National Wraparound Initiative Technical Assistance Call Transcript. Family Members as Wraparound Facilitators And Funding Wraparound with Medicaid

Transcription

1 National Wraparound Initiative Technical Assistance Call Transcript Family Members as Wraparound Facilitators And Funding Wraparound with Medicaid NOTE: There four sections to this call. Each has been made into a separate section in the transcript. 1) Introductions 2) What has been communities experience using family members to facilitate wraparound teams? 3) A section that touches on both topics Can family facilitators be paid from Medicaid funds? 4) How are communities using Medicaid or billing Medicaid within Wraparound? Introductions Beth Burke: Executive Director for Families ETC, we are a family organization that was developed out of our McKenry County Family Care System of Care and we are about 18 month olds and before I had this position I was the lead family contact for the system of care and while I was the lead family contact this was when we started to actively recruit, train and hire family resource developers to be calling families to forever be family facilitators. Terry, who is one of our initial Wraparound facilitators who I am going to let her introduce herself. Terry Lindohl: I am a wraparound facilitator but I am also a parent. I have been involved in wraparound for 6 years going on 7 years. I initial got involved with wraparound because my son, the school did a referral for my son and they didn t have any money to be a facilitator for my son and I was founder and had to leave my job to take care of him and volunteered to learn how to become a wraparound facilitator so my son could get the services and I have been here ever since. Thank you for having me. Gina Doyle: I am the clinical director with the Dawn project. The Dawn project is one of the program of choices in IN and we are system of care here in Mary County and have been system of care for the last 13 years. Our program director is here and I will let him introduce himself. Ken Shield: I am the program director of the Dawn project and have been here for about 12 months. Janet: We put this call together at least from our end from the National Wraparound Initiative in response to two sets of questions we were told were of interest to the participants in the call. The first one was: What has been communities experience using family members to facilitate wraparound teams?

2 and obviously that is the one that Beth and Terry are on the phone to respond too. The other one was: How are communities using Medicaid or billing Medicaid within Wraparound? What has been communities experience using family members to facilitate wraparound teams? Janet: I think it would be good to start with the first one. I don t know if anyone has more clarification of exactly what issues they liked, what Beth or Terry could speak to or whether it might be best for them to start by describing what they did and some of the challenges and benefits from organizing things in that way. Beth/Terry: Do we want to start out asking questions about using family partners and Wraparound facilitators, using specifics, you may want Beth to answer? Wendy: We had asking questions about that because we are a new system of care and will be doing our first intake October 1 st and we will have family support providers in TN, family support providers that are family members acting as facilitators. They will work together with mental health consultants who are primarily master levels people working as consultants with them on mental health case and crisis planning and all other kinds of things like that. I actually just got back from doing High Fidelity Wraparound Training with John VandenBurg and in the course of that, it came up that there were several issues around using family members as facilitators and possibly not being able to provide general family/peer support for families when that happens. We are in the process of starting to provide training for our family support providers to our entire staff. Here are our questions: 1) What should we be looking out for in terms of hiring family support providers if they are going to be facilitators what qualities should we be looking for? 2) What types of training tips can you give us in terms of helping these family support providers being able leap into action facilitating these teams specifically facilitation skills? 3) Do you have any experience balancing family support providers and mental health consultants on the same Wraparound team what you suggest around that? Beth: I am going to take a stab at answering the first question and Terry I would like you to respond to the training question and then we could both kind of stab at the third question if that is okay with you Terry? Sure no problem Beth: What would you look for in the hiring qualities? One of the most important qualities would be making sure the people you hire for that position have worked through their initial challenges with systems of partners. As you know there are going to be times that facilitators may need to work with someone from the school and if they are still not completely working through some of the triggers that may set off anger that is going to set your work back. So probably making sure the person you hire has worked through and can identify what those triggers are. That doesn t mean you have to hire someone perfect, we all certain thing that set us off but we need to learn how to work through them. I think that is where you clinical partners will be most beneficial to the parent Wraparound facilitator. We also looked for someone who had knowledge of the various systems that might be included on a child/family team. If they just came with one perspective they may have a harder time guiding the team but that

