Residentially Based Services Reform
in California
What is RBS Reform
•	California's Residentially-based Services Reform initiative seeks to transform the state's group homes, currently providing long-term congregate care and treatment, to programs combining short-term residential stabilization and treatment with follow-along community-based services to quickly reconnect youth to their families, schools and communities.

•	In 2007, with the passage of AB 1453 (Soto), support of the California Department of Social Services (CDSS), financial support from Casey Family Programs, and the creation of the RBS Reform Coalition, reform of the State's system for care and treatment of youth with challenging needs came to fruition. 

•	The legislation authorized selection of four counties or consortia of counties that, with private partners, will implement alternative program and funding models consistent with the framework document that defines and describes RBS. The lessons learned from these projects will inform planning for statewide implementation of RBS reform due to the Legislature in 2011.

Los Angeles Model

•	Los Angeles selected by State to participate in RBS

•	Parallel to State reform Los Angeles also working on Group Home Reform since 2005

•	The ResWrap* model Hathaway-Sycamores Child and Family Services developed with three other providers in Los Angeles in 2004, and presented at previous Alliance Conferences, became the basis for the development of the Los Angeles RBS reform model

•	*ResWrap combines Residential and Wraparound approaches

LOS ANGELES COUNTY RESIDENTIALLY BASED SERVICES DEMONSTRATION PROJECT
OPEN DOORS

    	Los Angeles County was selected, along with three other counties (San Bernardino, Sacramento and the Bay Area Consortium) to participate in an AB 1453 “Residentially Based Services” (RBS) demonstration project to shorten timeframes to durable permanency for children who face a residential stay. LA’s plan is to infuse residential care with Wraparound principles (active family voice and choice, facilitated planning process, care coordination, family finding), and transform the traditional residential milieu to a therapeutic community without walls. 

Note CA is a IV-E Waiver State and Los Angeles County is operating as one of two IV-E Waiver 
Counties in CA providing it greater flexibility in funding models than other Counties

Values
•	Children belong at home in their community

•	Families are experts on themselves and their children

•	Family culture is acknowledged and honored

•	Planning and treatment are individualized and strengths-based
 
•	Family involvement and connections are essential

•	Strong communities make strong families

•	Whatever it takes

Key Components of Model
•	Target Population
•	Children in or at risk of RCL – 12/14 placement (high-end placements)
•	52 bed demonstration 
•	Approximately 160 children to be served in 2 years

•	The RBS Collaborative Partners
•	DCFS
•	DMH
•	Five Acres  -  		(Boys only -   Ages 6-14 -   18 beds - 2 open)
•	Hillsides  -  			(Co-ed        -   Ages 6-17 -   18 beds - 2 open)
•	Hathaway-Sycamores  - 	(Boys only  -  Ages 6-17 -   16 beds - 1 open)

•	Innovations
•	Treatment without walls
•	Family search, engagement, preparation and support from Day 1
•	Flexible funding to support innovation
•	Waiving RCL requirements

 Key Components of Model continued
•	Key Features
•	One Child and Family Team across all environments 
•	One plan of care
•	Crisis stabilization without replacement
•	Respite in the community

•	Outcomes (see resources for details)
•	Safety, Permanency and Well Being;
•	Decreased length-of-stays in residential placements;
•	Reduced re-entry
•	Increased use of informal or “natural” community supports

•	Performance  Measures   
•	CAFAS		School Report Card 
•	CANS		WFI-4
•	YSS		Client Demographics
•	YSS-F		Changes of Placement 

Client Eligibility Criteria

•	Must be a Department of Child and Family Services (DCFS) Client

•	Would Otherwise Need RCL 12 or 14 Placement
•	As Determined by Resource Management Process & CANS (Child and Adolescent Needs and Strengths)
•	Must Enter Residential Treatment Program

•	Will Need Significant Community Development Work to Achieve Permanency

•	Will Need Significant Family Finding and Development Work to Achieve Permanency
•	Having or not having family not a criteria for admission
•	Bridge care available if family is not ready (foster home, relative home)

•	Will Need Intensive Services Post-residential to Sustain Permanency*

* DCFS case must remain open throughout arc of care

Benefits to Child and Family
•	One Child and Family Team Across all Environments
•	Care Planning Unifies Residential and Community Treatment
•	Family Search, Engagement, Preparation and Support from Day 1
•	Building Life Long Connections and Natural Supports from Day 1
•	Concurrent Community Work While in Residential
•	24/7 Mobile Crisis Support When in Community Phase
•	Crisis Stabilization Without Replacement (14 days)
•	Respite in the Community

Key Fiscal and Policy Challenges
Fiscal
•	How to build a better funding model
•	How to creatively overcome existing methods of payment
•	Blending funding streams to pay for model
•	Determining IV-E Allowable Costs in model 
•	Waiving the RCL System

Policy
•	How to change current attitudes toward residential care
•	Using data to determine how children fare
•	Leadership for Reform (CA Alliance / LA County/Providers/ Casey Family Programs – $ support for reform)
•	How long public policy changes take to implement
•	How to market project to “powers that be” (County BOS/State Officials/County Social Workers etc.)

