges• Lack of flexibility of leveraged dollars• Family Support organization model
Access to Needed Services & Supports
Louisiana Department of Health and Hospitals 9
Strengths• Regionally based Wraparound Agencies (WAA)
in all implementing areas• Waivers and State Plan Amendments with
expanded/enhanced allowable servicesChallenges• Limited children’s service capacity in state• Provider understanding/buy-in
Human Resource Development & Support
Louisiana Department of Health and Hospitals 10
Strengths• Consistent workforce development approach• Reimbursement for Child & Family Team
participationChallenges• Role of Family Support Organization in the
wraparound process• Information sharing
Accountability
Louisiana Department of Health and Hospitals – Office of Behavioral Health 11
Strengths• Goals established in Executive Order• Performance measures within WaiversChallenges• Undeveloped data collection methodology• Lack of CQI focus
Contact Information
Jody Levison-JohnsonDeputy Assistant SecretaryOffice of Behavioral [email protected]
Louisiana Department of Health and Hospitals 12
From the Balcony and On the GroundThe Louisiana Ground View
March 4, 2014
Choices Care Management
• Indiana Choices – Since 1997
• Maryland Choices – Since 2005
• DC Choices – Since 2008• Louisiana Choices – 2012• Illinois Choices – Since 2014
Choices Care Management
• More than 240 employees• $60 million annual budget• More than 1600 youth
served daily• Working across ALL child
serving systems – 60% child welfare
Coordinated System of Care
Choices Operating System
• Systems of Care Principles (clinical)– Family Centered Involvement– Wraparound Process– Multi-system Coordinated Care
• Care Management technologies (fiscal)– Capitated or Case Rates– Outcome Based – Flexible Funding
• Technology blending clinical & fiscal– Real Time Data – Data driven decision making
Wraparound Facilitation
PLAN
Case ManagerSchool
FamilyJuv Probation
Child Welfare Mental Health/Substance Abuse
WraparoundFacilitator Flex FundsProvider Network
Community Partnership
• Strengths– Choices previous experience building relationships– State vision, support, and engagement
• Challenges– Newness of wraparound concepts in community– Lack of understanding/buy-in at the local level
Collaborative Action
• Strengths– Focus on quality improvement– Ongoing dialogue and conference calls
• Challenges– Frequent operational changes from SMO– Decisions made without WAA input
Fiscal Policies & Sustainability
• Strengths– Start-up funding provided by state– Braided funding
• Challenges– Lack of control and passed on risk– Limited flex funds
Access to Needed Services & Supports
• Strengths– Expanded service array for waiver enrollees– Establishment of local natural supports
• Challenges– Need more service providers– Adequate availability of FSO in all areas
Human Resource Development & Support
• Strengths– Training provided by Institute for Innovation &
Implementation– Phased roll out and hiring
• Challenges– Turnover– Lack of familiarity with SOC & Wraparound in
workforce
Accountability
• Strengths– Information management system– Real-time data analysis
• Challenges– Labor intensive data collection process– Making changes retroactive
