Friday, March 21, 2008

View from the Front Lines: Trying to answer the questions.

Yesterday was another day where everyone had multiple agendas, and complicated problems.  Not that I mind complicated problems (they are often the most interesting ones), but dealing with them preclude doing much work on these many questions from EOHHS.  We should look at the next set.  I'm going to tackle the last question first, but ultimately will fill in the blanks.
Section 2.3A
(1) What staffing models would you recommend for ICC programs to enable them to serve children and youth and their families with diverse types of needs, needs that vary over time, and diverse levels of need? How could programs reliably respond to high levels of need in some families while simultaneously reliably serving families with less intense or acute needs?
Clearly we will need to play with this, but I think that the work on care coordination done as part of the Medical Home initiative should have some impact.  Care coordination for "children with special health care needs" can be classified by the coordinator on a three or four point scale, based on the needs of the child and family, and that "level" of CoC should guide the caseload.  At a guess, I would think that a single coordinator could handle about 30 units of care per week, where level 1 is one unit, level 2 is 2 units,  level 3 is 4 units and level 4  is 6 units, where a level 1 is a kid who is on maintainance/ check in once a week' mode,  and level 4 is FST level- this family is about to implode.  In an ideal world, the ICC would have some paraprofessionals so that the ICC could deploy different components of the team as needed.
(2) What staffing models would you recommend for families in which more than one Medicaid-eligible child needs ICC?  The ICCs are going to need to build relationships with the families, and it makes sense to make things happen.  Efficiency would dictate that weallow the kids in a family to have a single care provider.
(3) What do you recommend as qualifications for the ICC Care Manager? For supervisors?
ICC Care managers should be MSWs or really good BSW,  or RNs with psych experiences, with experience in family centered care.
(4) What supervisory ratios, if any, would you suggest for both Care Managers and Family Mentors? Why?  1:6, given the level support these folks are facing.  It is tough to tell you why, but that seems an appropriate number.  What do the rest of you think?
(5) How would you recommend using Family Mentors, given the likely shortage of trained Family Mentors?  Peculiar question;  if we don't have them, how can we use them?
(6) What are the advantages and disadvantages of standardizing program staffing models? Of allowing the program staffing model to vary by ICC provider?  This feels to me to be the most important question;  Massachusetts and even Worcester County is not a uniform place, and what works in Boston may not work in Worcester (and what works in Worcester may not work in the rest of Worcester County).  Programs should be judged by the results, not the means by which they get there.  Anything short of that will simply not work.
That said, evaluating the results of different staffing models is more difficult than ensuring program fidelity.  Needs more input from the evaluaton team to disign appropriate measures.

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