May 30, 2013 10:00 am - 3:00 pm Anaheim, CA

1. Pathway to ServicesCore Practice Model Guide Medi-Cal Manual for Intensive Care Coordination, Intensive Home Based Services, and Therapeutic Foster Care May 30, 2013 10:00 am - 3:00 pm Anaheim, CA

2. HOUSEKEEPING Deborah Lowery

3. REGIONAL Host Comments

4. 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

5. Abbreviations • CDSS California Department of Social Services • CPM Core Practice Model • CFT Child and Family Team • DHCS Department of Health Care Services • ICC Intensive Care Coordination • IHBS Intensive Home Based Services • TBS Therapeutic Behavioral Services • TCM Targeted Case Management • TFC Therapeutic Foster Care

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

11. Negotiation Process

12. Therapeutic Foster Care • State Update • State Plan Amendment • Update to the Medi-Cal Manual

13. Katie A. Class and Subclass Members • Who are the members of the Class and Subclass? • What guidance is provided on member eligibility consideration?

14. 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

15. 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 1830.205 or Section 1830.210. (Medi-Cal Manual, Glossary, Appendix A)

16. 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

17. Open Child Welfare Case Defined A child with an open child welfare is defined as any of the following: • Child is in foster care • 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)

18. Status of Child Welfare Case

19. Relationship of Services CPM

21. 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. 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. Child and Family Team

28. CPM Values and Principles Service Delivery Components Child, Youth, and Family

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.

30. Elements of a Successful Team

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. Family VoiceChild 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. 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 Appendix D • Sample of Progress Notes Appendix E • Medical Necessity Criteria Appendix F • Provider Qualifications* Appendix G • Non-reimbursable Activities 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.

39. 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

42. 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. 9

44. 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. 10

45. 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. 10

46. Transition Developing a transition plan for the client and family’s long-term stability including the effective use of natural supports and community resources. Transition Example 1: Susie, pg. 10

47. 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.

48. Intensive Home Based Services Activities

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