Louisiana’s Coordinated System of Care

Louisiana’s Coordinated System of Care

The Role of the WAA and its Relationship with the Statewide Management Organization in

the Coordinated System of Care.

Technical Assistance WebinarMarch 30, 2011

Louisiana’s Coordinated System of CarePurpose of today’s webinar is to

Acknowledge the national trend and evidence supporting wraparound in systems of care

Communicate the Louisiana structure to support wraparound in CSoC implementation

Explain the interaction between the WAA and the SMO in Louisiana’s CSoC

Answer questions about WAA, the SMO and other issues posed by attendees to support local responses to the RFA


Agenda

RFA process and Timeline Overview

Presentations by

Kathy Sternbach, Mercer

Kathy Kliebert, Deputy Secretary, DHH

James Hussey, Medicaid Behavioral Health Medical Director, DHH

Questions and Answers

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Projected Timeline

March 28, 2011- list of regional points of contact posted to www.dcfs.la.gov/csoc

April 1, 2011- updated list of questions and answers posted on www.dcfs.la.gov/csoc

May 13, 2011- 3:30pm- Application deadline

June 3, 2011- Potential presentation by responders

June 16, 2011- Announcement of awards

January 1, 2012- CSoC launch date

CSoC Request for Applications

CSoC Request for Applications

The response should reflect collaboration and partnership across the region, rather than the efforts of a single “lead agency” or similar entity.

This RFA is seeking to understand the level of community support and capacity to work towards CSoC development in the region, rather than looking for an individual agency or entity to manage implementation.

CSoC Request for Applications The purpose of this Request for Applications (RFA) is to

serve as the first step towards statewide implementation of the CSoC by identifying (1) the regions in Louisiana that are ready to participate in the first phase of CSoC implementation and (2) the communities within those regions that are most prepared to be part of that initial phase

The CSoC will implement one Family Support Organization (FSO) and one Wraparound Agency (WAA) per region, and each applying region can only support one FSO and WAA as part of their proposed CSoC under this RFA.

Technical Assistance for Applicants

Webinar Technical Assistance Meetings every Wednesday, 1:00 to 3:00 pm, from 3/23 - 5/4 dialing and webinar log in information will be will be

posted on the CSoC website

Email Questions and posting of answers on website Questions maybe submitted via email to

[email protected] through 5/04/2011. Answers to questions will be posted regularly throughout

the response period at the CSoC website (www.dcfs.la.gov/csoc).

Webinar Schedule 03/23/11 - Stakeholder & Family Leadership in Local CSoCs

03/30/11 – Family Support Organizations

04/06/11 - The Role of the WAA & its Relationship with the Statewide Management Organization in the CSoC

04/13/11 - National Wraparound Initiative (NWI)

04/20/11 - Provider Issues and Related Medicaid Requirements

04/27/11 - FSO and WAA Relationships with the Community

05/04/11 - CSoC Training by the Maryland Innovations Institute


Presentations by

Kathy Sternbach, Mercer

Kathy Kliebert, Deputy Secretary, DHH

James Hussey, Medicaid Behavioral Health Medical Director, DHH

Wraparound Facilitation within the CSOC Wraparound Facilitation:

Wraparound is an intensive, individualized care planning and management process.

It is not a treatment per se. Instead, wraparound facilitation is an intensive care coordination approach that fundamentally changes the way in which individualized care is planned and managed across systems.

The wraparound process aims to achieve positive outcomes by providing a structured, creative and individualized team planning process that, compared to traditional treatment planning, results in plans that are more effective and more relevant to the child and family.

Wraparound Facilitation within the CSOC

Additionally, wraparound plans are more holistic than traditional care plans in that they address the needs of the youth within the context of the broader family unit and are also designed to address a range of life areas.

Through the team-based planning and implementation process, wraparound also aims to develop the problem-solving skills, coping skills and self-efficacy of the young people and family members and and integrate the youth into the community by building the family’s social support network.

