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 Webinar March 30, 2011. Louisiana’s Coordinated System of Care. Purpose of today’s webinar is to
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The Role of the WAA and its Relationship with the Statewide Management Organization in the Coordinated System of Care.
Technical Assistance Webinar
March 30, 2011
Purpose 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
RFA process and Timeline Overview
Kathy Sternbach, Mercer
Kathy Kliebert, Deputy Secretary, DHH
James Hussey, Medicaid Behavioral Health Medical Director, DHH
Questions and Answers
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.
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.
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 CSoC.HelpDesk@la.gov through 5/04/2011.
Answers to questions will be posted regularly throughout the response period at the CSoC website (www.dcfs.la.gov/csoc).
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
Kathy Sternbach, Mercer
Kathy Kliebert, Deputy Secretary, DHH
James Hussey, Medicaid Behavioral Health Medical Director, DHH
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.
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.
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.
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
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:
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.
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.
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
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.)
Secure Care facilities
Residential treatment facilities
Development disabilities facilities
Louisiana’s CSoC will initially serve children and
youth that have significant behavioral health
challenges or co-occurring disorders that are in or at
imminent risk of out of home placement defined as
Homeless as identified by DOE
Implement an administrative structure that includes a Multi-Departmental Governance
Statewide Management Organization
Local Wraparound Agencies
Family Support Organizations
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
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
Manage and approve services for participants; prior authorize (when needed)
Quality management functions and reporting
Provider network management
credential, contracts, train, monitor, and ensure compliance from the provider network
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
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
Assessment and diagnosis
Mental health consultation
Day treatment/partial hospitalization
Behavioral aide services
Therapeutic foster care
Therapeutic group homes
Residential treatment centers
Inpatient hospital services
Addictive disorder services
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.
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.
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
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.
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
The 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
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.
Youth, Family, Caregiver, State Agency, Provider
Calls SMO toll
SMO Care Manager
CSoC SMO Referrals
WAA Facilitator Responsibilities
SMO Care Manager AuthorizationProcess
Wraparound Facilitator Responsibilities