1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

20. 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

21. 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

22. 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

23. Foster Care Redesign Webpage
Information on Foster Care Redesign can be found on the DFPS website at:

24. APPENDIX

25. 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.

26. 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

27. 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