Improving Outcomes for Children and Youth: Foster Care Redesign

1. Improving Outcomes for Children and Youth: Foster Care Redesign Texas Alliance Child Care Administrators’ Conference October 15th, 2010

2. Agenda • Project Overview • Quality Indicators • Stakeholder Involvement • Status • Preliminary Model • Issues • Next Steps

3. Overview • 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

4. 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.

5. 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

6. Process • 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

7. 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

8. 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

9. 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

10. Report: Request for Proposal Responses

11. 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

12. 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

13. 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)

14. 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

15. Status Preliminary Design

16. 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

17. Preliminary Design • Basic Elements • Contract for Continuum of Care • RFP for Continuum • Increased Family Involvement • Better Collaboration

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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”

24. Next Steps • Implementation Issues • Implications Workgroups • Report • PPP Recommendations • Stakeholder Participation/ Input • High Level Implementation Plan • Innovation Zones • Governance • Criteria for Decision-Making

25. Questions?