Managing Residential Care to Improve Permanency Outcomes

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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
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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

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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

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Partnership, contd

• 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

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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

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Understanding the Needs and Opportunities, contd

• 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

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Understanding the Needs and Opportunities, contd

• 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

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Looking at Outcomes Opportunities for Improving
Permanency

• Research shows that a childs 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.)

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Looking at Outcomes Opportunities for
Improving Permanency, contd

• 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

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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

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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
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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
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Baseline Performance-Percentage of Children
Hospitalized 0-180 days Post RTC Discharge
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Baseline Performance-Percentage of Children
Arrested 0-180 days Post RTC Discharge
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Baseline Performance-Percentage of Children
Readmitted 0-180 days Post RTC Discharge
Percentage of children readmitted decreased by
8 from CY 08 to 10 YTD
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Number of RTC Admissions
? RTC admissions have decreased by 12 between CY
08 and CY 09.
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Number of IICAPS Admissions
? IICAPS admissions have increased by 92 between
CY 07 and CY 09
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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

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What Have We Learned, contd?

• 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