maryland’s proposed title iv-e waiver demonstration application a presentation by dhr to the...
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Maryland’s Proposed Title IV-E Waiver Demonstration
ApplicationA presentation by DHR to the
Social Services Administration's Child and Family Advisory Board and
Members of the IV-E Waiver Committee & Provider Advisory Board
October 31, 2013, 9:30 - 12:00Baltimore, MD
Title IV-E Demonstration Waiver
BACKGROUND ON THE TITLE IV-E DEMONSTRATION WAIVER
Title IV-E Demonstration Waiver
Child and Family Services Improvement and Innovation Act HR 2883 (PL 112-34) Bill Signing
Provided HHS with authority to grant up to 10 waivers in each of FFY 2012, 2013 and 2014.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
New Demonstration Authority• HHS can authorize up to 10
new demonstrations in each of federal fiscal years 2012, 2013, 2014.
• 9 States were approved for waivers in FFY 2012.
• 8 States were approved for waivers in FFY 2013
Title IV-E Demonstration Waiver
Waiver States as of October 2013
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Title IV-E Demonstration Waiver
Key Requirements• States/Tribes must demonstrate readiness.• Required to implement Child Welfare Program
improvement policies.• States/Tribes must submit proposal covering 22
required items. (ACYF-CB-IM-12-05 of May 14, 2012).
• Demonstrations must be cost neutral to the federal government.
• Requires rigorous, independent evaluation.Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Cost Neutrality
• Cost comparison method• Capped allocation method
– What would the State/Tribe have received in IV-E Foster Care payments in the absence of the waiver?
– Capped allocation can include almost any foster care costs, but most state capped allocation waivers have included maintenance payments and administration.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Child Welfare DemonstrationsImplementation Time Frames
Casey Family Programs, 2013
State O-12 N-12 D-12 J-13 F-13 M-13 A-13 M-13 J-13 J-13 A-13 S-13 O-13 N-13 D-13
FL
CAOH 9/30/2015IN 6/30/2017OR 6/30/2016AR
CO
IL
MA
MI
PA
UT
WA
WI
June 2014 ->Dec. 2013
Title IV-E Demonstration Waiver
Where States Are
Casey Family Programs, 2013
Steps in the Process 2012 2013 2014Explore application ~Develop and Submit Application Negotiations with ACF Execute Terms and Conditions Developmental Cost Plan Initial Design & Implementation Rpt.
Evaluation Plan ~Schedule of Payments ~Implement ~
Key: Completed ~Underway
2012 StatesState Focus Target Population Scope
AR Comprehensive practice model. Expand EB and EI practices.
All children referred to CWS
Statewide with 8 counties in Year 1
CO Systemic reforms and innovative practices to increase family engagement
All children with screened in reports
Up to 64 counties
IL Address impact of early maltreatment and trauma
Children age 0-3 who enter care.
Cook County (Chicago)
MA Performance-based contracts of residential services
Children in residential placement and can return to family
Statewide – 3,400 youth
10
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
2012 States (continued)
11
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
State Focus Target Population Scope
MI Expand secondary and tertiary prevention to families with young children at risk
All children in specified communities
3 sites, 1,500 families over 5 years
PA New case practice model focused on family engagement, assessment and expanded use of EBPs.
All children in placement or receiving services
5 counties initially
WA Family Assessment Response (a differential response pathway as alternative to CPS)
Families screened in representing low or moderate risk
Statewide over five years.
WI Post-reunification case management and support services for 12 months post discharge
All children who have reunited
Milwaukee County year 1, remainder of state years 2 to 5.
Summary of New Demonstrations
12Casey Family Programs, 2013
Title IV-E Demonstration Waiver
State Scope Funding/ Cost Evaluation
AR Statewide Capped Allocation. Payments and Admin Outcome changes over time
CO Phased – up to 64 counties Capped Allocation – Payments and Selected Admin Categories
Matched case comparison and time series analysis
IL Age 0-3, Cook County Treatment/Control Comparison Quasi-experimental comparison
MA StatewideCapped Allocation – Payments and Admin (compare to Congregate care history)
Pre-post outcome comparison
MI 3 sites Treatment/Control Comparison Experimental design
PA 5 counties to start – can be expanded
Capped Allocation – Payments and Admin.
Interrupted time-series design using propensity score matching, and meta-analysis of common interventions.
UT Statewide Capped Allocation – Payments and Admin. Outcome & cost changes over time
WA Statewide – low to moderate risk families
Capped Allocation – Payments and Admin. Matched case comparison design
WI Milwaukee – may expand statewide
Capped Allocation – Payments and Admin
Matched care comparison – longitudinal outcomes
Title IV-E Demonstration Waiver
Common Strategies
Casey Family Programs, 2013
• Many states have identified expanded use of in-home services as a strategy.• Many states have identified trauma-informed assessments and care as
strategies. • Several states have identified implementation or expansion of differential or
alternative response initiatives.• Several states have identified use of Family Finding as a tool.• A number of states have identified family/youth engagement and
involvement as strategies.• Several states focus on kinship care (supporting effective placements and
moving those placements to permanency).• Several states are focusing on reducing reliance on congregate care or
residential treatment.• Several states are collaborating with their Medicaid and/or Behavioral
Health systems.
Title IV-E Demonstration Waiver
Increased Federal Emphasis
Casey Family Programs, 2013
• What are your target populations?• What interventions do you plan to use?• What outcomes do you expect?• What is your theory of change?• How will you evaluate these outcomes?• How realistic are your plans?• What are the costs and savings (goes beyond
cost neutrality)?
