5/15/2013. May 22, :00 am - 3:00 pm Redding, CA HOUSEKEEPING DEBORAH LOWERY REGIONAL HOST COMMENTS MAXINE WAYDA

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1 May 22, :00 am - 3:00 pm Redding, CA HOUSEKEEPING DEBORAH LOWERY 2 REGIONAL HOST COMMENTS MAXINE WAYDA 3 1

2 Overview & Purpose Regional Orientation Meetings Objectives Inclusion of the Family Voice Review the Information and Guidance Set Forth in the CPM & Medi-Cal Manual Dialogue on Training and Support Review FAQs and Responses Obtain and Provide Feedback on Technical Assistance, Local Implementation Needs, and Future Meetings 4 Abbreviations CDSS CPM CFT DHCS ICC IHBS TBS TCM California Department of Social Services Core Practice Model Child and Family Team Department of Health Care Services Intensive Care Coordination Intensive Home Based Services Therapeutic Behavioral Services Therapeutic Case Management 5 Katie A. et al v. Bonta Settlement In July 2002, a class action lawsuit was filed to obtain Wraparound and Therapeutic Foster Care services for children in or at risk of placement in foster care or group homes. In December 2011, the final settlement was approved. The Core Practice Model (CPM) Guide and the Medi-Cal Manual were developed as a part of the Settlement Agreement. 6 2

3 Who is Katie A? A 14 year old girl at the time lawsuit was filed. Placed in foster care for 10 years. Moved through 37 different placements. Early assessment indicated services needed, but did not receive trauma treatment or individualized mental health services. 7 Katie A. Settlement Agreement Supporting The facilitation of an array services that are delivered in a coordinated, comprehensive, and community-based fashion The development and delivery of a service that are guided by the values and principles of the Core Practice Model. Establishing effective and sustainable standards and methods to achieve quality-based oversight along with training and education that support the practice and fiscal models. 8 Katie A Settlement Agreement Addressing the need for subclass members to receive medically necessary mental health services: in their own home a family setting the most homelike setting appropriate to their needs To facilitate reunification and to meet their needs for safety, permanence, and well-being. 9 3

4 Why Not Wraparound? Focus of lawsuit was on Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services for EPSDT are more targeted and must be aligned with medical necessity Wraparound is a larger process that includes both activities and services that may or may not meet medical necessity 10 Negotiation Process 11 Therapeutic Foster Care State Update State Plan Amendment Update to the Medi Cal Manual 12 4

5 Katie A. Class and Subclass Members Who are the members of the Class and Subclass? What guidance is provided on member eligibility consideration? 13 Class Members (Appendix D, Page 51 of CPM) Children at risk of placement in foster care Children w/ a mental health condition Children in need of individualized mental health services 14 Subclass Members (Chapter 2, Page 3, Medi-Cal Manual) Full-scope Medi-Cal (Title XIX) eligible Have an open child welfare services case AND Meet the medical necessity criteria for Specialty Mental Health Services (SMHS) as set forth in CCR Title 9 Section or Section (Medi-Cal Manual, Glossary, Appendix A) 15 5

Subclass Eligibility (Chapter 3, Page 2, Medi-Cal Manual) In addition to the above criteria, the child and youth are currently in or being considered for other services such as.

6 Subclass Eligibility (Chapter 3, Page 2, Medi-Cal Manual) In addition to the above criteria, the child and youth are currently in or being considered for other services such as.. Wraparound, Therapeutic Foster Care, Specialized care rates due to behavioral health needs or other intensive EPSDT services OR Group home placement (RCL 10 or above), psychiatric hospital or 24-hour mental health treatment facility or experienced 3 or more placements within 24 months 16 Open Child Welfare Case Defined A child with an open child welfare is defined as any of the following: a) Child is in foster care b) Child has a family maintenance case (pre or post, returning home, in foster or relative placement), including both court ordered and by voluntary agreement It does not include cases in which emergency response referral are only made. (CPM Guide Appendix C, pg 49 and Medi Cal Manual Appendix A, pg 17) 17 Status of Child Welfare Case 18 6

7 Status of Child Welfare Case Open Child Welfare Case Intensive Care Coordination Intensive Home Based Services Closed Child Welfare Case Specialty Mental health Services Targeted Case Management 19 Relationship of Services CPM IHBS ICC Subclass Katie A Class 20 Serving the Class and Subclass Class Subclass Core Practice Model Approach and Activities Core Practice Model Approach and Activities Intensive Care Coordination Intensive Home Based Services 21 7

