Sustaining Ohios Waiver Reforms: Possibilities & Challenges 12 th Annual CW Demonstration Projects Meeting, June 2008 Human Services Research Institute Hamilton County DJFS Muskingum County Children Services

ProtectOhio Facts Ohios Title IV-E Waiver demonstration, ProtectOhio, began in October 1997; extended for another five years, thru County-administered child welfare programs: PCSAs Ohio is one of only four states that is using the waiver to reform its entire child welfare system. Evaluation team includes HSRI, Westat, & Chapin Hall Center for Children at the University of Chicago.

Phase II of ProtectOhio October 1, 2004 – September 30, 2009 Evaluation Period: February 2005 – March 2010 Target population & services: Any children (IV-E & non-IV-E) Any services (prevention & treatment, in-home and placement) Participating counties: 18 demonstration PCSAs, 17 comparison sites

Waiver Intervention Strategies as Alternatives to Foster Care Family Team Meetings (all counties) Supervised visitation (10 counties) Kinship supports (6 counties) Enhanced mental health/substance abuse services (5 counties) Other initiatives in individual counties

Organizational Changes Made During the Waiver Staffing changes New, redefined positions New, reconfigured units Closure of residential facilities Systematic attention to placement usage (utilization review)

Waiver Impact on CW Practice (Demonstration Counties View) Prospective, predictable funding level = more strategic and planful operations Culture shift toward more family engagement, prevention/earlier intervention, reduced foster care Creative responses to family problems/needs = increased range of services & supports Increased community engagement More focus on kinship caregivers Specific impact of FTM, SV Increased data = more support, value to CW

Waiver Impact on CW Practice (Evaluation Findings) FTM: when placed, more with kin Children in long-term placements More moved to permanency Move step-down to less restrictive Expenditure shift away from FC B&M Different patterns of movement through system – more openings, less placement Enhanced MH/SA – more assessment & treatment, shorter time frames

What Waiver Changes Counties Are Most Likely to Sustain and How FTM: central to culture shift, integrated in agency practice; minimal additional out-of-pocket costs SV: enhanced staff skills, added activities MH/SA: drug courts, psychologicals, etc. Joint decision-making for shared cases Will be sustained through Stretching staff assignments, workload; cross-training Moving cases more quickly Shifts in what existing $ are used for

What Waiver Changes Counties Are Less Likely to Sustain and Why Kinship supports –requires cash Newly hired staff – might shift responsibilities to other staff Contributions to services for children not open to CW Opportunity to evolve new initiatives Why cant continue: TANF, ESA funds are variable by year and county Local levy – unlikely more millage; might reallocate Partners unlikely to be able to increase contributions to shared cases, but stay at the table

Expected Negative Impact from Loss of the Waiver ** Loss of flexible funds PLUS: More staff needed for traditional IV-E reimbursement process Potential loss of experienced staff through retirement Harder to respond to increased demand from immigration, economic distress, increased substance abuse, higher transportation costs Loss of Consortium as venue for collective problem-solving and support

Hamilton Countys Experience 1996 – pre-Waiver 1997 – entered Waiver – continued into Waiver – left Waiver – re-entered Waiver 2

Reflections on Immutable Waiver Changes Fundamental purpose of Waiver: systems change by removing funding constraints Demo counties have focused on service innovations rather than funding streams – using funds to creatively solve problems Have learned that some things work and others dont = momentum and support for successful practices ** Wont /cant go back to 1996!