Wraparound Facilitation within the CSOC The wraparound process centers on intensive

care coordination by a child and family team (CFT) coordinated by a wraparound facilitator.

The family, the youth, and the family support network comprise the core of the CFT, joined by parent and youth support staff from the FSO, providers involved in the care of the family, representatives of agencies with which the family is involved, and natural supports chosen by the family.

The CFT is the primary point of responsibility for coordinating the many services and supports involved, with the family and youth ultimately driving the process.

Evidence Base for Wraparound In 2007, 91% of U.S. states had some type of

wraparound initiative 62% of the states were implementing some

type of statewide initiative. Over 100,000 youth nationally were estimated

to be engaged in a well-defined wraparound process

The research base has grown substantially: Only three controlled studies in 2003; There are nine such studies as of 2010, plus

the first meta-analysis (Suter and Bruns, 2009)

Bruns, E.J. and Suter, J.C. (2010). Summary of the wraparound evidence base. In E.J. Bruns and J.S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative

Evidence Base for Wraparound Major outcomes include:

Fewer restrictive placements, Improved school and broader functioning

(CAFAS), Reduced justice system recidivism and

detention use, and Reduced mental health symptomatology

(CBCL) For more on the evidence-base, visit:

http://nwi.pdx.edu/NWI-book/Chapters/Bruns-3.5-(evidence-base).pdf

http://depts.washington.edu/wrapeval/presentation.html

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Coordinated System of Care Model

The coordinated systems of care (CSOC) is an evidence-based model that is part of a national movement to develop family driven and youth guided care, keep children at home, in school, and out of the child welfare and juvenile justice system.

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Coordinated System of Care Model

An important CSoC goal is the reduction of highly restrictive out of home placements through the creation and maintenance of coordinated and effective community based services.

CSoCs also create partnerships with public and private providers of services that target children, youth and their families in a multi-agency, multi-disciplinary system of services.

Both of the above are key roles for the SMO and all Wraparound Agencies in in the CSOC.

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Proposed System of Care

Values and Principles:

Family-driven and youth-guided Home and community based Strength-based and individualized Culturally and linguistically competent Integrated across systems Connected to natural helping networks Data-driven, outcomes oriented

CSoC is a different approach to service delivery

Adoption of a Family-Driven Practice Model

Implementation of Wraparound planning, based on National Wraparound Initiative (NWI)

Stress and emphasize importance of providing family-driven services in natural settings–homes, schools, and in the community–instead of out or home placements (e.g., residential treatment, psych hospitals, long-term day treatment, etc.)

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Population of Focus for CSoC & Wraparound Agencies:

Detention Secure Care facilities Psychiatric hospitals Residential treatment

facilities Development disabilities

facilities

Louisiana’s CSoC will initially serve children andyouth that have significant behavioral healthchallenges or co-occurring disorders that are in or atimminent risk of out of home placement defined as

Addiction facilities Alternative schools Homeless as identified by

DOE Foster care

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Administrative Structure for the CSoC

Implement an administrative structure that includes a Multi-Departmental Governance

State Purchaser Statewide Management Organization Local Wraparound Agencies Family Support Organizations

CSoC structure

DHH Office of Behavioral Health

Statewide Management Organization (SMO)

Local Family Support Organization (FSO)

LocalWraparound Agency

Statewide Coordinating Council for the FSO network

Service Provider Network

Statewide Governance Body

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Current Medicaid Rules Revised to Expand Financing & Service Array Medicaid will work with CMS to amend state plan and

establish waivers State Plan Amendments & Waivers – Identify specific

population and specific services State Plan Amendments – home and community based

services; school based behavioral health services; substance abuse treatment services for children and adults; focus on evidence based and promising practices

1915c Waiver – Establish CSoC for children’s services, wraparound planning, peer supports

1915b Waiver – establish management by statewide management organization (SMO)

The SMO will collaborate with CSoC Governance and DHH/OBH to assist in the development of Wraparound Facilitation agencies and Family Service Organizations