3 doesn t mean they cannot learn. So if you are hiring more than one, that one is not quite as important to adhere too. The most important thing would be working through those communication glitches and hiring someone who knows how to access resources who has had experience doing that who might be connected in the community. The most important thing is making sure you are putting someone in that position who has worked though their own issues and can articulate and organize a family/child team. Beth: One of the questions you had was: Balancing mental health consultants with the family support and we did have some initial challenges with that. I think no process, when you are developing a new process, nothing comes without some conflicts and some challenges and as long as you know that going in and you commit to being open and honest and putting things on the table in a respectful way, you are going to learn a lot from that process. I heard someone say something about a challenge using family members as facilitators and not being able to provide enough support that is where families ECC comes in. When we have a lot of our family resource developers and Wraparound facilitators will actually call us and we can provide that parent/peer support so that they can focus on developing that family/child team. There is a way to do that you just have to explore how that is going to look within your own community and committing to the process and prioritizing what you need to get there is going to be most beneficial. Call member?: We are just wondering when you say we have hire or we have done this, can you tell us again who the we is? Beth: Good question because when we started the process, our system of care grant management leadership team was the one who did the recruiting and the interviewing, hiring and training that was led by me as the lead family contact that was basically because I had had experience working with our state federation of family chapter. We, meaning the mental health ward/family care hired the initial the family resource developers. We went through process of interviewing in a very different way. Thinking back it was probably a little intimating to some of the parents who came for the initial interview. Then we gave our recommendation based on our criteria to the agencies that expressed interest in having a family resource developer. Our family resource developers are housed in mental health agencies and one was housed in our regional office of education and in the initial period we often had one housed in our Latino coalition but the Latino coalition closed so they are now the two mental health agencies. They are now hiring their own family resource developers but they look to me to provide names of people who have met that readiness check Wendy: Is one of your resource centers the Mildred Berry Center. Beth: The Mildred Berry Center is in Blackbird that is in Winyah Bay? County which is two counties away. Our state has family resource developer that are attached to our staff, our training assessment and support services team that is statewide. We took that to the next level. Our statewide, we had mental health agencies like the Mildred Berry Center who had parents working for them but not all of them knew how to use the family resource developers to support parent and using them as clerical workers. So what we did is we took that position and took it to the next level using the Federal dollars to support that work.

4 Janet: Could you just clarify for me a little about the staffing patterns. So as far as the family resource developers were, if not on facilitating teams, were on an as needed basis for the team, is that correct? Do the clinical people (Master level) work consistently with team as a single team and come to all the meetings or acting more as an outside consultant? Beth: Our clinical Wraparound facilitators and Terry feel free to jump in and add to this. They work with the families who maybe the parents have some mental health issues as well. Our Wraparound facilitators work full time, they have a full case load probably more families than they probably should have. They don t work as the family support partner that are employed by the family ECC, those people/peer supports are brought in on a family/child team once that is assessed and the parent has agreed they want more family/peer support. Terry: We do use two Master level Wrap facilitators and then we have three parent partners Wrap facilitators and what we usually do is we have a case that we have been given and feel needs clinical consultant. We will pull either a Masters level clinician on the case who is a wrap facilitator. That is usually what we do. Then I like to address as far as the hiring piece, I would like to go back to that. My suggestion is that you choose from one who is going to be objective. What I mean by that is someone who realizing they have their own family story, however their family story is not like all of the other families that they are going to be working with. They can recognize how their own family situation felt like that they certainly can never understand how this family feels. Do you see what I am saying? So they can just be empathetic but not try to push their family solutions onto a new family. I quickly learned that each family is unique and I cannot possibly know how they feel. I do think it was blessing for us to become Wrap facilitators because as soon as the family learns we are parent partners they seem to be a little bit more open and sharing information and it seems to build a rapport a little bit quicker. We found it to be very beneficial in the engagement process. This next section of the call touches on both topics Can family facilitators be paid from Medicaid funds? Call Member?: My question is how are you funding this? Are you still using Federal dollars? Or have you found a funding source for non credentials or licensed people to be paid? Beth: One of our agencies is billing Medicaid and they have found a way to bill 45% of their time, I believe is Medicaid billable. They are looking at other funding sources to pay for the remaining. We have been very fortunate to have tried this under the System of Care having the Federal dollars at our disposal. Family services is also working on that Medicaid piece but Terry I not sure you have actually bee billing yet, have you? Terry: I am doing the billing process however they are not actually billing yet Call member?: We would love to go over how you bill Wraparound with non licensed people and for Wraparound Services for family members.

