Presentation relating to monitoring the implementation of Foster Care Redesign House Committee on Human Services July 16, 2012 Howard G. Baldwin, Jr., Commissioner Audrey Deckinga, CPS Assistant Commissioner

Committee Charge Monitor the implementation of Foster Care Redesign. Evaluate the mechanisms for monitoring and oversight, including rates, contracts, and client outcomes. 2 2

Background Goal of Redesign To improve outcomes for children, youth and families by creating sustainable placement resources in communities that will meet the service needs of children and youth in foster care, using the least restrictive placement settings. 3 3

Background DFPS recognized that children and youth are too often placed outside of their home communities, leaving behind family, friends, schools, church, homes and their support system Through Foster Care Redesign, DFPS seeks to: Promote positive outcomes for children, youth and families Improve the overall process and quality of care Align incentives with process and quality indicators in a manner that encourages the development of services in locations where they are needed 4 4

Background Current Challenges Imbalance in geographic distribution of services and providers Insufficient number of residential providers that offer a full continuum of services 5 5

Parameters for Redesign Model must neither require nor preclude additional funding, with the exception of funding for normal entitlement caseload growth Case management must remain the role of DFPS 6 6

Stakeholder Input Public Private Partnership (PPP) served as the guiding body Members representative of and conduits to large stakeholder groups Tasked with reaching consensus recommendation Input from a broad base of stakeholders Attended trade association meetings Attended community forums in each region Gathered input from Youth Leadership Council Held statewide community forum Created Redesign mailbox Published request for information (RFI) Conducted stakeholder survey Published draft Request for Proposal (RFP) for comment 7 7

Stakeholder Input The Individual needs of the child or youth are paramount. First and foremost, all children and youth are safe from abuse and neglect in their placement. Children and youth are placed in their home communities. Children and youth are appropriately served in the least restrictive environment that supports minimal moves. Connections to family and others important to the child are maintained. Children and youth are placed with their siblings. Services respect the child’s culture. To be fully prepared for successful adulthood, youth are provided opportunities, experiences and activities similar to those experienced by their non-foster care peers. Youth are provided opportunities to participate in decisions that impact their lives.

Stakeholder Input Obstacles to achieving quality outcomes Minimal provider input into placement decisions Fragmented service delivery system No single point of accountability Service Level System results in disincentive to improving well-being outcomes

Research Researched Models In Other States Lessons Learned Involve stakeholders early on Communication is critical Evaluation is necessary Designate dedicated staff for implementation Partnership and team work are critical Expect to change and adjust contracts over time Focus on data Invest sufficient resources in monitoring staff and staff training Analyzed Texas Specific Data Gap Analysis Strata and Outcomes 10 10

Redesign Model Emphasis on: Engaging the Community to Improve Outcomes for Children and Youth in Foster Care Development of local advisory committee that reflects community Community Engagement Plan for each stage of Implementation which must include specific strategies for engaging various stakeholders Developing Community Resources Accountability for Outcomes

Redesign Model Start-Up Period (Up to 6 months) Stage I (Anticipated 1-2 years) Implement performance based contracting for a continuum Blend rates across all service levels and eliminate tie between billing and authorized service level Stage II (Anticipated 1-2 years) Increase provider’s role with family and children in their care Provider allocation for services to family of children in their care Stage III (Anticipated 1-2 years) Implement case rate to include length of stay incentive Hold harmless in regard to financial remedies during first year Implement reinvestment of incentives to further improve outcomes for children in foster care

Redesign Model Change The Way DFPS Procures From open enrollment to competitive procurement Single Source Continuum Contractor (SSCC) ensuring full continuum of paid foster care services for all children and youth in catchment area Change The Way DFPS Contracts From effort-based contracts to performance-based contracts Financial incentives and disincentives for permanency Additional performance measures for well-being A single contract to provide all paid foster care services and other services for parents and families in a geographic area Change The Way DFPS Pays The Contractor From multiple rates to a single blended rate De-link service levels from rates Separate allotment of funds for other services to children and youth in foster care and their parents and families 13 13

Change the way DFPS Procures Current - Open Enrollment DFPS defines the services and how they’ll be delivered Providers apply for a contract Foster Care Redesign - Competitive Procurement DFPS defines the service need, but the providers define how the need will be met Providers compete for a contract

Change the way DFPS Contracts Performance Based Contracts Well-defined performance measures Length of stay outcomes Safe in care Placement close to home Tie payments and contracting decisions to performance expectations Flexibility given to contractor to achieve performance metrics Focus on major outputs and outcomes Monitor for results

Change the way DFPS Contracts Monitor and Oversight Creation of a monitoring tool specific to the SSCC contract Annual monitoring of contractor (programmatic, administrative and financial) which includes obtaining feedback from clients and service providers Centralized team approach to manage SSCC contracts Creation and monthly review of a data and performance dashboard Third party calculation of contractor’s performance measures Focus on SSCC’s oversight of its provider network and continuum of care Focus on Quality Assurance

