1. California Well-Being Project
Title IV-E
California Well-Being Project
Department of Health and Human Services
&
Department of Probation
October 28, 2014
Talking Points
1. Welcome and Introductions
2. Review Agenda

2. California Well-Being Project
Objective
To test child welfare interventions designed to decrease reliance on foster care and shorten the time children have open welfare cases.
Goals
Improve permanency and well-being outcomes
Increase child safety without over reliance in out-of-home care
Improve service array
Engage families through individualized case work
Talking Points
On March of 2006, the CDSS received approval from the US – DHHS to embark on a demonstration project to determine the efficacy of using flexible funding to improve outcomes for children and families. The waiver allows counties to use Title IV-E funding to serve both eligible and non-eligible children and families and to provide payments for services that are not allowed under current Title IV-E regulations.
Alameda and Los Angeles were the first counties to participate in the Waiver. They began their demonstration projects in July of Although initially targeted for a 5-year period, their projects have received extensions.
October 28, 2014
DHHS & Probation–Title IV-E Waiver

3. Participating Counties
Cohort 1
7/1/07 – 9/30/19
Alameda
Los Angeles
Cohort 2
10/1/14 – 9/30/19
Butte
Lake
Sacramento
San Diego
San Francisco
Santa Clara
Sonoma
Talking Points
As part of Cohort 1, Alameda and Los Angeles achieved mixed results with their demonstration projects:
Alameda decreased foster care entries from 3.3 to 1.8 children per 1,000 while Los Angeles remained stable at 4.1;
Both counties saw reductions in the number of children in foster care;
Both counties improved their reunification rates;
And Alameda reduced reentries by 36.6% while Los Angeles experienced and increase of 25.8%
Seven additional counties, including Sacramento, are joining Alameda and Los Angeles in the implementation of the waiver demonstration project. The projects officially began on October 1 with an initial duration of five years.
In order to participate, counties were required to and official resolution for their respective Board of Supervisors along with a 5-year project plan, budget and Memoranda of Understanding.
October 28, 2014
DHHS & Probation–Title IV-E Waiver

4. How Does It Work? Flexible use of federal foster care funding
Must include child welfare and probation – DHA in Sacramento County
Capped funding allocation based on 5-year average ( )
Requires maintenance of base spending level
Talking Points
Provides flexibility in use of federal foster care funding
for child abuse, foster care, and delinquency services
Expands types of cases that can be claimed to federal funding
Can now pay for non-Federally-eligible
Puts a limit on the amount of funding for allowable activities
Currently no cap, but much less flexible
Requires reinvestment of savings (federal and local) into programs
That will improve outcomes and reduce overall cases costs
Requires maintenance of base spending level
$107 million
This is greater than the capped funding under the waiver
Does not require more local spending but…
The waiver will not free up local funding to use in other ways, unless and until savings occur to reduce total costs
October 28, 2014
DHHS & Probation–Title IV-E Waiver

5. How Does It Work? (continued)
Counties must implement prevention and family centered practices
Requires reinvestment of savings into child welfare and probation Well-Being Project activities
The evaluation component will include process, outcomes and costs
Counties may opt out with fiscal repercussions
Talking Points
Counties are required to implement:
Safety Organized Practice (CPS)
Wraparound (Probation)
Counties may also implement additional optional interventions
There will be an evaluation of the project at the state and local levels
Counties may opt out of the waiver during the implementation period but will have to pay back some or all of the entire amount of the federal waiver funding provided from the beginning of the agreement.
October 28, 2014
DHHS & Probation–Title IV-E Waiver

6. Estimated Full Year Budget Comparison
Federal Funds
$49.5 M
Local Share
$107.1 M
$156.6 million
No Waiver
Waiver
Federal Funds
$66.3 M
Local Share
$107.1 M
$173.4
million
Talking Points
Base federal funding = $49.5 million
Additional waiver funds from feds = $16.7 million ($12.5 million for the first year)
Total federal funding under the waiver would not exceed $66.3 million.
Sacramento must maintain local spending at a minimum of $107 million
October 28, 2014
DHHS & Probation – Title IV-E Waiver