MARYLAND’S APPLICATION
PLACE MATTERS
Building on the Foundation of Place Matters
•Engaging Families: Developed a family centered child focus practice model. •Finding Permanence for Children: Keeping children in their home when safe; reducing the length of stay in care; finding permanent homes for children. •Using Data: DHR set goals for key measures and used data to analyze the caseload and make better decisions for at risk children
PLACE MATTERS
Out-of-home placements have
decreased 43% since 2007.
Using Data to Measure Success
0
2,000
4,000
6,000
8,000
10,000
12,000
Children in Out-of-Home Care
PLACE MATTERS
Group home placements have decreased 47%.
72% of youth in care are placed with families.
Using Data to Measure SuccessSep
-07
Dec
-07
Mar
-08
Jun-
08Sep
-08
Dec
-08
Mar
-09
Jun-
09Sep
-09
Dec
-09
Mar
-10
Jun-
10Sep
-10
Dec
-10
Mar
-11
Jun-
11Sep
-11
Dec
-11
Mar
-12
Jun-
12Sep
-12
Dec
-12
Mar
-13
Apr-1
3M
ay-1
3Ju
n-13
Jul-1
3
0
500
1,000
1,500
2,000
2,500
0%
5%
10%
15%
20%
2,053
1,685
1,485
1,412
1,2441,261
1,218
1,116
1,039994
954912
872841
798811
816792
741691
673644
627643
637599
588
20%
17%
15%13% 14%
12% 11% 11% 10%11%
10% 10% 10% 10%
Children in Group Homes # in GH % in GH
PLACE MATTERS
Using Data to Measure Success
FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 -
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500 4,130 3,775
3,190 3,207 3,479
3,235
Average # of Families Served in In-Home Services
Average FY
PLACE MATTERS
Children who grow up with permanent families are more likely to succeed later in life.
More children are finding permanent families through adoption, reunification and guardianships.
Our goal is for children to have no more than two placement changes a year and to reduce the length of stay in foster care.
Using Data to Measure Success
Title IV-E Demonstration Waivers
Federal Priority Areas
• Produce positive well-being outcomes for children, youth and their families, with particular attention to addressing the trauma experienced by children who have been abused and/or neglected;
• Enhance the social and emotional well-being of children and youth who are
available for adoption, as well as those who have been adopted, with a particular emphasis on those children who have been waiting the longest or are hardest to place in order to achieve and sustain successful adoptions;
• Yield more than modest improvements in the lives of children and families and contribute to the evidence base; and/or
• Leverage the involvement of other resources and partners to make improvements concurrently through child welfare and related program areas, including proposals to establish financial incentives based on the achievement of positive child outcomes.
Title IV-E Demonstration Waivers
Federal Goals Required to be Addressed by the
Waiver Application (at least one must be addressed)
• Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth.
• Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve the safety and well-being of infants, children, and youth.
• Prevent child abuse and neglect and the re-entry of infants, children, and youth into foster care.
Title IV-E Demonstration Waivers
Maryland’s Goals
• Build on successes in improving safety & permanency by promoting child well-being
• Leverage and build upon home- and community-based service array, including evidence-based and promising practices, to enhance availability of services in the community
• Establish a trauma-informed child welfare system• Support full implementation of Alternative Response
Title IV-E Demonstration Waivers
Ages of Children & Youth Served through In-Home Services in Maryland
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 180
50100150200250300350400450
Children in In-Home Services, June 2013, by Age
Title IV-E Demonstration Waivers
Ages of Children & Youth Served through Out-of-Home Care in Maryland
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
100
200
300
400
500
600
Children in OOH Care, June 2013, by Age
Title IV-E Demonstration Waivers
Potential EBPs & Promising Practices for Children and their Families with Child Welfare Involvement
(Non-Exhaustive List—For Discussion Purposes)
• Brief Strategic Family Therapy (BFST)*• Early Childhood Mental Health
Consultation (ECMHC)*• Family Connections*• Family Group Decision Making*• Functional Family Therapy (FFT)*• Functional Family Therapy—Child
Welfare• Grandparent Family Connections*• Homebuilders*• Home Visiting*• Motivational Interviewing*• Multidimensional Treatment Foster
Care (MTFC)*
• Multi-Systemic Therapy (MST)*• Multi-Systemic Therapy-Child Abuse
and Neglect (MST-CAN)• Oregon Model, Parent Management
Training• Parent Child Interaction Therapy
(PCIT)*• Peer Support*• Safe Care• Social and Emotional Foundations of
Early Learning (SEFEL)*• The Incredible Years• Triple P• Trauma-Focused Cognitive Behavioral
Therapy (TF-CBT)*• Wraparound**Currently available or being implemented in at least 1 jurisdiction in Maryland
Title IV-E Demonstration Waivers
Partnerships & Collaboration
• Key partners include the LDSS, Children’s Cabinet Agencies, providers, families and youth, universities and community organizations.
• DHR will connect with and leverage other initiatives, including– Children’s Cabinet EBP Implementation– Upcoming 1915(i) State Plan Amendment– System of Care Grants: MD CARES, Rural CARES, LIFT– Project Launch– C-West & Promise Heights– Thrive@25– Local activities and partnerships
Title IV-E Demonstration Waivers
Timeline & Next Steps
• Winter 2014: Application submitted• Spring 2014: Negotiation with HHS• September 30, 2014: Final day for
HHS to approve the application• Fall 2014: Implementation activities
begin• September 30, 2019: Final day of
Demonstration Waiver authority