Managing Residential Care to Improve Permanency Outcomes Presented by: Dr. Peter Mendelson, Chief, Bureau of Behavioral Health and Medicine, DCF Lori Szczygiel, MA, CEO ValueOptions Connecticut

Goals The goal of residential care is to return youth to community settings ~ ideally to families Youth in Residential Care deserve intensive behavioral health treatment which explicitly focuses on returning them to their families with help and with hope DCF and ValueOptions share a goal of increasing the availability of community services while decreasing the need for out of home service We are committed to stopping the “Residential Shuffle” and to fostering permanency and post- placement stability

Public and Private Partnership to Effectuate Change DCF and Medicaid in CT contract with an Administrative Service Organization (ASO), ValueOptions (VO), to provide a variety of utilization and quality management functions for the Connecticut Behavioral Health Partnership Residential management, tracking, reporting and outcome monitoring represent significant components Functions and staff (DCF and VO) are integrated within a Residential Care Team

Partnership, cont’d 10 ValueOptions staff and 10 DCF staff manage:  633 youth in residential placement  Admission process (determine level of care via state constructed guidelines and medical necessity)  Frequent concurrent reviews and monitoring  Referral and Tracking  Reporting  Analysis  Quality monitoring and management via reporting and on-site reviews

Understanding the Needs and Opportunities Two years of data have been tracked and trended:  Number of youth approved for out of home care  Average length of stay  Discharge delay  Risk management data (AWOLs, Arrests, Restraints, etc.) In 2008 DCF and VO established a workgroup to track and analyze 13 RTC outcome measures previously agreed upon by the Department and residential providers

Understanding the Needs and Opportunities, cont’d Our workgroup began the development of a Provider Analysis and Reporting (PARs) program to analyze residential services and to refine and incorporate outcomes in order to achieve enhanced rates of permanency PARs program is a quality improvement process with various action steps Providers are evaluated against generally accepted industry utilization and quality measures We provide regular feedback and support to providers to support performance improvement

Understanding the Needs and Opportunities, cont’d Second phase of PARs entails the attachment of financial incentives to the accomplishment of stated performance goals ~ a Performance Incentive Program (P4P) Quarterly PARs meetings since 2009 (aggregate data shared in statewide forum) Bi-annual, provider specific PARs program rolled out in CY 2009 Performance Incentive program under construction of CY 2010

Looking at Outcomes – Opportunities for Improving Permanency Research shows that a child’s experience in placement directly impacts post placement stability and permanency In placement metrics measured:  Length of time to achieve readiness for discharge  Average number of days children remain in placement beyond clinical necessity  Notable events while in placement  Attendance in school  Average number of hours the child is in treatment while in placement  Average number of hours of family treatment  Average number of hours spent on specific activities which will support post-placement permanency (family readiness, individualized supports, etc.)

Looking at Outcomes – Opportunities for Improving Permanency, cont’d Post Placement metrics measured:  Percentage of children discharged to a lower level of care  Percentage of children discharged to a lower level of care maintaining stability for 12 months  0 – 180 day post placement stability % of children hospitalized % of children arrested % of children readmitted to residential All of the above measures are designed to document outcomes post placement. Our intervention fails if stability and permanency are disrupted after a course of residential treatment

Overall Trends Some improvement has been seen but there is more work to be done 1/3 of the children served did not maintain permanency and post-placement stability

Baseline Performance – Average Length of Time to Achieve Readiness for Discharge ∙ Average length of time has decreased by 13% between CY ’08 and YTD ‘10

Baseline Performance-Percentage of Children Discharged from RTC to a Lower Level of Care · Percentage of children discharged to a lower level of care has increased by 7% from CY ’08 to ‘10 YTD

Baseline Performance-Percentage of Children Hospitalized days Post RTC Discharge

Baseline Performance-Percentage of Children Arrested days Post RTC Discharge

Baseline Performance-Percentage of Children Readmitted days Post RTC Discharge · Percentage of children readmitted decreased by 8% from CY ’08 to ’10 YTD

Number of RTC Admissions ▪ RTC admissions have decreased by 12% between CY ’08 and CY ’09.

Number of IICAPS Admissions ▪ IICAPS admissions have increased by 92% between CY ’07 and CY ‘09

What Have We Learned? To support stability and permanency, investment must occur within the community delivery system For many youth, investment in community services has led to a decrease in residential admissions and to the preservation of families Youth that do get admitted to residential programs are more challenging in terms of clinical presentation

What Have We Learned, cont’d? Focus is critical: Family Readiness is more important than “Fixing” the child Provider Analysis and Reporting and Performance Incentive Programs identify goals to support permanency and financially reward providers for positive outcomes Providers at rest tend to stay at rest