Innovation in Monroe Innovation in Monroe CountyCounty

Jody Levison-JohnsonDirector

Child & Family Service Quality & System DevelopmentCoordinated Care Services, Inc.

Technical Assistance CoordinatorMonroe County ACCESS

Presentation to the

Building Bridges Innovative Practices Workgroup

July 19, 2007

Monroe County, New Monroe County, New YorkYork

Upstate New York Upstate New York City of Rochester and City of Rochester and

surrounding areasurrounding area County Population: County Population:

735,343735,343 City Population: City Population:

219,773219,773 19 school districts19 school districts County driven systemCounty driven system

Monroe County Monroe County contextcontext Phase V funded system of care Phase V funded system of care

community (2005)community (2005) Collaborative efforts prior to cooperative Collaborative efforts prior to cooperative

agreement funding primarily between:agreement funding primarily between:– Office of Mental Health (mental health)Office of Mental Health (mental health)– Child & Family Services (child welfare)Child & Family Services (child welfare)– Office of Probation-Community Corrections Office of Probation-Community Corrections

(juvenile justice)(juvenile justice)– Coordinated Care Services, Inc.Coordinated Care Services, Inc.

Coordinated Care Coordinated Care Services, Inc. – HistoryServices, Inc. – History Management services organizationManagement services organization Originally incorporated in 1984Originally incorporated in 1984 Administered NYS demonstration Administered NYS demonstration

project on local management & project on local management & financing of mental health servicesfinancing of mental health services– Service planningService planning– EvaluationEvaluation– Community-wide information systemCommunity-wide information system– Alternative financing strategies including Alternative financing strategies including

capitation plan for adults with serious and capitation plan for adults with serious and persistent mental illnesspersistent mental illness

Reorganized in 1992 to become CCSIReorganized in 1992 to become CCSI

Coordinated Care Coordinated Care Services, Inc. – CurrentServices, Inc. – Current Departments:Departments:

– Child & Family Service Quality & Child & Family Service Quality & System DevelopmentSystem Development

– Adult Service Quality & System Adult Service Quality & System DevelopmentDevelopment

– Evaluation & Services Research Evaluation & Services Research (including Data Analysis)(including Data Analysis)

– Cultural & Linguistic CompetenceCultural & Linguistic Competence– Financial ServicesFinancial Services

Coordinated Care Coordinated Care Services, Inc. – CurrentServices, Inc. – Current Contract manager for the Monroe County Contract manager for the Monroe County

Office of Mental HealthOffice of Mental Health Project Management/Administration for Project Management/Administration for

several Monroe County initiatives several Monroe County initiatives including:including:– Family Access & Connection Team (integrated Family Access & Connection Team (integrated

entry point to care)entry point to care)– Youth & Family Partnership (care coordination)Youth & Family Partnership (care coordination)

Technical assistance and consulting across Technical assistance and consulting across NYS and in other communities in key NYS and in other communities in key service areasservice areas

The First StepThe First Step

Integrated and InnovativeIntegrated and Innovative

Care CoordinationCare Coordination

The impetusThe impetus

Silos which led to:Silos which led to:– ConfusionConfusion– FrustrationFrustration– DuplicationDuplication– ComplicationComplication– CompetitionCompetition

Family Voice: Keep it simpleFamily Voice: Keep it simple

The mandatesThe mandates

Family safetyFamily safety PermanencyPermanency Community safetyCommunity safety Personal safetyPersonal safety Emotional health and well-beingEmotional health and well-being Family voice and choiceFamily voice and choice

Youth & Family Youth & Family PartnershipPartnership

Innovative cross-system wraparound initiative Innovative cross-system wraparound initiative using child and family team processusing child and family team process

Created prior to receiving SAMHSA fundingCreated prior to receiving SAMHSA funding Redeployed staffRedeployed staff

– Mental HealthMental Health– Child WelfareChild Welfare– Juvenile JusticeJuvenile Justice

Initially 25 child/family pilotInitially 25 child/family pilot Comprehensive evaluation to demonstrate Comprehensive evaluation to demonstrate

outcomesoutcomes Expanded to serve 100 children and familiesExpanded to serve 100 children and families

YFP Program ModelYFP Program Model

Cross-trained care coordinators carry Cross-trained care coordinators carry out requirements of each departmentout requirements of each department

Serve as facilitator of child and family Serve as facilitator of child and family team processteam process– Identify strengthsIdentify strengths– Identify and prioritize needsIdentify and prioritize needs– Brainstorm options (traditional and non-Brainstorm options (traditional and non-

traditional responses)traditional responses)– Family driven/youth guidedFamily driven/youth guided– Respect for family cultureRespect for family culture