7. How Are Savings Generated?
Increased Budget
Additional federal funds (waiver)
Base amount (five-year average)
Unchanged local spending
Increased Investment in Better Outcomes
Lower Expenditures
Increased Investment in Better Outcomes
Decreased number of children in out-of-home care
Reduced entries and re-entries
SAVINGS
Talking Points
Savings are generated by achieving better outcomes in the form of:
Reduced entries into care through effective prevention strategies;
Reduction in the foster care population via increased permanency; and
Stable and safe permanency to reduce re-entries.
Savings must be invested into programs in subsequent years. For example:
if the county saves $1 million in year 1 as a result of these efforts
then the county must allocate the $1 million toward program costs in year 2.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

8. Increased federal funding
Potential Benefits to Sacramento County
$12.3 million in flexible federal funding for FY 14/15
Annualized $16.7 million through FY 18/19 (plus inflator)
Increased federal funding
Prevention
Wrap-around
Intensive family reunification
Evidence-based programs
Use of flexible dollars and reinvestment of future savings into programs…
Increased reunification for CPS children
More timely permanency for foster children
Reduced re-entries into CPS
Reduced recidivism for Probation children
Reduced entry into systems due to effective prevention
…for better outcomes
Talking Points
Sacramento can use funding to focus interventions that address local needs and capitalize on existing synergies and strengths without the constrains associated with Title IV-E funding.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

9. What is the Risk?
If total costs in a given year exceed the level of additional funding, the County will be required to absorb those excess costs with local funding
October 28, 2014
DHHS & Probation – Title IV-E Waiver

10. Variables Affecting Level of County Risk
Caseloads
Placement Costs Operation/Admin Costs
Realignment Growth
Talking Points
The most likely reasons for exceeding the waiver budget would be growing foster care caseloads and increased case costs.
The most likely sources for covering such unexpected increases would be realignment growth and County General Fund. However, if realignment dollars were to shrink, the county would face a widening fiscal gap.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

11. High Risk Scenarios Length Of Stays Entries & Reentries
Group Home Placements
Out-of-County Placements
Out-of-State Placements
Talking Points
Increases in these measures would increase the likelihood of a fiscal gap.
The average cost of foster care per year per youth is $30,000.
Audit rules are unclear at this time, however the county will have to provide documentation related to expenditures and outcomes.
Also, we do not know how effective the selected interventions will be in reducing costs and generating savings.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

12. Preliminary Plan for Use of IV-E Waiver (Full Year)
Department
Positions (FTEs)
Full Year Staff Costs*
Contracts*
Total*
DHHS 24
$2.6
$7.5
$10.1
Probation 12
$1.5
$2.7
$4.2
DHA 2
$0.3 __
Subtotal 38
$4.4
$10.2
$14.6
Aid Payments
$2.0
TOTAL
$16.6
*millions
October 28, 2014
DHHS & Probation – Title IV-E Waiver

13. Other Considerations Mitigating risk Early opt out costs
Funds set aside to cover unforeseen cost increases
Early opt out costs
County would have to pay back all waiver money spent on services that are not Title IV-E eligible under traditional funding structure
Sustainability
How would County fund waiver-related programs after the waiver period (FY19-20)?
Talking Points
We are trying to be prepared for possible fiscal gaps. So to the extend possible we have set aside funds to cover increases in costs. We also have to consider and be prepared for the unlikely scenario of opting out. Another issue is how do we sustain the program after the waiver period ends considering the federal government may end the waiver after FY In that event, the county would need to either provide local resources to backfill funding or reduce expenditures.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

14. QUESTIONS
October 28, 2014
DHHS & Probation – Title IV-E Waiver

15. Michelle Callejas Deputy Director
Child Protective Services
Michelle Callejas
Deputy Director 15
October 28, 2014
DHHS & Probation – Title IV-E Waiver

