Child Care Resource and Referral Services: Changes to Service Delivery in FY13

1. Child Care Resource and Referral Services: Changes to Service Delivery in FY13 July 2012

2. EEC Mission Statement The Massachusetts Department of Early Education and Care’s mission is to provide the foundation that supports all children in their development as lifelong learners and contributing members of the community, and supports families in their essential work as parents and caregivers.

3. EEC’s Mixed Delivery System Pediatricians Informal settings

4. Brain Building in Progress Initiative Representative Alice Wolf reads with children from the Castle Square program in Boston

5. Redefining High Needs Children • Building Capacity of Programs and Their Partners to Serve Families in Need • Currently, Massachusetts defines “high needs children” as those with sufficiently low household incomes, those in need of special education assistance, and other priority populations who qualify for federal and/or state aid. • In the Race to the Top – Early Learning Challenge grant, Massachusetts moved toward a broader definition of “high needs children” to include children who have multiple risk factors linked to poor school and life outcomes, including: • Children and parents with special needs; • Children whose home language is not English; • Families and children involved with multiple state agencies; • English language learners; • Recent immigrants; • Children with parents who are deployed and are not living on a military base; • Low-income households; • Parents with less than a high school education; and • Children who are homeless or move more than once a year.”

6. Data on High Needs Young Children in MA • The 2010 Census reported the Massachusetts’ population to be 6.5 million. Children from birth to age 5 accounted for only seven percent (442,592) of this total. • A significant proportion, however, may be categorized as “high need”. • Close to one-third of all children birth to 5 are low-income, according to the National Center for Children in Poverty, while 17.4% are English language learners, 6.7% have special needs, and .9% are homeless. • These children are most at-risk of encountering developmental delays and school readiness gaps and most likely to benefit from high-quality early learning and development experiences.

7. A Systemic Approach EEC Strategic Directions

8. Building the System • EEC is focused on strengthening the system of early education and care in Massachusetts as a critical element of the education pipeline from cradle to career. • The child outcomes that we are trying to achieve require investment in four critical areas: • teacher quality, • program quality, • screening and assessment, and • engagement of communities and families. • The system EEC is building includes all children, not just those who are subsidized or in formal care.

9. Supporting Child, Family, Community Outcomes

10. EEC Systems Development • Four systems across the state: • Educator/Provider Supports (EPS) • Coordinated Family/Community Engagement (CFCE) • Mental Health • Child Care Resource and Referral (CCRR) • Regionally/locally based • Focused on the needs of adults and supporting adult/child interaction • A strengths-based model of family support – inclusive of all, with prioritization of those most at risk • Not primarily focused on family income, though prioritize families with greater needs • Prioritize communities with multiple indicators of need. • Expand upon and support quality in new licensing regulations and QRIS • Allow for differentiation to meet local needs

11. EEC Systems Development

12. Improvements for Child Care Resource and Referral Financial and Data Management • Central data source reduces IT costs and eliminates the need for replication – multiple instances of families and providers. • PRISM(Person Resolution Information SysteM) a robust mechanism that uniquely identifies Individuals entered into the system • Common Subsidy Management and Intake business rules will exist for EEC Financial Assistance • Fully electronic/online attendance and billing submissions. • Better data quality and reporting capability. • Children that are already in CCFA or in KinderWait do not need to be re-entered during eligibility CCFA (New) CCIMS (Current) • There are ten separate CCRR databases. The data must be transferred to EEC daily. • Families who move to a different region are re-entered in the new CCRR database. • Voucher Subsidy Management business rules are not the same as those for Contracts. • Manual paper billing process . Thousands of Requests for Reimbursement are mailed to providers and returned for CCRR data entry.

13. Child Care Financial Assistance (CCFA) The CCFA system will have improved process and end user benefits 13

14. Financial Assistance Eligibility Process Changes (CCFA) • Fully Automated subsidy calculation based on EEC policies, regulations, State Median Income table. • Parent co-payment rules are applied by the system leading to accurate calculations. • Eligibility recalculation is applied immediately upon a family’s change of circumstances. • Well designed to handle changes to Household composition by accurately capturing when a family member enters or leaves the household.

