C ARE M ANAGEMENT E NTITIES IN
G EORGIA’ S S YSTEM OF C ARE
C ARE M ANAGEMENT E NTITIES

Role of CMEs in Georgia’s System of Care

What is a CME?

High Fidelity Wraparound as the practice model

How CMEs embody the Collaborative priorities
for the SED population

Key Findings of initial evaluation report

Ongoing opportunities and challenges

Inter-agency on the ground: the DFCS crosswalk
SOC: T HE BIG P ICTURE

SOC as framework and value base

Cluster of organizational change strategies
based on values and principles intended to
shape policies, regulations, funding
mechanisms and services & supports

Involves complex system change

Three familiar pictures to illustrate how CME
fits into SOC approach
SYSTEM OF CARE AT THE INDIVIDUAL LEVEL
neighborhood
health
Community
and recreation
vocational
DBHDD
We want families in a
SOC approach to
experience:
• Family driven
• Youth guided
• No wrong door
• Collaboration
• Combination of
natural and
professional
Youth
and
family
Public health
DJJ
Faith
community
DFCS
Extended
family and
friends
school
SUSTAINING SYSTEMS OF CARE
Philosophy
Infrastructure
The CME is an
element of SOC
infrastructure
Services
and
Supports
PREVALENCE UTILIZATION TRIANGLE
TARGET POPULATIONS IN A SYSTEM OF CARE
Intensive Services
60% of $$$
2-5%
CMEs are the top
of the triangle,
targeting the
highest risk youth
in restrictive,
costly placements
15%
80%
Early Intervention
Home & Communitybased; school-based
35% of $$$
Prevention &
Universal health
promotion
5% of $$$
W HAT
IS A
CME?

Set of identifiable structures & processes to support
the organization, management, delivery and
financing of services and supports across multiple
providers & systems.

CME creates a single locus of accountability to serve
youth and families in the community, in the context
of Georgia’s System of Care (SOC).

It is a quantifiable entity, with staff, minimum
standards, funding streams, outcomes.

Is our SOC achieving outcomes for youth with SED
and their families? The CME is the place this will be
answered
C OMMON E LEMENTS OF CME

Child and Family Teams, responsible for development,
coordination, and monitoring of individualized plans
developed in a family-driven model;

Intensive Coordination of formal, informal and natural
supports;

Quality Assurance to assess and improve the
implementation of wraparound and adherence to values;

Utilization Management to support real time analysis of
services and the cost and effectiveness of services;

Provider Network Management, with responsibility for
network recruitment, organization and oversight;

Evaluation, including outcomes for youth and families
served across life domains.
CME P RACTICE M ODEL

High fidelity Wraparound is the core practice

If it’s easy, you’re probably not doing wraparound!

Care Coordinator is NOT a Case Manager and is NOT
doing things FOR a family. The skill being developed is
facilitation of the Child and Family Team process

What makes it “high fidelity?”

Caseload size

Constant monitoring, observation, feedback, coaching

Skill sets for Wrap Supervisors, Family Support Partners,
Care Coordinators
CME AS MIRROR OF
C OLLABORATIVE FOR SED


Collaborative has 5 Committees (priorities)

Family and Youth Involvement

Interagency Collaboration

Workforce Development

Financing

CBAY
The CME embodies these functions for the target
population
CME S

IN
G EORGIA
Competitive selection process, state named 4 CMEs :

CHRIS Kids, Inc.

GRN Community Service Board

Lookout Mountain Community Services

MAAC (Multi Agency Alliance for Children)

Since Aug., 2009: Hired staff, trained on new practice
model, implemented minimum standards, developed
a database to match the practice of wraparound
(building on KidsNet success), established eligibility
and target population, serving youth and families

Almost 300 multi-agency high risk youth and families
enrolled in CME (waiver and non-waiver)
E ARLY F INDINGS FROM
E VALUATION REPORT

EMSTAR Research just completed 6 month evaluation of
implementation

Referrals from variety of pathways:


Community partners (mh, parents, schools)

KNIS

DFCS

CSPs

CBAY
Common criteria: High risk for out of home placement,
Average initial CAFAS scores 131 (non-waiver) & 153 (CBAY)
E ARLY F INDINGS FROM
E VALUATION REPORT


Fidelity to the Wraparound model:

meeting timelines for contact w/in 48 hours (91%),

Families choosing meeting locations (initial 92%; first
CFT 80%)

Strong evidence of inclusion of natural supports, and
revisions to the Wraparound Action Plan
ALOS in wrap is 12 – 14 months - outcome data not
available, but improved reports of improved
functioning and satisfaction (families and youth)
evident in early stage
O PPORTUNITIES A HEAD

OPPORTUNITIES

Partnership with DBHDD and growing with DFCS

Great commitment from staff and CME Directors

Advancing from fidelity to minimum standards to quality

CHIPRA federal grant (technical assistance and focus on
Family Support Partner role)

Continued training from MD partners and developing
Master Trainers in state

CME Implementation as “learning organization”
C HALLENGES

AHEAD
CHALLENGES

SUSTAINING - Billable functions and non-billable
essentials

Incorporating new CMEs

Incorporating new target populations

Expected attrition of front line staff

Unknowns with administration change

Database development

Provider network management- CME is dependent
upon viable, high quality provider network!
P LEASE N OTE

CMEs are in their infancy stage…learning wraparound,
learning CME functions.

Success only if administration (local, state, regional)
supports wraparound

CMEs make sense if recognize the shared problems:


Silo funding

restrictive placements

Families must drive decisions
Goal: Producing desired outcomes across life domains
through effective development and utilization of formal
and informal resources
T HE DFCS C ROSSWALK

Why we conducted the crosswalk between CFT
process in high fidelity wraparound and DFCS
Family Team Meetings

Findings and implications of the crosswalk

What is happening in practice for youth in the
CME
F INAL
NOTES

CME as vehicle for change in SED

What’s different?

High fidelity wraparound (Facilitating a Teambased strengths-based and family driven process)

Development of natural and informal supports

Still need high quality providers

Accountability

Requires inter-agency commitment to high risk
youth to sustain