Child and Adolescent Ambulatory Care Restructuring Project

1. Child and Adolescent Ambulatory Care Restructuring Project Kristin Riley Deputy Commissioner NYS Office of Mental Health August 2010

2. Historical Context to Change Agenda 2006 Achieving the Promise for NY’s Children and Families 2007 Clinic Restructuring Begins 2008 (April) Ambulatory Restructuring Begins 2008 (October) The Children’s Plan 2010 (October) New Clinic Treatment Regulations

3. Child and Family Ambulatory Care Restructuring • Original Focus: • Day Treatment • Case Management • Waiver • Partial Hospitalization • Stakeholders: Family, Youth, Providers, County/City MH, Advocates, State Agencies • Extensive Dialogue Required to Reach Consensus on Program Purpose and Structure • June 2009 Consensus Paper with Programmatic Recommendations Issued • “Restructuring the New York State Ambulatory Care System for Children and their Families”

4. Phase II. Child and Family Ambulatory Care Restructuring • Expansion of Mission 2009-2010 • Subcommittee to explore a broader Waiver program • Subcommittee to review Ambulatory Entry Points • PACC (Pre-Admission Certification Committee – RTF) • SPOA (Single Point of Access for children) • (Spring 2010) added Community Residence/Family Based Treatment with a focus on entry into these programs

5. Charge to Waiver Subcommittee • Review and make recommendations regarding the development of a broader Waiver program that would: • Have a base mix of service options (family support, peer support, care coordination, respite, skill building, intensive in-home, and crisis intervention) available to all children and families based upon need and multiple strata of care coordination. (merge case management with waiver, consider a “plan of care” option for service provision with limited care management). The service should be available regardless of ability to pay. • Consider the pros/cons of offering treatment as a part of the Waiver • Have a process for deeming children as Medicaid eligible. This would cover the majority of the target population. Also to include a state-aid component for serving children who could not be deemed Medicaid eligible. • Be consistent with the values and vision established throughout the Ambulatory Restructuring Project.

6. Charge to PACC, SPOA and CR/FBT Groups • Each group was charged with identifying operational approaches and guidelines that are consistent, statewide and measurable. • PACC: • Determining Eligibility • Waiting List Prioritization • Regulations • Incorporation of the interests of families, youth and SPOA • SPOA: • Level of care determination • Waiting List: Prioritization of resources (community based and residential) • Utilization review of resources (community based and residential) • Checks and balances regarding utilization

7. Charge to PACC, SPOA and CR/FBT Groups • Each group was charged with identifying operational approaches and guidelines that are consistent, statewide and measurable. • CR/FBT: • Catchment area---locally based (county), regional according to Field Office, statewide or within a certain radius of the residence • Admissions Decisions---composition of Admissions committee, determining access when multiple referrals are pending, balancing environment of CR and needs of current residents with needs of incoming referrals • Expectations re: usage for interim services when another level of care is indicated • Checks and balances regarding utilization

8. Feedback on Children’s Ambulatory Restructuring • OMH Conference Call with Stakeholder Leaders and Individual Comments • Too long of a project, too many meetings • Too confusing, too much, too broad • Right people are not at the table • Not enough communication • Simplify

9. Where do we go from here? • Take stock of work completed to date • Reduce scope of restructuring • Recommend continued exploration of “Super Waiver” model and CSPOA advances • New Day Treatment regulations (~2011-2012)

10. Where do we go from here? • Partial Hospitalization • Share consensus service grid for child and adolescent partial hospital with Commissioner Hogan and the OMH Adult Services Division. • (New) Enhanced School Service • Defer action

11. Where do we go from here? • Pre-Admission Certification Committee • Increase transparency with the PACC process (i.e. formal discussion with SPOA before and after the PACC decision) • Ongoing Community Education • PACC process • What RTF can and can not offer • Standardize documents required for eligibility review vs. document needs for admission to a specific RTF • If the PACC denies/defers eligibility, loop back to SPOA to initiate a cross system review

12. Where do we go from here? • Community Residence and Family Based Treatment • Strengthen and formalize mechanisms to connect CR/FBT – Family – Youth and SPOA connections. This should occur from initial eligibility through completion of the program. Education, agreements and partnerships • CRs and FBTs---clarify the purpose of OMH licensed residential programs…short term, intensive prepare for return to family. • Consistently define catchment areas for CRs and FBT (OMH Field Offices) • Strengthen youth-guided, family-driven aspects of residential programs

13. Where do we go from here? • Day Treatment • Advance consensus service grid for fiscal modeling Fall 2011 • Work with Day Treatment stakeholder group to finalize fiscal model and regulatatory change • December 2011 – June 2012 • Day Treatment new regulations • December 2012

14. Where do we go from here? • Single Points of Access • The vehicle for accessing higher intensity mental health services. • Important way for us to stay connected to young people and families in challenging times. • Balance Community-relevance with Consistency and Funding

15. Where do we go from here? • OMH review recommendations and observations for CSPOA. Identify any relevant modifications that could be made consistent with the recommendations/observations within existing funding levels. Share proposal with stakeholders for review and comment. • target to share OMH recommendations for CSPOA for stakeholder review and comment: January 2011

16. Where do we go from here? • Waiver and Case Management for Children • Positive impact – supporting families in raising their children and keeping kids out of residential/hospital level of care. • Older program models… range of opportunities and/or “challenges” to look at to reduce barriers, complexity, access and fiscal models • Tools for redesign likely to help with CSP and adaptations to other changes in the system • Changing the Waiver or Case Management will take significant time. Merit in looking at options early.

17. Where do we go from here? • OMH review recommendations and observations to date regarding “Super Waiver” • Generate more specific option(s) consistent with the recommendations/observations within existing funding levels.

18. Where do we go from here? • Share option(s) on how the OMH Waiver program could evolve with stakeholders for review and comment. • Target to share option(s) for Waiver • Jan 2011 • Stakeholder review and comment • Jan – Mar 2011 • Final recommendation to pursue “Super Waiver” or not • April 2011