florida department of children and...

November 15, 2019

Case Management Efficiency Project

(CMEP)Executive Leadership Briefing

Florida Department of Children and Families

Agenda

Opening Remarks

Case Management Efficiency Project (CMEP) Approach

A Day in the Life (exercise)

CMEP Focus Group Presentations

Close / Q&A

2

Opening Remarks

3

Dennis MilesRegional Managing Director

Bill D’AiutoChief Innovation

Officer

Efficiency Project Cause

Goal: Actionable Recommendation(s) Participation:

– Case Managers, Supervisors, Specialists

– CEO Board, CMO & DCF Coaches, FCC Advisor

– Diverse Geographies

Execution:– Ideation : Narrowing : Iteration : Validation

4

Efficiency Project Effect

We become more powerful when we empower others. Great leaders unleash the leader within each person, liberating them to use their own power. Everyone wants to feel like they are contributing to the vision.

empowerment

5

CMEP Focus Groups

6

Practice Accountability Committee

Retention & Permanency

ProfessionalDevelopment

Quality Case Management

E-Signature

In-Home Non-Judicial On Call

CMEP Focus Groups

7

Retention & Permanency

ProfessionalDevelopment

Quality Case Management

E-Signature

On Call

Practice Accountability Committee

In-Home Non-Judicial

8

Kunle AjayiSr. CWCM, FRC

Natalie GreenSr. CWCM, FRC

Wiline ProfilCWCMS, Childnet

Maria OxfordCWCMS, FSS

Allison McGregorCWCMS, CHS

A “Day in the Life” ExerciseTeam Members

9

Rebecca SmithProgram Manager

Johnell LambertChild Welfare Case Manager

Natalie GreenDependency Drug CourtCase Manager

Mary JohnsonOperations Specialist

Nicole AllenKinship Child Welfare Case Manager Supervisor

Practice Accountability CommitteeTeam Members

10

The absence of standardized training and utilization of Florida’s Practice Model among Child Protective Investigators, Case Managers, Department Attorneys, Guardian Ad Litems, and the Judiciary has led to misapplication of Assessments and Planning in Child Welfare. These discrepancies increase children’s time in Out Of Home Care, decrease efficiency in the case management process, and jeopardize child safety.

Practice Accountability CommitteeProblem or Need Statement

Create a Practice Accountability Committee “PAC”, who prepares and facilitates integrated trainings among the partners of the Child Welfare System.

• Trainings are attended within 90 days of entering the field and offered quarterly.

• Child Welfare Professional Certification

• Certification will include specific knowledge capture of The Practice Model’s Core Concepts and any updates to CFOP, CH 39, and or Administrative Code.

11

Practice Accountability CommitteeRecommendation

1,162 participants statewide from CPI, CM, GAL, CLS, and the Judiciary completed a survey consisting of six questions.

• 42% of participants did not agree that a child could safely return home if all safety analysis questions answered “yes.”

• 30% of participants were not able to correctly identify whether conditions for return were applicable.

• 88% of participants agreed that it would be beneficial to have integrated trainings as it would be more effective and efficient.

12

Practice Accountability CommitteeFacts, Evidence & Proof


13

“Of 93% of the cases, the Action reviewers rated 30.7% of the plans as sufficient to control for danger threats.”

*Source: Spring 2019 Quality Assurance Report.

14


Average Monthly Board cost per child($50 Avg Daily Board Rate per child x 30 days)

Out of Home Care (OOHC) cost per child(Avg Mthly Board cost x 5.74 months (additional months in OOHC beyond 12 months as of September 2019)

Savings when we exit 316 more children (thereby achieving Florida’s goal of 40.5% quantitative timely exits)

15

$1,500

$8,610

$2.7M

*Note: This does not include the ROI for PAC training.

Practice Accountability CommitteeProjected Impact

Professional DevelopmentTeam Members

16

Hillary ShaughnessyDevereux Regional Administrator

Megan VanEttenYFA Academy Supervisor

Professional DevelopmentProblem or Need Statement

The unrealistic portrayal of case management responsibilities for newly hired case managers in the pre-service training curriculum leads to frustration for a new case manager. This further leads to inefficient and ineffective service delivery outcomes.

