Embarking on A New Path Bill P. Martone President WPM Consulting - - PowerPoint PPT Presentation

The Community Technical Assistance Center of New York

Embarking on A New Path Bill P. Martone President WPM Consulting

The Community Technical Assistance Center of New York

T

• obtain Continuing Education Unit credits, please

1. Please log into the webinar system via your computer, and view the entire presentation 2. Go to http://socialwork.nyu.edu/alumni/continuing- education/OnlinePortal.html 3. Create a profile 4. Select today’s webinar 5. Pay the $15 processing fee 6. T ake the Knowledge T est* *The Knowledge Test will be made available to you within the week. You will receive an email with this information within 24 hours of this webinar.

The Community Technical Assistance Center of New York

January 15th 11am-12pm

Culture- Driven Leadership

There is growing recognition of the need for organizations to infuse a performance management culture not only in residential treatment, but in all levels of the organization. A critical component in all employees understanding and embracing a performance based culture is defining, teaching, assessing, and monitoring the essential competencies of those who deliver behavioral health services. This webinar will outline critical skill sets and identify strategies aimed at strengthening and supporting the workforce.

The Community Technical Assistance Center of New York

What is your role in your agency?

• A. Director/Administrator
• B. Supervisor
• C. Clinician
• D. Administrative Support
• E. Other

Agenda For Session 1

William P. Martone 12/18/15

• 1. Goals for The Series
• 2. Bill’s Background and Experiences
• 3. Emerging Trends - Top 40 Trends in Our Field
• 4. Reinventing the Organization
• 5. Assessing Where Your Organization is At
• 6. Q&A

Goals For The Series

William P. Martone 12/18/15

• Support you in identifying the strengths of your organization specific to

achieving sustained positive outcomes for youth and families.

• Support you in increasing your understanding about your organizational

capacity for developing or expanding community based services

• Hopefully increase your enthusiasm and understanding regarding specific

strategies you can go back and utilize to improve services in your own programs

Bill’s Background and Experiences

Agencies Employed At BBI Work Peer Faculty Agencies

Freddy

So Why Consider Offering More Services in Communities

Lets Look at Some Emerging Trends

Top 40 Trends

* to Expect in the next 3-5 years

William P. Martone 12/18/15

*From Tom Woll’s 40 Trends Report - to be released January 2016 – For the Alliance Residential Transformation

Project and The Strategic Change Initiative

• 1. Expecting less money from local, state and federal governments.
• 2. A strong emphasis by service purchasers on reducing their costs.
• 3. Many are saying they only want to buy evidence-based practices.
• 4. Most are saying they want to buy results instead of buying services.
• 5. Emphasis on durable results that can be sustained for 6-12 months.
• 6. Movement from child-centered to family-focused service delivery.
• 7. Faster moves toward permanency for children not returning home.
• 8. Engagement is seen as the means and stability is seen as the end.
• 9. Re-emergence of a focus on Maslow’s hierarchy of needs for families.
• 10. Promoting “safe, secure, calm and well” as the results of our efforts.

Top 40 Trends to Expect in the next 3-5 years

William P. Martone 12/18/15

• 11. Preparing for success with a stable family is the new test to teach for.
• 12. Emphasis on making community connections to existing resources.
• 13. Emphasis on helping the working poor to get better paying jobs.
• 14. Emphasis on helping to build natural support networks for families.
• 15. Care coordination and aftercare are seen as essential for durability.
• 16. Movement away from “one size fits all” and toward individualization.
• 17. Push to re-design all existing services to ensure more durable results.
• 18. Emphasis on learning how to teach normal developmental processes.
• 19. Emphasis on using wraparound designs to help meet family needs.
• 20. Emphasis on identifying and addressing the impact of trauma.