8 Values and Principles Children protected from abuse and neglect Services are needs driven & strengths based Services are individualized for each child and family Services are delivered through a multi-agency approach Parent/Family voice and choice Services are a blend of formal & informal resources Services are culturally respectful of the child and family Services are provided in family s community Children have permanency & stability 22 Family Voice 23 Core Practice Model Guide The Core Practice Model Guide (CPM) describes a significant shift in the way that systems and individual service providers are expected to address the mental health needs of children/youth and families in the child welfare system. CPM should be a guide for implementation of the expectations of practice, the required elements for fidelity practice to the model and approaches to implementation. 24 8

9 CPM Guide Overview of Child Welfare and Mental Health Values and Principles Teaming Trauma Informed Practice Practice Components Implementation Appendices 25 CPM Guide Values and Principles Trauma Informed Practice Integration within the guide 26 Child and Family Team The Child and Family Team (CFT )is a team that shares a vision with the family and is working to advance that vision while a team meeting is how the members communicate. No single individual, agency, or service provider works independently. Working as part of team involves a different way of decision making. 27 9

10 Child and Family Team Child/Youth, Family and Extended Family Informal Supports Formal Supports Friends Coaches Faith Based Connections Educational Professionals Mental Health Child Welfare Probation Officers Representatives from other agencies providing services to child/youth and family Regional Center Case Managers Substance Use Disorder Specialists Health Care Professionals 28 CPM Values and Principles Service Delivery Components Engagement Transition Child, Youth, and Family Screening (CWS) Assessment (MH) Monitoring and Adapting Service Planning and Implementation 29 Screening & Assessment Child Welfare Service assessment activities include screening for mental health needs Child welfare is responsible for seeing that a MH screening tool is completed for all children in open cases at intake and at least annually Mental Health assessment is more formal and completed by a MH professional MH worker communicates the results of the assessment to the child and family and reviews what part of the assessment, if any, must be shared w/cw and what parts the family wants to share

11 Elements of a Successful Team A process of a group of people coming together who are committed to a common purpose Mutual respect between team members and recognizing their value to the team Meeting schedules and locations are guided by the family s needs and preferences Membership must include child and family, CWS and MH and others identified by the family 31 CPM Appendices California Child Welfare System Appendix A Practice Standards and Activities Matrix Appendix B Glossary of Acronyms and Terms Appendix C Katie A. Settlement Background Appendix D 32 LUNCH 33 11

12 Family Voice Child and Family Team 34 Medi-Cal Manual (Chapter 5, pg. 7) Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS) 35 ICC and IHBS Community, family, and youth involvement are essential ICC and IHBS are guided by the CPM All new Subclass members must receive ICC services The CFT is the Essential element to implementation Provider requirements for ICC and IHBS are included in Appendix G of the Medi-Cal Manual 36 12

13 Medi-Cal Manual Highlights ICC and IHBS ICC Service Components and Activities ICC Coordinator ICC Service Setting, Activities, and Components Claiming Multiple Staff IHBS Services, Descriptions and Goals Claiming and Reimbursement Appendices Service Reference Charts Sample of Progress Notes Medical Necessity Criteria Provider Qualifications* Non-reimbursable Activities Appendix D Appendix E Appendix F Appendix G Appendix H 37 ICC: Service Components and Activities Services and supports are guided by the needs of the youth Involve a facilitated and collaborative relationship among youth, family, and involved child-serving systems Support the parent or caregiver in meeting youth s needs Must be delivered using a CFT to develop and guide the planning and service delivery process. Similar to the activities routinely provided as Targeted Case Management (TCM) Involve comprehensive assessment and periodic reassessment Involve periodic revision of planning Referral monitoring and follow-up 38 ICC Coordinator Must be mental health provider/practitioner Responsible for working within the CFT Ensures plans are integrated to comprehensively address the identified goals and objectives Ensures service activities are coordinated to support and ensure successful and enduring change Is a bridge between program outcomes, CFT, and plan development process. ICC Coordinator helps to ensure the integrated experience of children and families

14 ICC Coordinator vs. CFT Facilitator ICC Coordinator must be mental health provider ICC Coordinator is a member of the CFT CFT Facilitator can be any member of CFT CFT Facilitator can be a Youth, Family Member 40 ICC Service Settings Home (biological, foster or adoptive) Community Settings For the purposes of coordinating placement on discharge 30 days or less Psychiatric Facilities Group Home Hospital Settings 41 ICC: Service Components Assessing Transition ICC Service Planning Implementation Monitoring and Adapting 42 14

