managing residential care to improve permanency outcomes presented by: dr. peter mendelson, chief,...
TRANSCRIPT
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
198
22495
0
50
100
150
200
250
300
350
400
# o
f D
ay
s
Statewide 330 300 287
CY '08 CY '09 YTD '10
∙ 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 198
22395
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
% o
f C
hil
dre
n D
isch
arg
ed
LLOC Discharges 48% 53% 55%
CY '08 CY '09 YTD '10
· 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 0-180 days Post
RTC Discharge
46
61
11
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
% o
f C
hil
dre
n H
osp
ital
ized
% of Children Hospitalized 10% 14% 13%
CY '08 CY '09 Q1 '10
Baseline Performance-Percentage of Children Arrested 0-180 days Post
RTC Discharge
14
17
13
10 54
0%
5%
10%
15%
20%
25%
30%
% o
f C
hil
dre
n A
rres
ted
% of Children Arrested 23.3% 26.6% 18.3% 22.2% 22.5%
Q1 '09 Q2 '09 Q3 '09 Q4 '09 CY '09
Baseline Performance-Percentage of Children Readmitted 0-180 days Post
RTC Discharge101
91
12
0%
5%
10%
15%
20%
25%
30%
% o
f C
hil
dre
n R
ead
mit
ted
% of Children Readmitted 23% 21% 15%
CY '08 CY '09 Q1 '10
· 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.
0
100
200
300
400
500
600
700
800
900
# o
f A
dm
its
Children 635 721 632
CY '07 CY '08 CY '09
Number of IICAPS Admissions
▪ IICAPS admissions have increased by 92% between CY ’07 and CY ‘09
0
200
400
600
800
1000
1200
1400
# o
f A
dm
its
Children 644 965 1236
CY '07 CY '08 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