16. Title IV-E California Well-Being Project
Achieving Better Outcomes
Increased Safety
Prevention of Abuse and Neglect
More Timely and Successful Permanency
Talking Points
This Demonstration Project is a very good fit for CPS because it aims to improve the outcomes we consider key to our work: Safety, Permanency and Well-Being. 16
October 28, 2014
DHHS & Probation – Title IV-E Waiver

17. Planned Interventions
Safety
Safety Organized Practice (SOP)
Prevention
Focus on children 6 and older
Permanency
Intensive Family Finding and Kinship Support
Talking Points
SOP is the intervention required by the state and is part of their Core Practice Model launched as a result of the Katie A. settlement agreement. SOP is very similar to SOS, the engagement model implemented in Sacramento since It focuses on safety mapping and safety planning.
For our prevention effort we will expand Family Resource Center services to families with children 6 and older. This is a vulnerable population that has not been getting enough attention since the budget cuts in Fortunately, First 5 has been investing in the 0-5 population for several years with good results.
The permanency intervention entails enhancing our efforts to identify family for children in foster care so that they can be placed with their kin. Not only will we be identifying family members willing and able to care for the children but also providing supports for them to be able to do so. 17
October 28, 2014
DHHS & Probation – Title IV-E Waiver

18. Planned Interventions (continued)
Safety
SOP is engagement model
Similar to Signs of Safety
Prevention
Expanding services in Family Resource Centers
Permanency
Competitive process
Letters of Interest (LOI)
RFP
Talking Points
SOP – a strength-based, solution-focused approach that provides tools to meaningfully engage families. It is framework for critical thinking to support safety, permanency and well-being. SOP includes family engagement and assessment, behaviorally-based case planning, transition planning, ongoing monitoring and case plan adaptation as appropriate.
We currently are in the midst of a competitive bid process to identify providers for family finding services and kinship support services. We have published a request for letters of interests which were due on October 22 and based on the response an RFP may follow. We hope to provide intensive family finding to children per year. 18
October 28, 2014
DHHS & Probation – Title IV-E Waiver

19. Providers Staff Building Capacity
Contracting for permanency and prevention services
$1.1 million for FY 14-15
$36 million over 5 years
Providers
Partnering with providers to achieve outcomes
Support local and state evaluation efforts
Support policy development and training
Ensure compliance with CWS/CMS requirements
Staff
Talking Points
Contracting with permanency and prevention providers and hiring staff will allow us to build internal and external to improve outcomes and also to monitor indicators and document. Additional staff in particular will enhance internal infrastructure to support state and local evaluation efforts as well as policy development and training.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

20. Continuous Quality Improvement
Focus on Outcomes
Continuous Quality Improvement
Prevention
Permanency
Safety
Talking Points
We will use CQI to focus on short-term and long-term outcomes in order to determine the efficacy of the planned interventions. The success of our fiscal strategy depends on achieving the outcomes identified for each intervention.
We are also reinforcing lessons learned by utilizing a case discussion model at the line level to help social workers and supervisors analyze critical incidents to determine what went well with the case work, what went wrong and what how will they approach cases differently as a result. 20
October 28, 2014
DHHS & Probation – Title IV-E Waiver

21. Monitoring is Key
If chosen interventions do not lead to expected outcome improvements then
we will not continue investing in them
October 28, 2014
DHHS & Probation – Title IV-E Waiver

22. Projected Caseload Reductions
Year 1- Stable
Year 2 – 5% (ages 0-18)
Year 3 – 4% (ages 0-18)
Year 4 – 2% (ages 0-18)
Year 5 – 2% (ages 0-18)
Talking Points
We developed very conservative estimates for caseload reductions, with the thought that the largest impacts might happen during the initial years as we start to identify children that can be benefitted by the interventions. We anticipate diminishing reductions in later years as we begin to encounter children and families with more complex circumstances and multiple risk factors.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

23. $7 Million Over 5 years Anticipated Savings Talking Points
Based on our conservative estimates, if the reductions in caseloads and entries materialize we estimate savings based on reduced overtime, court costs, travel, fleet, and related costs.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

