From the Balcony and On the Ground The Louisiana Balcony View

1. From the Balcony and On the GroundThe Louisiana Balcony View March 4, 2014

2. Coordinated System of Care (CSoC) • 1915c/b(3) Waiver • Implemented in five of state’s 9 regions (1200 youth) • Wraparound Agencies • Family Support Organization • State Plan services + specialized services • Statewide expansion (2400 youth) planned for this FY Louisiana Department of Health and Hospitals – Office of Behavioral Health

3. Louisiana CSoC Regions Louisiana Department of Health and Hospitals

4. Implementation Essential Community/System Supports

5. Essential Community/System Supports • Community partnership • Collaborative action • Fiscal policies & sustainability • Access to needed services & supports • Human resource development & support • Accountability Bruns, E. J. & Walker, J. S. (2010). The wraparound process: An overview of implementation essentials. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative. Louisiana Department of Health and Hospitals – Office of Behavioral Health

6. Community Partnership Strengths Cabinet level state leadership engaged in development Broad-based inclusive planning process Challenges Family/youth engagement Geography Louisiana Department of Health and Hospitals – Office of Behavioral Health

7. Collaborative Action Louisiana Department of Health and Hospitals Strengths Policy development led by national experts Lead agency identified with expectation for collaboration (Executive Order) Challenges Concurrent move to statewide managed behavioral healthcare Lack of knowledge base and experience

8. Fiscal Policies & Sustainability Louisiana Department of Health and Hospitals Strengths 1915b/c waivers Braided funding Challenges Lack of flexibility of leveraged dollars Family Support organization model

9. Access to Needed Services & Supports Louisiana Department of Health and Hospitals Strengths Regionally based Wraparound Agencies (WAA) in all implementing areas Waivers and State Plan Amendments with expanded/enhanced allowable services Challenges Limited children’s service capacity in state Provider understanding/buy-in

10. Human Resource Development & Support Louisiana Department of Health and Hospitals Strengths Consistent workforce development approach Reimbursement for Child & Family Team participation Challenges Role of Family Support Organization in the wraparound process Information sharing

11. Accountability Louisiana Department of Health and Hospitals – Office of Behavioral Health Strengths Goals established in Executive Order Performance measures within Waivers Challenges Undeveloped data collection methodology Lack of CQI focus

12. Contact Information Jody Levison-Johnson Deputy Assistant Secretary Office of Behavioral Health Jody.Levison@la.gov 225.342.9532 Louisiana Department of Health and Hospitals

13. From the Balcony and On the GroundThe Louisiana Ground View March 4, 2014

14. Choices Care Management • Indiana Choices – Since 1997 • Maryland Choices – Since 2005 • DC Choices – Since 2008 • Louisiana Choices – 2012 • Illinois Choices – Since 2014

15. Choices Care Management • More than 240 employees • $60 million annual budget • More than 1600 youth served daily • Working across ALL child serving systems – 60% child welfare

16. Coordinated System of Care

17. Choices Operating System • Systems of Care Principles (clinical) • Family Centered Involvement • Wraparound Process • Multi-system Coordinated Care • Care Management technologies (fiscal) • Capitated or Case Rates • Outcome Based • Flexible Funding • Technology blending clinical & fiscal • Real Time Data • Data driven decision making

18. Wraparound Facilitation Case Manager Child Welfare Family Mental Health/ Substance Abuse School Juv Probation Wraparound Facilitator Provider Network Flex Funds PLAN

19. Community Partnership • Strengths • Choices previous experience building relationships • State vision, support, and engagement • Challenges • Newness of wraparound concepts in community • Lack of understanding/buy-in at the local level

20. Collaborative Action • Strengths • Focus on quality improvement • Ongoing dialogue and conference calls • Challenges • Frequent operational changes from SMO • Decisions made without WAA input

21. Fiscal Policies & Sustainability • Strengths • Start-up funding provided by state • Braided funding • Challenges • Lack of control and passed on risk • Limited flex funds

22. Access to Needed Services & Supports • Strengths • Expanded service array for waiver enrollees • Establishment of local natural supports • Challenges • Need more service providers • Adequate availability of FSO in all areas

23. Human Resource Development & Support • Strengths • Training provided by Institute for Innovation & Implementation • Phased roll out and hiring • Challenges • Turnover • Lack of familiarity with SOC & Wraparound in workforce

24. Accountability • Strengths • Information management system • Real-time data analysis • Challenges • Labor intensive data collection process • Making changes retroactive

25. Contact Information Shannon Van Deman Chief Financial Officer Choices, Inc. SVanDeman@ChoicesTeam.org 317.205.8311