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San Bernardino County RBS Demonstration

San Bernardino County RBS Demonstration. RBS Forum Sacramento, CA. September 4/5, 2008. Overall Approach. Transform the child and family experience for children placed in RCL-14, out of state, and in psychiatric hospitals so the Voice and choice for the child and family is present

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San Bernardino County RBS Demonstration

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  1. San Bernardino CountyRBS Demonstration RBS Forum Sacramento, CA September 4/5, 2008

  2. Overall Approach Transform the child and family experience for children placed in RCL-14, out of state, and in psychiatric hospitals so the • Voice and choice for the child and family is present • Continuity of care exists throughout the trajectory of care (no hand-offs, no drop-offs) • Continuum of care is planned, managed and reviewed regularly • Outcome focus of the demonstration is achieved County, Provider, and Community Partnership San Bernardino County RBS Demonstration

  3. Mission, Vision, Values Mission Working together to safely build and sustain positive, successful family connections and children’s futures. Vision The transformed system will provide resources specifically designed to facilitate the ongoing movement of children and youth who have complex emotional and behavioral needs toward more enduring and positive connection or reconnection with their families, schools and communities. The transformed system will create effective partnership and collaboration across systems in the interest of better outcomes for those youth and their families. Values Stability, permanency and safety focus Flexibility Integration across systems Continuous planning and evaluation across the arc of enrollment Continuity of care Partnership and engagement Family Driven - Youth Guided San Bernardino County RBS Demonstration

  4. Cornerstone Innovations • Family Passport • Care Coordination Team • Wrap approach throughout trajectory of care • ITFC-like foster care consistent with RBS A Continuum of Care with No Handoffs San Bernardino County RBS Demonstration

  5. Primary Outcome Focus • Reduced Length of Stay • Reduced level of care including out of state • Reduced Hospitalizations • Reduced AWOL incidents • Improved Permanency • Stable placement • Increased pro-social behavior • Life long connections Stakeholder-Driven San Bernardino County RBS Demonstration

  6. Baseline Sample Demographics* * Sample of 38 youth who had at least one RCL-14 placement day in 2007

  7. Outcome Baselines San Bernardino County RBS Demonstration

  8. Cost Baseline • Reflects costs over 2004 to 2007 for baseline sample • Average cost of $72,000 per yr per child San Bernardino County RBS Demonstration

  9. “Rachel” - A candidate for RBS (16.8 yrs old) • 2 abuse/neglect referrals • 12 GH placements in 9 GHs • 5 FFA placements in 3 FFAs • 2 psych hospitalizations • 12 AWOL incidents • 2 Wrap failures • 1 rape • 2 pregnancies, 2 miscarriages • Motivated to be with family • Maintains family contact • Searches for extended family • Stable out of state for 2 years • Engages in goal setting • Survival skills Jan Home under FM (Wrap) School and AWOL incident BM requests removal Back to GH #6 May AWOL from GH #6 FBM and GM return to DCS GH #7, AWOL GH #4, AWOL Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF Sep-Oct GH #8, pregnant AWOL (Las Vegas) Return by BM to temp. FFA AWOL x2, returns to GH #8 Oct-Dec AWOL in LA w/boy friend and GM 1995-98 - six unsubstantiated abuse/neglect referrals concerning younger sister 1996 – BM incarcerated 20 months; children w/GM 1999 – 1 referral concerning all 3 children Apr – Substantiated physical abuse by step parent; removal to FFA May-Dec 4 GH placements Dec Home under FM (Wrap) Respite GH #5 1st hospitalization GH #6 Jan-Jun Still AWOL, rape, miscarriage Jul-Oct FFA #3 AWOL (Back to GM) Oct-Dec 2nd hospitalization Conservatorship Dec-Present Placed out of state (RCL- 14) No activity San Bernardino County RBS Demonstration

  10. Designing a New System for Rachel Rachel San Bernardino County RBS Demonstration

  11. Proposed Funding Model • “Success First Wrap” MHSA • Funds Care Coordination Team across arc of enrollment for 12 slots • Approximately $3,000/mo/child • SB 163 Wrap takes over when MHSA ends • Rate for Facility Based Services - TBD San Bernardino County RBS Demonstration

  12. Potential Waiver Requests Still under consideration Waivers need to be provider driven San Bernardino County RBS Demonstration

  13. Current Status • One provider tentatively selected with both Wrap and residential beds • Funding streams identified and model under construction • High level System Design complete • Facility based service model under construction San Bernardino County RBS Demonstration

  14. Concerns/Issues/Requests for Help Models will evolve during implementation San Bernardino County RBS Demonstration

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