17

Professional DevelopmentRecommendation

DCF’s Quality Office standardize a statewide integrated pre-service training strategy for child welfare including:

• a structured field day guide

• an assigned agency mentor (certified CM), and

• minimum 1 week field observation prior to pre-service training.

This ensures case managers are fully equipped with the competencies necessary to provide efficient case management to the children and families we serve.

*The premise for the recommendations above is Dr. Wilke’s Florida Study of Professionals for Safe Families18

Professional DevelopmentFacts, Evidence & Proof

CMEP Survey October 2019 found the following:• 51% of case managers strongly agreed or agreed that they

felt frustration with the lack of knowledge/skills required to complete case management tasks asked of them for the cases they received following pre-service training.

• Only 34% of case managers felt that they could provide sufficient services to the families they served following pre-service because of the training they received.

19CMEP Survey October 2019 StatsTotal participants = 1019 (644 case managers, 160 case managers with <1 year experience)


*5-year longitudinal Florida Study of Professionals for Safe Families key findings:

• Workers in pre-service training CRAVED more field day opportunities…reportedly LOVED when they had someone to COUNT ON = “assigned mentors” within the agency (certified case managers with 1+ years of case management experience)

• Practices that increase worker confidence and competence to provide services are important areas to address in pre-service training field days

• Develop checklists for mentors and trainees to use to optimize learning experiences

*Source: Wilke, D. (2014-2019). The Florida Study for Professionals for Safe Families.20


Strongly agree22%

Agree29%Neither agree nor

disagree28%

Disagree15%

Strongly disagree6%

Case Managers with more than 1 year experience reported feeling frustration with the lack of knowledge/skills required to complete case

manager tasks for cases received following pre-service training.

21 CMEP Survey Data October 2019


Strongly agree, 7%

Agree, 27%

Neither agree …

Disagree, 23%

Strongly disagree, 11%

Case Managers with more than 1 year experience reported feeling that they could provide sufficient service to the families they served

following pre-service because of the training they received.

22 CMEP Survey Data October 2019

Professional DevelopmentProjected Impact

Children served by Case Management FY18/19Case Management staff surveyed lack sufficient competencies to properly service families towards intended outcomesChild safety, permanency and well-being affected

23

68,403

52%

35,570

Reducing frustration will increase case managers’ confidence in their ability to complete their job duties = less crisis

managers and more permanency enablers!

Quality Case ManagementTeam Members

24

Aqueela FarnellCWCM, CHS

Maria OxfordCWCMS, FSS

Joseph KimberlCWCM, FFN

Sarah RoaneCWCT, HFC

Stacie PadillaSr. CWCM, GCJFCS

Quality Case ManagementProblem or Need Statement

25

The current workload negatively affects the quality and effectiveness of case management resulting in decreased productivity of case managers and delays permanency due to additional time spent completing documentation and other tasks.

Quality Case ManagementRecommendation(s)

Universal Living Document - “One Doc”• Encompasses FFA-I, FFA-O, Progress Update, Judicial

Review Worksheet, Case Plan, Safety Plan, Staffing Packets, and provides a complete case history

CBC Transportation Program• Implement a transportation program providing

transportation services throughout each circuit to case managers and placements staff.

26

Quality Case ManagementFacts, Evidence & Proof

27

CMEP Survey October 2019 - “One Doc”• Duplicative documentation = 10 hours per week

• 85% Positive reaction to One Doc 99% Confidence with 5% Margin of Error


28

Per CMEP Survey (Transportation)• Transport and Supervision = 10 hours per week

• 81% say placements “Rarely” or “Never” assists with transport

• 74% say placements “Rarely” or “Never” assists with supervising children without a placement

• 44% of child welfare staff remain through the night with a child without placement

99% Confidence with 5% Margin of Error


29

Duplicative Documents

25%

Transporting17%

Supervising Visits8%

Other50%

% of Time Spent per Week

Transportation Program Recommendation

projected $21.6M annual savings

30

$17.55Hourly pay rate

669Transporters

52Weeks in a year

10Hours per week

$25.97MPRESENT

Annual spend

÷

×

2795# Florida case

managers

4Transporters per case manager

$11.85Hourly pay rate

52Weeks per year

2795# Florida case managers

40Hours per week

$4.39MPROPOSEDAnnual spend


×

×

×

Quality Case ManagementProjected Impact

31

Give 50% of the week back to case managers• 1.45M hours annually with One Doc

• 1.45M hours annually with Transportation

• 332 years worth of time spent annually

• Higher quality case management

• Enables CMs to be permanency enablers instead of crisis managers

Decrease number of children in care, their length of stay plus, case management overtime, working off the clock, turnover, etc.

