Oversight Agency Transformation: Best Practices and Positive Outcomes Julie Collins VP Practice Excellence, Child Welfare League of America (DC) (BBI Consultant) Sherri Hammack Coordinator, Building Bridges Initiative (TX) Mark Nickell Regional Executive Director, Seneca Family of Agencies (CA) (BBI Consultant) Laura Tate Youth Advisory Board Intern, Seneca Family of Agencies (CA) (BBI Consultant)
2 OBJECTIVES Increase your understanding and knowledge-base about oversight agency and systems of care strategies used in several different states across the country that have taken steps towards residential transformation in the areas of: Improving language and practice expectations in all oversight agency documents (e.g., policies; regulations) across all state agencies that interface with out-of-home care Creating partnerships across state agencies, i.e. to improve focus on permanency Fiscal strategies Workforce development issues Integrating residential within systems of care communities
REFLECTIONS: LAURA TATE, YOUTH ADVOCATE WHAT ARE YOUTH PRIORITITES FOR OVERSIGHT AGENCIES TO FOCUS ON?
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Strategies that Work Ensure Strong Leadership to Lead Transformation Effort Adopt a Reframe of Residential Services Residential is an intervention and not a destination Identify General System Enhancements Needed to Support Shift Examine/identify what can be done without any new money with new money 6
Strategies that Work Research, Review, & Analyze Data to Determine the Needs & Direction Get Expert Help Find Out What Others are Doing Work With Other Child Serving Systems/Agencies Create an Advisory Council of Key Stakeholders Obtain Key Stakeholders Input 7
Strategies that Work Build on Prior/Other Efforts Embed New Expectations in such areas as regulations, licensing requirements, policies and procedures Embed BBI/SOC Principles Training/Preparing of State/County Staff, Community Stakeholders Including Youth and Families, and Providers for the New Conceptual Framework/Redesign
Strategies that Work Start Somewhere! Act on at Least One or Two of the Best Practices and track the outcomes and learn from the results 9
State/County/City Specific Actions Engage with Other Child and Family Serving Departments to Create Foundations of Trust and Find Workable Solutions for Children, Adolescents, and Families Served by More Than One System Commit to a Collaborative Effort with the Providers Prepare State/County Staff, Community Stakeholders Including Youth and Families, and Providers for the New Conceptual Framework/Expectations 10
State/County/City Specific Actions Give Providers a Period of Time to Make the Changes/Improvements Use Data Develop Baseline and Provide TA Collaborate with the Providers to Create the Approach/Get Buy-In 11
Common Funding Approaches 12
State/County/City/Managing Entity Payment Methodologies Realignment of Existing Funds Different payment approaches Performance Based Contracting Contracting for Results/Outcomes which can Include Incentives or Penalties Value Based Purchasing
State/County/City/Managing Entity - Strategies Review Operations/Budget to see Where There is a Surplus or What Can Stop Doing so that the Funds can be Used Elsewhere No Additional Funds Needed Move Existing Monies From One Part of the Budget to Another on Own Without Need for Funding Source Approval Work With Funding Agency for Special Approvals for Flexibility or Adaptations of Existing Budget Identify Sustainable State, Tribal, and/or Local Match for Medicaid 14
State/County/City/Managing Entity - Strategies Reinvestment of savings from reductions in residential/hospital interventions, and back into preventative community services Adjust Payments to Ensure Not Creating Unfunded Mandates e.g. Parent Partners and Youth Advocates 15
Massachusetts
BBI in Massachusetts: Caring Together Adoption of BBI framework for reprocurement of all DMH & DCF residential services for youth Adoption of interagency restraint/seclusion initiative & Six Core Strategies Commitment to trauma-informed care Development / expansion of family & youth roles Parent Partners and Peer Mentors Development of: Continuum (in-home residential service with team) Occupational Therapy in more intensive programs High intensity community services
BBI in Massachusetts: Caring Together Flexible Service Models Following into community (including support in home schools) DCF & DMH Jointly: Developed standards & outcomes Overseeing implementation Providing oversight Coordinating utilization management Engaging in quality management activities Developing shared IT (reporting/documentation)
