Accessibility and Community Involvement and the Role of Residential in Systems of Care Bruce Kamradt...
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Transcript of Accessibility and Community Involvement and the Role of Residential in Systems of Care Bruce Kamradt...
Accessibility and Community Involvement and the Role of Residential in Systems of
Care
Bruce Kamradt
Cathy ConnollyJuly 19, 2007
Values That Guide Accessible Community-Based Care
Individualize the Provision of Services to Meet The Child’s and Family’s Unique Needs
Provide Access To A Comprehensive Array of Services and Supports
Strength-based approaches work best Services and Treatment are provided in the
community whenever possible Child and Family Team Guides Treatment and
Service Planning no matter where the child resides
Success determined thru Measurable Outcomes
What Is Wraparound Milwaukee-
I. Organized as a Unique Type of Public Care Management Organization--HMO
II. Defined Populations for Enrollment—children at immediate risk of Institutional placement—640 enrollees
III. Operates with Pooled Funds--$37 million—single payor of all services for SED youth Child Welfare Juvenile Justice Mental Health Medicaid
IV. No Formal Contracts -- Utilizes A Comprehensive Fee for Service Approach with Extensive Provider Network—Residential Treatment is a network service
V. Employs Care Coordinators who facilitate Child and Family Teams—one family and one plan
Continued
Wraparound Milwaukee - What Is It?
VI. Strong Mobile Crisis Services—24/7VII. Strong QA/QI and Single internet-based
Information System Serves All 230 Provider Agencies
VIII. Organized Family Advocacy and Support System Partners with Families
Continued
Daily Living Skills - TrainingIndependent Living Apt.Parent AideChild CareHousekeepingMentoringTutorLife Coach RecreationAfter School ProgrammingSpecialized CampsDiscretionary FundsSupported Work Environment
List of Available Servicesin Social / Mental Health Plan
Case ManagementReferral AssessmentMedication ManagementOutpatient
Individual/FamilyOutpatient - GroupOutpatient - AODA Psychiatric AssessmentPsychological EvaluationMental HealthAssessment/EvaluationInpatient Psychiatric Nursing
Assessment/ManagementConsultation with Other
Professionals
Group Home Care Respite Respite - Foster Care Respite - Residential Crisis Bed - RTC Crisis Home Foster Care Treatment Foster Care In-Home Treatment (Case
Aide) Day Treatment Residential Treatment Transportation Crisis 1:1 Stabilizers/Aides
Utilization of Residential Services Within Our System of Care
Average of 80 youth in Residential Treatment Centers and 75 youth in Group Homes-Out of Average Daily Enrollment of 640 youth
Average about $1800 per month per enrollee for above services or 45% of Service Costs
4 of our 9 Care Coordination Agencies are Residential or Group Home Providers
Overall Utilization of Residential Tx. has Decreased Over past 12 years from 375 Average RTC placements to 80 and Length of Stay from 12 months to 3.5 months
Best Practice Approaches for Residential Treatment In A System of Care
Residential Care should and can be Short-Term (30 – 90 Days)
Residential Care should be Pre-Authorized by the Purchaser
Integrate Residential Plan into Community Plan—Residential Care Is Part of A Strategy To Meet A Need
Involve and Engage Parents
High Risk Youth Need a Good Safety Plan
Best Practice Approaches for Residential Treatment …. continued
Outcomes should be Clear, Measurable and Time-Limited
Residential Staff should Participate with Community Professionals, Neighbors, Informal Supports on the Care Planning Team—The CFT Designs and Oversees The Care Plan Regardless of Where The Child Resides
Discharge should Occur When Immediate Needs are Met and Community Resources Put in Place to Meet longer Term Treatment Needs
Challenges For Purchasers And Providers
Political Support for Changing Role of Residential Care
Legal Support for Changing Role of Residential Care
Learning To Share The Same Values, Approaches and Goals
Expanding Array of Community Services Residential Centers Provide While Often Reducing The Physical Infrastructure
Training and Technical Assistance Required
Challenges For Purchasers And Providers…continued
Familiarizing Residential Centers and Other Agencies with Managed Care Techniques
– Participating in a Provider Network
– Fee-For-Service
– Prior Authorization
Establishing Outcomes for Youth in Residential Care—We May Each Be Evaluating Progress In Different Ways With Different Timelines
St. Charles: Brief History
Established in 1920 by Archdiocese as single service organization on 57-acre campus in Milwaukee, Wisconsin
Exclusively boys residence for 65+ years
Children were generally referred by family & others for “delinquency”
A Business Case for Change
Typical residential stay in 1960s-1970s was 3-4 years3-4 years in length
By 1980s, typical stay fell to 1 year1 year with ability to extend an additional year
Since Wraparound began, the initial commitment is generally 30 days30 days with average stay being 3-6 months3-6 months
Strategic Internal QuestionsSt. Charles had to question itself in the
face of change:
Who would we be if we were no longer defined by the facilities we had invested in over decades?
What would we do with all those facilities if multi-year residential stays were not going to return?
Elements of Immediate Change
MissionInternal “Self-Image”NameResidentially Focused StaffAbundance of Residential FacilitiesExcess Land
Change Forces New Vision
We would no longer be facilities-driven…we would serve youth & families wherever they might be
We would embrace the trend away from residential services, and transform ourselves to meet new market
As a result of strategic planning:
The Challenges of Change
1. DECISION-MAKING: From “experts” role exclusively making treatment decisions to “team members” providing input
The Challenges of Change
3. PERFORMANCE: From individual definitions of performance and quality to standardized community-wide indicators
The Challenges of Change
4. RESIDENTIAL POPULATION: From nearly 500 area youth receiving residential services to only 50
The Challenges of Change
5. SERVICE DELIVERY: From on-site residential treatment to in-home and community-based service delivery
The Challenges of Change
6. WORKFORCE DIVERSITY: From emphasis on residential staff/staff training to seeking/training for more diverse skills sets
The Challenges of Change
7. FINANCIAL PRESSURE: From full beds and balanced budgets with 1+ year stays to greater financial uncertainty and need to diversify funding sources
The Results of Embracing Change
Agency grew from $3 million to $13 million in annual revenues
Staff grew from 25 to 300Most importantly, positive results for
youth & families
Much has improved as a result of embracing change:
The Results of Embracing Change
Wraparound Care Coordination
Safety ServicesMedical Day TreatmentAlternative EducationIntensive Family
Development Services
St. Charles transitioned from a single service to a wide range of programming, including:
The Results of Embracing Change
MentoringResidential TreatmentShelter CareFamily PreservationFirst Time Juvenile
Offender ProgramAlternatives to Incarceration
St. Charles transitioned from a single service to a wide range of programming, including:
St. Charles: Programming Today
JAC, 6%
Shea, 5%
K Ctr, 3%
MDT, 7%
BR, 2%
IDT, 4%
Day Ctr, 2%
Cty Shelter, 19%
State Shelter, 4%
Kiley, 5%
MAT, 2%
Other, 4%
IFDS, 3%
ESP, 2%
Kenosha, 4%
TFC, 2%
Mentor, 3%
Wrap, 4%
Ed Ctr, 12%
Level 2, 4%
Safety, 3%FTJOP, 2%
Today, St. Charles Youth & Family Services is a well diversified service provider with no more than 20% of revenues being received from a single source.