evidence-based practice approach to support youth with complex mental and substance use disorders and their families. Public child- and family-serving
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This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) under SAMHSA IDIQ Prime Contract #HHSS23200700029I/Task Order HHSS234002T with SAMHSA, U.S. Department of Health and Human Services (HHS). served as the The views, opinions and content of this publication are those of the authors and do not necessarily All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without Communications, SAMHSA Substance Abuse and Mental Health Services Administration, Intensive Care Coordination for Children and Youth Complex : and Mental Health Services Administration; 201. http://store.samhsa.gov/. Or call SAMHSA at 1-77-SAMHSA-7 (1-77-726-4727) (English andEspañol). Publication No. SAMHSA complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. SAMHSA cumple con las leyes federales de derechos civiles nacionalidad

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In May 2013, the Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an Informational Bulletin on Behavioral Health Services for 1 This landmark policy issuance provided guidance to states, tribes, territories, and communities on effective home- and community-based services and interventions to support children with serious health challenges. Approximately one in 10 children in the United States has a serious emotional disorder,2 and mental health conditions represent the costliest health condition among children.3 Approximately 10% of children who are covered by Medicaid use health care services, yet their cost of care comprises an estimated 3% of all Medicaid expenditures for the quality and cost of care for these children and youth. 4 One of the key services and supports highlighted in the bulletin was Intensive Care Coordination (ICC) using Wraparound based on decades of research, including a meta-analysis spanning 30 years and 209 publications.5 The bulletin describes ICC as including seven components: ˜Assessment and service planning; ˜Accessing and arranging for services; ˜Coordinating multiple services; ˜Access to crisis services; ˜Assisting the child and family in meeting basic needs; ˜Advocating for the child and family; ˜Monitoring progress. In July 2014, the Center for Health Care Strategies Intensiv Coo his 201 ICC provides information on fiCare coordination is the deliberate between two or more participants (including the patient) involved in a patient™s care to facilitate the appropriate delivery of health care marshalling of personnel and other resources needed to carry out all required patient care activities, and often includes the exchange of information among participants responsible for different aspects of care.fl Closing the Quality Gap: A Critical Analysis of Quality Improvement No. 04(07)-0051-7).

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practice model. As a result, many communities across the country have chosen to implement Wraparound as Wraparound va greatly Wraparound has been used to refer to a value-base (used in some communities synonymously with systems of care), as well as to the idea of merely ‚wrapping™ all needed services around a family. Although the term is often used loosel y, over the past several decades, Wraparound has become 7 In fact, research has demonstrated positive outcomes associated Initiative, inclusive of particular sets of activities and including accountabilit y.8 Wraparound is most appropriate to support children and youth whose needs exceed the resources child- and family-serving system. At the youth and family level, Wraparound is a team-based care planning approach that builds upon strengths to identify appropriate formal and informal supports to address needs and root causes of challenges. The Wraparound care coordinator partners with the youth and their family to convene a team , community members, , and other and creative plan of care. fiWraparound is a process relying on a series of practice steps in order to bring a group of people together to craft and match services, supports and interventions to meet unique family needs. Often referred to as a process rather than a service or particular type of intervention, Wraparound integrates and builds on a variety of concepts from a range of sources. This integrative nature makes Wraparound particularly context and people involved in implementation.fl ~National Wraparound Implementation Center or the plan to be successful, Wraparound practitioners, community partners, and team members must support and empower youth and their families to be successful in their homes and communities. Effective and lasting support of youth with complex needs and their families requires a whole system response that extends beyond care coordination to include a comprehensive service array and robust provider network and non-traditional services), trauma-responsive and cross-system assessment tools, and focused workforce development and outcomes monitoring activities. State and local leaders have become more sophisticated in their system reform efforts and understand the necessity of creating a comprehensive and values-driven system of care. Leaders across child- and family- Wraparound approach most often aligns with these models and cuts across populations to coordinate care for youth with complex needs who multiple systems. States increasingly are using Medicaid to build more sustainable ICC approaches that are supported by a broad,

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Since the 2014 CHCS publication, many more ICC programs have been implemented across the country. The and quality outcomes, as well as many that are new. Even those that have been underway for some time may be in the process of revamping in the context of larger Medicaid redesign and health reform initiatives. The implemented and used across the country. ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜Staff Training, Capacity and Provider Networks ˜Evaluation and Monitoring with complex by developing or revamping ICC. ICC using high-quality Wraparound is one approach to care that improves clinical and functional outcomes while reducing the cost of care for children and youth. This resource includes lessons learned from 40 states and a small number of local jurisdictions that have implemented ICC, with and without high quality Wraparound, and quality improvement for jurisdictions embarking on or continuing their ICC implementation efforts. In an effort to 10

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View Point Health Care Management Entity and Princip purchaser/contractor for ICC/Wraparound Agency responsible for overseeing provision of ICC/Wraparound Department of Behavioral Health and Developmental Disabilities (DBHDD) contract with behavioral health provider organizations functioning as Care Management Entities (CMEs) for ICC/Wraparound Department of Community Health (DCH-Medicaid) and its Managed Care Organizations (MCOs) enroll providers as number of tiers) care management model State/county agencies overseeing, from a policy standpoint, the provision of ICC/ Wraparound DBHDD with the support of the DCH-Medicaid public agency, managed care entity) providing ICC/Wraparound and/or behavioral health services Quasi-governmental comprehensive community behavioral health centers: (1) View Point Health Care Management for Intensive Customized Care Coordination (ICCC) covered care vendors are in contractual arrangements to provide this

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