SuccessesSuccesses

Development of learning organizationDevelopment of learning organization Paved the way for future Paved the way for future

collaborationcollaboration Provided foundation for SOC grant Provided foundation for SOC grant

applicationapplication CQI processes in placeCQI processes in place Significant County cost savingsSignificant County cost savings Family satisfactionFamily satisfaction Family functional improvementsFamily functional improvements

YFP outcomesYFP outcomes

34%

26%

41%

32%

38%35%

52%

68%

19%

24%

32% 27%34%

19%

50%

60%

0%

72%

65%

58%

66%

88%

0%

14%

22%

40%

21%

24%

43%

69%71%

53%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Imp

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core

Domain

Percent improvement on CAFAS

Y1

Y2

Y3

Improvements in Functioning

YFP outcomesYFP outcomes

Family Satisfaction

   Y1Y1 Y2Y2 Y3Y3

Family reported Family reported overall satisfactionoverall satisfaction 76%76% 82%82% 86%86%

Family reported Family reported improvementimprovement 81%81% 88%88% 81%81%

Family would Family would recommend YFPrecommend YFP 80%80% 91%91% 84%84%

YFP outcomesYFP outcomes

Fiscal

$-$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000

Month

ly C

ost

Year One Year Two Year Three

Per Child Per Month Cost

Residential YFP

ChallengesChallenges

Integration of roles & staff re-trainingIntegration of roles & staff re-training Adjustment in family thinkingAdjustment in family thinking Moving from paternalistic to fiduciaryMoving from paternalistic to fiduciary Real collaboration = real conflictReal collaboration = real conflict Working in a vacuumWorking in a vacuum FidelityFidelity Providing the right types of supportProviding the right types of support

The Next StepThe Next Step

Integrated and InnovativeIntegrated and Innovative

Residential CareResidential Care

The impetusThe impetus

Youth and families in YFP Youth and families in YFP needing:needing:– StabilizationStabilization– Time awayTime away– Focused interventionFocused intervention– Intensity of milieuIntensity of milieu

County placement rates County placement rates remaining highremaining high

The mandatesThe mandates

Family safetyFamily safety Community safetyCommunity safety Personal safetyPersonal safety Emotional health and well-beingEmotional health and well-being Family voice and choiceFamily voice and choice Community teamCommunity team

CFT Driven ResidentialCFT Driven Residential

One provider agreed to serve as One provider agreed to serve as pilot/demonstration sitepilot/demonstration site

Concurrent enrollment in residential Concurrent enrollment in residential care and community-based care care and community-based care coordinationcoordination

Child and family team drives plan of Child and family team drives plan of care including all service and support care including all service and support decisionsdecisions

Emphasis on short-term stay for a Emphasis on short-term stay for a specific purposespecific purpose

Attempting to turn residential inside-outAttempting to turn residential inside-out

SuccessesSuccesses

County-Provider partnershipCounty-Provider partnership Testing new waters collaborativelyTesting new waters collaboratively Placements closer to homePlacements closer to home Active connection between youth Active connection between youth

and families while in placementand families while in placement Foundation for planned efforts to Foundation for planned efforts to

redefine residentialredefine residential Families have experienced successFamilies have experienced success

ChallengesChallenges

Staff role changes and re-trainingStaff role changes and re-training Adjustment in family thinkingAdjustment in family thinking Moving from paternalistic to Moving from paternalistic to

fiduciaryfiduciary Real collaboration = real conflictReal collaboration = real conflict Working in a vacuumWorking in a vacuum FidelityFidelity Providing the right type of supportProviding the right type of support

Challenges (continued)Challenges (continued)

Regulations and requirements of Regulations and requirements of funders and accreditorsfunders and accreditors– Unbundling of servicesUnbundling of services– Balancing value of treatment milieu Balancing value of treatment milieu

with individualized carewith individualized care

Questions and Questions and CommentsComments

Contact InformationContact Information

Jody Levison-Johnson, LCSWJody Levison-Johnson, LCSWDirectorDirectorChild & Family Service Quality & System Child & Family Service Quality & System

Development Development Coordinated Care Services, Inc.Coordinated Care Services, Inc.andandTechnical Assistance CoordinatorTechnical Assistance CoordinatorMonroe County ACCESSMonroe County ACCESS1099 Jay Street, Building J1099 Jay Street, Building JRochester, NY  14611Rochester, NY  14611(585) 613-7648(585) 613-7648jlevison-johnson@ccsi.orgjlevison-johnson@ccsi.org