Community-Based Care: An Examination of Practices and Outcomes

1. Community-Based Care:An Examination of Practices and Outcomes Cathy Sowell University of South Florida Svetlana Yampolskaya University of South Florida Neil Jordan Northwestern University Hope Phillips Family Services of Metro-Orlando DCF Dependency Summit August 28, 2008

2. Through the Title IV-E Waivers, states may spend Federal Title IV-E funds for supports and services (other than foster care maintenance payments) that protect children from abuse and neglect, preserve families, and promote permanency (U.S. Department of Health and Human Services, 2005). Florida’s Waiver was implemented in October 2006 through changes in State contracts with the CBC lead agencies. The Waiver authorizes a five year demonstration to show that flexible use of federal funds will result in improved outcomes for children and families. Florida’s IV-E Waiver Demonstration

3. IV-E Waiver Evaluation -Research Components Cost Analysis Examination of the impact that the IV-E Waiver has on CBC lead agency expenditures, specifically related to - dependency case management, licensed out-of-home care, and prevention/family preservation services Child Welfare Practice Analysis Examination of the changes in child welfare practice that are directly and indirectly related to the IV-E Waiver Demonstration Outcome Analysis Examination of permanency and safety outcomes for children and families involved in the child welfare system Implementation Analysis Examination of the planning and implementation process for the IV-E Waiver and the impact of the Waiver on DCF, CBC lead agencies, provider networks and local communities.

4. Child Welfare Practice Analysis: Purpose • To examine changes in child welfare practices that are both directly and indirectly attributable to IV-E Waiver implementation • Direct changes through the use of IV-E funds • Indirect changes that are consistent with the goals of the Waiver and may attribute the Waiver as a catalyst for the change • To examine the needs assessment process and determine if assessments are leading to appropriate case planning, services, and family engagement • To examine the relationship between CBC lead agency practices and child and family outcomes

5. Child Welfare Practice Analysis: Hypotheses The implementation of the Waiver will lead to the development and expansion of CBC lead agency services and strategies that will: • prevent or divert out-of-home placement while maintaining child safety, • engage families in service planning and provision, and • reduce lengths of stay in out-of-home care.

6. Child Welfare Practice Analysis: Components • Profiles of Practice and Performance • An examination of each lead agency’s service array prior to and during Waiver implementation • An examination of statewide trends in practice change • An examination of the relationship between practices and safety and permanency outcomes • Innovative Practices • Identification of practices being implemented by CBC lead agencies that: • are not utilized statewide, • have clearly defined policies and procedures, • and have a method for measuring the impact and outcomes of the practice.

7. Child Welfare Practice Analysis: Method • Practice changes are assessed by the FMHI-USF research team through lead agency surveys that are completed on an annual basis and follow up communication with stakeholders. • Innovative practices are identified through the survey and additional data is collected from program staff.

8. Child Welfare Practice Analysis: Findings Prevention and Diversion Strategies • Mobile Crisis Response Teams • Rapid response and intensive short term intervention for families in crisis • *Resource Specialists – HKI and FSMO • Co-located with CPI staff to identify appropriate services and supports for families involved in a report of abuse or neglect in a timely manner • Diversion Staffings • Brings CPI, CBC, and community providers together to identify appropriate services for a family and make timely referrals • *Peaceful Paths - PFSF • Domestic violence prevention program for at risk youth *These programs have been identified as an innovative practice

9. Child Welfare Practice Analysis: Findings Prevention and Diversion Strategies • *Family Connections – CBC Seminole • Utilizes a family team conferencing wrap-around approach and is intended to provide families access to services and support quickly • In-Home intervention programs • Substance abuse counseling • Wrap-around case management and services • Parent education for at-risk families • Family Preservation services *These programs have been identified as an innovative practice

10. Child Welfare Practice Analysis: Findings Family Engagement Strategies • Family Team Conferencing – utilized to varying degrees by 11 out of 20 lead agencies • Relative Caregiver programs - Supports relative caregivers, making it easier to navigate the system and attain necessary services and supports • GAP Project – Heartland/Devereux • Relative Caregiver Specialists – HKI & CNSW • Relatives as Parents program – UFF • Kinship Care Support – KCI • 10 week support group for caregivers

