What kind of outrage would there be if a child with asthma was told to "tough it out" no matter how bad their breathing got because they had already used up all of their benefits?

V.  Louisiana's Coordinated System of Care

A system of care:

• incorporates a broad, flexible array of effective services and supports for a defined population
• is organized into a coordinated network
• integrates care planning and management across multiple levels
• is culturally and linguistically competent
• builds meaningful partnerships with families and youth at service delivery, management, and policy levels
• has supportive policy and management infrastructure.

An important CSoC goal is the reduction of costly, highly restrictive out of home placements through the creation and maintenance of coordinated and effective community based services. CSoCs also create partnerships with public and private providers of services that target children, youth and their families in a multi-agency, multi-disciplinary system of services.

Recent estimates indicate the following percentages of these youth in Louisiana need behavioral health services:

• 40% of those placed in Office of Community Services (OCS) foster homes
• 70% of those in Office of Juvenile Justice (OJJ) out of home placements
• 20% of children and parents served in their home by OCS
• 50% of children and parents served in their home by OJJ

It is widely acknowledged that the needs of these children and families are currently being served through a fragmented service delivery model that is not well coordinated, is many times inadequate to meet the families' needs and is usually difficult to navigate. Further, state departments are not currently pooling resources and leveraging the 'smartest' financing to provide a coordinated system of behavioral health services to this population. This too often results in Louisiana's children with the highest level of need often detained in secure or residential settings, which are proven the highest cost services with the poorest outcomes.

CSoC efforts have been shown to provide solutions to common problems found in states and communities throughout the nation, including:

• Lack of home and community-based services and supports
• Patterns of utilization - racial/ethnic disparity and disproportionality
• High cost
• Administrative inefficiencies
• Poor outcomes
• Rigid financing structures
• Deficit-based/medical models, limited types of interventions

(Source: Pires, S. (1996). Human Service Collaborative, Washington, D.C.)

Goals, Values and Population of Focus

In a recent planning retreat, over forty agency and stakeholder leaders agreed as follows on the goals, values and population of focus for the  Louisiana Coordinated System of Care.

Values and Principles:

Population of Focus:
Louisiana's Coordinated System of Care will initially serve children and youth that have significant behavioral health challenges or co-occurring disorders that are in or at imminent risk of out of home placement. Out of home placements are defined as the following:

Goals of System of Care Implementation include:

• Reduction in the current number and future admissions of children and youth with significant behavioral health challenges or co-occurring disorders in out of home placements.
• Reduction of the state's cost of providing services by leveraging Medicaid and other funding sources as well as increasing service effectiveness and efficiency  and reducing duplication across agencies.
• Improving the overall outcomes of these children and their caretakers being served by the coordinated system of care.

 
Organization of the System of Care oversight and planning process:
The initiative is directed and overseen by the CSoC Leadership Team. The Leadership Team receives and acts on recommendations developed and submitted by a Planning Group regarding system design and implementation strategy. The Leadership Team is staffed by the Project Manager and assures departmental staff and external stakeholders work jointly in planning the Coordinated System of Care. The Leadership Team makes consensus-based decisions and is composed of the following individuals:

• Secretary Kristy Nichols,  DSS
• Deputy Secretary Tony Keck, DHH
• Secretary Mary Livers, OJJ
• Assistant Superintendent Donna Nola Ganey, DOE
• Deputy Medicaid Director, Randy Davidson, DHH
• Assistant Chief of Staff Tammy Woods and Policy Advisor Camille Conaway, Governor's Office
• Vee Boyd, parent, and Executive Director, Louisiana's Federation of Families for Children's Mental Health
• Sharon Dufrene, parent and advocate
• Michael Teague, Executive Director, Jefferson Parish Human Services Authority
• Representative of Supreme Court

Planning Group
The planning for the system design and development work of the initiative is being conducted by the Planning Group. As stated above, the Planning Group works at the direction of the Leadership Team and is facilitated by the Project Manager. The Planning Group is responsible for developing recommendations for submission to the Leadership Group. The Planning Group is composed of agency key staff and external stakeholders, including family members, advocates, and providers. The Planning Group will form workgroups as needed to perform activities necessary to meet the goals and timeline of the project workplan; workgroups may be time-limited to accomplish specified planning tasks and objectives and include broader representation than formal Planning Group members.

• Planning Group Members 
• Planning Group Documents