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Improving Outcomes for Children and Youth: Foster Care Redesign. Texas Alliance Child Care Administrators’ Conference October 15th, 2010. Agenda. Project Overview Quality Indicators Stakeholder Involvement Status Preliminary Model Issues Next Steps. Overview. Goals

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improving outcomes for children and youth foster care redesign

Improving Outcomes for Children and Youth: Foster Care Redesign

Texas Alliance

Child Care Administrators’ Conference

October 15th, 2010

  • Project Overview
  • Quality Indicators
  • Stakeholder Involvement
  • Status
    • Preliminary Model
    • Issues
    • Next Steps
  • Goals
    • Improve outcomes for children and youth
      • Permanency
      • Well being
  • Parameters
    • Neither requires nor precludes additional funding
    • Does not include transfer of case management responsibilities
quality indicators
Quality Indicators
  • Children are placed in their home communities.
  • Children are appropriately served in the least restrictive environment that supports minimal moves for the child.
  • Connections to family and others important to the child are maintained.
  • Children are placed with siblings.
  • Services respect the child’s culture.
  • To be fully prepared for successful adulthood, children and youth are provided opportunities, experiences and activities similar to those experienced by their non-foster care peers.
  • Children and youth are provided opportunities to participate in decisions that impact their lives.
project objectives
Project Objectives
  • Determine Where And What Kind Of Services Are Needed.
  • Determine How To Contract For Those Services:
    • Outcomes
    • Performance Measures
    • Procurement Processes
  • Determine How To Pay For Those Services:
    • Rate Structure
    • Fiscal Implications
  • Review of Previous Work, Recommendations and Plans
  • Coordination with Other Groups Working On Foster Care Related Issues
  • Review and Analysis of Other States’ Experiences in Performance-Based Contracting
    • Calls with Missouri and Tennessee
    • Review of Kansas, Illinois, Florida and other Models
    • National Reports
  • Extensive Stakeholder Involvement
  • Internal and External Implications Workgroups
stakeholder involvement
Stakeholder Involvement
  • Guiding Body: Public-Private Partnership
  • Other Involvement To Date
    • 2,210 stakeholders participated in 132 meetings, focus groups or presentations
    • 2,659 webpage views
    • 2,057 visitors to webpage
  • CPS/Provider Meetings in Every Region
  • Texas Council of Child Welfare Boards
  • Judicial Commission for Children, Youth and Families
stakeholder involvement8
Stakeholder Involvement
  • Texas Network of Youth Services (TNOYS)
  • Statewide Youth Leadership Council
  • Advocates
    • Texas Court Appointed Special Advocates
    • CPS Statewide Parent Collaboration Group
    • Public Forum
    • Texans Care for Children
    • Advisory Committee for Promotion of Minority Adoption
    • Texas Association for the Protection of Children
  • Other Workgroups/Legislatively Mandate Committees
  • Internal DFPS and HHSC Staff
work groups
Work Groups
  • Public-Private Partnership and Other Stakeholders
    • Fiscal Matters Workgroup
    • Services Workgroup
    • Assessment Focus Group
    • Collaboration Focus Group
    • Accountability
    • Performance Measurement
  • Internal Workgroups
    • Contract
    • Procurement
    • Placement
    • Disproportionality
    • Utilization Review
rfi responses
RFI Responses
  • Respondents
    • Twenty Responses
      • 19 Texas Providers
      • 15 Currently Licensed By DFPS, Some Multiple Licenses
      • 5 Were COA Accredited
      • 1 Self-identified As Medicaid Provider
  • Overarching Themes
    • Ensure Accountability
    • Improve Assessment Process
    • Provide Flexibility
    • Improve Collaboration
    • Improve Use of Technology
improving contracting
Improving Contracting
  • Improving Availability/Developing New Capacity
    • Contract For Continuum
    • Use Case Rates
    • Provide Incentives For Exceeding Performance Measures
    • Develop Partnerships/Networks
    • Contract For Specific (Minimum) Number Of Beds, Specific Services
    • Provide More Flexibility To Meet Unique Needs
    • Continue to Use Medicaid Services
improving services
Improving Services
  • Engage Communities
    • Use Team Approach
    • Use “Wrap-around” Services
    • Develop Community Partnerships To Establish Network
    • Contract With A Community Development Organization
  • Improve Assessment Processes
  • Use Trauma-informed Care
  • Have Foster Care Providers Work With Families
  • Encourage, But Don’t Require Accreditation (Until It Can Be Funded)
improving accountability
Improving Accountability
  • Use RFP to Select Providers
  • Contract for Specific Outcomes, Measure Achievement of Outcomes
  • Implement Objective, Measurable Performance Measures (Based On Quality Indicators) and Align ASFA and CFSR Requirements
  • Implement UR Process with Benchmarks
  • Require Continuum Contract Agency to Demonstrate Capacity to Develop, Manage and Maintain Subcontracting Relationships


