Mark LaneBay Area Consortium

RBS Local Implementation Coordinator

TransformingBay Area

Residential Services

Planning Process

5 Counties

x 3 Departments

= Chaos

Developing consensus(July 11 TA meeting)

How are we going to work together?

Lead County vs. Shared Coordination vs. Shared Purchase ….

Who decides?

What approach makes sense?

Mission: To work together to help the children and families in our target populations build and sustain whole lives.

Guiding PrinciplesService-based, rather than place-based

Families will be part of the team and the decision-making process

Locally provided continuity of care and services

Culturally competent and strength-based services

Minimal disruptions in connections for youth and families

Focus on safe, stable, permanent living environment

Services customized to meet the family’s unique situation

DEVELOPING THE MOU

Nature of the Relationship

Vision

Shared expectations

Roles and Responsibilities

ENGAGING THE PROVIDERSTHROUGH AN RFQ

Refining the Target Population

Restating the Guiding Principles

Outlining the Program Design

Defining the Criteria to Deliver Services

KEY INNOVATIONS forTRANSFORMING BAY AREA

RESIDENTIAL SERVICES

Provider InnovationsFlexible use of staff resources

Flexible use of facility-based interventions

Increased trend of community-based interventions

Ongoing and flexible decision-making

Balance between place-based and community-based activities

Funder Innovations

Building contracts with an assumption of trust and based on anticipated transactions throughout the duration of the project.

Family involvement as a key business practice.

Process-based contracting in which key actions are outlined, agreed-upon, and monitored.

County Worker Innovations

RBS is seen as an affirmative choice

Use of RBS should be a decision of first resort, rather than last resort

Next Steps

Issue the RFQ

Engage the qualified providers

Complete the funding model

Outline the Waiver Requests

Plan for Implementation

Target PopulationsTarget PopulationsBay Area ConsortiumBay Area Consortium

Residentially Based ServicesResidentially Based Services

Lois Rutten, Contra Costa County

Who Are These Youth?Who Are These Youth?

Phase 1 Phase 1 Target PopulationsTarget Populations

Family ReattachmentFamily Reattachment– Younger children who are in placement Younger children who are in placement

due to a combination of family due to a combination of family disruption, abuse and/or dangerous disruption, abuse and/or dangerous behaviors that can’t be managed in behaviors that can’t be managed in other settingsother settings

Pathways to PermanencyPathways to Permanency– Children and youth who are growing up Children and youth who are growing up

in placement and do not have a in placement and do not have a permanent planpermanent plan

Phase 2 Phase 2 Target PopulationsTarget Populations

Bridge to Success and SafetyBridge to Success and Safety– Youth with complex needs who are Youth with complex needs who are

mandated to out of home placement mandated to out of home placement in the juvenile justice system but are in the juvenile justice system but are currently in detentioncurrently in detention

Reconnecting and ReconstructingReconnecting and Reconstructing– Sexually exploited girls who are Sexually exploited girls who are

unable to stay in placement using unable to stay in placement using current approachescurrent approaches

How Many Youth?How Many Youth?

All youth/children in this pilot must All youth/children in this pilot must be:be:– A dependent or ward of the court A dependent or ward of the court

described in section 300 or 602 of the described in section 300 or 602 of the Welfare & Institutions Code and/or,Welfare & Institutions Code and/or,

– Receiving services under AB 3632Receiving services under AB 3632

Family Reattachment – 100Family Reattachment – 100 Pathways to Permanence – 600Pathways to Permanence – 600

Criteria for Determining Criteria for Determining Target PopulationTarget Population

Statistical case Statistical case review – review – CWS/CMSCWS/CMS

Individual case Individual case review – look for review – look for common common characteristicscharacteristics

Optimal volume to Optimal volume to sustain population?sustain population?

Is there an existing Is there an existing cross-system cross-system partnership?partnership?

Can a program be Can a program be regionally regionally implemented?implemented?

Common CharacteristicsCommon Characteristics

Age and GenderAge and Gender– Male Male – 12-16 years old12-16 years old

EthnicityEthnicity– African AmericanAfrican American

Average length of placement in group careAverage length of placement in group care– More than 2 yearsMore than 2 years

Average number of placementsAverage number of placements– 5-75-7– Out of countyOut of county

Minimal family and community connectionsMinimal family and community connections Multiple psychotropic medicationsMultiple psychotropic medications Multiple assessments/evaluations for Multiple assessments/evaluations for

treatmenttreatment– Diagnosis?Diagnosis?

Next StepsNext Steps

RFQ responseRFQ response Intake & referral processIntake & referral process Project entry/exit/capacityProject entry/exit/capacity TrainingTraining

– ProvidersProviders– StaffStaff– CommunityCommunity

Measure resultsMeasure results

Residentially Based Services Proposed Funding Streams

BAY AREA CONSORTIUM

Presented by: Liz Crudo, San Fransisco County and Ellen Bucci, San Mateo

County

Objective

• To provide an overview of potential funding streams;

• Discuss potential funding model;

• Next steps.

Current funding sources

• Residential stay AFDC-FC Medi-cal / EPSDT

• Community stayAB 163 Wraparound FundingMedi-cal / EPSDT

Potential Funding Streams

• EPSDT

– Case mgmt

– Medication support

– Therapy

• SB 163 Wraparound

• AFDC Residential Rate

– Monthly bed rate board and care

– In house stabilization

Potential Funding Streams (con’t)

• Other Wrap Dollars

– New or unused slots

– Wrap Savings

• Mental Health Services Act (MHSA)

• PSSF / CAPIT / STOP / TANF/Family Preservation/TCM/CALWORKS

• County General Fund

New Funding Model Assumptions

No new moneys;

Impact of State budget;

Providers will need to be Medi-cal certified for billing and leverage purposes;

Will require waivers and utilization of multiple funding streams;

New Funding Model Assumptions (con’t)

Need to build service model first, then funding structure (What do we want to achieve, rather than how much money do we have?);

Providers need to be WRAP eligible; and

Counties will need to apply for additional WRAP slots.

Counties would each need to contract with the provider for Medi-cal

New Funding Model Questions to be answered

• Service Model needs to be discussed and explored with Providers (Providers have knowledge re:making funding work);

• Need cost information from Providers; – Cost per individual youth will vary greatly?– Price Point? (average fair price)– Existing staff to be utilized or new staff?– How will youth without Medi-Cal be served?

Next Steps

• Complete RFQ;

• Hold discussions with providers;

• Create funding model.