Community Planning Tool: Multisystemic Therapy

During the program selection and planning process it is important to research and compare available evidence-based programs to ensure that the selected program is the best fit for your community and existing resources. This tool is designed to help your community plan for Multisystemic Therapy (MST) implementation with a commitment to quality and long-term sustainability.

The readiness and planning process involves five general steps. Steps 1 and 2 are addressed in the Community Readiness Tool, and it is strongly recommended that communities work through that tool before proceeding with the Community Planning Tool which focuses on Steps 3 through 5.

STEP 1: Program selection: Is MST a good fit for your community?

STEP 2: Assess the investment of key stakeholders

STEP 3: Plan for sustainability

STEP 4:Prepare for implementation

STEP 5: Develop a plan to assess program impact

On page 7 of this document you will find a checklist for Important Dates & Documentation. In addition, a larger collection of Evidence-based Intervention Program Readiness and Planning Tools, developed to help communities select programs that fit local needs and plan for sustainable implementation, can be found at http://www.episcenter.psu.edu/counties-EBIs

The EPISCenter, MST Services and its Network Partners, and the OMHSAS Children’s Bureau are available to work with your community throughout the program selection, planning, and implementation process, including answering questions, reviewing plans, and participating in planning meetings. Contact information is provided on the last page of this document.

MST Services has developed a six-stage Program Development MethodTM (PDM) to assist providers. The Community Planning Tool outlines steps that are important for Pennsylvania communities, while also indicating where these steps align with the stages of the MST Program Development MethodTM.

The Community Planning Tool should only be used after community need and readiness have been established.

(The EPISCenter represents a collaborative partnership between the Pennsylvania Commission on Crime and Delinquency (PCCD), and the Bennett Pierce Prevention Research Center, College of Health and Human Development, Penn State University. The EPISCenter is funded by PCCD and the PA Department of Human Services. This resource was developed by the EPISCenter through PCCD grant VP-ST-24368.)

(STEP 3) Plan for Sustainability)

· If there will be an RFP, consider having it reviewed by MST Services, the EPISCenter, and DPW for consistency with the MST model and state policies around MST.

· Identify a provider for the service. The provider agency should meet the following criteria:

· Agency has strong relationships and good reputation with local stakeholders

· Agency leadership is invested in evidence-based programming.

· Agency is financially sound and is able to support the ramp-up of services.

· Agency is successful with hiring and retaining Masters-level clinicians.

· Agency has experience with M.A. funded services and is in good standing with OMHSAS.

· Agency is invested in the use of data to demonstrate outcomes, and agrees to utilize the MST Enhanced Website and the INSPIRE system for data reporting.

· The agency commits to MST’s required and recommended program practices and characteristics. (This is evaluated during Stage B of the MST Program Development Method TM, Program Feasibility Assessment.)

· Vision and mission statements are collaboratively developed by the team, including key stakeholders and provider. This ensures that team members are working with shared expectations and goals.

Vision Statement: The vision statement should answer the questions “What do we hope to accomplish by implementing MST in our community? What is our long-term goal?” It will be used to guide decision-making and select performance measures.

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Mission Statement: The mission statement is more specific regarding what the MST program is expected to do and should include the purpose of the program and how, specifically, it will contribute to the group’s vision.

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· The MST Critical Issues Session occurs. This includes finalizing eligibility criteria for the target population and establishing a referral process. (Stage C of the MST Program Development MethodTM)

· Community stakeholders develop a plan for encouraging referrals to the program.

This differs from the referral process developed with the provider and speaks to how the investment of county leadership will be translated into referrals from line staff, which is a common barrier to program success. Unlike many traditional services, an MST team will not be sustained if referrals are low. The plan may include strategies such as:

· Require all line staff to attend quarterly or semiannual presentations about MST

· Require provider agency to regularly share outcomes data with referral sources

· Establish a process for regular check-ins by supervisors to ensure referrals are being made to the program

· Identify a county-level coordinator who can be responsible for identifying cases appropriate for referral to MST

· Establish weekly meetings where county cases are discussed and assigned to the most appropriate service

· Ineffective strategies include one-time education about the new service – this is generally not sufficient to change referral patterns.

Our plan: _________________________________________________________________________

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· Develop a plan for ensuring the majority of referred youth can begin services immediately. One of the recommended options should be chosen and agreed upon by the stakeholder team:

· Option 1: BH-MCO will provide an initial authorization (4-6 weeks) based on a pre-assessment completed by the program and require the full M.A. packet be submitted before the authorization period is extended.

· Option 2: County funds will be used to pay for services until the youth is authorized by M.A.

Provider develops a budget and, partnering with the BH-MCO and county leaders, identifies funding for each aspect of the budget.The Collaborative Funding Plan, available on the EPISCenter website at http://www.episcenter.psu.edu/counties-EBIs , is recommended as a guide.

· Additional resources: Cost Questionnaire and Salary Guidelines, available from MST Services, and the Program Costs section of the MST Implementation Manual , available at http://www.episcenter.psu.edu/guide

· Budget should allow for a profit margin to buffer provider against unexpected expenses and financial challenges.

· Budget takes into consideration that in Pennsylvania MST providers are expected to hire primarily Masters-level MST therapists, and allows for sufficient support staff so that therapists can focus on clinical service delivery.

· Review the 2011 letter clarifying how county funds may be used for EBPs: http://www.episcenter.psu.edu/sites/default/files/Special%20Grants%20Letter%20Jan%202011.pdf

· County submits a request for adequate county funding as part of Needs Based Budget & Plan.

· A schedule is established for regular planning and implementation meetings involving the provider and key stakeholders.