Preliminary Design

preliminary design elements
Preliminary Design Elements
  • Building the Infrastructure
    • How to Contract
    • Where to Contract
    • How to Pay
  • Improving Efficiency
    • Increased Coordination of Services to Families
    • Enhanced Collaboration
    • Engagement of Community
  • Improving Outcomes
    • Enhanced Role in Working with Families
preliminary design
Preliminary Design
  • Basic Elements
    • Contract for Continuum of Care
    • RFP for Continuum
    • Increased Family Involvement
    • Better Collaboration

Project Objectives: December 2010

  • Determine How To Contract
    • How to Procure
    • What to Procure
    • What Performance Measures
  • Determine Where To Contract
    • Gap Analysis (Where Services Are Needed)
  • Determine How To Pay
how to contract decisions
How To Contract: Decisions
  • How to Procure
    • Performance-Based Contract
      • Established Outcomes
      • Maximum Flexibility
      • Incentives with First Year “Hold Harmless”
    • Request for Proposals (Competitively Procured)
      • Open to For and Not For Profits
      • Open to In-State and Out-of-State Providers (with preference for Texas Experience)
      • Open to a Variety of Networking/Contracting Models
how to contract continued
How to Contract, Continued
  • What To Procure
    • Continuum Of Foster Care (All Levels Of Foster Care)
    • Separate Allocation For Services To Families Of Children In Provider’s Care (Currently Contracted Services)
  • What Performance Measures
    • Outcomes
      • Days In Care - Time To Permanency
      • Improvement In Child Functioning/Service Level
    • Quality Indicators
where to contract
Where to Contract
  • Decided
    • Continuum Contract in Geographic Catchment Areas
    • Multiple Contracts for “Fall Back”/Contingency Plan
    • Catchment Area Large Enough to Minimize Financial Risk
  • In Process
    • Other Criteria for Catchment Areas
how to pay
How to Pay
  • Decided
    • Eliminate Link Between Billing And Authorized Levels Of Care
    • Rate Includes Consideration Of Blend Across Levels Of Service
    • Resources Will Be Transferred Equivalent To Transferred Responsibilities
  • Still In Process
    • Consideration Of Expected Utilization
    • Incentives Based On Reductions Of Days In Care
other decisions
Other Decisions
  • No Child Will Be Moved From Stable Placement To Accommodate “Close Proximity” Requirement
  • Decisions Will Be Made On “Best Interest Of The Child”
  • Implementation Will Be Gradual; No Statewide “Flip The Switch”
  • Various Models May Be Used For Delivering Continuum
  • Continuum Will Include All Levels Of Foster Care
  • Funds For Services To Families Will Not Be Part Of Blended Rate; Will Be Separate Allocation
  • DFPS Will Commit Resources For Administrative Costs “Trade-offs”
next steps
Next Steps
  • Implementation Issues
    • Implications Workgroups
    • Report
      • PPP Recommendations
      • Stakeholder Participation/ Input
      • High Level Implementation Plan
    • Innovation Zones
      • Governance
      • Criteria for Decision-Making