CHILD WELFARE SERVICE ARRAY

1. CHILD WELFARE SERVICE ARRAY Developing a Partnership for Outcomes Achievement Iowa DHS, Davenport Service Area Presented by: Denise Gonzales, DHS and Tom Wilson, FRI 4/9/08

2. Characteristics of a Collaborative Partnership • Building trust among partners • Developing learning opportunities for partners • Recognizing opportunities for change • Mobilizing people and resources to create change • Building shared ownership • Using a variety of approaches to capture ideas • Active communication • Shared goals • Building cultural awareness

3. Contract Implementation Contractor “start up” • Contractor notified of award decision 7/25/08 • Contract signed 9/4/07 • Implementation date 10/01/08 • Hiring staff (new) 23 Care Coordinators 3 Supervisors 1 Transporter, 1 Intake Specialist • Staff training • Purchasing equipment • Case assignment

4. THE TASK OF MOVING CASES TO THE NEW SERVICE ARRAY AND SIMULTANEOUSLY FACILITATING PRACTICE CHANGE FOR STAFF

5. Preparation • Joint training presented by DHS and FRI • Administrative and supervisory meetings • Three phase case transition plan developed • Transition dates were matched with family need and current level of service • Referral packets were assembled

6. Preparation Challenges • Lack of contractor capacity; set back transition dates • Referral packets were not complete • Supervisors hand correcting 3055s created billing problems • Correction required significant staff time • A central-point-of-contact process was developed

7. Preparation Successes • Issues resolved by the central-point-of-contact process • Active communication patterns developed • Opportunities for change were identified • Learning opportunities were identified • Partnered problem solving and compromise were standardized

8. BEST PRACTICE STRATEGIES Mobilizing People and Resources to Create Change

9. Challenges of the Process • Communicating case progress as it moves through the assessment phase and meeting times to Family Resources • Family Resources assigning a Care Coordinator in time to attend the initial family team meeting (supervisors frequently attend in place of the Care Coordinator at the initial FTM) • Staff continuity for families due to high turnover rate in Care Coordinator positions

10. Data • Current open cases Scott = 229 Muscatine/Cedar = 81 • Total number of families served 10/1/07-3/31/08 = 409 • # of cases closed through 3/31/08 = 102 • Cases closed successfully = 80

11. Status of Implementation of FSRP Services • Our service area has reached full utilization of FSRP Services. • Stability of Family Resources Care Coordinators remains a challenge. • Many families have had several different workers within the six-month period due to this attrition. • Joint team building activities have been undertaken to improve communication and understanding between workers.

12. Status of the Family Functioning Assessment • Assessment tools are in the initial stages of incorporation. • Contractors are not routinely sharing completed assessment documents with DHS. • Progress reports do not reflect the implementation of assessments. • Family functioning assessment information is not incorporated into the case planning process.

13. THE ROLES OF DEPARTMENT WORKERS AND CONTRACT WORKERS

14. Challenges with Role Definition • DHS workers want to match families and providers. • Care Coordinators look to the DHS worker to provide case specific strategies. • DHS workers are acting as mentors to new service providers. • Care Coordinator attrition makes case management difficult. • DHS workers need to develop trust in the service provider. • Care Coordinators are developing their skills.

15. Communication Successes • Regular communication meetings occur at the supervisory and administrative levels • Communication structure provides an effective avenue to resolve conflicts or disputes • Contractual disputes have been mutually resolved • Line staff are progressing in their levels of communication • Family team meetings provide a venue for collaborative case plan development

16. Communication Challenges • Communication at the line worker level has been slow to develop • Written communication (progress reports) has not been consistently completed timely. • Progress reports have not adequately communicated case progress or the implementation of the model of practice • Report formats have been cumbersome and have not met the needs of the contractor, DHS, the courts or families

17. Communication Between DHSand ServiceContractors • For case specific issues - the line worker communication is a point of continuing development. • For program specific issues – the supervisory communication is also a point of continuing development. • For contract issues – a dispute resolution form was developed and is utilized throughout the service area. • The majority of issues identified have been related to worker or case-specific. • Family Resources has been responsive in dealing with issues presented. • The question and answer system has provided essential guidance and precipitated contract adjustments that serve both parties.

18. DHS Worker Survey Results • Inability to match provider skills to family needs. • Contractor focuses on meeting the minimum standards of compliance in the contract rather than the long-range outcomes. • Contractor lacks understanding of the urgency related to child welfare cases. • Contract workers generally lack experience in working with difficult families. • High attrition rate due to high needs of the families being serving. • Enjoy increased level of contact with families. • Difficulty with the referral process in the beginning. • Families report less satisfaction with current service providers than in the past. • Families are being engaged in services more quickly than in the past. • Families report less contact with service providers than in the past.

19. DHS Worker Survey Results (cont.) • Staff feedback indicated improvement from the first to the second quarter. • Improvement was attributed to getting to know the contracted service providers and becoming more comfortable with the communication process.

20. Team Building Activities • Family Resources provided trained mediators to conduct team-building sessions that include all Care Coordinators, DHS Case Managers and all supervisors. • Two sessions have been conducted and it was decided that these sessions will be continued for at least the next few months. Goals: to facilitate continued communication, to develop better understanding. • Staff feedback has been positive.

21. Contractor Standpoint : Contract Advantages • Increased private/public partnership Weekly supervisor meetings, monthly multi-disciplinary meetings, monthly administrative meetings, monthly contract monitor meetings, family team meetings for all cases • Opportunity to work with entire family versus “designated child” • Greater flexibility in service provision • Performance-based • Narrower focus in work with families (safety)

22. Challenges to Serving the Entire DHS Population Issues that tax contractor resources: • Court ordered supervised visits multiple times weekly • Large family constellations • Children in out-of-home placement in different locations • Lack of transportation available to the family • Complexity of family issues (i.e., DV, SA, MH) • Non-custodial parent contacts • CFSR expectations for meeting federal outcomes

23. Contractor Standpoint: Contract Disadvantages or Struggles • Inadequate case rate based on: - number ofsupervised visitations - amount of travel required - 1 case = 1 family, regardless of number of children or location of family members - cost of subcontracting • Contractor is held responsible for client outcomes, yet case management remains with public agency • System Fragmentation

24. Contractor Standpoint : Lessons Learned • Start up costs need to be increased • Start up period needs to be lengthened • Staff capacity developed based on actual cases referred versus anticipated cases • Judges need further education

25. Status of the Collaborative Relationship Six Months into the Contract • Contract Monitors have been providing technical assistance and monitoring activities to ensure the success of the contractors in providing the services. • Contractors and the Department are continuing to communicate to improve their collaborative relationship. • In each service area, adjustments are being made by both parties to ensure the success of the contract.

26. “Changing the system means giving up the way things have always been done that are no longer working.” William Glasser