Top 40 Trends to Expect in the next 3-5 years

William P. Martone 12/18/15

• 21. Emphasis on developing guidance for staff behaviors in their work.
• 22. Emphasis on shorter durations of service whenever possible.
• 23. Emphasis on continuing to reduce the use of out-of-home care.
• 24. Emphasis on using out-of-home care primarily for crisis stabilization.
• 25. Emphasis on developing an integrated, collaborative system of care.
• 26. Emphasis on change leadership as the method to adapt organizations.
• 27. Using strategic data analysis to inform responsive decision-making.
• 28. Significant efforts to begin to integrate physical and behavioral health.
• 29. Call for collaborative relationships with primary healthcare providers.
• 30. Efforts to strengthen and enforce performance-based contracts.

Top 40 Trends to Expect in the next 3-5 years

William P. Martone 12/18/15

• 31. Continued movement toward more risk-sharing and managed care.
• 32. Emphasis on developing improved training and support for line staff.
• 33. Emphasis on finding ways to adjust organizational identity and culture.
• 34. Emphasis on community-based over campus-based service delivery.
• 35. Need for new business plans and more sophisticated financial systems.
• 36. Changing public sector role, moving away from direct service delivery.
• 37. Public sector to focus more on defining community priorities.
• 38. Public sector to focus more on developing and enforcing contracts.
• 39. Public sector to look for solution-finding partners for systems of care.
• 40. Flexible, responsive, capable and collaborative are key trend words.

Reinventing the Organization

Case Example From Hathaway-Sycamores

Mission

Of Hathaway-Sycamores Child and Family Services

Cultivating hope and resilience to enrich the well-being of children, adults, families and communities

In 1994

Nic he 60 Be d Re side ntial Pro g ram – DCF

So me Be g inning F amily Wo rk – Pic nic s/ Ca mp us Visits/ Ho me Visits Co nc e rns abo ut w hat Manag e d Care Mig ht Me an Be g an Building an Array o f Co mmunity Base d Se rv ic e s

In 2000

Be c ame a Wraparo und Ag e nc y Hire d Pare nt Partne r (Pe e r to Pe e r Suppo rt) Be g an Utilizing Wraparo und Philo so phy T hro ug h Out All Our Pro g rams/ Se rv ic e s Built Pare nt Partne r Pro g ram Intro duc e d Pare nt Partne r Into Re side ntial Milie u – Ke y Ste p in T

In 2004

Intro duc e d Re sWrap

In 2005

Me rg e r 187 Re side ntial Be ds Adde d a fo rme r Pare nt Co nsume r to Bo ard o f Dire c to rs

In 2010

34 Re side ntial Be ds Be g an Re side ntially Base d Se rv ic e s - (De mo nstratio n Pro je c t)

Key Highlights

E nvir

• nme nta l c ha ng e s

Lack of fiscal resources Lawsuits Rate Reform Growth in community based services

Na tiona l Ac c r e dita tion – JCAHO

Changed our organization Data driven decision making Performance Improvement focus 2010 began Performance Excellence Project – quest for state/national quality award

Ag e nc y- wide imple me nta tion of Wr a pa r

• und Philosophy

Wrap started in 2000 Strength based Families as partners Development of Child and Family Team No difference from kids in residential – getting better outcomes in community

Building Br idg e s Initia tive

Values and Principles continued to drive change Adapted by state Association Adapted into RBS in Los Angeles

Changing the Metaphor of Placement

The Transformation of a Residential Program

Key Issues in Change

Intr

• duc tion of Pa r

e nt Pa r tne r s

From 1 to 40

Re s/ Wr a p – Home wa r d Bound Pilot

Combining a RTF with Wraparound Philosophy – importance of Child and Family Team Implemented Res/Wrap in LA County in 2004 Four agency pilot Each model varied slightly in approach, but contained core elements Funded through agency wraparound reserves Achieved LOS of 9 months

F a mily Se a r c h a nd E ng a g e me nt

Detective to identified staff

Dir e c tive Supe r vision

Focus on precision of intervention

Cr e a te d a Cor e Pr a c tic e Mode l (will re vie w la te r)