15 Assessing Example 2, John, Page 9 John s parents talked about the different circumstances that were going on when he became so anxious he could not handle remaining in the location, including someone touching him or lots of noise and activity from the younger children in the house. The ICC Coordinator and Parent Partner assisted John s Parents and John to identify what circumstances were going on when he seemed calmer and more in control: morning seems better than later in the day; fewer people seem better; talking is better than touching when giving feedback. 43 Assessing Assessing client and family s needs and strengths Assessing the adequacy and availability of resources Reviewing information from family and other sources Evaluating effectiveness of previous interventions and activities Assessing Example 1: John, pg Service Planning and Implementation Developing a plan with specific goals, activities, and objectives Ensuring the active participation of client and individuals, and clarifying the roles and the individuals involved Identifying the interventions/course of action targeted at the client and family s assessed needs Service Planning & Implementation Example 1: John, pg

16 Monitoring and Adapting Monitoring to ensure that identified services and activities are progressing appropriately Changing and redirecting actions targeted at the client s and family s assessed needs, not less than every 90 days Monitoring and Adapting Example 1: Susie, pg Transition Developing a transition plan for the client and family s longterm stability including the effective use of natural supports and community resources. Transition Example 1: Susie, pg ICC: Claiming Multiple Staff pg. 12 Each staff may claim ICC for the CFT meeting clearly linked to the mental health client plan goals and/or the information gleaned during the meeting that contributed to the formulation of the mental health client plan or revisions Medi-Cal reimbursement must be based on Staff time (e,g. a single staff member who participates in the CFT meeting cannot claim for more time than the length of the meeting plus any documentation and travel time) Progress notes must include evidence of incorporation of CPM elements described in the CPM guide

17 Intensive Home Based Services Activities Supporting Educating Improving 49 Intensive Home Based Services (IHBS) Delivered through an individualized treatment plan Care planning team develops goals and objectives for all life domains: Family life, community life, education, vocation, and independent living Subclass who are receiving IHBS are eligible for medically necessary specialty services mental health modes of service, consistent with identified needs meeting medical necessity criteria Specific goals and objectives are developed 50 IHBS Descriptions Individualized Strength-based interventions Designed to ameliorate mental health conditions that interfere with a child functioning Interventions aim at building skills for youth to successfully function in the home and community, Interventions aim at improving the families ability to assist youth in building and maintaining skills to function in the home and community 51 17

18 IHBS Goals Community participation Independent functioning Building social, communication, behavioral, and basic living skills Child is engaged in community activities in order to work towards the completion of identified goals and objectives in a natural setting 52 ICC and IHBS Claiming & Reimbursement Claiming: Appendix F California Code of Regulations (CCR) Title 9, Division 1 Chapter 11 Procedure code T1017 HK Medical Necessity Criteria Reimbursement ICC same rate as Targeted Case Management Services IHBS same rate as Specialty Mental health Services 53 Information on Claiming and Reimbursement For cost report and provider certification purposes, ICC will be identified using Mode of Service 15 and Service Function Code 07, and IHBS will be identified using Mode of Service 15, Service Function Code 57. The following table lists this mode and procedure mapping: Service Mode of Service Service Code Procedure Code Procedure Modifier Intensive Care Coordination (ICC) T1017 HK Intensive Home Based Services (IHBS) H2015 HK 54 18

19 Claiming and Reimbursement In order to identify all specialty mental health services provided to subclass members, MHPs shall identify all claims for services provided to clients identified as subclass members by supplying the Loop 2300 REF- Demonstration Project Identifier (DPI) segment with the value KTA as the Demonstration Project Identifier (data element REF02). At this time, use of the DPI is not a requirement to claim for FFP reimbursement, however, MHP s are strongly encouraged to submit this indicator as soon as possible so that all services to subclass members may be reported. 55 Training and Support 56 CPM Training Support A multi-disciplinary subcommittee of the Statewide Training and Education Committee (STEC) convened to make recommendations for training and staff development. Curricula resources that may be relevant have been collected and analyzed to inform curricula development and training. Recommendations for staging curricula development, training and support have been approved by STEC and submitted to CDSS for review

