san bernardino county rbs demonstration implementation rbs forum sacramento, ca march 4/5, 2009
TRANSCRIPT
San Bernardino CountyRBS Demonstration
ImplementationRBS 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
March 4/5, 2009 San Bernardino County RBS Demonstration 2
ValuesTailored Flexibility
Permanency Focus
No Handoff, No Drop Off
Family-driven, Youth-Guided
Trauma Informed Stabilization
Partnership and Integration Across Systems
March 4/5, 2009 San Bernardino County RBS Demonstration 3
RBS Oversight Committee
-Program-Training-Contracting & Finance-Foster Family Care
RBS Organization
March 4/5, 2009 4San Bernardino County RBS Demonstration
Primary Outcome Focus(Dashboard)
March 4/5, 2009 San Bernardino County RBS Demonstration 5
1. Ratio of Res Tx : Community Tx 2. Out of state placements
3. Hospitalizations
4. AWOL incidents
5. Permanency
a. Stable placementb. Increased pro-social behaviorc. Life long connections
Improvement
March 4/5, 2009 San Bernardino County RBS Demonstration 6
RBS System Design
Child/Family Plan of Care
POCGoals
Enrollment
March 4/5, 2009 San Bernardino County RBS Demonstration 7
CSWCSW
IPC(RCL-14 Cert?)
NO
OtherPlacement
Initial Care Coordination
Team Meeting
PlacementPlacementPlacementPlacement
BeginBeginBeginBegin
1a
1
Enrollment inRBS
Complete
??
??
??
?? Wait and queue time in days
??AB Case Mgr
AB Case Mgr
Placement
POPlacement
PO
??
CPUCPU
RBS Enrollment Meetingincluding
Collecting and Analyzing Child and Family Data(Case Mining)
4
Provider AcceptChild?
RBS
Other
NO
2
YES
Information
3
Referral
YES Information
TDM/IEP
TDM/IEP
Placement
March 4/5, 2009 San Bernardino County RBS Demonstration 8
4
Initial Care Coordination
Team Meeting
Enrollment inRBS
Complete
BedAvailable
BedAvailable
Res TxRes Tx
TailoredRBS Care
CoordinationIn Current
Setting
TailoredRBS Care
CoordinationIn Current
Setting
Res TxStill
Needed
Res TxStill
Needed
Yes
No
Placement
Yes??
??
?? ??
??
BedNow
Available
CommunityCare
CommunityCare
YouthStabilized
No
??
8
7
5
6 9
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
March 4/5, 2009 San Bernardino County RBS Demonstration 9
Placement HighlightsCare 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
March 4/5, 2009 San Bernardino County RBS Demonstration 10
Community Care Highlights
March 4/5, 2009 San Bernardino County RBS Demonstration 11
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
Implementation Details Under Discussion
• RBS exit process
• Streamlined documentation
• Joint training plan
• Integrated QA/QI
• Local evaluation processMarch 4/5, 2009 San Bernardino County RBS Demonstration 12
Funding Model*
Residential Treatment (estimated 12 mos)
• RCL-14 Rate $6,694/mo
• Full Service Partnership (FSP)– MHSA “Success First Wrap” $3,000/mo– EPSDT (typical) $5,600/mo
*Plan to model out year savings and decide on reinvestment strategies at annual review.
March 4/5, 2009 San Bernardino County RBS Demonstration 13
Funding Model Continued
Community Based Care (estimated 6 months)
• ITFC Rate (steps down) $4,476/mo• Full Service Partnership (FSP)
– MHSA “Success First Wrap” $3,000/mo– EPSDT (typical)
$5,600/mo
• SB 163 Wrap if/when MHSA period ends – AFDC $1,847/mo– EPSDT $ 800/mo
March 4/5, 2009 San Bernardino County RBS Demonstration 14
Waivers – None
• Standard State/County systems
• RCL system (Points under discussion)
• Tailored CCL and QA/QI surveillance for RBS
March 4/5, 2009 San Bernardino County RBS Demonstration 15
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 sustainabilityMarch 4/5, 2009 San Bernardino County RBS Demonstration 16