Fostering Results for Ohio’s Children Child Welfare Finance Reform

1. Fostering Results for Ohio’s ChildrenChild Welfare Finance Reform Crystal Ward Allen, Executive Director Public Children Services Association of Ohio State Partner, Fostering Results pcsaocwa@iwaynet.net

2. Fostering Results • PCSAO is a partner of Fostering Results, a national education and outreach initiative for improving child welfare practices by addressing federal financing policy and improved court processes. • The National Center for Adoption Law and Policy (at Capital University) is also a partner. • We want your input on Finance and Court Reform!

3. The Child Protection Mission • Safe Children • Stable, Permanent Families • Supportive Communities

4. ASFA Goals and Objectives • Safe Children – Health & Safety of Children is Paramount • Stable Families, Supportive Communities – Reasonable Efforts to Prevent Removal, and for Reunification • Timely Permanency – Reasonable Efforts for Permanency • Post-Permanency Support – AA Subsidy

5. Public Policy Considerations • Child Brain Development research – safety, connections, stability essential • Poor Academic Outcomes for foster kids • “Aging Out” kids w / poor outcomes • Too many media stories of forgotten kids • In effort to adopt as many kids as possible, “Special Needs” subsidy lost focus

6. Today’s Resource Situation • Inflexible Title IV-E federal funds • Limited State and Local Resources • Inequitable Resources • Increasing Costs • Inadequate Supportive Services (MH, Alcohol & Other Drug Tx.) • Tetris Effect of Adoption Subsidies

7. Effective Practice - Family Centered Neighborhood Based Services • Seek Safety –Safety & Risk Assessment • Engage Relatives & Kin – Genograms • Get Families Positively Connected - EcoMaps • Build Communities – Partner withnon-traditional and traditionalentities • Plan for Permanency – Concurrent Case Planning • Measure Performance – CFSR is a start…if flawed

8. Permanency DefinedAll with Safe, Stable Families • Maintain with Family • Reunify with Family • Custody Transfer to Relatives • Adoption • Planned Permanent Living Arrangement is not permanent…

9. Independent Living • Not a permanency goal, but Essential Life Skills • Assistance with transition from childhood to adulthood • Limited Services & Support available - engagement up to young adult (vs. agency decision-making) • Ed, Training Vouchers available

10. Re$ource Recommendation$ • Flexible & Adequate Federal Funding • Prioritized, Time Limited Behavioral Healthcare Funding • Adequate State Funding • Equitable, Adequate Local Funding • State should assume Adoption Subsidy responsibility

11. ProtectOhio IV-E Waiver • ProtectOhio Title IV-E Waiver works • Rather than funding only placement activities, awards stable funding for in-home and placement activities • Budget neutral, based on historical averages, and responds to control group caseload changes • Only addresses FCM IV-E funds

12. ProtectOhio Outcomes • Waiver counties showed slower growth in placement costs than non-waiver counties. • Waiver counties shortened Length of Stay! • Waiver counties received more revenue than under regular financing. • Waiver counties increased spending on workforce and other supportive services • Enhanced collaboration locally • Increased use of managed care strategies

13. ProtectOhio Status • 5 year demo, going on 6 years • Ohio negotiating 5 year Extension • Ohio negotiating Statewide Expansion • Currently authorized thru 3/31/04 • Feds should award Extension & Expansion now!

14. Federal Child Welfare Refinancing - Activities • President Bush Block Grant / Flexible Funding Option proposal – too few details • Pew Commission on Foster Care and the Courts – Report due May 5, 2004 • Helen Jones Kelly (Montgomery CSB) is Commission member, will join us for dialogue in May meeting • PCSAO has opportunity for input

15. Crystal’s Federal IV-E Refinance Recommendations & Details • Model after ProtectOhio FCM Flexible Funding • De-link IV-E Eligibility from AFDC standards • Allow IV-E Eligibility for Deserted Babies, and Disrupted AA Adoptions • Require State (and local) MOE • Allow financing to respond to significant policy changes • Exempt Training , Administration and SACWIS

16. Crystal’s Title IV-E Permanency Funding Recommendations • Continue Adoption Assistance program • Target AA to truly Special Needs children • Allow IV-E Relative Guardian Subsidies (at a rate below adoption subsidies) • Maintain IL Ed & Training Vouchers

17. Kinship Permanency Issues & Recommendations • Less traumatic for children • Greater overall stability, academic performance • Few Relatives meet, want to comply with Foster Care Regulations • TANF Child Only grant is paltry - $243 +$70/child • Need Child Care Subsidy based on TANF Child Only eligibility • Allow Title IV-E Kinship Subsidy for Legal Custody / Guardianship

18. State Adoption Support Recommendations • Increase State Fiscal Responsibility for Adoption • Target IV-E AA Special Needs Subsidies to Waiting Children, not healthy infants & toddlers • Allow $0 Payment Subsidy for At-Risk Kids, revisit if conditions appear • Ensure Medicaid coverage for all Adopted Children – (for post adopt services) • Develop & use Medicaid service providers • Target PASSS funds, improve cash flow

19. Supportive Behavioral Health Services – MH & AoD Tx. Issues • CFSR findings - inadequate services for children & families • GAO Reports – children w/ mental health issues being “dumped” into child welfare and juvenile justice systems • Affects efforts to maintain child in own home, reunification, child treatment needs, length of stay, and post adoption stability

20. Behavioral Health Services Recommendations • Increase Resources for Children & Families • Provide Prioritized Time-Limited Family Services, on ASFA clock basis • Require Behavior Health Parity for Private Insurance (HB 225 - similar co-pays, # outpatient sessions, inpatient coverage) • Enhance wraparound Medicaid MH services (IHCBS) • Train Medicaid providers with expertise in permanency and attachment disorders

21. Model for Supportive Services Success - Ohio’s ASFA, HB 484 • Court Mandated Assessment & Treatment - Failure to Engage is Grounds for TPR • Time-limited, Priority Alcohol and Other Drug (AoD) Tx services for CPS Families • CPS and AoD Tx systems to work together • $4 M/yr dedicated funding in state budget • Still a challenge for effective practice…

22. The Drain…Recommendations • High Placement Costs – Prevent placements and shorten Length of Stay with Community Based Wrap Around Services • High Treatment Costs – MH Parity, Time-Limited Priority Services for Families • The Adoption Assistance Subsidy Inequitable – Stabilize at State Level • Adoptive Families seeking subsidies in “anticipation” of problems – provide Medicaid card

23. Child Protection, Strengthening Families, Permanency? • Financing shouldn’t make them compete! • Invest in services up-front • Invest in Time-Limited Services for Caregivers • Support Kinship Caregivers • Target permanency supports to special needs children

24. For More Information • Pew Commission on Foster Care and the Courts – www.pewfostercare.org • Fostering Results – www.fosteringresults.org • ProtectOhio, “Evaluation of Ohio’s IV-E Waiver” – www.hsri.org • Annie E. Casey Foundation – www.aecf.org • PCSAO, various resources - www.pcsao.org