11. Child Welfare Practice Analysis: Findings Strategies to Promote Permanency • *Family Finding - Our Kids & KCI • A practice used to identify supports for children in foster care and increase connections. Utilizes the program model developed by Kevin Campbell • Standardized assessment tools • Utilization management reviews • Foster Parent Support • Foster Home Management – BBCBC & PFSF • support and placement stability • Foster parent mentor program - UFF • Enhanced foster parent training

12. Child Welfare Practice Analysis: Findings Strategies to Promote Permanency • Family Stabilization and Placement Services – HKI • Improve placement stability in at-risk families and relative and foster home placements • Educational Liaisons • Reunification Services and Supports • Post Adoption Services and Supports • Adoption Support Groups • Adoption Case Managers • assist families in identifying resources within the community, engage adoptive families in organized activities and identify training/workshop opportunities

13. Outcome Analysis: Purpose • To examine the permanency and safety outcomes for children and families involved in the child welfare system prior to and during the five year IV-E Waiver implementation period

14. Outcome Analysis: Hypotheses Flexibility in spending allowed by the Waiver will result in an expanded child welfare service array and subsequent improvements in safety and permanency outcomes for children and families. Specifically: • the number of children entering out-of-home care will decrease, • the number of children exiting out-of-home care will increase • the length of stay in out-of-home care will decrease, • re-entry rates into out-of-home care will decrease, • abuse during services will decrease, and • recurrence of maltreatment will decrease

15. Outcome Analysis: Method • Use of event history or survival analysis based on Home Safenet administrative data • All indicators were calculated for each CBC lead agency and for Florida • A subset of the indicators were chosen for the current analysis, based on those that are thought to be most impacted by practice changes

16. Outcome Analysis: Findings Prevention Indicator Proportion of Children Whose Case Was Opened for Services in SFY05-06 and Who Entered Out-of-Home Care Within 12 Months • This indicator relates to the effectiveness of the child welfare system at preventing families who are receiving community-based services from requiring out-of-home care to maintain child safety. • No target set by DCF for this measure and no national standard • Children were followed up for 12 months and percentages were calculated for each lead agency and for the state of Florida.

17. Entry Into Out-of-Home Care After Receiving Services

18. Entry Into Out-of-Home Care After Receiving Services • Statewide, the proportion of children entering out-of-home care was equal to 23.3%. • ChildNet had the lowest proportion (14.3%) of children entering out-of-home care within 12 months after their case was opened for services. • ChildNet has developed a network of community agencies that provide voluntary Family Intervention Services targeted towards families with children at imminent risk of removal from the home. • FSMO had the next lowest proportion (15.5%) • FSMO utilizes a diversion program, Community-Based Interventions, Resource Specialists, family involvement in Initial Case Conferences, and Family Team Conferencing.

19. Reunification and Placement with Relatives Permanency Indicator Proportion of Children who Entered Out-of-Home Care in SFY05-06 and Were Discharged for Reasons of Reunification or Placement With Relatives Within 12 Months • Three reasons for discharge were included in the calculation of this indicator: • (a) long-term custody to relatives, • (b) guardianship to relatives, and • (c) reunification with parents or original caregivers • The state goal set by DCF for the proportion of children exiting within 12 months for reason of reunification is 76%.

20. Reunification and Placement with Relatives

21. Reunification and Placement with Relatives • Statewide, 48.2% of children who entered out-home care in SFY05-06 exited within 12 months for reasons of either reunification or placement with relatives. • KCI and FFN had the highest proportion of children discharged within 12 months because they were either reunified or placed with relatives (63.7% and 59.0%, respectively). • To support the reunification process, KCI contracts with The Nurturing Program, the in-home parenting services component of The Child Abuse Prevention Project located at the University of Florida. • FFN, reported the use of Family Support Teams and Family Team Conferencing (FTC) to improve permanency and safety outcomes for children. • The next three performers on this indicator, CBC of Brevard, St. Johns, and PSF also report using FTC.

22. Re-entry Into Out-of-Home Care • This indicator was based on children who exited out-of-home care during SFY05-06 for reasons of reunification or placement with relatives. These children were followed for 12 months to determine if they re-entered out-of-home care. • The statewide target for this indicator, set by DCF, is no more than 9% of children discharged will re-enter out-of-home care.

