Behavioral Health Partnership Oversight Council

Provider Advisory Subcommittee

Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
www.cga.ct.gov/ph/medicaid

Meeting Summary: September 22, 2006
Co-chairs: Susan Walkama & Dana Marie Salvatore
Next SC meeting date to be announced

Attendees: Susan Walkama & Dana Marie Salvatore (Co-Chairs), Karen Andersson & Peter Mendelson (DCF), Lori Szczygiel (VOI), Cathie Coridan (MtSTJohn), Lynne Kol,& Steve Girelli (Klingberg),Enid Peterson (Wheeler), John Eckstein &, Heather Gates (CHR), Anna Kemper (Waterford C. School),Jean Alberghini(Noank Baptist Group Homes), Dan Murray (Wellspring), C. Smith & Tony DelMastro (children's Center, Hamden),Justine Stagon & Lorna Little (St. Agnes Family Ct),Duffy Cechowski, Dayna Snell (DCF CPT), M. McCourt (Leg. Staff).

Meeting Focus
DCF provided information and solicited provider/family representative input on the most recent changes planned for the DCF residential and group home referral processes. Karen Andersson and Peter Mendelson reviewed background on the CPT, outlined problems with the current system and reviewed the implementation of the revised CPT process that now will be administered by the BHP Administrative Service Organization, ValuOptions (VOI).

Issue:
Peter Mendelson stated that the current CPT processes were inadequate and insufficient. The current system does not have the capacity to deal with the volume of referrals (many of which are sent as part of concurrent planning processes) nor to track children to ensure they are receiving the services needed, including alternatives to residential placement. Recently DCF tried to improve the process of matching children with appropriate levels of services through the comprehensive global assessment. The system remained encumbered by referral volume, ability to do timely assessments, match services to the child and track the treatment/placement outcomes.

Solution:
The CPT is not being eliminated, rather restructured. Karen Andersson and Peter Mendelson outlined the new processes for managing referrals that include:
• Utilization of a CT adaptation of the Child Adolescent Needs & Strengths (CANS) form; this was described as a communication tool to be completed by the DCF area office social worker (not the clinician) that organizes the child's clinical, psychosocial, education information. This would be used in place of the global assessment tool.
• The CANS information will be sent to ValueOptions for review and a determination of the appropriate level of care for the client. ValueOptions will identify alternative treatment to residential care and discuss this with the child's practitioner.
• DCF and VOI will:

o Prioritize placements, identifying emergent needs from referrals.
o A team (providers are invited to participate) will meet regularly to review the referrals, identify urgent cases and treatment/placement decisions and bed availability throughout the State.
o A computerized weekly report to track referrals and action will be generated, sorted by area DCF offices. The report will sort referrals by age, gender and diagnoses. Data will assist DCF in future planning for needed community-based and residential treatment services.

Implementation of the revised CPT
DCF and VOI will implement the revised residential referral process in November through a sequential process that will initially focus on team prioritization of referrals by a standard assessment, identification of the appropriate level of care and matching available bed/alternative treatment availability. While providers may not be aware of the actual revised process, DCF's intent is that the CPT process should be transparent.

Discussion
Participants generally expressed appreciation of DCF's recognition of the limitations of the current CPT process and initiation of a process to improve services to those involved in the process. Questions/concerns raised included the following key areas:

ü Families are concerned that the community-based system doesn't yet have the capacity to meet 'alternative' needs. DCF said that the refined system will allow the State to look at CT's capacity, especially for community services such as therapeutic foster care, etc. Families stressed it is important to look BOTH at capacity and the quality of community-based services by local areas.
ü Concern was expressed about the current level of acuity of patients in other levels of care such as Extended Day Treatment and subacute care and PRFT capacity problems. Seeking appropriate alternative levels of care to residential care may further stress the community system. DCF stated that their budgeted dollars are not all spent on residential care; dollars are going toward community based care. Susan Walkama said this discussion about DCF expenditures to residential versus community-based services will be taken up at the BHP Oversight Council. Data are needed to explain where patients are “stuck” and why, what are the outcomes and savings associated with a broader range of services.
ü Issues for specific populations in this system were identified including assessing needs for pregnant clients and interface of the Juvenile Justice system with DCF in this process. Karen Andersson stated DCF is working with Court Support System and parole system to use the CANS for the JJ population. (Pregnancy and a mental health diagnosis is one of the criteria for consideration of VOI's intensive care management.)
ü Current lack of timeliness of residential placement concerns families. Interim treatment may not prevent the youngster from escalating to an acute level of care need.
ü VOI wants provider feedback on what information on the CANS would be useful to them (i.e. client specific vs. aggregate information by region) and who should provide this information (i.e. VOI vs. the DCF area office).

The Provider Advisory subcommittee chairs will announce the next meeting (probably in November). VOI offered to host the meeting at Rocky Hill so participants can view the computer program tracking CPT referrals and level of care authorizations.