24. Possible Risks Talking Points
One of the risk scenarios we face is the increase in entries into foster care which increases the in-care population and related foster care payments.
The graph shows considerable decrease in the number of children in care 0-17 years of age since However, there is a recent uptick which is worrisome, particularly if the number continues to grow over several years.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

25. Possible Risks Talking Points
As you can see, this graph shows the recent increase in entries. Although the trend line still shows a decrease, the recent uptick is worrisome. We have done a lot work on entries, bringing our numbers more in line with state trends after been one the counties with the highest numbers of entries. So this uptick is something we are watching and will continue to watch closely.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

26. QUESTIONS
October 28, 2014
DHHS & Probation – Title IV-E Waiver

27. Brian Lee Division Chief
Probation
Brian Lee
Division Chief 27
October 28, 2014
DHHS & Probation – Title IV-E Waiver

28. Title IV-E California Well-Being Project
Achieving Better Outcomes
Decreased Entries
Reduced Recidivism
Prevent Delinquency 28
October 28, 2014
DHHS & Probation – Title IV-E Waiver

29. Planned Interventions
Entries
Wraparound Services (WRAP)
Recidivism
MultiSystemic Therapy (MST)
Prevention
Functional Family Therapy (FFT)
Talking Points
As a core service intervention, that will be implemented statewide by all county probation departments entering the Well-Being Project, Wraparound Services will be offered to youth exhibiting delinquent behaviors that put them at risk of being removed from their homes and placed in foster care. The Wraparound model will involve a family-centered, strength-based, needs-driven planning process for creating individualized services and supports for the youth and family. Specific elements of the Wraparound model will include case teaming, family and youth engagement, individualized strength-based case planning, and transition planning.
MultiSystemic Therapy (MST) program. MST is an intensive family and community-based treatment program that focuses on chronically delinquent or violent youth. The modality seeks to address all environmental systems that impact a troubled youth. These systems include their homes, schools, neighborhoods and peer groups. Designed to work with chronically delinquent and violent youth, MST seeks to make an impact on each of the systems that may support or put a youth at higher risk of delinquent behavior.
Functional Family Therapy. FFT is a short-term, high-intensity therapeutic intervention program designed to work with at-risk youth and their families. With an average of 12 sessions (in home or at a clinic) spread out over a 3-4 month period, FFT uses a strength-based treatment modality to promote protective factors associated with delinquent behaviors. FFT also helps empower those involved to look at how their actions impact themselves and those around them. 29
October 28, 2014
DHHS & Probation – Title IV-E Waiver

30. Providers Staff Building Capacity $11.7 million over five years
Assist with outcome, audit and service delivery
Cross-over youth practice model and other cross-systems initiatives
Case management and supervision
Staff
Talking Points
The Probation Department would add several non-sworn, support staff to include one Human Services Program Planner and two Administrative Services Officers 2.  The support staff would assist with outcome, audit and service delivery.  Additionally, the Probation Planner would be devoted to cross agency programs and services such as the cross-over youth practice model and other initiatives that overlap Behavioral Health, Probation and Child Welfare.  Probation would also seek to add 4 Deputy Probation Officers, 2 Sr. Deputy Probation Officers and 1 Supervising Probation Officers to provide supervision to the growing AB12 caseloads as well as to case manage and supervise the WRAP services being delivered.  These additions would be necessary due to the adding resources to populations of youth who, due to budget limitations, are not supervised currently.  These resources and the subsequent supervision are necessary to provide the preventative services necessary to ensure caseload growth and costs do not occur.  The approximate cost is $1.6 million.
October 28, 2014
DHHS & Probation – Title IV-E Waiver

31. Projected Caseload Reductions
Decreased time in out-of-home placement
October 28, 2014
DHHS & Probation – Title IV-E Waiver

32. QUESTIONS
October 28, 2014
DHHS & Probation – Title IV-E Waiver