Community Based Care in Florida and the IV-E Waiver

1. Community Based Care in Florida • and the IV-E Waiver

2. Florida's Waiver - Approved 2006 • Impact of Community Based Care and Waiver • New Federal Waiver - Authorized 2011

3. Florida System • Abuse and Neglect investigations are performed by the state Department of Children and Families ( except in five counties where the local Sheriff has responsibility through contract with DCF ) • Community Providers and subcontractors provide services through fixed price contracts for children and families referred by the state

4. CBC Milestones • CBCs were tested as a concept in the mid 90s - Sarasota YMCA • Florida statute mandated statewide expansion in late 90s • Complete statewide outsourcing occurred in 2005 • Mental health care assigned to CBCs 2005

5. Florida Vision for Waiver • Florida, believed that there were children in out-of-home care that would not have needed to come into care if we had a more effective array of services to support children remaining at home without compromising safety.  • They wanted to safely reduce entries, speed reunification (when this could be accomplished safely) and also move more rapidly to permanency through adoption  or permanent guardianship when reunification was not going to happen.  • The waiver and the ability to use funds with greater flexibility are tools – but having a clear understanding of your system and your vision for change are the critical first steps in the process.

6. Florida Waiver Provisions • Florida agreed to remove the entitlement nature of IV-E funding and take on the risk of a fixed priced agreement in trade for the flexibility to spend funds on things other than out of home care.

7. Florida Waiver Provisions • The HHS agreed to approve the flexible funding if Florida further agreed to four basic goals: • ♦ to expedite the achievement of permanency through either reunification, adoption, or legal guardianship; • ♦ to maintain child safety; • ♦ to increase child well-being; and • ♦ to reduce administrative costs associated with providing community-based child welfare services.

8. Expanded Waiver Services • • Early intervention services in situations of developing family need to prevent crises that jeopardize child safety and well-being; • • Payments for goods or services that reduce short-term family stressors and help divert children out-of-home placement (e.g., payments for housing, child care, etc.); • • Evidence-based, in-home services to prevent out-of-home placement; • • Services that promote expedited permanency; • • Enhanced training for child welfare staff and supervisors; • • Improved needs assessment practices; and • • Long term supports for families to prevent placement recidivism.

9. Waiver External Evaluation • The Waiver required an ongoing evaluation ( University of South Florida ) • “Evaluation reports indicate that the project was successful in meeting its four outcome goals. • Community Based Care (CBC) lead agencies are shifting resources to the front end of the system and into diversion and early intervention services.” • Reports are publicly disclosed (http://centerforchildwelfare.fmhi.usf.edu/DataReports/IVEReport.shtml)

12. New Federal Waiver • September 2011 Congress reauthorized HHS to approve new waivers for up 30 additional states - up to10 each year for 2012, 2013 and 2014. • No new funding is provided in this 2011 reauthorization

13. New Requirements • Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth • Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve safety and well-being • Prevent child abuse and neglect and the re-entry of infants, children and youth into foster care.

14. Priority for Projects • Focus on positive well-being outcomes for children, youth and their families, especially those who have experienced trauma related to maltreatment • Focus on the social and emotional well-being of children and youth who are available for adoption, as well as those who have been adopted • Are designed to yield “more than modest improvements” in the lives of children and families and contribute to the evidence about what works to improve child and family outcomes • Leverage the involvement of other resources and partners to make improvements concurrently through child welfare and related program areas, such as delivery of effective mental and behavioral health services and continuity of Medicaid eligibility as children move in and out of foster care.

15. Recent Waivers Contain • Prevention services designed to provide family support, maintain child safety and stabilize the family before foster care becomes necessary • Services to reduce lengths of stay in the foster care system by addressing the underlying reasons that brought a child into foster care (eg., linkages to housing supports and other concrete services, substance abuse referrals, and mental health supports.) • Services to safely transition youth from more institutional settings to family settings • Post-permanency services for children that have left foster care but still need supports

16. Federal Waiver Timeframe • Previous waiver processes started in January and encouraged a letter of intent from the state • While guidelines have not been released for the final round of waiver applications the expectation is that a letter will not be required but applications should be submitted no later than March • Selected states will be awarded before September 30, 2014 • New Leadership in the Children’s Bureau could influence new waiver guidelines

17. Recap • Flexibility of funding - Funds follow child not the provider • Keep children at home if it can be done safely • Move children to permanent families more quickly • Do a better job of helping older children transition to adulthood • Focus more on the well-being of children