101: Wyoming s Care Management Entity & High Fidelity Wraparound. June 2015

Transcription

1 101: Wyoming s Care Management Entity & High Fidelity Wraparound June 2015

2 Today s Agenda Welcome! (Tracey Alfaro, Sr. Network Project Manager, Implementations) 101: Wyoming s Care Management Entity and High Fidelity Wraparound (Pat Hunt, Director of Child and Family Resiliency Services) Introducing the CME System of Care and the Role of Wraparound What Does this Mean for Families What Does this Mean for Other Team Members Wrap-up Contact Information and Q & A (Tracey Alfaro) 2

3 Introducing the CME Beginning July 1, 2015, Magellan will be contracted by the Wyoming Department of Health Division of Healthcare Financing (DHCF) as the Care Management Entity (CME). The CME offers a centralized vehicle for coordinating the full array of care for children and adolescents with complex behavioral health needs. 3

4 CME goals Expand to a statewide model for evolving the system of care in partnership with state agencies through a care coordination approach with HFWA as the vehicle Build a CME model that recognizes, embraces, and responds to Wyoming s strengths, unique geographic characteristics, and cultural diversity Create a HFWA Model/program that is uncomplicated for children and families regardless of their eligibility qualification 4

5 Some of our tasks Deliver training for youth and families and others who work with them Develop certification process Ensure providers meet the requirements & are enrolled in Medicaid Develop a web site, member handbook and other communication venues Establish IT infrastructure that supports the exchange of healthcare information Ensure high quality and fidelity to the HFWA model 5

6 CME Structure Program Director IT Manager Network Manager Trainer Coach Clinical Manager Mgr Quality Outcomes Community Liaison Finance Manager Data Analyst Network Coordinator Care Worker Communications Manager Customer Service Assoc. Psychiatric Consultation

7 System of Care & the role of Wraparound! 7

8 Magellan deeply appreciates the permission granted to adopt/adapt information from The Wraparound Process User s Guide A Handbook for Families for some parts of this presentation. The guide is a product of the National Wraparound Initiative. Citation: Miles, P., Bruns, E.J., Osher, T.W., Walker, J.S., & National Wraparound Initiative Advisory Group (2006). The Wraparound Process User s Guide: A Handbook for Families. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Children s Mental Health, Portland State University. 8

9 Definition A system of care is: A spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life. 9

10 System of Care Framework The ring symbolizes the team that supports youth and families throughout the Wraparound process. 10

11 Guiding Principles 1. Ensure availability and access 2. Provide individualized services 3. Include evidence-informed and promising practices 4. Services are in the least restrictive, most normative environments that are clinically appropriate 5. Families, other caregivers, and youth are full partners 6. services are integrated at the system level 7. Provide care management methods at the practice level 8. Provide developmentally appropriate services that produce optimal outcomes 9. Facilitate the transition of youth to adulthood 10. Incorporate promotion, prevention, and early identification and intervention 11. Incorporate continuous accountability and quality improvement mechanisms 12. Protect rights and promote effective advocacy 13. Serve in a manner that is non discriminating 11

12 Core Values of system of care Family Driven Youth Guided Cultural and Linguistic Competence Individualized and Community Based Evidence Based 12

13 Family Driven The needs of the child and family determine the types and mix of services provided. Family driven means that families have a primary decision-making role in the care of their children, as well as in the policies and procedures of care Please refer to handouts for discussion 13

14 Youth guided Young people have the right to be empowered, educated, and given a decision making role in the care of their own lives as well as the policies and procedures governing care for all youth in the community, state and nation. This includes giving young people a sustainable voice and then listening to that voice. Please refer to handouts for discussion 14

15 Successful approaches require a shift From Collaboration: Agencies are familiar with each other s missions and roles, key staff work with each other at the child/family level, but often retain single system decision making power and planning. To Integration: Agencies are familiar with each other s missions and roles, key staff work with each other at the child/family level, sharing decision making in a team format that includes the family, producing a single plan that meets all system mandates and that is owned by the entire team. 15

16 What is High Fidelity Wraparound? According to the National Wraparound Initiative, Wraparound is a planning process that follows a series of steps to help children and their families realize their hopes and dreams. The wraparound process also helps make sure children and youth grow up in their homes and communities. It is a planning process that brings people together from different parts of the whole family s life. The process includes a Family Care Coordinator, a Family Support Partner and a Youth Support Partner who are available to the family s team. HFWA includes people (such as trainers, coaches and process mentors) and tools to ensure best practices and conformity to the model. 16

17 High Fidelity includes Facilitators who are trained in a high number of skill sets to use a defined process to consistently implement HFWA. Standardized practice accomplished through mandatory coaching to the skill sets. Facilitators and coaches who go through a credentialing process. 17