In-Home Non-JudicialTeam Members

32

Jancy LongPrevention Manager

Sheila LaMarreLead Child Advocate

Stephanie LucasChild Welfare Case Manager Supervisor

Tiffany J. EwellFamily Care Counselor Supervisor

Regina SirmonesLead Family Care Manager

In-Home Non-JudicialProblem or Need Statement

The way in which in-home cases are handled is not consistent statewide which is contributing to recidivism, unnecessary effort and, in turn, burnout on behalf of case managers.

33

In-Home Non-JudicialRecommendation

Each CBC develop specialized units for in-home cases to standardize practice/safety management service delivery.

In-Home case managers should be capped at a caseload of 11-20 CHILDREN to deliver safety management services at the level necessary to ensure child safety in these cases.

Florida Coalition for Children and Department of Children and Families to form a committee to identify evidence-based services to improve outcomes (reduced recidivism/removal) for in-home cases.

34

In-Home Non-JudicialFacts, Evidence & Proof

35

79% of Florida child welfare respondents SUPPORT specialized non-judicial units.

Strongly Agree47%

Agree32%

Strongly Disagree

2%

Disagree4%

Neither Agree or Disagree

15%

Recommendation: Each CBC to create a specialized unit for in-home cases.


36

300

205

17 24

11185

50 4 7 7

STRONGLY AGREE

AGREE STRONGLY DISAGREE

DISAGREE NEITHER AGREE OR DISAGREE

77% of Case Managers and 88% of Supervisors SUPPORT specialized units.

Case Manager Supervisor

Recommendation: Each CBC to create a specialized unit for in-home cases.


37 Recommendation: In-Home case managers should be capped at a caseload of 10-12 children.

72% of child welfare professionals in the State of Florida believe a non-judicial caseload should be capped at 20 to effectively manage the case.

1019 respondents from from child welfare agencies in FloridaNote: 136 respondents provided no information.


Qualitative Case Review Data (FL CQI, CFSR/PIP, CBC RSF)(Quarter 4 of SFY 2018-2019 OCW Quality Assurance Report)

– Over the last 12 quarters, overall performance regarding items involving in-home case reviews are trending the wrong direction specifically in the areas of safety plan development, safety plan sufficiency, and monitoring.

– Only 6 of 20 CBC’s are performing at an 80% or above on all RSF in-home review elements.

Quantitative data (OCW CQI Division AD HOC Report )

– In SFY17-18, 16% of all children served in-home non-judicial were removed as a result of a subsequent investigation. 38 Recommendation: Each CBC to create a specialized unit for in-home cases.


Benefits of Evidenced-Based services:– Adequately address child/family needs

– More likely to prevent child fatalities and severe injuries related to future child maltreatment from families that are served (Pecora, 2017)

39 Recommendation: Florida Coalition for Children and Department of Children and Families form a committee identifying service providers whose practices are evidence-based to improve the outcomes of in-home cases.

In-Home Non-JudicialProjected Impact

40

Through the implementation of the aforementioned recommendations, we project:• $10,676,250 in savings for out-of-home care costs and

$307,581 savings in investigation costs as a result of a decrease in recidivism cases and removals.

• Increased worker satisfaction and confidence on behalf of CMA staff in their ability to provide effective services to families.


