1. Fiscal Strategies That Support Positive Outcomes
Jim Dalton,PsyD/President & COO, Damar Services, Inc./IN
Georgetown Pre-Institute Training Program
Effective Residential Service Interventions
July Orlando, FL

2. Fiscal Initiatives in Indiana
Practice Reform as Primary
Clinical Partnerships
Lead Agency Model
Community-Based Residential Treatment (CBRT)
Needs are Not Services (Flexible Funds)
Funding Length of Stay and Recidivism

3. Practice Reform
Funding that Rewards Providers for Permanency (vs. head in bed).
Funding Model that Requires Practice Reform and Change for success.
Partnerships Among Residential Providers – Training, Clinical and Fiscal Oversight (safety nets)
Specialization and the Elimination of Competition through right sizing # of available “beds”

4. No More “Heads in Beds” Failure of the business model
Reduction of residential referrals
Motivation re-directed to family and community
Significant business opportunities

5. Needs are Not Services Needs require funding
Service Menus drive behaviors
Families don’t “Need” Services
Reformed Clinical Model

6. Modernizing Residential Supports for Children and Families
Traditional
Integrated Services
Placement Complete the “Program” Length of Stay Variable Institutional-Based Pathology-Based Child-Focused Individual Provider Cost-Prohibitive Various Recidivism
Service When and where needed LOS not a $ Variable Home-Comm-Based Strength-Based Family Focused Supportive Network Cost-Effective Outcome Accountability

7. Indiana DCS
2010 Clinical and Fiscal Reform The Integrated Services Model Roll Out and Expansion

8. Integrated Services Model
Less Restrictive
Home, Wraparound, Community, Family Supports
Individualized and Flexible 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Residential Intervention/Crisis Intervention
Individualized and Flexible
Less Restrictive
More Restrictive
Service Per Diem- Months 1-12
“Guarantee” Service Fees- Months 13-24

9. Indiana’s Reform Initiative The Integrated Services Model
I.S. Outcome Measures
# of Days Out of Home
Treatment in own Home/Community
Recidivism
# of Closed Cases
Cost (If N = M reduction year 1 and
3.1M reduction in 2 years)

10. ISP Outcomes N = 160 Youth and Families 37,000 Service Days
35% Have Never Touched Residential
21% of Service Days – Residential
79% of Service Days – Home/Relative
14M less cost when compared to controls (based on historical residential outcome data and cost data)

11. Contact Info.
Dr. Jim Dalton, Psy.D, HSPP, CSAYC President and COO Damar Services, Inc. Indianapolis, Indiana