15. Financial Assistance Attendance Changes (CCFA) • Online attendance entry will be used versus paper rosters • Attendance will be marked for each day services are utilized thus allowing for accurate reporting • Current method only captures number of days attended in a given month • CCFA will enable: • recording of attendance for authorized services only • ability to track utilization of services authorized • ability to override attendance in specific scenarios (appropriate authority needed)

16. Financial Assistance Policy/Regulation Changes CCIMS CCFA • Attendance - 30 absences in a 6 month period or 3 consecutive unexplained absences (providers will not be paid if these numbers are exceeded) • Special Need of Parent - 12 month authorization, renewable for 2 years thereafter and, in chronic situations, can be extended with EEC authorization • Special Need of Child - parent must have a service need of work, education or training • Attendance – Allows up to 10 absences per month or 3 consecutive unexplained absences • Special Need of Parent - authorization is renewed every 12 months without a prescribed end date • Special Need of Child –this can be a service need and a parent does not have to work. 

17. Financial Assistance Rate/Fee Changes CCIMS CCFA • Rates paid –pay based upon age of child.  • CCFA will “unblend” the rates and give separate rates for summer and for school year.  This will result in programs being paid less in certain situations. • Rates paid –pay is based upon program type.  • Blended rates – CCIMS reflects a “blended” rate whereby the summer rate and school year rate are blended into one rate for consistency for parents

18. Child Care Resource and Referral Voucher Administration *September 2009 New Voucher Placement number was 1,736 *October 2009 New Voucher Placement number was 982 Source: CCIMS

19. Child Care Resource and Referral Voucher Administration *These numbers represent the volume of new (blue) and reassessed (red) vouchers written state-wide each month. These numbers do not capture no-show appointments or appointments held for vouchers not written due to insufficient documentation. Source: CCIMS

20. Need for Child Care Resource and Referral Services Reform Recent studies, taken together, point to a need for the following reforms in CCR&R services in MA: • Standardization of CCR&R services across all contracts, • Increased use of technology and unified data systems, • Streamlined and/or centralized voucher management, • Increased access to information for all families, subsidized or not, on early education options and quality - including the QRIS, • Clarification around the training and technical assistance role of the CCR&Rs, • Alignment with national best practice and CCR&R quality assurance.

21. Research Completed • Review of MA CCRR studies • Conversations with EEC staff • Conversations with MA CCRRs • Conversations with MA CFCEs, Mass211, etc. • Conversations with other state CCRR networks/agencies • Review of other state CCRR procedures documents • Attended NACCRRA Symposium

22. Introduction • Over the past 40 years Massachusetts has supported Child Care Resource and Referral Agencies (CCRRs) and the work they have accomplished on behalf of families and providers throughout the Commonwealth. • CCRRs play an important role in supporting EEC’s mission. To this end, CCRRs’ guiding principle will be to strengthen families through the services they provide. • CCRRs serve a wide spectrum of families across the state. • CCRRs have a strong commitment to serving those who are most vulnerable: families that qualify for subsidies, are newcomers, are in transition, speak languages other than English, have children with special needs. • CCRRs have strong relationships with child and family serving agencies, in particular a strong partnership with CFCEs. • CCRRs develop and support a varied provider workforce, and their support for the workforce is strengthened by their work with EPS grantees.

23. CCRR Operations Criteria EEC will contract with strong CCRR agencies that meet industry standards and have qualified staff, engage in strategic planning, are fiscally sound, coordinate with other agencies that serve families and providers and have systems in place that support their technological needs. CCRRS will have: • NACCRRA Quality Assurance • Sound understanding of EEC licensing regulations and EEC initiatives • Professional staff with bachelor’s in field appropriate to their position (ECE or related field), and direct experience in the early education and care field • Trained staff use NACCRRAware to input provider data, family data, generate reports • Technical capacity, IT support to carry out agency functions and provide online services • Written policies and procedures to include operations, orientation and personnel • Sound financial policies and procedures in place • Staff that reflect the diversity and linguistic needs of the families and providers in the cities and towns they serve • Professional development for staff to include orientation & ongoing training • Staff that are supervised and evaluated on a regular basis • Partnerships with CFCE, EPS grantees, Mass211 and convene regional meetings with these agencies • Capacity to produce data reports for EEC and other constituents • Plan for gathering feedback from various constituencies regarding delivery of services • Board of Directors or Advisory Committee that reflects cities and towns served • Involvement in the early education and out of school time care field through membership in local, state and national organizations and associations

24. Family Engagement: Objective Families have access to high quality information, resources and referrals that meet their specific needs and are educated regarding cost, quality and availability of early education and out of school time care. CCRR will use the Strengthening Families framework, which provides a concrete frame to support families, increase knowledge of growth and development, increase knowledge of social and emotional development, resilience and social networks.