5 Eric: My understanding is that this is somewhat dependent on the State Medicaid plan and whatever or not peer support is something in the Medicaid plan, is that true? Beth: Yes. Our state allows for that. It depends on how you, what you have been doing and how you have been providing the support and if there is somebody else on the team who is billing Medicaid. I don t think, from the same agency, then we cannot bill for the time. So it is a very strategic process they are going through and as a result they have to put a lot of time and effort into teaching them how to write their progress notes. There is a coding they use for the work they are doing and they are not billed at the same rate as someone with a Masters level but this is something our community has embraced as a much need value and so they have accepted that. Eric: My best understanding of that, at least in our state of Washington, there are provisions for peer support to be provided and billed to Medicaid in our state plan but more so perhaps than the individual who are able to bill for their time doing peer support/family support. The issue is whatever or not they have been hired or admitted within an organization that is licensed clinical service delivery site. There is only one such building, one parent organization in Washington that is gone so far to establish itself as enunciate bill with all of the licensing and insurance requirements but if folk are interested in contacting that person in Spokane Washington. She has a lot of stories to tell about the process of being able to set their organization up such so they can bill Medicaid for the time of their family support partner. Beth: Eric do you have? contact information? Eric: I will look but I think the thing to do is to ask her if people can contact her and I could provide a list of people who want to contact her along with information about this call. Eric: People were talking a little bit in the last conversation about different ways to set up the capacity to provide family partner support and I just wanted to plug in for folks to be aware that there are at least five articles in the Resource Guide to Wraparound with titles such as How Family Partner Contribute to the Phases and Activities of Wraparound, Building of Family Partner Foundations: A dozen mistakes in using family partners in wraparound by Pat Miles and so forth and that can all be found at the National Wraparound Initiative website. If you go to the resource guide you will find all these articles including at least one that lays out examples of the many options for supporting family support partner work in a Wraparound project. Gina: That sounds great but maybe it would be best if we talked about this in another call Janet: That sounds like a good idea. I want to make sure that Terry has a chance to make any more comments and then in the interest of fairness since we also have Gina on the call too, to start figuring out the questions we have about Medicaid are. Terry: I just want to address the types of training. I have been offering ongoing trainings. It is very important that you; there are certain trainings our supervisors have asked us to go to, one of them would be the Transitional Youth Training, The Transition to Independence Conference, there are so many trainings that I could begin to tell you. I think that giving your parent partner access to the

6 trainings but minimally giving weekly supervision with a clinical clinician and senior parent partner is a good idea. Somebody who can give expert advice, there was a lot of lack of area in the beginning but we have definitely master that now. We have a supervisor accessible to us whenever we need her. We have a parent team leader position that is being developed here and I think those are actions in a positive direction. As far as the other question, balancing yourself as a Wraparound facilitator, I think that is a fine balance and I have learned a lot this year as far as balancing the work schedule and the emotional impact and also the challenging lifestyle I have at home. I think making sure your parent partner takes the time they need to get the things done. Also helping them learn to set boundaries, helping them learn balance their needs and challenges at home with the needs and challenges at work on top of the needs and challenges of family they were going to be supporting. It was very easy to get to the burn out point and putting them through the training we did at the beginning but that ongoing training and ongoing supervision is critical. How are communities using Medicaid or billing Medicaid within Wraparound? Gina: We have a contract with the Department of South Services to provide Wraparound services to youth they refer to us. Both who are referred to Child Welfare and Juvenile Court and then we also have a contract with a local school district in their specialized department. All of those referral sources pay at the case rate to manage the care for the children we service. Up to a couple months ago, we have begun subcontracting with community mental health centers in Indianapolis to provide us with teen coordinators and supervisors that were actually Wraparound facilitators. In Indiana, you had to be an employee of the community mental health center in order to bill Medicaid rehab options that person for Medicaid for case management. That is how we funded those positions up until just a couple of months ago. The care coordinators were all billing case management for the various tasks they were doing, facilitating team meetings, collaborating with other professionals and doing family visits and their various assessments and things like that. Because of the changes in the Indiana state Medicaid we have ended our partnership with the community mental health centers because in Indiana the Medicaid rehab options would really going to limit the capabilities of our staff, the care coordinators to be able to build upon what they were doing. Up until just recently our care coordinators were billing Medicaid rehab options for case management. Any questions about that? Eric: I would just like to say it is a pretty typical approach to trying to access Medicaid resources is going through the rehab options or case management maybe just a little more about the pluses and minus, or that were problematic in using that option. Gina: Certainly one of the things that was difficult was whatever agencies billed Medicaid you really have to follow a medical model and so all of the things that were being billed for had to be medical necessary and relate back directly to the treatment plan and be signed off for by the psychiatrist or the agencies psychologist. In doing Wraparound 100% of the activities that are needed like care coordinator really don t fall into the strict medical model definition, so that was one of the problems. Also there was an ongoing challenge in documenting because the work we do really takes a strength based approach to our work but really all the documentation needs to be deficit based and so care coordinators had to

