Monday, March 24, 2008

CSAs: What are they good for?

Now we are getting to the heart of the Rosie D remedy: the CSA. According to the guidance:
"... the CSA will provide ICC to MassHealth-enrolled children and youth in the Service Area. ICC will provide the Wraparound Care Planning model of care coordination. Wraparound Care Planning is based on an ecological understanding of the child and the child’s functioning. The process assesses, engages, and works with all aspects of the child’s “ecology”: the child’s physical and mental health, family, extended family, peers, school, recreation, and communities to which s/he belongs. To effectively partner with families to engage this full breadth of the child’s world, the CSA needs to have and continually nurture relationships throughout its community, including with primary care providers, hospitals, schools, community agencies, other providers, recreational programs, child care resources, housing and food programs, residential and shelter providers.
The CSA also needs to be able to train, supervise and administratively support the clinical and paraprofessional staff who will be working with children and families in ICC. The Wraparound Care Planning model is promising in its ability to develop highly individualized, clinically sophisticated, multi-dimensional care plans. However, for the very same reasons, it is a challenging model to learn, to master and to sustain."

These CSAs sound like a cross between Annie Sullivan,  Saul Alinsky and Jane Addams.  Can this really be done?  Anyway, the RFI looks for our input.
(1) Do you have any comments or suggestions on the proposed CSA qualifications?
My first comment is one of wonder;  the bar is set (appropriately) quite high for this program, and it is not clear to me who will achieve that standard.  I am concerned about that the need to provide services from birth to 21 will restrict the ability of some agencies to apply, as the needs of families vary so much over that time span.  I am also concerned about having in place a model of Wraparound Services.  I suspect that, in many parts of the state, these CSAs will be "start-ups" because noone is doing Wraparound at present. 

(2) How do you suggest addressing potential conflicts of interest for ICC providers who self-refer?  
Good point.  It needs to be addressed openly.  You will need to demonstrate a firewall between the "care-coordination" side of things and the service delivery side.  

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