Fiscal Model for Los Angeles
•	The RBS providers will be paid a new RBS case rate which will fund up to ten months in residential care, a Child and Family Team, concurrent family finding engagement, preparation and support, respite, crisis stabilization, and intensive parallel community-based interventions including the development of connections. 
 
•	After ten months of residential care (not necessarily concurrent) have been used, the rate will convert to a lower rate to incentivize providers to reconnect children with their families and communities and return them quickly to home based settings.  

•	Waiving the RCL System for the RBS Units only; the RCL system will no longer apply so that all Open Doors beds (formerly RCL 12 or 14) represent a single level of care. The Waiver Request reflects the transformed staffing and treatment model outlined in the Voluntary Agreement and the Funding Model.  
Fiscal Model for Los Angeles continued
Current Funding Model-
•	Utilizes a Rate Classification System (RCL 1-14) for payment of residential care.  High-end placements are considered RCL 12 – 14.  Community Wraparound may be utilized after a child leaves the residential program

•	Residential (see resources for details)
•	RCL 12 – (7/1/09 -$5891)  (10/1/09 - $5302) (11/4/09 - $5891) (12/14/09 – $7794) 
•	RCL 13 -  (7/1/09 -$6294)  (10/1/09 - $5665) (11/4/09 - $6294) (12/14/09 – $8319)
•	RCL 14 -  (7/1/09 -$6694)  (10/1/09 - $6025) (11/4/09 - $6694) (12/14/09 – $8835)
•	Mental Health – EPSDT (unlimited)

•	Community Wraparound
•	Tier 1 - $4184
•	Tier 2-  $1250
•	Mental Health - EPSDT – (estimated average per child is $2246)

  Fiscal Model for Los Angeles continued
RBS Model – 24 month demonstration project
•	Residential
•	$10,194 for up to 10 non-consecutive months of care ($8319 + $1875) (was $3900 at $6294)
•	$4184 after 10 months of residential care
•	Mental Health – EPSDT (estimated at $5000/mo)
•	Higher residential rate funds the following:
•	Residential components of board and care traditionally funded by the RCL system
•	Child and Family Team
•	Family Finding, Engagement, Preparation and Support (FFEPS)
•	Parallel community based interventions
•	Flexible Services Funding (flex funds) to cover contingencies such as crisis stabilization*
 
*A crisis stabilization episode is a temporary return to the residential facility lasting no more than 14 days and does not count against the 10-month limit for the residential rate.  After 14 days, the episode will be  considered a return to residential treatment and will count against the 10-month limit imposed on residential care.

•	Community Care – any time not in residential care 
•	$4184 -  foster home costs deducted if child is in Foster Care ($1430-$1679)
•	$1250 - rate if child is in Intensive Treatment Foster Care ($4,028 – not deducted)
•	Mental Health - EPSDT – (estimated at $2246/mo)

Fiscal Model for Los Angeles continued
•	Provider is at risk for meeting cost neutrality over a 24 month period - $147,314
•	Reconciliation process after 24 month period

•	Reconciliation Process
•	Average cost per child defined as: 
•	The exit cohort 
•	Children in care for 24 months during the first 24 months of the Demonstration 
•	If average cost is over $147,314 provider pays difference back to County
•	If average cost is less than $147,314 savings shared 50/50 between provider and County – dollars to be used for reasonable and allowable child welfare related services

•	Actual Residential Cost Determination 
•	Residential Rate is an estimate
•	Actual costs to be determined at conclusion of project
•	Provider may keep up to 10% excess over actual cost
•	Any excess beyond 10% is returned to the County
•	Rate to be renegotiated if project is extended beyond 24 months

      Staffing Model (for a 16 bed facility)

Staffing Model for RBS including 
residential and community 
components of the model

Techniques Used to Overcome Fiscal and Policy Challenges

•	Partnerships of Key Visionary Individuals
•	Including parents and youth in planning
•	Re-conceptualizing the use/purpose of residential treatment
•	Significant Investment of Time
•	Neutral Coordination by 3rd parties (consultants and Casey)
•	Building off Wraparound Principles/Values
•	ResWrap Pilot Results
•	Family Decision Making/Child &Family Team
•	Fundamental shift in philosophy on how the family is viewed
•	Realization that many children being successfully served in Wraparound in the community are the same children being referred to residential treatment
•	Developing Fiscal Creativity 
•	Creating cross-team Training and Evaluation Workgroups for the project
•	Social Marketing to County Social Workers

Additional Resources

Information on the California RBS Reform 
Coalition project and other County models 
can be found at:  www.rbsreform.org

•	William P. Martone –   williammartone@hathaway-sycamores.org