Change the way DFPS Pays Rates no longer tied to service levels or type of placement Single rate paid for all children and youth A different rate is calculated for each catchment area In Stage III, financial incentives to reduce length of stay

Metropolitan Catchment Area Non-Metropolitan Catchment Area Procurement Metropolitan Catchment Area DFPS Region Number of Proposals Region 7 (Austin/Central Texas Area) 4 proposals Region 11 (Corpus Christi/ Rio Grande Valley Area) 2 proposals Non-Metropolitan Catchment Area DFPS Region Number of Proposals Region 1 (Lubbock/ Panhandle Area) 2 proposals Regions 2/9 (Midland-Wichita Falls)

Metropolitan Catchment Area Non-Metropolitan Catchment Area Procurement Tentative Awards Metropolitan Catchment Area Region 11 (Corpus Christi/ Rio Grande Valley Area) Lutheran Social Services of the South Non-Metropolitan Catchment Area Regions 2/9 (Midland-Wichita Falls) Providence Service Corporation of Texas

Implementation Mitigating Risk Limitation of initial roll-out to two catchment areas Insurance and Performance/Payment Bond Refine model based on evaluation prior to implementing in other catchment areas Subcontracts can revert to DFPS

Next Steps Complete Negotiations – Summer 2012 Initial SSCC Contracts – Effective September 2012 Start-Up Phase in Initial Catchment Areas Lasts up to 6 months from effective date of contract SSCC submits their management and community engagement plans DFPS and SSCC develop local joint protocol section of operations manual Evaluation of readiness to begin Stage I of Implementation First child is referred to SSCC for services – March 2013

Next Steps Evaluation Continuous Quality Improvement Chapin Hall Determine performance gaps Recommend strategies to close the “gaps” Determine if strategies are effective Evaluation of Implementation University of Texas School of Social Work and Institute of Organizational Excellence Process evaluation Pre- and Post- surveys on collaboration Focus groups and individual interviews

Foster Care Redesign Webpage Information on Foster Care Redesign can be found on the DFPS website at: http://www.dfps.state.tx.us/Child_Protection/Foster_Care/redesign.asp

APPENDIX

Redesign Model Texas Tennessee Nebraska Missouri Kansas Florida Population of Focus DFPS children/youth in paid foster care Children/youth in foster care with needs greater than basic DHHS Child Welfare, Juvenile and Status Offender Population who require services with high levels of needs . Family preservation, adoption and foster care Most programs and services beyond investigation Overall Goal of Effort Place and serve children in their home communities in the least restrictive environment/improve outcomes for children in care Safely reduce the number of children in Focus on serving their own homes and reducing the number of children in the state’s care Reduce the time a child or youth remains in residential placement Improve services and meet program targets. Increase community participation in affected by abuse/neglect Responsibility for Case Management DFPS Department of Children’s Services Providers Implementation Approach Staged Implementation of SSCC responsibilities in the Region Refine/Improve model prior to expansion in additional Regions Phased in approach by clusters of counties adding new counties each year over a multi - year period until all counties were included. Refined model as it moved to the next Phase. Roll out of model across state according to pre determined time frame. Initially piloted in 2 regions and then gradually rolled out in the remainder of the state. Refinement occurred as the process moved forward. Implemented statewide by program beginning with family then adoption and lastly re integration/foster care. The entire process was fully implemented in a few short months. by pilot districts through adaptive implementation that allowed for changes based on the evolving nature of the effort.

Stakeholder input gathered and used to develop new foster care model The Road to Redesign Activity Time Frame Stakeholder input gathered and used to develop new foster care model January-November 2010 Public Private Partnership reaches consensus on Foster Care Redesign Model and submits recommendations to DFPS Commissioner December 2010 82nd Texas Legislature grants approval for DFPS to move forward with Redesign effort through passage of Senate Bill 218 Spring 2011 DFPS releases Request for Proposal for initial two Single Source Continuum Contracts August-November 2011 DFPS conducts evaluation of proposals received in response to Request for Proposals November 2011-June 2012 DFPS announces tentative contract awards and begins final negotiation phase of procurement June 20th 2012

Legislation House Bill 1, Rider 25, 82nd(R) Legislative Session Requires DFPS to submit a report that includes: Expenditures for Foster Care Redesign Progress toward achievement of improved outcomes for children, youth and families based on the quality indicators Senate Bill 218 by Nelson, 82nd(R) Legislative Session Requires DFPS to implement a redesign of the foster care system in accordance with the Foster Care Redesign report Authorizes HHSC to develop a separate payment rate for use in the redesigned system, which must tie payments to performance targets. 27 27