Scenario: Removal Rates decreased to 10% standard

$10,676,250 savings in OOHC costs

41

$50 x 365 = $18,250Average annual cost OOHC per child

$18,250 x 1,567 = $28,597,750Annual OHC costs

Assumptions• $50 = Average costs of OHC per child, per day• 365 = days in a year• 1,567 = # of children removed after IHNJ services in 2017

$50 x 365 = $18,250Average annual cost of foster care

$18,250 x 982 = $17,921,500Annual OOHC costs


Scenario: Removal Rates decreased to 10% standard

$307,581 savings in investigation costs

42

$946.40 ÷ 1.8 = $525.78Average cost of investigation per child

$525.78 x 1,567 = $823,897Investigation costs

Assumptions• Average cost of a DCF investigation: $946.40• Average # of children per investigation: 1.8• 1,567 = # of children removed after IHNJ services in 2017

$946.40 ÷ 1.8 = $525.78Average cost of investigation per child

$525.78 x 982 = $516,316Investigation costs

e-SignatureTeam Members

43

Liz GoodmanDependency Case Manager

Samantha CraskeARS Dependency Case Manager

Tiffany ScottDependency Case Manager Trainee

Marcus RankinDependency Case Manager Supervisor

Lisa ZamoraDependency Case Manager

e-Signature Problem or Need Statement

Current case management manual signature practices create a burden on personnel productivity.

44

e-SignatureRecommendation

Adopt and implement e-signature practice(s) Statewide across the entire child welfare system/network

45

e-SignatureDefinition

• Two signature types – electronic and digital• Florida statue Ch. 668.50

• (2)(i) Government agency • (7)(a)(c)(d) Legal recognition of electronic records,

electronic signatures and electronic contracts• (13) Admissibility in evidence

• Uniform Electronic Transactions Act (UETA)• Electronic (e) signature - shift towards paperless

processes augmenting current and future document management

46

e-SignatureFacts, Evidence & Proof

Scenario: one case manager and one supervisor

A minimum of 695,955 hours expended annually obtaining manual signatures

4791

documents signed per case (on average)

182signatures for one case

16.42average caseload per case manager

2signatures required (case manager + supervisor)

2,988signatures per case manager

5minutes minimum obtaining signature

14,940minutes obtaining signatures

60minutes per hour

249hours obtaining signatures

2,795Statewide case managers

×

×

×

×

÷

CMSCM

e-SignatureProjected Impact

48

Consider how many signatures we obtain across

the entire system!

CM/CMS

Dad’s Attorney

Caregiver

GAL

CLS

Mom

Dad

Child

Mom’s Attorney

GAL Attorney

Safety Manager

#3

Safety Manager

#2

Safety Manager

#1

= 695,955 hours

On CallTeam Members

49

Sherina JohnsonProgram Director

Amber WookeySenior Full Case Manager/Coach

Nancy VargasAdoption Specialist

Katherine HiersDependency Case Manager

On CallProblem or Need Statement

On call requires case managers and supervisors to work nights, weekends and holidays in addition to their required full-time duties. This reduces work life balance and increases stress and anxiety in workers. Furthermore, this results in a decrease of the quality of interactions between case managers and displaced children.

50

On CallRecommendation

Designate a certified on call unit to work nights, weekends and holidays. The designated on call unit will be responsible for all on call related incidents. This will reduce stress and burnout of case managers and allow CMO’s to focus on employee well-being and satisfaction.

51

On CallFacts, Evidence & Proof

52

• 2795 Primary Case Managers in Florida

• (A sample of 887 case managers) resulted in an average of573,688 assigned on call hours per year

• Average on call shift = 7 days (112 hours) every 5.8 weeks

• Each worker averages 646 on call hours/year

• 1,805,570 total yearly hours scheduled for on call statewide


53

Strongly Agree42%

Agree28%

Neither Agree nor Disagree

23%

Disagree5%

Strongly Disagree

2%

Case Managers report that their family time is negatively affected by on call duties


54

41% Strongly Agree

27% Agree

24% Neither Agree nor Disagree

6% Disagree 2%Strongly Disagree

Case Managers report increased stress in dealing with children while on call due to extended work hours


55

Strongly Agree41%

Agree24%


25%

Disagree8%

Strongly Disagree

2%

Case Managers report experiencing significant sleep disturbances while on call


56

53% Strongly Agree

8% Agree

32% Neither Agree nor Disagree

5%Disagree 2% Strongly

Disagree

Case Managers report feeling as though our quality of work and interactions with our children and families would

improve if on-call was no longer a required task.


57

Strongly Agree 42%

Agree25%


24%

Disagree7%

Strongly Disagree

2%

Case Managers report experiencing increased feelings of anxiety and dread in anticipation of on call shifts.

