Los Angeles County RBS Demonstration

1. Los Angeles CountyRBS Demonstration RBS Forum Sacramento, CA March 4/5, 2009

2. Lessons Learned From RBS Process • ResWrap in 2004 – “RBS will be easy” • Without culture/system change no transformation • Unforeseen contracting difficulties in order to support innovation intended • RBS has become the foundation for future care • Reduction in out-of-home care caseload • Understanding that Residential and Wrap is a partnership and Res Tx milieu is different Los Angeles County RBS Demonstration

3. Mission, Vision, Values Working Mission The Los Angeles RBS Demonstration Project will support the transformation of residential care within the child welfare system to empower families, have community focus and achieve permanency. Working Vision The creation of a strength-based, family-centered, needs-driven system of care that transforms group homes from long-term placements to short-term family driven interventions, which are not place-based, concurrently provide for seamless transitions to continuing care, and support the safety, permanency and well-being of youth and their families. Los Angeles County RBS Demonstration

4. Demonstration Profile • Children in or at risk of RCL – 12/14 placement • 48-54 bed demonstration • Approximately 200 children to be served in 2 years • Three providers Los Angeles County RBS Demonstration

5. Provider Demographics and Plans Los Angeles County RBS Demonstration

6. Cornerstone Innovations • Wraparound-based Child and Family Teams during residential treatment • Family finding, engagement, preparation and support during residential treatment • Residential therapeutic milieu infused with Wraparound principles • Portability of intensive treatment interventions across settings Los Angeles County RBS Demonstration

7. Cornerstone Innovations Continued RCL-12 and RCL-14  RBS • One level of care • Single rate plus a “patch” • Streamlined referral process Los Angeles County RBS Demonstration

8. Eligibility Criteria Necessary: • Projected need for 24 hour care at least 50% of the time • Need for intensive community development And/Or • Need for intensive family development Sufficient but not necessary: • Will need intensive services after residential discharge to maintain permanency • Would benefit from a therapeutic community and peer interaction • Meets minimum threshold of therapeutic need (DMH/CANS) Los Angeles County RBS Demonstration

9. Service Elements • Facilitated planning process - Child and Family Teams • Continuity of care across all environments • Unified Plan of care • Family finding and engagement • Family connections • Respite • Crisis stabilization • Staff roles • Exploring evidenced-based practices Los Angeles County RBS Demonstration

10. Baseline Data Notes: • Exit cohort data FY 07/08, CWS/CMS • N = 980 children Los Angeles County RBS Demonstration

11. Outcomes - Dashboard SAFETY PERMANENCY WELL BEING SATISFACTION FIDELITY COST Los Angeles County RBS Demonstration

12. Instruments YSS, YSS-F WFI CANS CAFAS Los Angeles County RBS Demonstration

13. RBS Organization Los Angeles County RBS Demonstration

14. Initial Referral & Enrollment Provider Liaison 2 RBS RMP/TDM Screening Assessment (CANS) Placement and assignment Decision Appropriate RBS Bed Available Level of Care? 1-7 YES Begin 1 RBS RCL-12 6 NO RCL-14 Benefits Coord/Transition Utilization Mgmt Utilization Review Care Management Administration Funding (payment) QA/QI 3 ? RUM Unit DCFS Wraparound Administration RCL-14 Pre-screening & Prep Other placement ISC Provider Assignment 1-14 2-7 CSW 1-7 4 RCL-14 Screening Committee 5 YES • Existing Provider Pop. • Unit conversion • Expedited County and provider process DMH AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff NO ? ? RCL-12 & 14 1-7 ? Wait and queue time in days Placement Los Angeles County RBS Demonstration

15. Streamlined Referral & Enrollment Provider Liaison 2 RBS RMP/TDM Screening Assessment (CANS) Placement Decision Provider Assignment Wrap Enrollment Appropriate RBS Bed Available 1-7 YES Begin 1 Res Tx NO RUM Unit Other placement RBS 4 2-7 CSW Placement 3 • Existing Provider Pop. • Unit conversion • Expedited County and provider process DMH AB Case Mgr. Reg. Collocated Staff Assessment Staff Monitoring Staff RBS ? Wait and queue time in days ? Los Angeles County RBS Demonstration

16. Proposed Funding Model RBS Rate • Residential treatment • Family finding, engagement, preparation and support (flexible use) • Child and Family Team • Risk Pool • Payment for 1st 9 mos • Extended LOS • Respite • Unanticipated costs • Set aside per month per child for 1st 9 months of care - TBD • Access rules – TBD Residential • 9 mos • Single rate + Patch Wraparound • 12 months • Wrap rate = $4,184, excluding placement costs Cost reconciliation • Annually • Share risk and benefit – methodology TBD Los Angeles County RBS Demonstration

17. Waiver Requests • RCL • Replace RCL point system with new staffing and treatment model • Other - TBD Los Angeles County RBS Demonstration

18. Status and Plan • Provider selection Completed • Voluntary Agreement and Funding Model Due 3/23 • Wrap contract amendment with RBS May • Training and culture change May-Jul • Unit conversion Aug-Sep Los Angeles County RBS Demonstration

19. Open Questions • Bridge care • Unit design (CCL implications) • Culture change and training Los Angeles County RBS Demonstration