18 Who qualifies for High Fidelity Wraparound (HFWA)? Children identified as meeting the criteria for the HFWA as determined by the CASII, ECSII and LOC must be: Youth ages six (6)- twenty (20) must have a minimum CASII composite score of twenty, and youth ages four (4) & five (5) must have an ECSII score of eighteen (18) to thirty (30) OR the appropriate social and emotional assessment information provided to illustrate level of service needs; and And may include: Must have a DSM Axis 1 or ICD diagnosis that meets the State s diagnostic criteria. Youth ages 4-21 who have Medicaid who are at risk of out-of-home placement (defined and identified as youth with two hundred (200) days or more of behavioral health services within one State fiscal year); Youth ages 4-21 who have Medicaid who currently meet PRTF level of care or are placed in a PRTF; Youth ages 4-21 who have Medicaid who currently meet acute psychiatric stabilization hospital level of care; had an acute hospital stay for mental or behavioral health conditions in the last 365 days; or are currently placed in an acute hospital stay for mental or behavioral health conditions; Youth on the Children s Mental Health Waiver (1915(c)); and Youth ages 4-21 who have Medicaid referred to the CME (who meet defined eligibility, including clinical eligibility and SED criteria). 18

19 Additional services & supports are available through HFWA Respite must be identified in the plan Access to flex funds to support plans of care with best practices and innovative solutions; tied directly to need Youth Support Parent Support Family Care Coordinator Youth and Family Training (Children s Mental Health Waiver ONLY) 19

20 Principle Family voice and choice Team based Natural supports Collaboration Community-based Culturally competent Individualized Strengths based Unconditional Outcome based Evidence of the principle in HFWA Youth and families identify their team. The team is committed to them through informal, formal, and community support and service relationships. The team is committed to youth and families through informal, formal, and community support and service relationships. Solutions include networks of interpersonal and community relationships. Team members blend perspectives to develop the plan and share responsibility for implementing, monitoring, and evaluating its results. Aims for service and support strategies to take place in the most inclusive, most responsive, most accessible, and least restrictive settings possible. Engages communities as natural supports. Respects and builds on the values, preferences, beliefs, culture, and identity of the child/youth and family, and their community. The team develops and implements a tailored approach to supports, and services that fit the youth and family The process identifies, builds on, and enhances the capabilities, knowledge, skills, and assets of the child and family, their community, and other team members. Commitment to work toward the goals included in the wraparound plan The goals of the plan are tied to indicators of success that show youth and families are getting the outcomes they say are important. 20

21 Wraparound terms (Please refer to the handout for definitions) 21

22 How Wraparound works A wraparound team (child and family team-cft) is formed to help define and refine family strengths, culture, vision and needs; prioritize needs and create the plan; and then carry out the plan one prioritized need at a time until the formal team is no longer needed because the vision of the family has been achieved. All service providers in the plan of care are expected to be a part of the CFT. 22

23 4 Phases of Wraparound This phase happens when families have gained the experience to run their own team meetings, have gained skills regarding crisis, know their team, have access to support and can continue without wraparound staff. 4) Each team member takes their assignments from the plan of care to implement it. They continue to meet to review progress, assess the plan,, make adjustments and assign new tasks Transition 3) Implement Youth & Families 1) Engage & Prepare 2) Plan A family care coordinator meets with youth and families to discuss the Wraparound Process and listen to their story. Support partners are available for families and youth. The first Child & Family Team (CFT) meeting yields a written plan of care 23

24 Elements of the plan The plan includes necessary services and supports in each life domain: Residence living situation Safety Family Legal Social Medical Emotional Other as defined by youth, family & team Educational/Vocational The team identifies natural (informal) supports and formal interventions, such as: Community resources available for youth and families - consistent with their cultural beliefs and practices May involve individuals outside the immediate family and include a variety of resources found in the neighborhood or larger community External to the child and family and, once accessed through active affiliation, become part of the child's and family's strengths therapy clinical care primary care - pediatric dental skill building 24

25 What does this mean for families? 25

26 Families will be asked - to help develop a team and make decisions with that team. to identify their family s strengths and needs. to consider with their team a variety of actions to meet needs. to understand that the wraparound plan will change regularly. to evaluate whether your plan is getting to the results or outcomes you want. 26

27 Families can expect a facilitator to contact you to get to know you and your family. to have regular team meetings. to get copies of all plans and reports including your wraparound plan and your strengths inventory. the first youth/child and family team meeting to occur within 30 days of your initial conversation with your facilitator. the wraparound facilitator to ask you to sign papers so that he or she can talk to other people in preparing for your first team meeting. to be respected and your voice to be heard throughout the process. 27