Eventually a County and Statewide Model Created Today County is discussing Underlying Needs

RBS De monstr a tion Pr

• je c t (se e a ppe ndix fo r a dditio na l de ta ils)

4 Counties in CA - 3 Providers in Los Angeles 17 Bed Pilot started in 2010

Changing the Metaphor of Placement (continued)

The Transformation of a Residential Program

Key Issues in Change

R

BS Value s (Se e Appe ndix for

De tails on RBS)

• Childre n Be lo ng a t Ho me in T

he ir Co mmunity

• F

a milie s a re E xpe rts o n T he mse lve s a nd T he ir Childre n

• F

a mily Culture is Ac kno wle dg e d a nd Ho no re d

• Pla nning a nd T

re a tme nt a re I ndividua lize d a nd Stre ng ths-b a se d

• F

a mily I nvo lve me nt a nd Co nne c tio ns a re E sse ntia l

• Stro ng Co mmunitie s Ma ke Stro ng F

a milie s

• Wha te ve r I

t T a ke s

19

F isc al Bre ak Down In Dollars

1994 - T

he Syc a mo r e s – b ud ge t o f $5,848,000

Residential Mental health NPS Development

Development NPS Residential

F isc al Bre ak Down in Pe rc e ntage s

1994 - T

he Syc a mo r e s – b ud ge t o f $5,848,000

Residential Mental health NPS Development

Development NPS Residential

F isc al Bre ak Down in Dollars

Sta rt o f F Y’ 2011- b udg e t o f $49,715,000

Residential Residential Demonstration Project School Wraparound FFA FRC TILP Adoptions Mental Health Development

F isc al Bre ak Down in Pe rc e ntage s

Sta rt o f F Y’ 2011- b udg e t o f $49,715,000

Residential Residential Demonstration Project School Wraparound FFA FRC TILP Adoptions Mental Health Development

Fiscal Position in 2015

The Hathaway-Sycamores budget at the beginning of FY’14-15 was > $55,000,00 All Growth Since 2011 has been in Community-Based services and has been >$5 Million

Asse ssing Whe re Your Organization Is At

Identify and promote practice and policy initiatives that will create strong and closely coordinated partnerships and collaborations between families, youth, community- and residentially-based treatment and service providers, advocates and policy makers to ensure that comprehensive services and supports are family-driven, youth-guided, strength-based, culturally and linguistically competent, individualized, evidence and practice-informed, and consistent with the research on sustained positive outcomes.

BBI Mission

BBI Self-Assessment Tool: Purpose

• Establish guideposts for operationalizing principles and practices of the BBI Joint

Resolution.

• Provide information about:
• The degree of continuity, seamlessness and integration of services

and support.

• The extent to which known promising and/or best practices are

being utilized in both or either residential and community settings.

• A platform to stimulate quality improvement (QI) activities - intended to

identify guidelines where there is disagreement between respondents OR where no or little activity is occurring as assessed by one or more parties (i.e. family members), so that QI work can occur.

• The SAT is NOT intended to be used for monitoring program “compliance”.
• The SAT Glossary provides a definition of terms used throughout the SAT. It is

available at the BBI website (www.buildingbridges4youth.org) 27

BBI Self-Assessment Tool Framework: Assumptions

• Regulatory bodies are already monitoring standards and practices in

residential and community settings.

• Other resources (e.g. cultural competency, self assessment, wraparound

fidelity) are available and do not require duplication.

• A high degree of mutual interdependence between all stakeholder is

important to implement the values and principles of the BBI Joint Resolution.

• The tool is intended to spark dialogue, inclusive of community, family, youth

and agency staff who are involved and familiar with the residential agency-to help structure conversations that focus collective energy on outcomes and effective practices.