23. Re-entry Into Out-of-Home Care

24. Re-entry Into Out-of-Home Care • Statewide, the proportion of children discharged in SFY05-06 to their original caregivers or with relatives that re-entered out-of-home care was 9.5%. • HKI and Our Kids had the lowest proportion of children re-entering out-of-home care after exiting in SFY05-06, 6.2% and 7.8%, respectively. • HKI and Our Kids also both have the longest lengths of stay in out-of-home care. • FSS, Children’s Network, FSMO, KCI, and PSF met or exceeded the state goal.

25. Outcome Analysis: Conclusions • Shorter length of stay in out-of-home care corresponds to higher re-entry rates • Most lead agencies did not reach state goal for reunification • Additional services and supports are needed for families with children who receive in-home services to prevent children’s entry into out-of-home care

26. Cost Analysis: Purpose • Understanding how lead agency spending has evolved in response to IV-E Waiver • Not expected to reduce overall expenditures for child protective services • Waiver removes barriers to how lead agencies use federal dollars • Should lead to more efficient and effective use of federal and state resources • Potentially minimizes burden on state taxpayers

27. Cost Analysis:Hypotheses • Flexible spending allowed by the IV-E Waiver will result in: • Increased lead agency efficiency in spending IV-E dollars • Increased spending for prevention, early intervention, & diversion services • Decreased spending for out-of-home (OOH) care

28. Cost Analysis:Method • Longitudinal analysis (SFY 05-06, SFY 06-07) • Unit of analysis = lead agency service contract • 22 service contracts across 20 lead agencies • Data Sources • Florida Accounting Information Resource (FLAIR) • DCF Office of Revenue Management

29. Cost Analysis:Findings • In SFY06-07, lead agencies spent all available IV-E foster care funds for the first time in the history of Community-Based Care

30. Dependency Case Management Expenditures as a % of Total Expenditures, FY05-06 vs. FY06-07

31. Licensed Out-of-Home Care Expenditures as a % of Total Expenditures, FY05-06 vs. FY06-07

32. Prevention/Family Preservation/In-home Expenditures as a % of Total Expenditures, FY05-06 vs. FY06-07

33. Ratio of Out-of-Home Care Expenditures to Prevention/Family Preservation/In-home Expenditures, SFY05-06 vs. SFY06-07

34. Cost Analysis:Conclusions • Some evidence of increased efficiency in resource use • Lead agencies were able to access all budgeted federal and state funds during 1st year of Waiver • Stakeholder interviews with lead agencies & DCF fiscal staff confirmed favorable impact of Waiver on accessing fiscal resources

35. Some evidence of changes in spending, but not all as hypothesized % of spending on prevention/family preservation/in-home services nearly doubled year-over-year, although still small Substantial decreases in the ratio of $ spent on OOH care services compared to $ spent on prevention, family preservation, and in-home services Modest increase in the proportion of spending on licensed OOH care Notable decrease in the proportion of spending on dependency case management Cost Analysis:Conclusions

36. Cost Analysis:Conclusions • Considerable variation across lead agencies with each service type • Negative correlation between dependency case management spending and licensed out-of-home care • Trade-off between dependency case management and OOH care may reflect different practice philosophies and/or local child welfare population needs • Consistent with CBC principles of local control over the management of the entire services continuum

37. Study Limitations • Practice data is based on lead agency self report, with varying degrees of specificity about services and programs • Expenditures reported here are limited to those reported to DCF • Do not reflect lead agency spending of non-DCF resources (e.g., state Medicaid funding not directly tied to child welfare, locally generated revenue) • Lack of valid comparison group prevents us from concluding that all spending changes were attributable to the Waiver rather than other policy or system changes

38. Discussion • The lead agency survey has been revised to collect more detailed information about lead agency programs and strategies in an effort to relate practices to performance • Future reports will include longitudinal analyses of the prevention, permanency, and safety indicators to examine lead agency performance over time, since the implementation of the Waiver • An implementation analysis is being conducted to obtain lead agency and DCF perspective on the root causes of specific indicators and the relationship between indicators • Cost data will continue to be tracked and also triangulated with practice data to examine the relationship between expenditures and practice

39. Contact Information Amy Vargoavargo@fmhi.usf.edu Mary Armstrong armstrong@fmhi.usf.edu Svetlana Yampolskaya yampol@fmhi.usf.edu Neil Jordanneil-jordan@northwestern.edu Tara King-Miller tmiller@fmhi.usf.edu Cathy Sowellcsowell@fmhi.usf.edu FMHI/USF http://cfs.fmhi.usf.edu/