Care Management Entities in Georgia’s System of Care

1. Care Management Entities in Georgia’s System of Care CME Implementation Committee March 2010

2. Care Management Entities • Role of CMEs in Georgia’s System of Care • What is a CME? • High Fidelity Wraparound as the practice model • How CMEs embody the Collaborative priorities for the SED population • Key Findings of initial evaluation report • Ongoing opportunities and challenges • Inter-agency on the ground: the DFCS crosswalk

3. SOC: The BIG Picture • SOC as framework and value base • Cluster of organizational change strategies based on values and principles intended to shape policies, regulations, funding mechanisms and services & supports • Involves complex system change • Three familiar pictures to illustrate how CME fits into SOC approach

4. SYSTEM OF CARE AT THE INDIVIDUAL LEVEL • We want families in a SOC approach to experience: • Family driven • Youth guided • No wrong door • Collaboration • Combination of natural and professional

5. SUSTAINING SYSTEMS OF CARE The CME is an element of SOC infrastructure

6. PREVALENCE UTILIZATION TRIANGLE TARGET POPULATIONS IN A SYSTEM OF CARE Intensive Services 60% of $$$ Early Intervention Home & Community-based; school-based 35% of $$$ CMEs are the top of the triangle, targeting the highest risk youth in restrictive, costly placements Prevention & Universal health promotion 5% of $$$

7. What is a CME? • Set of identifiable structures & processes to support the organization, management, delivery and financing of services and supports across multiple providers & systems. • CME creates a single locus of accountability to serve youth and families in the community, in the context of Georgia’s System of Care (SOC). • It is a quantifiable entity, with staff, minimum standards, funding streams, outcomes. • Is our SOC achieving outcomes for youth with SED and their families? The CME is the place this will be answered

8. Common Elements of CME • Child and Family Teams, responsible for development, coordination, and monitoring of individualized plans developed in a family-driven model; • Intensive Coordination of formal, informal and natural supports; • Quality Assurance to assess and improve the implementation of wraparound and adherence to values; • Utilization Management to support real time analysis of services and the cost and effectiveness of services; • Provider Network Management, with responsibility for network recruitment, organization and oversight; • Evaluation, including outcomes for youth and families served across life domains.

9. CME Practice Model • High fidelity Wraparound is the core practice • If it’s easy, you’re probably not doing wraparound! • Care Coordinator is NOT a Case Manager and is NOT doing things FOR a family. The skill being developed is facilitation of the Child and Family Team process • What makes it “high fidelity?” • Caseload size • Constant monitoring, observation, feedback, coaching • Skill sets for Wrap Supervisors, Family Support Partners, Care Coordinators

10. CME as mirror of Collaborative for SED • Collaborative has 5 Committees (priorities) • Family and Youth Involvement • Interagency Collaboration • Workforce Development • Financing • CBAY • The CME embodies these functions for the target population

11. CMEs in Georgia • Competitive selection process, state named 4 CMEs : • CHRIS Kids, Inc. • GRN Community Service Board • Lookout Mountain Community Services • MAAC (Multi Agency Alliance for Children) • Since Aug., 2009: Hired staff, trained on new practice model, implemented minimum standards, developed a database to match the practice of wraparound (building on KidsNet success), established eligibility and target population, serving youth and families • Almost 300 multi-agency high risk youth and families enrolled in CME (waiver and non-waiver)

12. Early Findings from Evaluation report • EMSTAR Research just completed 6 month evaluation of implementation • Referrals from variety of pathways: • Community partners (mh, parents, schools) • KNIS • DFCS • CSPs • CBAY • Common criteria: High risk for out of home placement, Average initial CAFAS scores 131 (non-waiver) & 153 (CBAY)

13. Early Findings from Evaluation report • Fidelity to the Wraparound model: • meeting timelines for contact w/in 48 hours (91%), • Families choosing meeting locations (initial 92%; first CFT 80%) • Strong evidence of inclusion of natural supports, and revisions to the Wraparound Action Plan • ALOS in wrap is 12 – 14 months - outcome data not available, but improved reports of improved functioning and satisfaction (families and youth) evident in early stage

14. Opportunities Ahead • OPPORTUNITIES • Partnership with DBHDD and growing with DFCS • Great commitment from staff and CME Directors • Advancing from fidelity to minimum standards to quality • CHIPRA federal grant (technical assistance and focus on Family Support Partner role) • Continued training from MD partners and developing Master Trainers in state • CME Implementation as “learning organization”

15. Challenges ahead • CHALLENGES • SUSTAINING - Billable functions and non-billable essentials • Incorporating new CMEs • Incorporating new target populations • Expected attrition of front line staff • Unknowns with administration change • Database development • Provider network management- CME is dependent upon viable, high quality provider network!

16. Please Note • CMEs are in their infancy stage…learning wraparound, learning CME functions. • Success only if administration (local, state, regional) supports wraparound • CMEs make sense if recognize the shared problems: • Silo funding • restrictive placements • Families must drive decisions • Goal: Producing desired outcomes across life domains through effective development and utilization of formal and informal resources

17. The DFCS Crosswalk • Why we conducted the crosswalk between CFT process in high fidelity wraparound and DFCS Family Team Meetings • Findings and implications of the crosswalk • What is happening in practice for youth in the CME

18. Final notes • CME as vehicle for change in SED • What’s different? • High fidelity wraparound (Facilitating a Team-based strengths-based and family driven process) • Development of natural and informal supports • Still need high quality providers • Accountability • Requires inter-agency commitment to high risk youth to sustain