Monitoring Foster Care Redesign Implementation - House Committee on Human Services

1. Presentation relating to monitoring the implementation of Foster Care RedesignHouse Committee on Human ServicesJuly 16, 2012 Howard G. Baldwin, Jr., Commissioner Audrey Deckinga, CPS Assistant Commissioner

2. Committee Charge Monitor the implementation of Foster Care Redesign. Evaluate the mechanisms for monitoring and oversight, including rates, contracts, and client outcomes. 2

3. Background Goal of Redesign To improve outcomes for children, youth and families by creating sustainable placement resources in communities that will meet the service needs of children and youth in foster care, using the least restrictive placement settings. 3

4. Background DFPS recognized that children and youth are too often placed outside of their home communities, leaving behind family, friends, schools, church, homes and their support system Through Foster Care Redesign, DFPS seeks to: Promote positive outcomes for children, youth and families Improve the overall process and quality of care Align incentives with process and quality indicators in a manner that encourages the development of services in locations where they are needed 4

5. Background Current Challenges Imbalance in geographic distribution of services and providers Insufficient number of residential providers that offer a full continuum of services 5

6. Parameters for Redesign Model must neither require nor preclude additional funding, with the exception of funding for normal entitlement caseload growth Case management must remain the role of DFPS 6

7. Stakeholder Input • Public Private Partnership (PPP) served as the guiding body • Members representative of and conduits to large stakeholder groups • Tasked with reaching consensus recommendation • Input from a broad base of stakeholders • Attended trade association meetings • Attended community forums in each region • Gathered input from Youth Leadership Council • Held statewide community forum • Created Redesign mailbox • Published request for information (RFI) • Conducted stakeholder survey • Published draft Request for Proposal (RFP) for comment 7

8. Stakeholder Input The Individual needs of the child or youth are paramount. • First and foremost, all children and youth are safe from abuse and neglect in their placement. • Children and youth are placed in their home communities. • Children and youth are appropriately served in the least restrictive environment that supports minimal moves. • Connections to family and others important to the child are maintained. • Children and youth are placed with their siblings. • Services respect the child’s culture. • To be fully prepared for successful adulthood, youth are provided opportunities, experiences and activities similar to those experienced by their non-foster care peers. • Youth are provided opportunities to participate in decisions that impact their lives.

9. Stakeholder Input Obstacles to achieving quality outcomes • Minimal provider input into placement decisions • Fragmented service delivery system • No single point of accountability • Service Level System results in disincentive to improving well-being outcomes

10. Research Researched Models In Other States Lessons Learned Involve stakeholders early on Communication is critical Evaluation is necessary Designate dedicated staff for implementation Partnership and team work are critical Expect to change and adjust contracts over time Focus on data Invest sufficient resources in monitoring staff and staff training Analyzed Texas Specific Data Gap Analysis Strata and Outcomes 10

11. Redesign Model Emphasis on: • Engaging the Community to Improve Outcomes for Children and Youth in Foster Care • Development of local advisory committee that reflects community • Community Engagement Plan for each stage of Implementation which must include specific strategies for engaging various stakeholders • Developing Community Resources • Accountability for Outcomes

12. Redesign Model • Start-Up Period (Up to 6 months) • Stage I (Anticipated 1-2 years) • Implement performance based contracting for a continuum • Blend rates across all service levels and eliminate tie between billing and authorized service level • Stage II (Anticipated 1-2 years) • Increase provider’s role with family and children in their care • Provider allocation for services to family of children in their care • Stage III (Anticipated 1-2 years) • Implement case rate to include length of stay incentive • Hold harmless in regard to financial remedies during first year • Implement reinvestment of incentives to further improve outcomes for children in foster care

13. Redesign Model Change The Way DFPS Procures From open enrollment to competitive procurement Single Source Continuum Contractor (SSCC) ensuring full continuum of paid foster care services for all children and youth in catchment area Change The Way DFPS Contracts From effort-based contracts to performance-based contracts Financial incentives and disincentives for permanency Additional performance measures for well-being A single contract to provide all paid foster care services and other services for parents and families in a geographic area Change The Way DFPS Pays The Contractor From multiple rates to a single blended rate De-link service levels from rates Separate allotment of funds for other services to children and youth in foster care and their parents and families 13

