Managing Residential Care to Improve Permanency Outcomes

1. Managing Residential Care to Improve Permanency Outcomes Presented by: Dr. Peter Mendelson, Chief, Bureau of Behavioral Health and Medicine, DCF Lori Szczygiel, MA, CEO ValueOptions Connecticut

2. Goals • The goal of residential care is to return youth to community settings ~ ideally to families • Youth in Residential Care deserve intensive behavioral health treatment which explicitly focuses on returning them to their families with help and with hope • DCF and ValueOptions share a goal of increasing the availability of community services while decreasing the need for out of home service • We are committed to stopping the “Residential Shuffle” and to fostering permanency and post-placement stability

3. Public and Private Partnership to Effectuate Change • DCF and Medicaid in CT contract with an Administrative Service Organization (ASO), ValueOptions (VO), to provide a variety of utilization and quality management functions for the Connecticut Behavioral Health Partnership • Residential management, tracking, reporting and outcome monitoring represent significant components • Functions and staff (DCF and VO) are integrated within a Residential Care Team

4. Partnership, cont’d • 10 ValueOptions staff and 10 DCF staff manage: • 633 youth in residential placement • Admission process (determine level of care via state constructed guidelines and medical necessity) • Frequent concurrent reviews and monitoring • Referral and Tracking • Reporting • Analysis • Quality monitoring and management via reporting and on-site reviews

5. Understanding the Needs and Opportunities • Two years of data have been tracked and trended: • Number of youth approved for out of home care • Average length of stay • Discharge delay • Risk management data (AWOLs, Arrests, Restraints, etc.) • In 2008 DCF and VO established a workgroup to track and analyze 13 RTC outcome measures previously agreed upon by the Department and residential providers

6. Understanding the Needs and Opportunities, cont’d • Our workgroup began the development of a Provider Analysis and Reporting (PARs) program to analyze residential services and to refine and incorporate outcomes in order to achieve enhanced rates of permanency • PARs program is a quality improvement process with various action steps • Providers are evaluated against generally accepted industry utilization and quality measures • We provide regular feedback and support to providers to support performance improvement

7. Understanding the Needs and Opportunities, cont’d • Second phase of PARs entails the attachment of financial incentives to the accomplishment of stated performance goals ~ a Performance Incentive Program (P4P) • Quarterly PARs meetings since 2009 (aggregate data shared in statewide forum) • Bi-annual, provider specific PARs program rolled out in CY 2009 • Performance Incentive program under construction of CY 2010

8. Looking at Outcomes – Opportunities for Improving Permanency • Research shows that a child’s experience in placement directly impacts post placement stability and permanency • In placement metrics measured: • Length of time to achieve readiness for discharge • Average number of days children remain in placement beyond clinical necessity • Notable events while in placement • Attendance in school • Average number of hours the child is in treatment while in placement • Average number of hours of family treatment • Average number of hours spent on specific activities which will support post-placement permanency (family readiness, individualized supports, etc.)

9. Looking at Outcomes – Opportunities for Improving Permanency, cont’d • Post Placement metrics measured: • Percentage of children discharged to a lower level of care • Percentage of children discharged to a lower level of care maintaining stability for 12 months • 0 – 180 day post placement stability • % of children hospitalized • % of children arrested • % of children readmitted to residential • All of the above measures are designed to document outcomes post placement. Our intervention fails if stability and permanency are disrupted after a course of residential treatment

10. Overall Trends • Some improvement has been seen but there is more work to be done • 1/3 of the children served did not maintain permanency and post-placement stability

11. Baseline Performance – Average Length of Time to Achieve Readiness for Discharge ∙ Average length of time has decreased by 13% between CY ’08 and YTD ‘10

12. Baseline Performance-Percentage of Children Discharged from RTC to a Lower Level of Care · Percentage of children discharged to a lower level of care has increased by 7% from CY ’08 to ‘10 YTD

13. Baseline Performance-Percentage of Children Hospitalized 0-180 days Post RTC Discharge

14. Baseline Performance-Percentage of Children Arrested 0-180 days Post RTC Discharge

15. Baseline Performance-Percentage of Children Readmitted 0-180 days Post RTC Discharge · Percentage of children readmitted decreased by 8% from CY ’08 to ’10 YTD

16. Number of RTC Admissions ▪ RTC admissions have decreased by 12% between CY ’08 and CY ’09.

17. Number of IICAPS Admissions ▪ IICAPS admissions have increased by 92% between CY ’07 and CY ‘09

18. What Have We Learned? • To support stability and permanency, investment must occur within the community delivery system • For many youth, investment in community services has led to a decrease in residential admissions and to the preservation of families • Youth that do get admitted to residential programs are more challenging in terms of clinical presentation

19. What Have We Learned, cont’d? • Focus is critical: Family Readiness is more important than “Fixing” the child • Provider Analysis and Reporting and Performance Incentive Programs identify goals to support permanency and financially reward providers for positive outcomes • Providers at rest tend to stay at rest