1. 2011 MFP Summit:
Advancing Community Living Through Systems Transformation
PRTF Lessons Learned
Successes and Challenges in the 9 PRTF Waiver Initiative States
October 18, 2011

2. Maryland RTC Waiver
Kansas PRTF-CBA
Georgia CBAY
Montana PRTF Waiver
South Carolina CHANCE
Mississippi MYPAC
Alaska
RPTC/FASD Waiver
Virginia Children’s
Mental Health Program
Indiana CA-PRTF

3. Overview of Psychiatric Residential Treatment Facility (PRTF) Waiver Demonstration
Sherry Peters, MSW, ACSW
Director of PRTF Waiver Initiative
National Technical Assistance Center for Children's Mental Health Georgetown University Center for Child and Human Development
Phone: (202)
Fax: (202)
Website:

4. PRTF Waiver Overview
Section 6063 of the Deficit Reduction Act (DRA) of 2005
authorized up to $218 million for a 5 year Community Based Alternative to Psychiatric Residential Treatment Facilities (CBA to PRTF) demonstration (FY07 through FY11).
PRTF opportunity:
to be recognized as a type of institution for which a home and community based waiver program could be established.
CMS Initial Award
At beginning of FY 2007 CMS awarded demonstration grants of over $55 million to 10 states (currently 9 states are included in the demonstration)

5. Overview Continued Transitions and Diversions:
Over 3000 children have been transitioned or diverted from PRTF institutions since the beginning of the demonstration.
Demonstration to Permanent Waiver:
Legislation is being considered to make the waiver permanent beyond September 30, 2012
Funding:
As of September 30, 2011, CMS awarded the funding for the final year of the demonstration plus two years to allow the states to build capacity to continue to serve children and youth in the community.

6. Maryland Residential Treatment Center (RTC) Waiver
Jennifer Lowther, LCSW-C RTC Waiver Program Director Ph: Fax:

7. Maryland - Successes
System of Care recognition and support in Medicaid regulations
Care Coordination embedded in CMEs with a practice model of High Fidelity Wraparound
System of Care principles adopted
Quality Assurance Plan development and implementation
CME chart reviews provided opportunity to improve Waiver procedures, policies and care for Waiver youth
Collaborative process with state, local jurisdictions and other SOC grants’ perspectives

8. Maryland – Challenges Building sufficient provider capacity
(-) Unable to open in Western MD due to lack of waiver crisis/stabilization and respite providers
(+) Growing expressive therapists across state and motivated crisis/stabilization provider network
Cumbersome Medicaid application process
(-) Slow medical, financial and technical eligibility process
(+) Technical assistance and policy created to improve application process

9. Georgia Community Based Alternatives for Youth (CBAY)
Linda Y. Henderson-Smith, PhD
Assistant Director
C & A Mental Health Department of Behavioral Health and Developmental Disabilities Division of Mental Health
Office of Community Mental Health
office
blackberry
– fax

10. Georgia - Successes
Developed and implemented statewide Care Management Entity system in the state of Georgia
Implemented Wraparound model in the state of Georgia
FY10 financial data - $78,406 institutional care, $29,492 – CBAY
Served over Only about15% returned to PRTF for longer than 60 day period, but most returned to the program and have been successful thus far.

11. Georgia - Challenges
Culture Shift for system to accept Wraparound Model and CBAY
Policies – other child-serving agencies policies and regulations not shifting to adjust to this population
Procedures – shifting the core system to attending meetings and having one plan and providing the clinical level of services needed
Families - shifting families from viewing the institution as respite versus utilizing community- based respite
Sustainability

12. Kansas Psychiatric Residential Treatment Facility-Community Based Alternatives (PRTF-CBA)
Krista Morris
SRS DBHS Mental Health
Community Based Managed Care Team, Project Manager

13. Kansas - Successes
The SED Waiver provided for infrastructure and a vast provider network for the implementation of the PRTF CBA on April 1, 2008
Since April 1, 2008, 601 youth have been served on the PRTF CBA - Current Enrollment:
210 males
104 females
74 age 12 years and under
224 age13-18 years old
16 age years old

14. Kansas - Challenges
The children/youth served on the CBA tend to remain on the program for shorter durations, but return more frequently than on the SED Waiver.
ALOS SED= 9 months ALOS CBA=6 months
Of 256 enrollments this grant year, 37 were re- enrollees (approximately 15%)

15. South Carolina Children’s Health Access in Community Environments (CHANCE)
Erin Donovan
Jeanne Carlton

16. South Carolina - Successes
Our relationship with our advocacy group (Federation of Families)
Ensures family choice in provider(s) and services
Independent entity to report family concerns
Maintains relationship with families over course of waiver starting at intake
Positive Outcomes for youth enrolled in the PRTF Waiver and positive feedback from families
Providing support services in the home and community has resulted in adequate parental support, increased safety precautions, and reduced placement in PRTF facilities per surveys conducted
Families have reported that the support services received have allowed youth to improve their socialization skills, achievement in school, improved health, and behaviors.

