Level of Care Tool Utilization

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Level of Care Tool Utilization

• A Multi-County Initiative
• And
• A Single County Initiative

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Southwest OhioRegional Collaborative Butler,
Clermont, Hamilton, Montgomery, Preble,
WarrenSummit County Children Services
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SORC Background

• Sept 2008, Butler Co. Commissioners
• Suggested topics
• Regional recruitment of foster/adoptive homes
• Private foster care agency reviews
• Regional contractual rates
• Integrated software pilot
• Public/key audience education
• Disaster/emergency cooperation

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SORC Initial Perceptions.
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SORC Identified Opportunities

• Given the current and future economic climate we,
  collectively, realized we could not continue to
  operate in the same manner
• Opportunity to work together to provide the best
  care to the children and families we serve
• Opportunity to better serve children both locally
  and regionally
• Improve placement stability by placing children
  in the appropriate level of care to meet their
  need

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SORC Level of Care Tool Initiative

• Increase agencys involvement in ensuring
  children are placed in the least restrictive LOC
• Ensure that placement decisions are driven by
  childrens behavioral characteristics that will
  impact the demands on the placement resource
• Promote similar provider expectations/
  requirements across the region
• Improve and streamline services to children while
  reducing administrative burdens on counties and
  providers

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SORC Placement NumbersChildren in Paid
Placements

• At the end of 2008 there were roughly 2500
  children in paid care throughout this six county
  area
• As of March 2010, there were 2409 children in
  paid care throughout the collaborative area

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SORC Placement Dollars

• In 2008, the six county region was spending in
  excess of 60 million dollars for placement
  costs.
• In 2009, the collaborative area spent 60,101,919
  for placement costs

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SORC LOC Tool Development Progression

• Functional Assessment Scale initially developed
  by Alice Lin and a research team from UNC/Chapel
  Hill School of Social Work under a contract with
  NC Department of Social Services N.C. F.A.S.
• Tested for reliability and validity from 1996
  through 1997
• In Ohio, the scale went through local
  modifications in urban counties when being field
  tested for inter-rater reliability and content
  validity

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SORC SW Tool development progression

• Hamilton County Protocol was developed in 2003
• Butler County Protocol borrowed with permission
  modified in 2008
• Alice Lin, LOC creator, customized the Southwest
  Ohio Level of Care Tool in June 2009
• SWLOC Tool assesses for Basic Foster Care,
  Therapeutic Low, Therapeutic High, Group Home,
  Residential Treatment (open and locked)

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SORC Conceptual Foundations of the LOC tool

• Focus on functioning, not DSM diagnosis,
  medications, etc.
• Consider strengths and weaknesses of the childs
  functioning
• Incorporate child welfare domains with behavioral
  health issues
• Used in combination with assessment of family and
  environmental domains
• Preserve rater discretion
• Use for admission and continued stay reviews

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Summit County LOC Assessment ToolImplementation
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Summits Background

• February 2006, Summit County Children Services
  implemented The Level of Care Assessment Tool
• Summit County developed contracted rates with
  Providers based on The Level of Care
• Prior to 2006 all rates were Provider driven

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Summits Background (cont.)

• Prior to the Level of Care and development of the
  Assessment Tool, there was no true matching
• Placements were not based on needs / behaviors

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Summits Initial Thoughts

• Children would be placed based on their needs /
  behaviors
• Ensure children would be placed in the Least
  Restrictive Environment
• Children would have only one placement in a
  custody episode
• Reduce paid placement budget
• SCCS staff originally afraid it was more work
• Some workers felt that they were losing control
  of their case
• Training for Providers, SCCS staff and Juvenile
  Court staff

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Summit Placement Numbers

• In January 2006, 318 children in Paid Placement
  
• 189 Foster Care
• 38 Group Home
• 91 Residential
• In January 2007, 375 children in Paid Placement
  
• 261 Foster Care
• 36 Group Home
• 78 Residential
• End of 2009, 212 children in Paid Placement
• 123 Foster Care
• 40 Group Home
• 49 Residential

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Summits Financial Impact

• 2005 15,329,511
• 2006 13,923,386
• 2007 13,066,856
• 2008 11,286,164
• 2009 10,759,766

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Summits Level of Care Tool

• 140 questions with narratives
• Tool automatically assigns a Level of Care
• Six Levels of Care
• Detail, Detail, Detail

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Summits Impact

• Reduction in the Paid Placement Budget
• Decrease in youth placed in Temporary ER Shelter
  Care
• Decrease number of youth placed in residential
  care
• An On Call 24/7 Placement Manager
• Development of Resource Managers Placement Unit

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Summit Goals

• Continue to stay within the Paid Placement Budget
• Decrease the length of stay for youth in
  residential care
• Ongoing collaboration with Summit County agencies
  to develop plans for step downs and emancipation
  plans
• Continue to encourage Providers to recruit foster
  homes in Summit County

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SORC Implications Impact for Providers

• Increased standardization, consistency and
  county participation in decision-making about
  level of care determination
• Having to more clearly define the services being
  provided
• Greater accountability to demonstrate outcomes
• The shared challenge of developing service
  alternatives to fill the gap while being cost
  effective

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SORC Provider Impact (cont.)

• Additional opportunities being identified for
  regional collaboration
• Providers fear losing money and in some cases, a
  reality
• Overall reduction in the use of residential
  care/decreased length of stay duration in
  residential care settings
• Providers fear losing control
• Better understanding of agency financial
  situation and funding streams available

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SORC Provider Impact (cont.)

• Increased competition for our business
• Opportunity for dialogue with counties
• Change is hard, for some..and welcomed by others
• Unfunded Mandates claimed by some
• Some felt the tool was a threat, until the tool
  was shared with the provider group

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SORC Impact on Agency Staff

• Staff afraid they were losing discretion
• Staff afraid of more work
• Differences of opinions if being completed by
  UM/UR versus Caseworkers
• Fear of provider response

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SORC Challenges of Implementing

• Bridging communication gap given variety of
  names for levels of care
• Distrust in tool validity/reliability
• Financial impact on providers
• Meshing small county with large county needs
• Dealing w/ opposition

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SORC Benefits of implementing

• Uniformity from county to county
• Open dialogue between counties
• Improved dialogue w/ providers
• Reduction of costs
• Improved confidence of staff in requesting
  placement type

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SORC County to County comparison

• All six counties using now
• Still some variance from county to county
• Completed by UM/UR or Caseworker
• Scored by Supervisor, UM/UR dept, CW, FCFC
• Timing of reassessments

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Ultimately, both SORC and Summit find
Public agencies and private providers share the
common goal of providing quality services to
youth.