25. Family Engagement Policies • CCRR is knowledgeable regarding the early education and out of school time care needs of families in their cities & towns by conducting community needs assessment, reviewing census data, connecting with community stakeholders such as newcomer leaders, public schools, early intervention, and CFCEs • CCRR has a depth of understanding of their cities and towns through knowing the diversity, changes, informal spaces (libraries, museums), school policies, public officials & community leaders • All families have access to accurate, meaningful consumer information, education and referrals that meet their specific needs and assist them in quality care decision making process online, phone calls, in person, email, mail, fax and new smart phone application • All families will receive information and referrals in a timely manner that meets high quality customer service benchmarks, and is sensitive to the families in their cities and towns including cultural, socio-economic, language and other factors. Families will be provided a minimum of 3 and maximum of 15 referrals within one business day • All families are educated on a range of topics including licensing regulations and the definition of high quality environments, to include but not limited to information on types of care, exemptions in licensing, staff child ratios, group size, provider education, health & safety, accreditation, QRIS areas, and step by step action plan for search • CCRR will educate and provide referral services to families using vouchers, communicating by phone, in person, by fax, email, or visits at DTA office, explain voucher process, speak with providers on behalf of families, and check in within a week to see how search is going

26. Family Engagement Policies • Enhanced Referral services are provided to families that are hard-to-serve/high risk and/or have specific care needs (special needs, transitional families, speak English as a second language) by trained Specialists who have core knowledge of child development. Specialist obtains consent to speak with providers on families behalf, offers in person appointments and non traditional office hours, helps families make step by step action plan and conducts check in/follow up call within one week • Coordination between CCRR and Mass211 takes place, by CCRR taking calls passed from Mass211 for families in need of Enhance Referrals. CCRR contacts Mass211 at least 3 times a year to discuss services and coordination • Families are informed about the range of care costs in their cities and towns and financial assistance/tax credits available on website and during phone calls • All families are educated on the concepts of high quality care as specified in QRIS, through link to EEC information on website, during referral calls, and by encouraging parents to ask providers about their level of quality • Collaboration and coordination between CCRRs and CFCEs takes place through creation of a partnership plan, meetings once a year, and CCRR conducting a minimum of 2 follow up phone calls to CFCEs per year

27. Family Engagement Policies • Families are made aware of and linked to other agencies and organizations that provide services and information regarding young children, such as but not limited to: CFCEs, libraries, museums, EEC, public schools, public health, WIC, early intervention • CCRR provides high quality information on child development including use of ASQ developmental screening, which is discussed with families on vouchers and other families who might benefit from it. CCRR directs families to the CFCEs, tracks calls referred to CFCEs and helps families to complete ASQ if needed • Family services will be outcomes driven and informed by results of family satisfaction survey conducted via mail, phone and/or online to families 3 weeks after services are provided. Data results will be reviewed monthly and test calls will be completed • CCRR serves as an educator for high quality early education and out of school time care through engaging in activities to raise awareness such as promoting initiatives like Brain Building in Progressamong others

28. Family Engagement Activities • Conduct regular community care needs assessment and analysis • Connect regularly with community stakeholders regarding care needs • Review census data for cities and towns served to better understand family demographics • Make connections with community leaders and public officials • Provide customized information and referrals via various modes • Return messages within one business day • Provide families with information and referrals in a timely fashion • Provide individualized educational information • Educate parents regarding types of care and quality indicators as per QRIS specific definitions • Help families to develop step by step action plan for search • Create plan for providing services in languages most prevalent in cities and towns served • Provide consumer education services and materials in languages reflective of the cities and towns served. • Conduct family satisfaction survey via online, email or by phone • Provide outstanding customer service as defined by NACCRRA Quality Assurance Best Practices criteria • Using active listening skills, interview parents to gain understanding of their preferences before providing referrals; • Respect parents’ criteria and provide information and referrals based on family preferences • Refer families to Enhanced Services Specialist if applicable