MA Continuum Core Practice Elements Practicing cultural relevance Engaging youth & families Conducting a comprehensive collaborative assessment Collaborative care coordination Assessing risk, safety planning, & supporting families through crisis Incorporating psychiatry & OT consultation Providing intensive therapeutic interventions Ensuring continuity with higher levels of care Bridging community integration Strengthening well-being through respite Supporting life transitions
Innovations in MA Residential Practices Coordinator of Family Driven Practice CTCS staff position dedicated to advancing family driven practice in the Caring Together system Caring Together designers created this positon to ensure the vision kept its focus Perform support, training, and coaching across Caring Together Continuously supports the importance of family driven care and inclusion of family voice at every level
Future Focus for MA Caring Together New working relationships Many staff in Caring Together leadership roles within both state agencies are new and developing working relationships as we move forward Sharing data Both state agencies are working on ways to look at agency specific data, as well as create new data platforms that will work for both state agencies Coaching and training Developing creative ways to fund coaching and training opportunities Keeping things simple Working to address complications and unintended consequences of the collaboration and focus on agency needs
Working with a Managed Care Entity
VA RTC Regulatory Project DMAS convened three workgroups Five sessions from 10/6/2015-10/21/2015 Membership consisted of Nominated Representatives from Providers, OCS, VACSB, DBHDS Licensing, DSS, Parent Advocates, Magellan Workgroups were organized into three areas: Medical Necessity, Clinical Program Requirements, Care Coordination and Discharge Information from the 2014 and 2015 Educational Funding Workgroup was also considered
VA Improving Residential Programs Mission: Transition three of our most complex programs into models with evidence based treatment approaches, standardized medical necessity criteria, and rigorous program requirements. Create a youth and family focused system that will match future Managed Care administration structures, oversight and contracting requirements. Support residential providers so they can implement family engagement and ensure the involvement of and direction by youth and families in all aspects of their care.
VA IACCT: Independent, Assessment, Certification, and Coordination Team Magellan will serve as a single point of entry for youth at risk of admission to residential treatment. For all Medicaid funded residential admissions, referrals must be made to Magellan, and the admission will be coordinated by the Independent Assessment, Certification and Coordination Team (IACCT). Magellan has an Intensive Care Manager as part of their program and Family Support Coordinator (FSC)
VA Family Support Coordinator (FSC) Perform outreach to the family or guardian to coordinate any face-toface assessments, encourage and facilitate family engagement in any treatment option decisions Provide education for informed decision making regarding treatment, & offer any other support or assistance to the family throughout the course of treatment Promoting family engagement throughout the course of treatment whether the plan of care is residential treatment or community based services In cases where the plan of care is community based, the FSC will remain engaged with the family to support the community based plan of care and help identify supports After discharge from residential, the FSC remains in contact at least monthly to provide ongoing support to the youth and family
Did you learn about any new strategy/ strategies that you want to use in your agency or advocate for in your state? What barriers get in the way from an oversight perspective of supporting best residential practices?
BBI Resources BBI Fiscal Strategies that Support the Building Bridges Initiative Principles - http://www.buildingbridges4youth.org/sites/default/files/bbi_fiscal%2 0Strategies_FINAL.pdf BBI Draft Fiscal Strategies Informational Document (Currently Under Review) Collins, J., McLaughlin, W., Peters, S., Rauso, M. (2014). Policy & monitoring: Federal, state & county examples of transformation. Best Practices in Residential: A Roadmap to Improve Long-Term Outcomes, New York, NY, Routledge.
