San Bernardino CountyRBS Demonstration

RBS ForumSacramento, CA

September 4/5, 2008

Overall ApproachTransform 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

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County, Provider, and Community PartnershipCounty, Provider, and Community Partnership

Mission, Vision, ValuesMission

Working together to safely build and sustain positive, successful family connections and children’s futures.

VisionThe 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.

ValuesStability, permanency and safety focus

FlexibilityIntegration across systems

Continuous planning and evaluation across the arc of enrollmentContinuity of care

Partnership and engagement

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Family Driven - Youth GuidedFamily Driven - Youth Guided

Cornerstone Innovations• Family Passport

• Care Coordination Team

• Wrap approach throughout trajectory of care

• ITFC-like foster care consistent with RBS

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A Continuum of Care with No HandoffsA Continuum of Care with No Handoffs

Primary Outcome Focus

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1. Reduced Length of Stay

1. Reduced level of care including out of state

2. Reduced Hospitalizations

3. Reduced AWOL incidents

4. Improved Permanency

a. Stable placementb. Increased pro-social behaviorc. Life long connections

Stakeholder-DrivenStakeholder-Driven

Baseline Sample Demographics*

Frequency %

Male 15 39%

Female 23 61%

Black 11 29%

Latino 6 16%

Native American 1 3%

White 20 53%

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

Outcome Baselines

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PERMANENCY BL

Avg. current GH stay 7.7 mos

2 in foster home, LOS 0.9 mos

1 at home, length of stay 3.8 mos

Avg. Time in Foster Care 6.2 yrs

Avg. # of prior placements 3.0

Reentry in to foster care tbd

Exits to permanency tbd

#of supportive connections tbd

WELL BEING: BL

Avg. time in GH care 24.5 mos

Avg. # days AWOL 24.8 days

Avg. # of AWOL episodes 3.2

Avg. # days in hospital 40.8

Cost Baseline

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COST BL

Total cost of FC (sample) $7.5M

GH Cost $5.6M

Out of state costs $1.6M

Non Tx foster home costs $30K

FFA costs $206K

Other small family homes $90K

Hospitalization cost $760K

Total 3-yr cost $8.2M

•Reflects costs over 2004 to 2007 for baseline sample•Average cost of $72,000 per yr per child

“Rachel” - A candidate for RBS (16.8 yrs old)

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1995 - 1999 2000 - 2003 2004 2005 2006

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

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

No activity

No activity

Apr – Substantiated physical abuse by step parent; removal to FFA

May-Dec 4 GH placements

Dec Home under FM

(Wrap)RespiteGH #51st hospitalizationGH #6

Apr – Substantiated physical abuse by step parent; removal to FFA

May-Dec 4 GH placements

Dec Home under FM

(Wrap)RespiteGH #51st hospitalizationGH #6

Jan Home under FM (Wrap)School and AWOL incidentBM requests removalBack to GH #6

May AWOL from GH #6FBM and GM return to DCSGH #7, AWOLGH #4, AWOL

Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF

Sep-Oct GH #8, pregnantAWOL (Las Vegas)Return by BM to temp. FFAAWOL x2, returns to GH #8

Oct-Dec AWOL in LA w/boy friend and GM

Jan Home under FM (Wrap)School and AWOL incidentBM requests removalBack to GH #6

May AWOL from GH #6FBM and GM return to DCSGH #7, AWOLGH #4, AWOL

Jun-Sep AWOL from GH #4, AWOL from 2 FFA Placements, ends up w/ BF

Sep-Oct GH #8, pregnantAWOL (Las Vegas)Return by BM to temp. FFAAWOL x2, returns to GH #8

Oct-Dec AWOL in LA w/boy friend and GM

Jan-JunStill AWOL, rape, miscarriage

Jul-OctFFA #3AWOL (Back to GM)

Oct-Dec 2nd hospitalizationConservatorship

Dec-PresentPlaced out of state (RCL- 14)

Jan-JunStill AWOL, rape, miscarriage

Jul-OctFFA #3AWOL (Back to GM)

Oct-Dec 2nd hospitalizationConservatorship

Dec-PresentPlaced out of state (RCL- 14)

• 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

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Designing a New System for Rachel

Rachel

Rachel

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

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Potential Waiver Requests

Still under considerationWaivers need to be provider driven

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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

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Concerns/Issues/Requests for Help

Models will evolve during implementation

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