29. Family Engagement Activities • Link with other state agencies/community organizations that work with families to expand services • Ensure that staff are prepared to serve all families in service area • Provide services in traditional and non-traditional office hours • Assign Specialists to work with families who are in need of Enhanced Referral service. • Help families to develop step by step action plan for search • Using ECIS consent form, obtain permission from parents to discuss needs, contact providers on behalf of parent, and determine if there is provider availability. • Provide special assistance for high need families, including in person appointments • Conduct follow up/check in calls on enhanced referrals provided within one week • Conduct parent satisfaction survey • Provide services to families in need through various methods: • Inform families of the voucher process details, • Use active listening skills to best understand the needs of the family (such as transportation, language, culture, special needs, etc.) as they relate to care needs • Have a specific process and script for actively educating families on selecting quality care by promoting the QRIS concepts • Refer family to Enhanced Referral Specialist for Enhanced Referral service for child care search • Work closely with Mass211 by taking calls passed for families in need of Enhanced Referral services

30. Family Engagement Activities • Contact Mass211 at least 3 times a year to discuss services and engagement process • Inform families on general costs of care based on geographic region, age of child, and type of care. • Have website contain a link to the information on the EEC website • Staff share information during all referral calls about the elements of quality care as specified by QRIS, and where to find more information • Encourage parents to ask providers about their quality level in order to make informed decisions • Convene individual meetings with each CFCE in service area • Obtain and provide family resource information to or with CFCE • Create partnership plan with CFCE regarding what and how information will be shared to best serve families • Conduct follow up phone calls with each CFCE to review and adjust plan • Share with families information on value of CFCE and resources they have relative to family needs • Provide information and links to agencies/organizations/informal spaces on CCRR website • Direct families using vouchers or others to the CFCE agency in their community for developmental information including access to the ASQ • Track number of referrals to CFCE for all services including ASQ screening • Conduct family satisfaction evaluation surveys with all families who receive service 3 weeks after services are provided via mail, phone, online • Conduct random test case calls to evaluate service

31. Provider Development & Engagement: Objective Services for providers are intentional, coordinated, measureable, aligned with QRIS, and ensure provider access to training and technical assistance that links to EEC licensing requirements and standards.

32. Provider Development & Engagement • Recruitment of new providers and new care slots takes place based on the needs of the community, and is informed by supply and demand data analysis activity and census data. Regular scheduled calls are made to existing providers regarding increasing capacity, recruitment information is posted and presentations are made to local business groups • NACCRRAware is used to maintain information on licensed providers in CCRR’s cities and towns, all providers are contacted/included in database, all data fields are completed, provider closures are tracked and reported to EEC, and exit interviews with providers who leave are conducted and documented • Provider voucher agreements are executed, reviewed and monitored. New providers are recruited to take voucher familiesand oriented to system, and training and TA is provided to all providers in the voucher system. CCRR will follow EEC Voucher Provider Monitoring Process to include risk assessments of all providers taking vouchers within 2 years time, complete provider renewals, and complete reviews of providers with cited complaints • The training and technical assistance needs of the providers in CCRR cities and towns are assessed as they relate to EEC licensing, health and safety, and voucher utilization, through conducting and analyzing annual provider needs assessment • Collaboration and coordination between CCRR and EPS grantees takes place through individual meetings with EPS grantees, creating partnership plan on provider service coordination, sharing provider data, and follow up calls to EPS grantees to review and adjust plan • Providers are informed of EPS grantee professional development and training opportunities by posting EPS trainings on CCRR website, promoting EPS courses during provider training and TA

33. Provider Development & Engagement • High quality trainings on various topic areas are provided which focus mainly on EEC licensing requirements. Trainings are delivered in person or via webinar; are offered at convenient times and locations and in multiple languages as needed; a training calendar is issued annually which is linked to EEC’s calendar and made available via CCRR website, mailings, and postings at provider conferences; training evaluation surveys are conducted • Quality technical assistance is provided to providers in person, via phone, email and online, to include start up orientation for new providers, licensing regulations/deficiencies in coordination with EEC’s Licensor, and other topics such as but not limited to: facilities/space, serving at-risk families, inclusion settings and funding opportunities • A tracking system for training and technical assistance given to providers is in place; data is analyzed to report results such as numbers served, provider type, provider location, trainings offered, etc. • Providers are educated on QRIS system and how to access trainings that help them achieve their QRIS level goal during phone calls when CCRR updates database, through linkages to EPS grantees for QRIS training, when promoting QRIS during start up orientation, and through recognition of providers with high QRIS levels