14. Change the way DFPS Procures • Current - Open Enrollment • DFPS defines the services and how they’ll be delivered • Providers apply for a contract • Foster Care Redesign - Competitive Procurement • DFPS defines the service need, but the providers define how the need will be met • Providers compete for a contract

15. Change the way DFPS Contracts Performance Based Contracts • Well-defined performance measures • Length of stay outcomes • Safe in care • Placement close to home • Tie payments and contracting decisions to performance expectations • Flexibility given to contractor to achieve performance metrics • Focus on major outputs and outcomes • Monitor for results

16. Change the way DFPS Contracts Monitor and Oversight • Creation of a monitoring tool specific to the SSCC contract • Annual monitoring of contractor (programmatic, administrative and financial) which includes obtaining feedback from clients and service providers • Centralized team approach to manage SSCC contracts • Creation and monthly review of a data and performance dashboard • Third party calculation of contractor’s performance measures • Focus on SSCC’s oversight of its provider network and continuum of care • Focus on Quality Assurance

17. Change the way DFPS Pays • Rates no longer tied to service levels or type of placement • Single rate paid for all children and youth • A different rate is calculated for each catchment area • In Stage III, financial incentives to reduce length of stay

18. Procurement

19. Procurement Tentative Awards

20. Implementation Mitigating Risk • Limitation of initial roll-out to two catchment areas • Insurance and Performance/Payment Bond • Refine model based on evaluation prior to implementing in other catchment areas • Subcontracts can revert to DFPS

21. Next Steps • Complete Negotiations – Summer 2012 • Initial SSCC Contracts – Effective September 2012 • Start-Up Phase in Initial Catchment Areas • Lasts up to 6 months from effective date of contract • SSCC submits their management and community engagement plans • DFPS and SSCC develop local joint protocol section of operations manual • Evaluation of readiness to begin Stage I of Implementation • First child is referred to SSCC for services – March 2013

22. Next Steps Evaluation Continuous Quality Improvement • Chapin Hall • Determine performance gaps • Recommend strategies to close the “gaps” • Determine if strategies are effective Evaluation of Implementation • University of Texas School of Social Work and Institute of Organizational Excellence • Process evaluation • Pre- and Post- surveys on collaboration • Focus groups and individual interviews

23. Foster Care Redesign Webpage Information on Foster Care Redesign can be found on the DFPS website at: http://www.dfps.state.tx.us/Child_Protection/Foster_Care/redesign.asp

24. APPENDIX

25. Texas Tennessee Nebraska Missouri Kansas Florida DFPS children/youth Children/youth DHHS Child Children/youth Family Most programs in paid foster care in foster care Welfare, with high preservation, and services Population of with needs Juvenile and levels of needs adoption and beyond Focus greater than Status in foster care . foster care investigation basic Offender Population who require services Place and serve Safely reduce Focus on Reduce the Improve services Increase children in their the number of serving time a child or and meet community Overall Goal of home communities in children in children in youth remains program targets. participation in Effort the least restrictive foster care their own in residential serving environment/improve homes and placement children outcomes for reducing the affected by children in care number of abuse/neglect children in the state’s care Responsibility Department of Children’s Services for Case DFPS Providers Providers Providers Providers Management Staged Phased in Initially piloted Implemented Implemented Implementation of approach by in 2 regions statewide by by pilot Implementation SSCC clusters of and then program districts Approach responsibilities in the counties adding gradually beginning with through Region new counties rolled out in family adaptive Roll - out of each year over a the remainder preservation, implementation model across multi - year of the state. then adoption that allowed state according Refine/Improve period until all and lastly re - for changes to pre - model prior to counties were integration/foster based on the determined expansion in Refinement included. care. The entire evolving nature time frame. additional Regions occurred as the process was of the effort. process moved fully Refined model forward. implemented in as it moved to a few short the next Phase. months. Redesign Model

26. The Road to Redesign

27. Legislation House Bill 1, Rider 25, 82nd(R) Legislative Session Requires DFPS to submit a report that includes: Expenditures for Foster Care Redesign Progress toward achievement of improved outcomes for children, youth and families based on the quality indicators Senate Bill 218 by Nelson, 82nd(R) Legislative Session Requires DFPS to implement a redesign of the foster care system in accordance with the Foster Care Redesign report Authorizes HHSC to develop a separate payment rate for use in the redesigned system, which must tie payments to performance targets. 27