28

Elements of the BBI SAT

• 1. Child and Family Team
• 2. Family Driven Practices
• 3. Youth Guided Practices
• 4. Cultural and Linguistic Competence
• 5. Entry Into Residential Treatment
• 6. During Residential Treatment
• 7. Post-Residential Treatment
• 8. Community System of Care
• 9. Performance and Evaluation in the System of Care

29

Who is the SAT for? Designed to be used with groups of:

• Residential staff
• Community staff
• Advocates
• Youth
• Families
• Funders/ oversight agencies

Approaches to Administering the BBI SAT

Decide which is the best approach for your program and/or community; examples include, but are not limited to:

• The residential or community program lead staff completes the tool with one discipline of

staff at a time, followed by discipline specific dialogues and decisions about action steps regarding improvement needs based on findings;

• The residential or community program lead staff completes the tool with groups of youth

and/or families, involving them in dialogue about improvement needs; the ‘findings’ and the summation of the youth/family discussions/recommendation are then shared with executives and/or the group responsible for the BBI Improvement Project at the residential program;

• A comprehensive approach to the SAT, including staff at all levels from residential and

community partner organizations, youth, families, and payers.

Often initiated by the residential provider. Consider a variety of implementation options, including pre-discussion of items w/ respective groups of stakeholders. Create opportunities for respondents to discuss the results and collaborate to identify organizational and systemic improvements.

31

Examples of BBI SAT Implementation Approaches

• Use the BBI SAT for internal staff development and training
• Consider adapting a SAT simulation exercise for training
• Take sections of the BBI SAT and implement in staff meetings, or as part of

youth/staff community meetings

• Facilitate a discussion of the ratings
• Convene discussions of individual items as promising/best practices
• Use the Family and Youth tool as the basis for an exit interview and present

results to staff at least annually

• Use sections for QI discussions with community partners
• Formalize the process internally with Board review and full implementation

and analysis of results

• Establish Learning Collaborative at State or regional levels – ensure

stakeholders with BBI expertise and families/youth are partners

32

• 3. Youth-Guided Practices

1 2 3 4 5 Don’t Know/ Doesn’t Apply Never/ Almost Never Rarely Sometimes Often Always/ Almost Always

The goals of the treatment plan are based on the youth’s own goals.

    

If they are able, youth guide the Child and Family Team meetings.

    

Youth develop full understanding of the treatment plan.

    

Youth are involved in everyday decision-making about their care.

    

Peer advocates support youth in:

• a. Treatment Planning

    

• b. returning to the community

    

• c. transition to post-residential placement

    

Youth have a voice in selecting members of their Child and Family Team.

    

E xample s F rom the SAT

• 8. Community Syste m of Ca re

Example of Use

LA Providers utilized the SAT Tool from Building Bridges

• Administered at Start of RBS Program
• Completed by All 3 Providers
• Comparison of Demonstration Project and RCL Programs
• Groups Completing Included:
• Residential staff
• Community staff
• Advocates
• Youth
• Families
• Funders/ oversight agencies
• To be re-administered after the first 4 years of the project

35

The SAT Glossary provides a definition of terms used throughout the SAT. It is available at the BBI website (www.buildingbridges4youth.org)

Another Tool for Organizational Assessment

http:/ / www.createthefuture.com/ CBtoolkit.htm The Center fo r Public Skills Training Capacity Building To o lkit 1 1 T his Capacity Building Action Planning Toolkit w as o riginally developed by Frank Martinelli and Shelly Schnupp for use by local

associations of the Great Lakes Alliance of the YWCA as part of the GLA Capacity Building Project.

Organizational Capac ity Outc ome Domains

• Or

g a niza tiona l De ve lopme nt. Inc lude s ma na g e me nt a nd pla nning pra c tic e s,

g o v e rnanc e pra c tic e s a nd fina nc ia l ma na g e me nt syste ms, a nd use o f te c hno lo g y to impro v e e ffic ie nc y o f o pe ra tio ns.