On CallProjected Impact

# of estimated hours repurposed back to case management agencies utilizing a designated on call unit.This would afford case managers more quality time with children and families they serve and reduce worker burnout and fatigue.

58

1,805,570

Retention and PermanencyTeam Members

59

Dolene HarriganCase Manager Supervisor

Kathleen YokleyCase Manager Supervisor

Marilyn TillisLead Case Manager

Karen YarleyCase Manager Supervisor

Joyce EdwardsCase Manager Supervisor

Retention and PermanencyProblem or Need Statement

Case managers are struggling to complete the necessary requirements of our daily job due to vacancies, resulting in higher than normal caseloads and delayed permanency for the families we serve.

60

Retention and PermanencyRecommendation

Create a statewide committee to research, evaluate, and promote consistency and/or standardization of the following:

• Salaries and benefits packages

• Technology solutions

• New Case Management position allocations to equal the cases received from DCF during that FY.

Additionally we recommend the committee conduct a Feasibility Study to determine if Case Management should sustain an Impact Team (or Tiger Team) similar to the CPIs – providing additional aid when crisis overburdens our resources.

61

Retention and PermanencyFacts, Evidence & Proof

62

12-20 Average Caseloads statewide (depending on where you live)

124 Different systems utilized by case managers statewide (geo-dependent)

44% FY 18/19 Case Manager Turnover (1,201 CM’s annually)

60% Case Managers are working 2 or more jobs due to their salary

76% Case Managers felt oversight from an impartial 3rd party would be beneficial

96% All surveyed believe that insufficient pay and benefits leads to turnover

Sources: Case Management Workforce Metrics; CMEP Efficiency Survey

63

263335

429

547

650

0

100

200

300

400

500

600

700

1 CMs 2 CMs 3 CMs 4 CMs 5 CMs

Days to PermanencyOn average, how many Case Managers do you think our children see?

28,000 kids in our system2,000 had 1 case manager

72%Permanency

Performance Statewide(CFSR period 7)

Retention and PermanencyFacts, Evidence & Proof

Retention and PermanencyProjected Impact

64

Statewide consistency creates countless benefits: • Increased Productivity among case managers

• Improved Retention Rates- A 10% turnover reduction will save Florida over $1,376,634M

annually and enable 582,400 more hours to spend working with our families

• Transforms our “crisis managers” into permanency enablers

• Improved CFSR Outcomes- Permanency within 12 months

Transformation at Work

Hours available due to designated on-call strategy

1.8M HrsDue to out-of-home care and investigation cost savings

$11.0M

Hours available by utilizing Universal One Doc & Transportation Program

2.9M HrsAnnual savings utilizing transport program

$21.6M

700+K HrsHours available by automating one

point-to-point signature capture scenario

Annual savings associated with achieving FL’s 40.5% exit goal through PAC

$2.7M

The CAST

66

QUALITY CASE MANAGEMENTSarah Roane, TLAqueela FarnellStacie PadillaMaria OxfordJoseph Kimberl

PROFESSIONAL DEVELOPMENTMegan VanEtten, TLHillary Shaughnessy

CBC PLACEMENTSAllyson Garceau, TLWiline ProfilKunle AjayiAllison McGregor

IN-HOME NON-JUDICIALTiffany J. Ewell, TLJancy LongSheila LaMarreRegina SirmonesStephanie Lucas

E-SIGNATUREMarcus Rankin, TLLiz GoodmanSamantha CraskeTiffany ScottLisa Zamora

ON CALLKatherine Hiers, TLNancy VargasAmber WookeySherina Johnson

RETENTION & PERMANENCYKaren Yarley, TLJoyce EdwardsDolene HarriganMarilyn TillisKathleen Yokley

EXECUTIVE LEADERSHIPDennis Miles, ESBill D’Aiuto, ESStephanie Weis, CGinger Griffeth, CKatie Guemple, CPatricia Nellius-Guthrie, AKarin Flositz, AAndry Sweet, ANick Intintolo, PMDTL = Team Leader

C = CoachA = AdvisorES = Executive StakeholderPMD = Program Management Director

PRACTICE ACCOUNTABILITY COMMITTEEMary Johnson, TLNicole AllenRebecca SmithNatalie GreenJohnell Lambert