Building Bridges Initiative Work with Oversight Agencies towards Improved Residential Outcomes for Youth and Families Presented by: Sherri Hammack, National BBI Coordinator
BBI & SOC = Natural Partnership Very similar missions/core values Family-Driven Care Youth-Guided Care Cultural & Linguistic Competence Clinical Excellence Quality Standards Focus on Collaborations Focus on Sustained Positive Outcomes Children and Families Served Young People with Behavioral and Emotional Challenges and their Families This Photo by Unknown Author is licensed under CC BY-NC-SA
BBI & SOC = Natural Partnership Cross-Systems Collaboration Mental Health/Behavioral Health Child Welfare Juvenile Justice Education/Schools Intellectual Disabilities Substance Abuse Deaf and Hard of Hearing Formal and Informal Community Supports Focus on promising, best, evidence-informed & best practices and Trauma-Informed Care This Photo by Unknown Author is licensed under CC BY-NC-SA
BBI TA focus in States/Counties On-site training, webinars, customized consultation approaches, and on-site learning exchanges; Coaching partnerships and peer-topeer learning/quality improvement collaboratives; Reviewing new RFPs; Reviewing and updating licensing, contracts and other oversight agency documents; This Photo by Unknown Author is licensed under CC BY-NC-SA
BBI TA focus in States/Counties Supporting the developing of revised/new Medicaid regulations and fiscal; and Identifying and implementing outcome-driven cultures of care and use of post-residential outcome measures. This Photo by Unknown Author is licensed under CC BY-NC-SA
States/Counties BBI worked with in 2017 and 2018 Texas Illinois Kentucky Louisiana Massachusetts Michigan Philadelphia County Colorado Pennsylvania- 4 Counties New York North Dakota Rhode Island Nevada New Jersey North Carolina South Carolina Virginia This Photo by Unknown Author is licensed under CC BY-NC-SA
PHILADELPHIA: Examples of BBI TA Provided This Photo by Unknown Author is licensed under CC BY-SA On-Site Training Programs and Expert Consultation Calls on Residential Best Practices/FDC/YGC for multiple system stakeholders Philadelphia leaders attend out-of-state BBI-endorsed training on EBP Six Core Strategies Expert consultation calls with different systems stakeholders (e.g., Policy & Fiscal Best Practices; Outcome Data Measures; Medicaid) Review/feedback on different policies, RFP for new PRTFS, new residential program models against residential best practices
Texas: Another example of a BBI & SOC partnership On-Site Trainings in Texas Texas leaders attend out-of-state BBIendorsed training on Six Core Strategies Multiple Webinars: Residential & CW Partnership towards ensuring Permanent Connections Family-Driven Care/Engaging Families Moving from Control to Collaboration Review on policies/state documents specific to residential Experts coach individual residential providers on targeted program improvement areas Preparation - Learning & Action Network
Examples of some results so far in different states/counties: Education & commitment from different system stakeholders to support residential best practices aligned with research on positive outcomes post-discharge Improved partnerships between oversight agencies and stakeholders specific to residential interventions (e.g., TX HHSC & DFPS with The Texas Institute for Excellence in Mental Health - a center of excellence at a Texas University, includes support of a state webpage: TX Building Bridges ; MA DCFS/DMH/Providers collaboration on permanency practices) Use of new/updated oversight agency documents - RFPs, residential contracts, licensing standards that include language and practice expectations consistent with the literature on improving positive outcomes post-residential discharge
Examples of some results so far in different states/counties: Changes in Medicaid Rules that support working with and spending time with families in their homes and communities Residential partnerships with Managed Care and others in developing and implementing BBI demonstration pilots Developed buy-in from residential program leaders towards residential transformation Internal residential program focus on improving residential program practices via learning communities, reading & discussing BBI resource materials, supervision/coaching Hiring family and youth advocates
Examples of some results so far in different states/counties: After on-site reviews - improved practices in residential programs (< restraints, police calls, AWOLs & use of standardized approaches like points/levels; > use of FDC, YCG, CLC, & TIC practices) Multiple examples of individual residential transformations towards a range of best practices (permanency practices; engaging families; youth voice, choice and individual strengths/passions with peers in the community; working with families in their homes and communities; addressing CLC issues including practices to support needs of youth who identify as LGTBQ) Improving use of data to inform practice, use of debriefing with focus on how better to support youth (vs. blaming youth), use of post-discharge data measures
Looking forward to continuing & expanding Building Bridges Initiative partnerships with oversight agencies and their respective child and family systems across the country! Youth & Families This Photo by Unknown Author is licensed under CC BY-SA
Mark Nickell Regional Executive Director, Seneca Family of Agencies (CA): The Journey of California from Traditional Residential to RBS to STRPT
Have a discussion at your table about the oversight agency you work for or the one you work closely with, using the following questions: 1) What oversight agency practices are being used in your geographical area that are consistent with the best practices discussed during the presentation? 2) What strategy areas do you believe are the most important for your oversight agency to change/improve? 3) What are areas of influence/what could you do to make improvements to the strategy area(s) identified?
Contact Information www.buildingbridges4youth.org Dr. Gary Blau Gary.Blau@samhsa.hhs.go v 240-276-1921 Beth Caldwell bethanncaldwell@gmail.co m 413-717-0855 Sherri Hammack svhammack@sbcglobal.net 512-964-6164 Lloyd Bullard bbi.lbullard@gmail.com 301-437-2378 Laura Tate laurentate374@gmail.com Julie Collins jcollins@cwla.org 202-590-8865 JuRon McMillan juronbbi@gmail.com 404-242-3150 Mark Nickell mark_nickell@senecacent er.org 413-717-0855