• Pr
• g r

a m De ve lopme nt. E

xa mple s inc lude the q ua ntity a nd sc o pe o f se rv ic e s o ffe re d, c lie nt re c o rdke e ping pra c tic e s, a nd the a b ility to e ng a g e in inte rna l se lf-e v a lua tio n fo r c o ntinuo us pro g ra m impro v e me nt a nd a c c o unta b ility.

• Re ve nue De ve lopme nt. Inc lude s pla nning , tra ining , a nd re so urc e s to e ng a g e in fund

de v e lo pme nt, the numb e r o f de v e lo pme nt e ffo rts dire c te d a t e xisting a nd ne w so urc e s, a nd the suc c e ss o f tho se e ffo rts.

• L

e a de r ship De ve lopme nt. F

• r e xa mple , le a de rship a nd pro fe ssio na l de v e lo pme nt

tra ining fo r no n-pro fit dire c to rs, sta ff, a nd b o a rd me mb e rs.

• Community E

ng a g e me nt. Inc lude s e ffo rts to e xpa nd c o mmunity a wa re ne ss a b o ut the

• rg a niza tio ns’ se rv ic e s, a nd the numb e r a nd type s o f pa rtne rships with o the r
• rg a niza tio ns in the ir c o mmunitie s.

Building Org a niza tiona l Ca pa c ity – que stions to ask

Vision & Mission a nd Str a te g y: Do e s the a g e nc y’ s missio n a nd v isio n a ddre ss c o mmunity

a nd is it inc lude d in yo ur stra te g ic pla n?

Gove r na nc e a nd L e a de r ship: Do e s the o rg a niza tio n ha v e stro ng a nd e ffe c tiv e le a de rship

a t b o th the sta ff a nd b o a rd le v e l tha t is c o mmitte d to b uilding a n a rra y o f c o mmunity se rv ic e s?

Re sour c e s De ve lopme nt: Do e s the o rg a niza tio n ha v e the ne c e ssa ry re so urc e s(b o th

pe o ple a nd fina nc ia l) to de v e lo p ne e de d c o mmunity se rv ic e s?

Inte r na l Ope r a tions a nd Ma na g e me nt: Do yo u ha v e in pla c e HR Po lic ie s a nd Pro c e dure s,

Sta ff Re c ruitme nt & Re te ntio n Stra te g ie s, a Sta ff De v e lo pme nt Pla n inc luding div e rsity a nd c o mpe nsa tio n g o a ls, v o lunte e r pla n, a de q ua te fina nc ia l pla nning a nd b udg e ting c a pa c ity, inte rna l c o mmunic a tio ns, Info rma tio n syste ms, e tc . ?

Str a te g ic Re la tionships: Is yo ur o rg a niza tio n kno wn in the c o mmunity thro ug h ma rke ting

a nd pub lic re la tio ns; c o mmunity e duc a tio n a nd a dv o c a c y; c o lla b o ra tio ns, a llia nc e s a nd pa rtne rships; ne two rking ; a nd mo re ?

Se r vic e De live r y a nd Impa c t: Ca n yo u de mo nstra te tha t yo ur po te ntia l c o mmunity b a se d

se rv ic e s a re ne e de d, will ma ke a diffe re nc e to so c ie ty a nd tha t yo u a re a b le to me a sure a nd e v a lua te the se pro duc ts a nd se rv ic e s?

