Bucks County Behavioral Health, Magellan Health Services, and Access Services partnered in 2013 to improve the services and supports being provided to Transition Age Youth (between the ages 16-26) with behavioral health challenges to improve their health and wellness outcomes. According to the TIP Stars website, this population of young people have higher secondary school dropout rates, higher rates of arrest, incarceration, and unemployment, and lower rates of independent living compared to their peers without disabilities (Clark & Unruh, 2009a; Wagner, Kutash, Duchnowski, Epstein, & Sumi, 2005; Wagner, Newman, Cameto, & Levine, 2005; Vander Stoep, Beresford, Weiss, McKnight, Cauce, & Cohen, 2000; Vander Stoep, Weiss, Kuo, Cheney, & Cohen, 2003). According to the U.S. Department of Education (2011), nearly 45 percent of students with EBD drop out of high school annually which is related to lower wages (Rouse, 2007), lower employment rates (U.S. Department of Labor, Bureau of Labor Statistics, 2010), and poorer health (Pleis, Ward, & Lucas, 2010). Through the implementation and adaptation of the evidence supported model Transition to Independence Process (TIP), ™ developed by Dr. Hewitt “Rusty” Clark, services became available in Bucks County to young people to assist them in achieving their goals of independence and stability and improving their outcomes.
Description of the Initiative
Historically, according to a review of the Bucks County HealthChoices data, transition age youth often dropped out of behavioral health services at the age of 18 and would not reenter until their late 20’s, early 30’s. Often they were struggling due to lack of education and employment opportunities, unmanaged emotional issues, poor and unstable living conditions, and limited social connections. The current services available did not target these areas or the development of skills required to achieve independence.
Through the County, Magellan, Access Services and TIP Stars partnership, TIP was launched in 2013 to serve Bucks County HealthChoices members between the ages of 16 to26 through a Blended Case Management platform. The young people enrolled had a goal of independence and had a history of HealthChoices service utilization. The Transition to Independence Process is a program that helps engage youth in their own futures through a planning process, provides them with services/supports, and involves them (and others) in a process that prepares and facilitates greater self-sufficiency and successful achievement of goals related to each Transition Domain. TIP is a relationship-based, person-centered planning process that focuses on the youth’s future plans. Transition Facilitators (Blended Case Manager’s) support the young people to develop their independence and self determination across the following domain areas, while supporting their development of healthy relationships and supports. TIP address the following areas: Employment and Career; Education; Living Situation; Personal Effectiveness and Wellbeing; and Community Life Functioning. Each young person is assigned a Transition Facilitator (Blended Case Manager) to provide weekly support on goal attainment. The caseload size is small to allow for more frequent contact with the youth during this time of transition.
Bucks County provided reinvestment funds to assist Access Services in starting the program, allowing for the hiring of staff, building caseloads, funding training by the STARS training Academy on the TIP model provided by Dr Rusty Clark, as well as building local capacity by supporting an Access staff to become a local TIP Site Based Trainer. Additionally, support was provided to have Magellan and County staff trained as TIP Fidelity Assessors to provide ongoing quality management. TIP staff were trained on evidence supported strategies to assist with youth engagement, skill building, problem solving, and mediation with supports. This comprehensive five-day training was essential to ensuring that staff have the necessary skills and tools to support the youth. Access Services provides support to 60 young people at any given time and the young person remains in the program until they have achieved their goals as defined by themselves.
TIP has impacted access to services, the quality of services, and improved the cost effectiveness of services. By providing a service that is youth driven, strengths-based, and outcomes-focused, we anticipate that fewer youth will drop out of HealthChoices services during this critical time period. We also believe that the intensive staff training and smaller caseloads will increase the quality of supports being provided to the young people, and that the outcomes of increased education, employment, stable housing, as well as more stable social and emotional wellbeing will reduce the long term costs for these HealthChoices members.
Bucks County and Magellan have remained focused on the quality outcomes of the TIP program and program fidelity. Access Services completes the TAPIS as an outcomes measure for each youth enrolled in the TIP program at admission and discharge. The 2016 Bucks TAPIS results indicate improvement in the following areas at discharge: employment increased 18 percent and community mobility increased by 41 percent. The County, Magellan, and Access provide the fidelity assessment process annually to track implementation of the TIP model and as a continuous quality improvement tool for ongoing oversight. The Fidelity assessment Process involves three main components: Fidelity QI Survey/Interview on TIP Model Organizational Implementation; Fidelity QI Probes on TIP Model Practice Implementation; & Fidelity QI Young Person Focus Group on TIP Model Impact. The 2017 Fidelity results indicate the following: staff scored an 89 percent in their knowledge of the TIP practices and their implementation of the core TIP skills. The Youth focus group results were all 90 percent or above, with 100 percent of the youth reporting that services were youth-driven and tailored to their identified needs.
Additionally, Magellan conducted a detailed cost analysis of the Buck county TIP program in 2016. Results indicated a 69 percent reduction in per member per month costs in the post TIP period when compared to the pre-TIP service utilization, with an overall return on investment of 1.31. Bucks County, Magellan, and Access Services continue to meet quarterly to review program implementation and ensure that the program continues to meet the targeted areas of service delivery. Magellan has continued its relationship with the STARS training Academy for ongoing technical assistance and support, as well as training biannually for all TIP program staff, allowing for TIP expansion across other counties in 2016.
The success of the TIP program is a result of the partnership between Bucks County, Access Services, Magellan and the TIP Stars Training Academy which supported program implementation, both fiscally and structurally, to ensure quality services were available to transition age youth. The well-planned implementation ensured that well qualified and supported staff were delivering the services to achieve the best outcomes.
Tara Karbiner is the Children’s Clinical System Transformation Manager for Magellan Behavioral Health of Pennsylvania. A licensed Clinical Social Worker, Tara has worked at Magellan for 17 years, focusing on program development and implementation for services for children and adolescents with social emotional challenges in Pennsylvania. She provides oversight to the services and supports for Transition Age Youth and helped launch Transition to Independence Process (TIP) in five Pennsylvania Counties since 2013.