Improving Outcomes for Children and Youth: Foster Care Redesign

Texas AllianceChild Care Administrators’ Conference

October 15th, 2010

Agenda

• Project Overview

• Quality Indicators

• Stakeholder Involvement

• Status

• Preliminary Model

• Issues

• Next Steps

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

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.

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

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

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

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

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

Report: Request for Proposal Responses

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

Improving Contracting

• Improving Availability/Developing New CapacityContract For Continuum Use Case RatesProvide Incentives For Exceeding Performance MeasuresDevelop Partnerships/NetworksContract For Specific (Minimum) Number Of Beds, Specific ServicesProvide More Flexibility To Meet Unique NeedsContinue to Use Medicaid Services

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)

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

Status

Preliminary Design

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

Preliminary Design

Basic Elements Contract for Continuum of Care RFP for Continuum Increased Family Involvement Better Collaboration

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

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

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

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 ProcessOther Criteria for Catchment Areas

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

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”

Next Steps

• Implementation Issues

Implications Workgroups

Report

PPP Recommendations

Stakeholder Participation/ Input

High Level Implementation Plan

Innovation Zones

Governance

Criteria for Decision-Making

Questions?