Pathways to Mental Health Services

February 11, 2014
Katie A Toolkit Webinar
Presented by:
Troy Konarski, Staff Mental Health Specialist,
Litigation Support, DHCS
Overview & Purpose
 Review the Information and Guidance Set Forth in the
Core Practice Model & Medi-Cal Manual
 Updates on Implementation
 Obtain Feedback on Technical Assistance and Local
Implementation Needs
Katie A. et al v. Bonta Settlement
In July 2002, a complaint was filed to obtain Wraparound
and therapeutic foster care services for children in or at risk
of placement in foster care or group homes. In December
2011, the final settlement was approved. The Core Practice
Model Guide and the Medi-Cal Manual were developed as a
part of the settlement agreement.
Who is Katie A?
 Katie A. was a 14-years old girl at the time of the 2002 settlement. At 4 years old
she was removed from her home and placed in foster care, where she remained for
10 years. Early assessments indicated she had a history of trauma and that intensive
trauma treatment and supportive services for her caregiver would be the best
approach to transitioning her home with her caregiver.
 Katie at age 8 was placed almost solely in congregate care facilities even though she
responded best to one-on-one attention, and had difficulty with peer relations. She
was moved through 37 different placements, including: 4 group homes, 19 different
stays at psychiatric hospitals, a 2 year stay at Metropolitan State Hospital, and 7
stays at MacLaren Children’s Center.
 Early assessment indicated the services she and her family needed. She did not
receive trauma treatment or other individualized outpatient mental health services.
Katie A Class and Subclass Members
 Who are the members of the Katie A. Class and Subclass?
 What Guidance is Provided on Member Eligibility
Katie A. Class Members
 Children and youth who are or at imminent risk of
placement in foster care
 Have a mental illness or condition that has been
documented, or if assessed would have a diagnosis with a
mental illness or condition
 Who need individualized MH services
 Katie A identified a Class of children who must be
provided services set forth and guided by the CPM
Katie A. Subclass Members
 Katie A Subclass are an identified subset of the Katie A
Class who must also be provided a set of intensive
services in addition to the services set forth and guided by
the CPM
 Are full-scope Medi-Cal (Title XIX) eligible;
 Have an open child welfare services case (See definition
in Appendix A, Glossary of the Medi-Cal Manual); and
 Meet the medical necessity criteria for Specialty Mental
Health Services (SMHS) as set forth in CCR Title 9
Section 1830.205 or Section 1830.210.
Eligibility Considerations For Subclass
In addition to the above criteria, the child and youth are
currently in or being considered for:
 Wraparound
 Therapeutic foster care
 Specialized care rate due to behavioral health needs or
other intensive EPSDT services
 Including but not limited to:
 Therapeutic Behavioral Services (TBS)
 Crisis stabilization/intervention
(see definitions listed in the Medi-Cal Manual glossary)
Core Practice Model
The Core Practice Model Guide (CPM) describes a
significant shift in the way that individual service providers
and systems are expected to address the needs of
children/youth and families in the child welfare system, and
additionally, it is intended as a blueprint for wider practice
change and systems reform.
CPM should be relied on for further guidance on the
expectations of the model, the required elements for fidelity
practice to the model and approaches to implementation.
Core Practice Model Guide
 Values and Principles
 Teaming
 Successful Elements
 Child and Family Teams
 Models
 Practice Components
CPM: Service Delivery Components
Monitoring and
Service Planning
CPM Child and Family Team
The Child and Family Team (CFT )is a team that shares a
vision with the family and is working to advance that vision,
while a team meeting is how the members communicate. No
single individual, agency or service provider works
independently. Working as part of a team involves a different
way of decision-making.
Medi-Cal Manual
Guided by the Principles and values of the Core Practice Model
 Provide mental health plans (MHPs) and Medi-Cal providers with
information regarding the provision of three specialty mental
health services for those children/youth who are members of a
class of children covered by a Settlement Agreement in a lawsuit
Katie A v. Bonita. Katie A Class and Subclass Members
 Clarifies and provides guidance on the coverage and
documentation requirements under Medi-Cal of Intensive Care
Coordination (ICC), Intensive Home Based Service (IHBS) and
Therapeutic Foster Care (TFC)
 Additionally, serves as a supplement to other federal and state
documents related to the delivery of specialty mental health
services in the State of California
Intensive Care Coordination (ICC)
Intensive Home Based Services (IHBS)
 Definitions of ICC and IHBS services
 Descriptions of service settings provided in the documentation
 Review of claiming and reimbursement guidance
 Overview of service components, activities, and review
 Assessing
 Service Planning and Implementation
 Monitoring and Adapting
 Transition
Intensive Care Coordination (ICC)
The difference between ICC and the more traditional TCM
service functions is that ICC must be used to facilitate
collaborative services approach described in the CPM for
the Katie A. Subclass.
ICC Coordinator
ICC coordinator is responsible for working within the CFT
to ensure that plans from any of the system partners are
integrated to comprehensively address the identified goals
and objectives and that the activities of all parties involved
with service to the child/youth and/or family are coordinated
to support and ensure successful and enduring change. The
coordinator must be a mental health professional.
ICC: Transition
Developing a transition plan for the client and family long
term stability including the effective use of natural supports
and community resources.
Technical Assistance
 Weekly Technical Assistance for general and specific
concerns related to calls
17 County learning collaborative
Specific Technical Assistance on Financial issues
related to implementation
Local technical assistance for counties that require
additional supports to complete plans
On going response to FAQ’s
Coordinated trainings
California Department of Health Care Services
and California Department of Social Services
Contact Information
 California Department of Health Care Services
 Email address: [email protected]
 California Department of Social Services
 Email address: [email protected]

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