RBS Reform

1
RBS Reform

• AB1453 Soto, October 2007
• Sponsored by CAFS, CDSS
• Legislative Findings
• -General dissatisfaction with how group homes
  are
• used in FC system.
• -Current role and outcomes for group homes not
  well-
• defined.
• -Laws regulations have not been changed to
  match
• changes in evolving expectations, i.e.,
  permanency.
• -Group homes are not authorized or funded to
  deliver services
• to families to prepare them to provide a
  permanent home.

2
RBS Reform, cont.

• Statewide Implementation Plan
• -CDSS must convene a workgroup to develop an
  operation plan
• to transform the current group home system
  into a system of
• Residentially Based Services (RBS)
• -Plan is due to legislature by Jan. 1, 2011
• -Plan must use the experience of the RBS models
  which will
• be tested by counties
• -Testing through Voluntary Agreements between
  Co Providers
• -Plan to be aligned with Framework for a New
  System of
• Residentially Based Services in CA- CACFS 2006
• Group care is an intervention, not a
  destination

3
RBS Reform, cont.

• Statewide Implementation, cont.
• -12/07 RBS Forum to Invite Interest
• -3/08 Letter of Interest
• -5/08 Four Demo. Counties Selected
• Sacramento
• LA
• San Bernardino
• Bay Area Consortium (SF, San Mateo, Contra
  Costa, Santa
• Clara, Solano)
• -Develop Program Funding Model for RBS
  2008/09
• -Demo model implementation early 2009
• -Implementation timelines revised for early
  2010

4
RBS Reform, cont.

• What is RBS?
• A framework for a comprehensive approach to
  addressing the needs of a critical care
  population
• Based on a review of research indicating the
  practices most likely to be associated with
  effectiveness
• A systemic approach to integrating the arc of
  care across multiple environments and
  interventions
• Who is RBS for?
• Children who would otherwise be repeatedly placed
  in high-level group homes and remain in placement
  for long periods of time
• This subset of children have highly disrupted
  family relationships and typically poor
  permanency outcomes

5
RBS Reform, cont.

• RBS Components
• -Continuous and extensive family involvement
• -Short-term, highly intensive group care
• -Parallel, pre-discharge services with the
  family and community
• -Permanency Services
• -Post-discharge aftercare and support
• Cornerstone RBS Innovations
• -Enrollment, not placement
• -Comprehensive care coordination
• -Parent youth Involvement in key
  decision-making
• -Individualized child family treatment with
  array of
• facility and community based services
• -Parallel aftercare services
• -Identifying measuring outcomes

6
RBS Reform, cont.

• Sacramento County RBS Reform Team
• -Child Welfare, Probation, Mental Health, DHA,
  Group Home
• Providers, Parent Partners, Youth
  Partners/Leaders, SCA, SCOE
• Our Vision
• Reconnecting Children, Families Community
• Our Mission
• Insure that all children and youth who receive
  residential services
• are ultimately able to connect or reconnect with
  family, school community so they can achieve
  productive adult life outcomes.
• Creating a positive and sustainable arc of care
  that anchors children with their families and
  families with their communities

7

• RBS
  Reform, cont.
• Sacramento County RBS Providers
• Quality Group Homes
• Martins Achievement Place
• Childrens Receiving Home of Sacramento
• RBS Local Implementation Team
• Providers, Mental Health, Child Welfare,
  Probation, Youth Family

8
RBS Reform, cont.

• Sacramento County RBS Outcome Goals
• Increased of children and youth discharged to
  permanency
• Improved placement stability for children and
  youth in group care
• Decreased of children and youth re-entering
  after discharge from group care
• Shortened length of career stay for children and
  youth in group care
• Decreased of out of county placements

9
RBS Reform, cont.

• Initial Start-up Population
• CW, MH, Prob. youth ages 12-16 who are currently
  residing or at risk of residing in RCL 12-14
  group care who have emotional and behavioral
  needs that cannot be satisfactorily treated in a
  less restrictive setting
• 22 slots/beds to start
• Child Welfare 10
• Probation 8
• Mental Health 4
• 3 providers w/plan to increase number of youth
  and providers over time

• Referral Criteria
• The youth has a broad range of chronic emotional,
  behavioral and psychological disabilities and has
  had no more than one (1) group home placement
• The youth has a current connection to a family or
  non-related extended family member that is a
  viable resource as a permanency option
• The family is willing and able to participate in
  the RBS program and
• The youth is not currently receiving wraparound
  services.

10
RBS Reform, cont.

• How to fund?
• -Required cost neutrality for state county
  general fund
• -Baseline LOS placement cost data to
  determine neutrality
• -Flat rate cost reimbursement proposed using
  state county
• AFDC-FC flexibly/ 9mo. placement, 18 mo.
  Enrollment
• -MHSA CW funding for enhanced EPSDT services
• -Private foundation
• -Provider upfront investment
• -Need fiscal regulatory waivers
• -Risk pool for provider county
• Evaluation
• -Walter R. McDonald Assoc.
• -CANS, CWS/CMS, YSS, YSS-F
• -Internal for cost neutrality

11
RBS Reform, cont.

• Current Challenges
• Cost Neutrality Other Budget Constraints/Require
  ments
• Declining Resources
• Securing funding and developing a model that
  promises desired outcomes
• Preparing Amended Voluntary Agreement/
  Funding/Program Model to CDSS

12

RBS
Reform, cont.

• Sacramento Implementation Timelines
• -5/09 Submission of Voluntary Agreement, Program
  Funding Model to CDSS
• -11/09 Resubmission of Program Funding Model
• -12/09 Feedback Response Session
• -1/10 CDSS/County MOU
• -2/10 BOS and Contracting w/Providers
• -3/10 Implementation