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Functions of SMO

The contracted Statewide Management Organization (SMO) will serve as the single experienced behavioral health entity, whose role is to provide the following key management functions for the CSoC: Member services (24/7 toll free access) Referral to wraparound agency (WAA) or providers Utilization management

Manage and approve services for participants; prior authorize (when needed)

Training Quality management functions and reporting Pay claims Provider network management

credential, contracts, train, monitor, and ensure compliance from the provider network

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Training to Support Increased Provider Capacity and Expansion of Services

All Providers will need to become Medicaid providers Three components are necessary to successfully

train providers and build capacity in local communities. Training on these components will be provided as selected communities implement CSoC

Wraparound process Building EPB and promising practice capacity Workforce skill development

Additionally, the SMO will provide training for WAAs, providers and State staff on

operating protocols related to Utilization Management and quality management

filing and resolution of grievances and appeals

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Wraparound services, including Assessment facilitation of the child and family team individual service plan development intensive case management

Youth peer supportPsychoeducation - Parent Support and Training Independent living/skills buildingShort term Respite servicesCrisis Stabilization

Specialized Services for CSoC Target Population:

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Assessment and diagnosis

Treatment planning Mental health

consultation School-based services Home-based services Outpatient

psychotherapy Medical management Day treatment/partial

hospitalization

Crisis services Behavioral aide services Therapeutic foster care Therapeutic group homes Residential treatment

centers Inpatient hospital services Transportation Addictive disorder services

CSoC will include expansion of state plan to support needed service array

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CSoC and Wraparound are a different approach to service delivery Utilizes a Family-Driven Practice Model

Wraparound Facilitation, an intensive, individualized care planning and management process, is not a treatment but an important component in a System of Care for children and families.

Wraparound philosophy values the perspectives of the family – including the child or youth – in all phases and activities.

Natural supports for the family are increased by building interpersonal relationships and resources available in the family’s network of social and community relationships

Activities focus on strengths to help the child and family recognize, utilize, and build talents, assets and positive capacities.

Role of WAA WAA’s are providers of administrative

services as contracted with the SMO; WAA Services are funded through savings

generated from the effective management of State Plan Services, including inpatient services, residential treatment, and other community-based services.

WAA Performs CSoC Treatment Planning

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Wraparound Facilitation Through an individualized team planning process,

plans are more holistic, effective and more relevant to the child and family than traditional treatment plans. They: address the needs of the youth within the context of

the broader family unit in a range of life areas Aim to develop problem-solving, coping skills and self-

efficacy of youth and family members

Intensive care coordination allows care coordinators to work with youth and families at small ratios.

Emphasis on integrating the youth into the community and building the family’s social support network.

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Wraparound Facilitation Wraparound Agencies (WAAs) serve as the locus for

access, accountability, service coordination and utilization management functions for populations of children who have or are at high risk for multi-system involvement.

WAAs act as a bridge between the Statewide Management Organization (SMO) and families to independently plan and coordinate care.

The WAA is responsible for facilitating the wraparound process, convening the child and family teams (CFT), developing individualized plans of care that cross agencies and assigning one accountable care coordinator

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Wraparound Facilitation The SMO refers eligible children/youth to WAA with a 30

day authorization to arrange community services for the child and family while establishing the CFT, with input from the child and family.

Inpatient/out-of-home placements must be pre-authorized by the SMO during the initial 30 day and subsequent authorization periods.

An assessment by a licensed mental health professional using the CANS must be obtained. The findings are sent to the WAA wraparound facilitator to assist the CFT with the wraparound planning process.

The WAA wraparound facilitator submits the care plan to the SMO for review before the end of the 30-day period.

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Wraparound Facilitation WAAs work with youth, families, providers, regional agency

staff, the courts, community organizations and FSOs to coordinate plans of care and access to comprehensive services and supports.

The WAA ensures participation and integration with child welfare, juvenile justice, and local education and the Family Support Organization (FSO).