34. Provider Development & Engagement • Linkages for providers are made to other agencies that have information pertaining to young children and family services during phone calls and is provided on website; numbers of referrals to agencies are tracked in NACCRRAware to produce reports of activity • CCRR has knowledge of providers’ physical space/facility through onsite visits to 10% of new and existing providers per year; visits are tracked for reporting purposes • CCRR services are marketed to providers in the field by posting information and conducting outreach using website, social media, newsletters, EEC start up packets, and at local AEYC conferences and community group meetings • Education and consultation is provided to informal care providers (e.g. in home and relative care providers) to include topics on health and safety issues such as basic child development milestones, SIDS and Shaken Baby Syndrome, and information is provided in languages needed for those who speak English as a second language • CCRR works to promote high quality early education and out of school time care by promoting quality care initiatives and disseminating information

35. Provider Development and Engagement Activities • Analyze supply and demand of early education and out of school time care in community by age group and type of care • Review census data regarding any increase in number of young families moving to community to inform provider recruitment efforts • Create schedule of regular calls to existing providers to ascertain interest in increasing their licensed capacity • Post recruitment information on line and in newspapers • Conduct presentations with local chamber of commerce and other business groups as it relates to access to high quality early education and out of school time care • All providers are contacted regarding being in the database • All fields in NACCRRAware are completed based on National Data Set. Additional configurable fields are completed to capture • Track and report to EEC all provider closures, and conduct exit interviews with providers who are closing • Assign specific staff person to manage provider voucher process • Recruit new providers to take families on vouchers and encourage existing providers to increase their numbers of families on vouchers • Provide training and TA to providers on the voucher system, including forms, expectations, etc. • Specialists follow EEC Voucher Provider Monitoring Process, and risk assessment is completed for all voucher providers in cities and towns over a 2 year period • Complete provider renewals

36. Provider Development and Engagement Activities • Complete reviews on voucher providers who have complaints cited • Conduct formal annual training and TA needs assessment of all providers in service area • Analyze needs assessment results and put in context with other existing information on provider training and TA needs • Review needs assessment results with EPS grantees to coordinate and deliver provider training and TA as it relates to licensing or voucher utilization • Convene individual meetings with each EPS grantee in service area • Create partnership plan with EPS grantee regarding what and how information will be coordinated to best serve providers without duplication • Provide EPS with provider contact information and other provider data for outreach and statistical purposes • Coordinate with EPS regarding the unmet needs of providers focusing on health and safety and/or licensing needs • Post EPS trainings on website • During trainings and TA, promote and provide information to providers on their local EPS offering • Track number of providers that are referred to EPS • Prepare and deliver trainings in diverse methods such as webinar, in person, etc. • Provide onsite trainings at times and locations at which providers can attend and in languages needed • Coordinate with community experts to deliver trainings

37. Provider Development and Engagement Activities • Issue a detailed training calendar which includes date, time, location, description, language, cost and make available through multiple methods e.g. on website, through mailings, at BAEYC, libraries, etc. • Link CCRR training calendar to EEC training calendar • Conduct provider evaluations on each training provided via survey • Provide TA in person, by telephone, online and via email to answer questions and link providers to resources • Provide specific TA to new providers which includes comprehensive start up orientation and materials • Provide TA on licensing regulations and licensing deficiencies in coordination with EEC’s Licensor’s TA given to providers • Collect, compile and analyze data on CCRR training and TA given using NACCRRAware Training Tracker. • During calls to providers when updating database provide education on and promote QRIS • Link providers to EPS for QRIS competency training • Provide information and links to QRIS in newsletters and on website • Promote QRIS during start up orientation TA and during other provider TA and training

38. Provider Development and Engagement Activities • Recognize and support providers that are entering at and achieving higher levels of quality • Track percentages of providers that have moved up in QRIS levels • During calls, TA and training, and on website provide information on how to access agencies • Track number of referrals to various agencies using NACCRRAware • Conduct onsite visits with both new and existing providers in service area, including providers who do and do not take vouchers • Track onsite visits using NAACCRRAware • Provide basic health and safety training to providers used by families on vouchers • Inform providers of CFCEs and other family resources • Include providers in CCRR training email/mail distribution list • Provide information to providers on how to become licensed • Conduct activities designed to raise awareness of high quality care and QRIS • Promote Brain Building in Progress, Week of the Young Child and other state and national initiatives • Disseminate information regarding public issues affecting early education and out of school time care

39. CCR&R Timeline Phase Three: Re-contracting July - September • EEC will develop an RFR that reflects the protocols and post as an open bid for CCR&R Services. • Contract awards will be announced by Sept. 15, 2012 Phase Four: Transition to new CCR&R model. Oct. – Dec. New CCR&R contracts start: January 1, 2013.