20 CPM Training Support Will use an Implementation Framework to spread, sustain and train the Core Practice Model across all levels of the child welfare and mental health workforces.[see CPM Guide Chap 3] Will use a Learning Collaborative process as one of several methods to inform the implementation curriculum, which is initially aimed leadership and management. Learning Collaborative will be comprised of interested counties from all CA regions, selected by CDSS & DHCS in consultation with CMHDA & CWDA. 58 CPM Training Support The Learning Collaborative counties will provide feedback for the development of statewide, multidisciplinary training and coaching materials for supervisory and line-worker staff. Multi-disciplinary training and coaching materials will be incorporated into revisions currently being made to CWS Common Core Curricula, and Title IV-E pre-service educational curricula and shared with training entities for mental health The contributions from the Learning Collaborative will serve as a basis to inform planning for broader training across all California counties. 59 Available Assistance from the Regional Training Academies (RTAs) Assistance with completing the Readiness Assessments. Participation and assistance with implementation teams and work groups. Support of Learning Collaborative activities. Assistance with development and provision of countyspecific training and staff development activities

21 Next Steps 61 State/local Accountability, Communication and Oversight (ACO) Taskforce: FYI The Agreement requires DHCS and MHPs to conduct specific activities related to data, accountability, quality assurance and oversight, including the establishment of a joint State/local Accountability, Communication and Oversight (ACO) Taskforce. MHPs may participate in or provide input to the ACO Task Force that will be forming to address these issues. The Agreement also requires a statewide data-informed system of accountability, communication and oversight 62 State/local Accountability, Communication and Oversight (ACO) Taskforce :FYI Improves data exchange and matching among California Department of Social Services (CDSS), DHCS, MHPs and county child welfare services (CWS) agencies; Uses existing data collection and baseline and performance benchmarks to the greatest extent feasible Determines what will be measured to evaluate progress in implementing and providing access to ICC and IHBS Establishes a method to track the use of ICC and IHBS Develops requirements and a general plan for the collection of data and information about children in the class (beginning with sub-class and extending to entire class at a future date) who receive mental health services to evaluate utilization patterns including types, frequency, and intensity of services, and timely access to care. First meeting June 1,

22 Joint Management Structure 64 Technical Assistance Weekly Technical Assistance Conference Calls on Information and Needs Related to Implementation Initiating STEC Learning Collaboratives to Ensure the Exchange of Successful Implementation Practice Approaches and Identify TA & Training Needs Focused TA on Finance Related to Implementation and Sustainability Regional and Local Technical Assistance and Information Exchange On going FAQs and Responses 65 Announcements Future Regional Trainings: May 29, Pasadena May 30, Anaheim June 5, Riverside Additional Training Venues: Institute (Formerly Wraparound Institute), June 2014 Resource Center for Family Focused Practice Website 66 22

23 Readiness Assessment and Service Delivery Plan to DHCS by on later than May 15, 2013 Technical Assistance is available 67 Questions and Feedback 68 Frequently Asked Questions & Responses Question #1: If a Subclass member no longer has an open child welfare case and, subsequently, does not meet subclass eligibility criteria, is the child/youth still eligible to receive ICC and/or IHBS? Question #2: If a child/youth is receiving ICC and IHBS and it is determined that ICC is too intensive for the child/youth s needs, can the treatment plan be modified to include TCM in place of ICC? Question #3: Are there new documentation requirements for ICC and IHBS? Question #4: Can a subclass member receive IHBS and Therapeutic Behavioral Services (TBS) at the same time? 69 23

24 Lessons Learned from Orientations Comparison tables will be created: ICC/Wraparound/Targeted Case Management IHBS/Wraparound/Therapeutic Behavioral Services FAQs 70 Acknowledgements Parent Partners, Youth, and Families Members of the Core Practice Model and Medi-Cal Manual Subgroups Regional Training Academies Counties, Providers, and the Resource Center for Family- Focused Practice California Mental Health Directors Association California Welfare Directors Association 71 California Department of Health Care Services California Department of Social Services Contact Information California Department of Health Care Services Website: dhcs.ca.govkatieaimplementation California Department of Social Services Website: Thank you! 72 24

Katie A. / Pathways to Mental Health Services Operational Manual. December countyofsb.org/behavioral-wellness

Katie A. / Pathways to Mental Health Services Operational Manual December 2016 countyofsb.org/behavioral-wellness 1 Contents Introduction/Departmental Policy 2 Identification, Screening and Referral 3