Additional WAA responsibilities: Track children, services provided and service costs Utilization management/review of each child Quality assurance at the local level Outcomes management/monitoring of individual children Input data into a management information system to track

and monitor functions integrated with SMO MIS Monitor and support development of local provider capacity

with SMO to fill gaps in service availability

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Wraparound FacilitationThe Plan of Care

identifies the assigned task and person responsible for implementing the identified support to attain a specific goal.

Includes community partners identified by the CFT to provide natural supports for the family to meet the child/youth’s needs.

Has a crisis and safety plan section that identifies potential crisis scenarios what action steps or strategies need to be

implemented persons responsible to mitigate the risk

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Wraparound Facilitation All WAA staff must participate in training provided

by the state prior to the delivery of treatment planning or services under this contract.

The state will provide certification for Wraparound Facilitators employed by the WAA, certifying completion of the required training.

This certification will be part of the credentialing / subcontracting process administered by the SMO.

Role of the SMO vs WAACSoC Referral Process – Step 1

Calls SMO toll free line

Youth, Family, Caregiver, State Agency, Provider

SMO Member Services

•Takes basic info

•Checks Medicaid eligibility

•Transfers call (warm line) to SMO Care Manager

SMO Care Manager

• Discusses needs

• Conducts CANS Brief Screen

•If CSoC Eligible, refers to WAA, Independent Assessor and FSO

CSoC Referral Process – Step 2

•CANS Assessment

•CFT participation

Wraparound Agency

IndependentEvaluator

FSO

•Family Education and Family/Peer Support Services

•Assistance with CFT process

•30 Day Authorization for community services

•Immediately refers to services during first 30 days

•Immediately works with family and youth to assemble Child and Family Team (CFT)

•Assists family with Medicaid application, if needed

•Initiates the development of a sustainable POC

CSoC SMO Referrals

WAA: Developing a Sustainable POC, Step 3

WAA Facilitator Responsibilities

•Assembles the CFT identified/ agreed upon by the family/caregiver, child/youth or custodial agency (e.g., natural supports, schools, Certified Family and Cultural Support Specialists, Certified Youth Support and Training Specialists, Judges, staff from DCFS, DOE OJJ, OBH)

•Links the Independent Evaluator/CANS information and the FSO to the CFT process and POC

•Conducts the Wraparound planning process to identify the individual needs and strengths of the child and family/caregiver

•Develops a customized and sustainable wraparound approach and POC, consistent with wraparound planning goals and signed by a licensed behavioral health practitioner

•Submits the POC and CFT meeting documentation to SMO care manager for review prior to the end of 30 days from the initial referral

SMO: Reviewing and Authorizing A Sustainable POC, Step 4

SMO Care Manager Authorization Process

•Care manager reviews the POC for consistency with the child/youth and family/caregiver’s strengths and needs (as identified by CANS, broad assessment and the POC) and utilization guidelines published by the SMO (and approved by CSoC Governance)

•If POC meets these criteria, the SMO Care Manager provides authorization of services for a period of up to 90 days for most children/youth, or longer subject to medical and social necessity

• If the POC is inconsistent with assessed needs and strengths and the utilization guidelines for the desired services, or it exceed the cost of care limitations (established by CMS Authorities), the SMO Care Manager will make a recommendation for further discussions with the CFT

WAA: Referrals and Ongoing Case Management Step 5

Wraparound Facilitator Responsibilities

•Assists the CFT to develop a sustainable POC (if initial POC is not authorized by the SMO) through review of the child/youth and family/caregiver’s strengths and needs. Resubmits the POC to the SMO Care Manager for review. The SMO Care Manager will assist the Wraparound Facilitator with clarification of utilization guidelines and cost of care limitations to help the CFT develop an approvable POC

•Refers the child/youth and family/caregiver to community resources and providers as soon as the POC is authorized

•Provides intensive case management, consistent with the needs of the child/youth and monitors the appropriateness and effectiveness of the POC

•Convenes the CFT as needed and to update the POC every 90 days


Questions?

[email protected]

www.dcfs.la.gov/csoc

Documents

Louisiana’s Coordinated System of Care