28 How families can be prepared Make an initial strengths list of what each member of your family does well, what they like and what their best features are. Make a list of who has been helpful to you or your family as well as who cares about what happens to you. Think about your goals and what you would like your family life to be like in the future. 28

29 You have a team to help your child & family You and your team will have an opportunity to evaluate whether your plan is getting the results or outcomes you want. Your plan will change regularly based on it s effectiveness or changes that occur in your family s life. As each priority need is met your new plan will focus on the next need and how to support you in getting it met as well. 29

30 Phase 1: Engagement & preparation A care coordinator and a family support partner (if you choose one), meets with youth and families to discuss the Wraparound Process and listen to their story. Youth and family members will identify who should be on their team. 30

31 Phase 2: Initial planning You ll attend your first Child & Family Team (CFT) meeting with people who are providing services to your family as well as people who are connected to you in a supportive role. You and your team will develop a crisis plan At the end of the meeting, each team member will take on agreed upon tasks. When the meeting is over, everyone will know what they have to do and how to contact other team members. 31

32 Phase 3: Plan implementation Based on your planning meetings, your team will create a written plan of care. You have committed to action steps, team members are committed to doing the work, and your team comes together regularly. When your team meets, you ll do four things: 1. Review your accomplishments and see what s going well. 2. Assess whether your plan has been working. 3. Adjust things that aren t working. 4. Assign new tasks. The plan should include skill building strategies for you and your child. 32

33 Phase 4: Transition You ll reach this final phase when you can confirm the following: You have held practice crisis drills and are confident you know what to do if things go wrong. You have a way to access services in the future. You have a way to connect with other families who have been through the process. Your concerns have been considered. You have a list of team member phone numbers who you can contact if needed. Leaving Wraparound has been discussed with the whole team. You have written documents that describe your strengths and accomplishments. Your family is running its own team meetings. 33

34 Remember.. Your plan should include natural supports. These can include friends, family members, community organizations or others who can help your family on the journey to your goals. Natural supports are also important because your team stays with you through the transition phase. After that, your family will use the formal and informal supports necessary to continue to plan on your own. 34

35 What does this mean for other team members?

36 Independent evaluators Serve as a liaison and gather data to help ensure families meet the criteria to qualify for HFWA through the CME or the state Administer CASII or ECSII Complete and submit application Participate as a team member Support youth, families and their teams by updating criteria for them to remain in HFWA as long as it is necessary 36

37 Respite Providers Respite is planned. Provides relief during stressful times Is a short term and temporary solution that matches the identified need of the participant/family Must be identified in the plan of care Strengthens skills of participants/families & offers enrichment preserving the family unit & supporting the continued residence of the child Providers are expected to be a part of the child and family team. Can be provided in the provider s residence, participant s residence or a non-institutional community location 37

38 Respite does not - Replace daycare Serve as a substitute for care otherwise available through schools or adjunct community programs Replace a crisis plan 38

39 Remember - Youth, families and other team members need you To be active participants To follow through with your commitments in a timely manner To provide them relevant & current information for making decisions Your help is appreciated! 39

40 Balancing support for youth & families Planning Team Family Care Coordinator Family Support Partner Youth Support Partner Respite Program Director CME Certified HFWA Trainer/Coach Network Manager Network Coordinator Clinical Manager Community Liaison Quality Manager Psychiatric Consultation IT Manager Data Analyst Communications Manager Customer Care Associate System HFWA Trainers Process Mentor Coaches Providers Formal services needed by families includes physical (pediatric and family practitioner), mental and dental health, etc. Communities Includes child serving systems and natural supports 40

41 How can you help youth & their families? Let them know how they can connect with other families who have similar experience (examples could include support groups, family run organizations such a UPLIFT, etc.) Let them know to call Toll-free: Share information with them about the CME Guide them to the member handbook, located at under the tab For Youth and Families 41

42 Contact Information For Provider Questions/Inquiries: Send to Beginning on 7/1/15, you can call to speak to a customer service representative or ask to be transferred to a WY CME program representative (clinical, trainer coach, network manager, etc.) Please visit the Magellan of Wyoming website at and go to the For Providers section. We will have a Frequently Asked Questions (FAQ) document posted and continually updated with answers to all questions we receive from providers regarding the implementation. Recordings of the webinar sessions, the PowerPoint presentation, and handouts will be posted here as well. 42

43 Q&A We are here to help you! Questions, Comments, Feedback, Concerns? Reminder Request: Please complete the Post Test at the end of this webinar session You should have already completed the Pre Test prior to this webinar session Please give us your feedback on today s training session by completing the training satisfaction survey 43

44 44 Thank You!

45 Confidentiality Statement for Providers The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. 45