Ca pa c ity Building T

• olkit E

xa mple – Inte rna l Ma na g e me nt a nd O pe ra tio ns

Ca pa c ity Building T

• olkit E

xa mple – Se rvic e De live ry a nd Impa c t

Ca pa c ity Building T

• olkit E

xa mple – Stra te g ic Re la tio nships

E xample s of Community Base d Se rvic e s Organizations May De ve lop

• C o -O c c ur

r ing /Addic tio n Pr e ve ntio n Se r vic es

• Fo ste r

C ar e

• Inte nsive T

r e atme nt Fo ste r C ar e

• A do ptio n
• T

r ansitio nal Inde pe nde nt L iving

• Family Re so ur

c e C e nter

• Sc ho o l Base d Me ntal He alth Se r

vic e s

• Sc ho o l Base d Educ atio nal Pr
• g r

ams

• T

he r ape utic Be havio r al Se r vic e s – In-Ho me

• O utpatient/ Psyc hiatr

ic Se r vic es

• Ho me Base d Se r

vic e s

• Yo uth A dvo c ac y
• Family Finding / Se ar

c h & Eng ag e me nt

• Family Pr

e se r vatio n

• Kinship Suppo r

t Se r vic e s

• Par

e nt A dvo c ate Pr

• g r

ams

• Wr

apar

• und
• Emplo yme nt Se r

vic es

• Ho using Se r

vic e s

• Day C ar

e / He ad Star t

• C har

te r Sc ho o ls

• 0-5 Se r

vic e s

• A utism Spe c tr

um Se r vic e s

Topics for Future Webinars Include

Systems Approach to Change

• A systematic approach to providing community-based services

Management Infrastructure Needs

• Organizational culture and how that will impact the work with families, staff retention.
• Hiring for the right people to do this new kind of work and how you move along those who don’t.

The Value of Real & Effective Partnerships

• Establishing connections with community providers
• How to implement timely, relationship-based resources to meet needs in multiple life domains

Innovative Service Delivery Models

• Short term crisis models
• Intensive In-home models

Outcomes

• An agencies commitment to improve the outcomes for children and families should be the

fundamental driver of system change efforts.

• How do you utilize data to support these change efforts
• Focus on functional skills in the community vs. in residential and also on long-term, sustained

positive outcomes. Supervision Models

• What are the critical skill sets
• Family finding skills
• Ongoing training & mentoring

’ s

Contact Information

William P. Martone President WPM Consulting, Inc. 1516 Beech Street South Pasadena, CA 91030 Cell Phone: 626-831-6850 E-Mail: martonewilliam@gmail.com

The Community Technical Assistance Center of New York

Yvette Kelly yvette.kelly@nyu.edu

Appendix

Residentially Based Services Reform in California

Wha t is R BS R e form

California's Residentially-based Services Reform initiative seeks to transform the state's group homes, currently providing long-term congregate care and treatment, to programs combining short-term residential stabilization and treatment with follow-along community-based services to quickly reconnect youth to their families, schools and communities. In 2007, with the passage of AB 1453 (Soto), support of the California Department of Social Services (CDSS), financial support from Casey Family Programs, and the creation of the RBS Reform Coalition, reform of the State's system for care and treatment of youth with challenging needs came to fruition. The legislation authorized selection of four counties or consortia of counties that, with private partners, will implement alternative program and funding models consistent with the framework document that defines and describes RBS. The lessons learned from these projects informed planning for statewide implementation of RBS reform presented to the Legislature in 2011.

L

• s Ang e le s Mode l

L

• s Ang e le s se le c te d by State to partic ipate in RBS

Paralle l to State re fo rm L

• s Ang e le s also wo rking o n

Gro up Ho me Re fo rm sinc e 2005 T he R

e sWrap* mo d e l Hathaway-Syc amo re s Child and

Family Se rvic e s d e ve lo pe d with thre e o the r pro vid e rs in L

• s Ang e le s in 2004, and pre se nte d at pre vio us Allianc e

Co nfe re nc e s, be c ame the basis fo r the d e ve lo pme nt o f the L

• s Ang e le s RBS re fo rm mo d e l

*Re sWrap c o mbine s Re side ntial and Wraparo und appro ac he s

LOS ANGELES COUNTY RESIDENTIALLY BASED SERVICES DEMONSTRATION PROJECT

OPEN DOORS

L

• s Ang e le s Co unty wa s se le c te d, a lo ng with thre e o the r

c o untie s (Sa n Be rna rdino , Sa c ra me nto a nd the Ba y Are a Co nso rtium) to pa rtic ipa te in a n AB 1453 “ Re side ntia lly Ba se d Se rvic e s” (RBS) de mo nstra tio n pro je c t to sho rte n time fra me s to dura b le pe rma ne nc y fo r c hildre n who fa c e a re side ntia l sta y. L A’ s pla n is to infuse re side ntia l c a re with Wra pa ro und princ iple s (a c tive fa mily vo ic e a nd c ho ic e , fa c ilita te d pla nning pro c e ss, c a re c o o rdina tio n, fa mily finding ), a nd tra nsfo rm the tra ditio na l re side ntia l milie u to a the ra pe utic c o mmunity witho ut wa lls.