7 juggle that so that the work they were doing/documenting reflected the medical necessity but also reflect the strength and capabilities of the children/youth we were serving. Janet: So as far as documentation, did you have to have two sets of documentation? One for the team to maintain the work and the other to report for Medicaid purposes or were you able to fuse those two so you didn t have a double documentation burden on your facilitators? Gina: We had one documentation but it was difficult for the care coordinators to juggle that. It was difficult for the care coordinators who came from mental health center and very use to the medical model to flip to a more strength base approach and it was difficult for those folks who had never worked in psychiatric hospital or community mental health center to understand how to document within that medical chart but relate to people in a more social rehab model. Janet: Can you describe some of those services or activities that weren t Medicaid billable under the rehab options? Gina: Sure, one of the big things was just spending time with the kids and the families. And getting to know them and build stronger relationships and repertoire with them and that just takes time. I think that was really difficult to justify to Medicaid because sometimes it was just stopping by a family s house on your way home from work to see how they were or sharing a meal with them. That can be difficult to tie back to the treatment plan. Call member?: Can you discuss a little more about your population? Are you in a rural area? Gina: We are in a urban area. Call member?: Can you also talk about your crisis plan with your care coordinators? Gina: Here in Indiana, we have a community mental health center that we partnered with and they all have a way of handling crisis s for their clients however, when a family or child was being served by us through their staff, we really utilized the whole team, the community and the supports that were available to respond to crisis. The respond from the community mental health center was typically was a very small piece of that crisis plan. Gwen: What were some of the non billable services of Medicaid? I know if California which is called Medical, travel, when you travel to different locations that is not billable but to get around that what the parent partners did was to have a conversation or a strength assessment or even talk about skills the parents needed to learn while traveling and that particularly time was billable because you were teaching the parents strategies that would help the child. Gina: We did that too. Even though this is an urban environment we live in, our County is still pretty large where children can be up to an hour away from here. So we face that too. For our staff, a lot of times they were not able to bill for the whole amount of time that they spent doing the transport or waiting for the court case to be called. There are multiple ways to document using SOAP, SOAT with a similar format which focuses what you are writing in your progress note

8 Liz: Question for the Donn project.who request the % of the facilitators salary that you were able to bill when they were subcontracting with the mental health center when they were billing Medicaid? Gina: I think it really varies. Most care coordinators bill approximately hours of case management. I don t know what their salaries were I think they were in the range of low 30 40,000 dollars and what we were told is that care coordinators need to bill a minimum of 80 hours a month but probably between hours to sustain their position with their salary and benefits. We had 6 or 7 care coordinators per team that support one supervisor. Call member: Were the 6/7 care coordinators able to sustain their position? Gina: For the most part yes. Call member: Were you able to pay those people on the team who came from other agencies, we called them flex funds. Gina: Yes, actually all those funds are flex funds and it is our job to manage the money and met the children s needs. We were able to pay everyone who came to team meetings who were not able to bill Medicaid. We would pay them their hourly rate for whatever service they provide for their services. Call member to Gwen: I have a question to follow up on very good information about the family support partners and mental health consultants. We are in the process of hiring the mental health consultants and she thought of what are the factors she should consider for hiring these people? Cheryl?: One of the things she is looking at is hiring people right out of school not only for salary reasons but because they don t have that other way imprinted in their minds. I would like to ask a question about whatever or not you have any more tips for us about what we should be looking for in a good mental health consultant? Gina: When we hired a large group of care coordinators just a couple of months ago, we actually had them come in a groups and we did an overview about our agency. We broke them up into small groups and in those groups we facilitated discussions about various topics that had to do about Wraparound. We got to see how people communicated, what their understanding was of the question and what their opinions were about the responses. We also got to see how they reactive in a group setting which was very helpful to us. Eric: We haven t heard about the benefits of trying to make sure you don t base staff selection on any role simply on some sort of interview, some typical job interview with candidates but to provide them with some sort of opportunity to demonstrate how they might respond to different types of situations. I know that Kim wanted to have an announcement made about joining the Family Leadership Call on the second Thursdays of each month but I will send you that information via on how family partners join that particular call.

9 Eric: Great stuff in the Resource Guide to Wraparound on both of these topics. Just go to wrapinfo.org and click on resource guide to wraparound and there is an article in there called Financing Wraparound: There is much more than money and talks about the Medicaid Billing that we were just discussing. If you have additional questions or concerns, you can me and I will try to find out by contacting either Eric or Janet. Thank you and have a great weekend.