17. South Carolina - Challenges
Coordination of Care between providers
Built in conflict of interest due to providers conducting initial level of care assessment
Overcoming these challenges
Looking at policy revisions
Considering contracting out with independent person to provide level of care assessments

18. Mississippi Youth Programs Around the Clock (MYPAC)
Jennifer R. Grant
Division Director II
Special Mental Health Initiatives
Bureau of Mental Health Programs
Mississippi Division of Medicaid
(601)  
Fax: (601)

19. Mississippi - Successes
Annual MYPAC Mission Training for provider staff hosted by MS Division of Medicaid
Development of a secure web based application for the purpose of sharing information and gathering data

20. Mississippi - Challenges
Lack of technical assistance to begin the data collection piece for the National Evaluation
Through trial and error, the MS Division of Medicaid MYPAC staff began with Excel spreadsheets and later worked with a team from Medicaid’s Bureau of Systems Management to develop the secure web based application we now call eEVALUATION.
Getting the communities in the Mississippi Delta to “buy-in” to the program.
Through efforts by several child serving state agencies, as well as the MYPAC providers, education and outreach in the MS Delta increased the awareness for an alternative to a PRTF placement for youth in the Delta counties.

21. Montana Psychiatric Residential Treatment Facility (PRTF) Waiver
Laura Taffs
PRTF Waiver Supervisor Children's Mental Health Bureau
(406)    
cell (406)
fax (406)

22. Montana - Successes
High-Fidelity wraparound facilitation as a Waiver service
Engagement with providers once they understand the Waiver
Serving high-needs youth and their families in their homes and communities
Family and youth empowerment and development of self-efficacy
High-Fidelity wraparound facilitated team approach: provider collaboration on teams, family and youth voice and choice
Involvement of natural supports on teams
CMS staff at all levels have been great partners

23. Montana - Challenges
Some psychiatrists’ concerns about liability when serving high- needs youth at home
Engaging some providers in serving high-needs youth and families through non-traditional approaches
Some families’ reluctance to participate in High-Fidelity wraparound team approach (preference for targeted case management)
National Evaluation MDS requirements and reporting difficulties
Development of Caregiver Peer to Peer Support Specialists (Family Support Partners)
Provider development in very rural areas
Capacity building for the High-Fidelity wraparound facilitation process and preventing drift from fidelity to the skill sets are time- and labor-intensive.

24. Indiana Community Alternatives to Psychiatric Residential Treatment Facility (CA-PRTF)
Rebecca Buhner Assistant Deputy Director - Office of Integrated Recovery Policy and Planning FSSA/Indiana Division of Mental Health and Addiction

25. Indiana - Successes
Large Number of Participants Enrolled – State had basic understanding of Wraparound and System of Care prior to CA-PRTF Grant
Data Driven Decisions – Grant Team uses all data available to assist providers with quality improvement.

26. Indiana - Challenges
Communication with Community (Providers and Participants) – Started a public SharePoint website to enhance communication between DMHA/OMPP and the community
Providers lacking knowledge to effectively do their job – We have increased amount of required training and opportunities, Wraparound Facilitator Certification Process

27. ALASKA RPTC/Fetal Alcohol Spectrum Disorder (RPTC/FASD) Waiver
Barbara Knapp
Project Director
RPTC/FASD Waiver
Division of Behavioral Health
(phone)
(fax)

28. Alaska - Successes
PRTF Grant has increased awareness of how FASD affects behavioral challenges
Youth are frequently diagnosed with ADHD, poor impulse control, Bipolar, Oppositional Defiance, Conduct Disorder, Reactive Attachment Disorder
Because of FASD Behavioral health treatment must be approached differently
Behavioral challenges may be brought under control – but the FASD will always be there.
How has this knowledge helped Alaskan youth with behavioral health challenges?
Increased use of one to one service providers
Successful diversion from Residential Psychiatric Treatment and criminal justice system
Maintained youth in community placements longer, behaviors not escalating to PRTF levels

29. Alaska – Challenges
Lack of front-line workers - program is only as strong as the workers who do the everyday work
 New job concepts take time to get through large corporations
Flexible shifts result in Agency anxiety over less than full time employees
Frontline workers worry about making a living while working at low wages
Mentors may not offer billable skills every 15 minutes

30. Virginia Children’s Mental Health Program
Mendy Meeks
Children's Mental Health Program Director
(804)
Fax (804)

31. Virginia - Successes
July 1, 2010 VA allows financial eligibility to be based solely on the child/youth’s income.
Though the numbers may be low the projected enrollment numbers, children/youth being served in the program are doing well.

32. Virginia - Challenges Low enrollment due to several factors:
Not diversional waiver (participants must reside in PRTF for at least 90 days)
Parental income (causing more youth to be ineligible for Medicaid/Program)
Lack of continued case management
Local agencies using other funding sources and not promoting program
Limited Medicaid providers that specialize with mental health needs of youth or accept rates of services offered under the program

33. Wrap-Up and Summary of Lessons Learned
Ron Hendler, MPA
Technical Director - MFP and PRTF Programs
Division of Community Systems Transformation
Disabled and Elderly Health Programs Group
Center for Medicaid, CHIP and Survey and Certification

34. Wrap-Up With Ron Hendler
Overall lessons learned
Successes
Challenges
Next Steps