No te : CA is a IV-E Wa ive r Sta te a nd L

• s Ang e le s Co unty is o pe ra ting a s o ne o f two IV-E Wa ive r

Co untie s in CA pro viding it g re a te r fle xibility in funding mo de ls tha n o the r Co untie s 52

Ke y Compone nts of Mode l

T ar ge t Population Children in or at risk of RCL – 12/14 placement (high-end placements) 52 bed demonstration Approximately 160 children to be served in 2 years T he R BS Collabor ative Par tne r s DCFS DMH Five Acres - (Boys only - Ages 6-14 - 18 beds - 2 open) Hillsides -

(Co-ed - Ages 6-17 - 18 beds - 2 open)

Hathaway-Sycamores -

(Boys only - Ages 6-17 - 16 beds - 1 open)

Innovations Treatment without walls Family search, engagement, preparation and support from Day 1 Flexible funding to support innovation Waiving RCL requirements

Ke y Compone nts

c ontinue d

Ke y F e a tur e s

One Child and Family Team across all environments One plan of care Crisis stabilization without replacement Respite in the community

Outc ome s (se e re so urc e s fo r de ta ils)

Safety, Permanency and Well Being; Decreased length-of-stays in residential placements; Reduced re-entry Increased use of informal or “natural” community supports

Pe r for ma nc e Me a sur e s

CAFAS School Report Card CANS WFI-4 YSS Client Demographics YSS-F Changes of Placement

Clie nt E lig ibility Crite ria

Must b e a De p a rtme nt o f Chi

ld a nd Fa mi ly Se rvi c e s (DCFS) Cli e nt

Wo uld Othe rw i

se Ne e d RCL 12 o r 14 Pla c e me nt

• As Determined by Resource Management Process & CANS (Child and Adolescent Needs and Strengths)
• Must Enter Residential Treatment Program

Wi

ll Ne e d Si gni fi c a nt Co mmuni ty De ve lo p me nt Wo rk to Ac hi e ve Pe rma ne nc y

Wi

ll Ne e d Si gni fi c a nt Fa mi ly Fi nd i ng a nd De ve lo p ment Wo rk to Ac hi e ve Pe rma ne nc y

• Having or not having family not a criteria for admission
• Bridge care available if family is not ready (foster home, relative home)

Wi

ll Ne e d Inte nsi ve Se rvi c e s Po st-re si d e nti a l to Susta i n Pe rma ne nc y*

* DCF S c ase must re main o pe n thro ug ho ut arc o f c are

Ke y F isc a l a nd Polic y Cha lle ng e s

F isc a l

How to build a better funding model How to creatively overcome existing methods of payment

• Blending funding streams to pay for model

Determining IV-E Allowable Costs in model Waiving the RCL System

Polic y

How to change current attitudes toward residential care Using data to determine how children fare Leadership for Reform (CA Alliance / LA County/Providers/ Casey Family Programs – $ support for reform) How long public policy changes take to implement How to market project to “powers that be” (County BOS/State Officials/County Social

Workers etc.)