(STEP 4) Prepare for Implementation)

· Provider’s initial responsibilities:

· Submit service description to OMHSAS Children’s Bureau for review and approval. An MST service description template is available from the Children’s Bureau upon request. Note that MST is a BHRS program exception service and as such falls under Medical Assistance Bulletin 1153-95-01, a copy of which can be found at: http://services.dpw.state.pa.us/olddpw/bulletinsearch.aspx?BulletinId=2019

· Enroll in PROMISe as a Provider Type 340.

· Complete BH-MCO process for becoming an enrolled MST provider.

· Establish Service Agreements with other agencies and providers, to facilitate smooth referrals of youth when necessary.

· Provider reviews OMHSAS expectations regarding compliance with M.A. requirements and documentation. These include but are not limited to:

· OMHSAS Site Audit Tool (available upon request from OMHSAS Children’s Bureau)

· See #15 in the FAQ about MA Enrollment, Billing, & Monitoring, available at http://www.episcenter.psu.edu/resources/DPW

· MST & D&A: Questions and Answers, available at http://www.episcenter.psu.edu/ebp/multisystemic

· MST Paperwork Training and MST Paperwork Samples, available at http://www.episcenter.psu.edu/ebp/multisystemic

· Sample ISPT Invitation and Feedback Form, available at http://www.episcenter.psu.edu/resources/DPW

· A managed care rate is set.

· The rate is consistent with the model requirement that each therapist carry 4-6 cases.

· The budget allows for administrative support to handle case management responsibilities such as helping youth become M.A. eligible, obtaining authorizations for care, scheduling evaluations and Interagency Service Planning Team (ISPT) meetings, and so forth. It is not only more cost-effective to identify support staff to assist with these tasks, but it also allows clinical staff to focus their time and energy on providing care to clients and their families.

· Billable activities are clearly agreed upon and put in writing. See the Collaborative Funding Plan for guidance.

· A county-provider contract is established, outlining the amount of funding available, how county funds will be used for MST (i.e., allowable costs), which youth are eligible, how funds can be accessed, and billing/payment structure. The 2011 letter clarifying how county funds may be used for evidence-based programming should be used for guidance: http://www.episcenter.psu.edu/sites/default/files/Special%20Grants%20Letter%20Jan%202011.pdf

· One or both of the following occur. These steps will reduce the amount of time that the county is responsible for paying for services.

· County leadership engages County Assistance Office regarding a process to expedite M.A. eligibility packets for youth referred to MST.

· Provider and BH-MCO work together to establish a protocol for accessing retro-eligibility. This allows providers to bill M.A. for services from the date the MA packet is submitted to the CAO, rather than waiting until the date it is approved.

· An on-site MST Site Readiness Review Meeting is held with MST Services. (Stage D of MST Program Development MethodTM)

· Staff Recruitment Assistance and Orientation Training occurs, with assistance from the MST Expert. (Stage E of the MST Program Development MethodTM)

· Provider recruits, interviews, and hires therapists, support staff, and other critical program personnel. The provider should utilize the Therapist and Supervisor Recruitment Toolkits developed by MST Services. Hiring staff that are a good fit for the model will benefit the program in a number of ways.

· Staff completes the 5-day MST Orientation.

· Provider contacts EPISCenter to get set up in INSPIRE. (See Assessing Program Impact for more information.)

(STEP 5) Develop a Plan to Assess Program Impact)

· County stakeholders and BH-MCO review the INSPIRE Data Highlights Report (available at http://www.episcenter.psu.edu/EBIReports) and determine what additional performance measures, if any, they would like reported by the provider. These measures should be directly related to the program vision established by the team.

Additional Data Requested:

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Note: Stakeholders are strongly encouraged to use the INSPIRE report and keep additional data requests to a minimum. INSPIRE facilitates reliable and standardized outcome reporting by MST providers across the state. Additional reporting requirements increase the administrative burden and associated expense for providers.

· Frequency and format of reporting to local stakeholders is determined: ____________________________

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· MST Director from provider agency reviews the INSPIRE FAQ and the INSPIRE Quarterly Reporting Protocol. Available at: http://www.episcenter.psu.edu/node/181

· Provider contacts The Penn State EPISCenter to initiate participation in INSPIRE.

· Provider returns necessary forms to EPISCenter: 1) authorization for access to MST Enhanced Website data, and 2) data sharing agreement.

· Provider identifies who will responsible for data entry and submitting quarterly reports, and submits this information to EPISCenter to have user accounts created.

· Provider reviews INSPIRE materials on-line and downloads copies of the User Screen Guides, available at: http://www.episcenter.psu.edu/node/181

· INSPIRE users participate in INSPIRE training at: http://www.episcenter.psu.edu/inspire/mst-training

(Important Dates & Documentation)

Important Planning Dates

· The earliest that BH-MCO funding for MST will be available: _____/_____/_____

· The earliest that county funding for MST will be available: _____/_____/_____

· MST Critical Issues Session: _____/_____/_____

· MST Site Readiness Review Meeting: _____/_____/_____

· Dates for 5-Day MST Orientation: _____/_____/_____ -_____/_____/_____

Documentation

· Service description approval from OMHSAS

· Provider Service Agreement with other programs

· Provider contract with MST Services and/or Network Partner.

· County-provider contract

· Funding plan

(Who to Contact For More Information)

(MST Services, Inc.Melanie Duncan, Ph.D.Project Manager(843) 856-8226melanie.duncan@mstservices.com ) (EPISCenterLiz Campbell, Ph.D.Intervention Programs Coordinator(717) 508-4778ecampbell@episcenter.org )

(OMHSAS Children’s BureauEbonnie Simmons-Hall, MSWProgram Representative(717) 772-6870esimmonsha@pa.gov )

7For more information, visit www.episcenter.psu.edu or call (814) 863-2568