F isc a l Mode l for L

• s Ang e le s

T he RBS pro vide rs will b e pa id a ne w RBS c a se ra te whic h will fund up to te n mo nths in re side ntia l c a re , a Child a nd F a mily T e a m, c o nc urre nt fa mily finding e ng a g e me nt, pre pa ra tio n a nd suppo rt, re spite , c risis sta b iliza tio n, a nd inte nsive pa ra lle l c o mmunity-b a se d inte rve ntio ns inc luding the de ve lo pme nt o f c o nne c tio ns. Afte r te n mo nths o f re side ntia l c a re (no t ne c e ssa rily c o nc urre nt) ha ve b e e n use d, the ra te will c o nve rt to a lo we r ra te to inc e ntivize pro vide rs to re c o nne c t c hildre n with the ir fa milie s a nd c o mmunitie s a nd re turn the m q uic kly to ho me b a se d se tting s. Waiving the RCL S yste m fo r the RBS Units o nly; the RCL syste m will no lo ng e r a pply so tha t a ll Ope n Do o rs b e ds (fo rme rly RCL 12 o r 14) re pre se nt a sing le le ve l o f c a re . T he Wa ive r Re q ue st re fle c ts the tra nsfo rme d sta ffing a nd tre a tme nt mo de l o utline d in the Vo lunta ry Ag re e me nt a nd the F unding Mo de l.

F isc a l Mode l for L

• s Ang e le s c ontinued

Provider is at risk for meeting cost neutrality over a 24 month period - $147,314

Reconciliation process after 24 month period

Reconciliation Process

Average cost per child defined as:

The exit cohort Children in care for 24 months during the first 24 months of the Demonstration

If average cost is over $147,314 provider pays difference back to County If average cost is less than $147,314 savings shared 50/50 between provider and County – dollars to be used for reasonable and allowable child welfare related services

Actual Residential Cost Determination

Residential Rate is an estimate Actual costs to be determined at conclusion of project Provider may keep up to 10% excess over actual cost Any excess beyond 10% is returned to the County Rate to be renegotiated if project is extended beyond 24 months

Sta ffing Mode l (for

a 16 be d fac ility)

Residential Group Care Residential Director 0.40 Milieu Supervisor 1.00 Youth Specialists 14.00 On-Call Youth Specialists 3.00 18.00 Community Services Staff Program Director 1.00 Clinical Supervisor 1.00 Clinician 6.50 Lead 2.00 Family Facilitator 6.50 Youth Specialist 6.50 Family Finding & Engagement 2.00 Lead Parent Partner 1.00 Parent Partner 6.50 Family Crisis Response Team 6.00 Administrative Support 1.50 40.50 Mental Health Specialty Staff Psychiatric Services 1.00 Medical Services Staff 1.50 TBS 6.00 MHRS Staff/Youth Specialists 9.00 17.50 Shared Program Support Program Oversite & Supervision QA/QI Clinician 0.50 DMH Billing & Chart Staff 1.50 2.00 Total Salaries & Wages 78.00

Ini ti a l Sta ffi ng Mo d e l fo r RBS i nc lud i ng re si d e nti a l a nd c o mmuni ty c o mp o ne nts

• f the mo d e l

T e c hnique s Use d to Ove r c ome F isc a l a nd Polic y Cha lle ng e s Pa rtne rships o f Ke y Visio nary Ind ividuals

Including parents and youth in planning

Re -c o nc e ptualizing the use / p urp ose o f re sid e ntial tre a tme nt Signific a nt Investme nt o f T ime Ne utra l Co ordinatio n b y 3rd p a rties (c o nsulta nts a nd Ca se y) Building o ff Wra p aro und Princ iple s/ Values

ResWrap Pilot Results Family Decision Making/Child &Family Team Fundamental shift in philosophy on how the family is viewed Realization that many children being successfully served in Wraparound in the community are the same children being referred to residential treatment

De velo ping F isc al Crea tivity Cre a ting c ro ss-te am T raining a nd E valuatio n Wo rkgro up s fo r the p ro je c t So c ia l Marke ting to Co unty So c ial Wo rke rs

Additional Resources

Information On The California RBS Reform Coalition Project And Other County Models Can Be Found At:

www.rbsreform.org

The Community Technical Assistance Center of New York

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