1. Overview of Child Welfare Waiver Demonstrations Overview of Child Welfare Waiver Demonstrations April 23, 2013 Presented by: Gail Collins Director, Division of Program Implementation Children’s Bureau

2. Child Welfare Waiver Demonstrations Section 1130 of the Social Security Act (SSA) authorizes HHS Secretary to approve State demonstrations involving the waiver of provisions of titles IV-E and IV-B of the SSA. All demonstrations must have a rigorous evaluation (process, outcome and cost) conducted by a third-party evaluator. All projects must be cost neutral to the Federal government, i.e., total amount of Federal funds used for demonstration must not exceed the amount of Federal funds that would have been provided under titles IV-B and IV-E in the absence of the demonstration.

3. Child Welfare Waiver Demonstration Unlike discretionary grants, waiver demonstration projects do not provide additional funding to carry out new services. Instead they allow more flexible use of Federal funds to test new approaches to service delivery. Projects must generate reduced title IV-E costs (usually IV-E foster care) in order to pay for other child welfare services (e.g., prevention, in-home services, post-permanency supports, etc.)

4. History of Waiver Authority Section 1130 waiver authority, established in 1994 through Public Law 103–432, gave HHS Secretary authority to approve total of 10 State demonstrations. Adoption and Safe Families Act (ASFA) of 1997 extended and expanded HHS’s authority to use waivers for child welfare programs by allowing up to 10 new waiver demonstrations each year. Authority approve new waiver demonstrations expired on March 31, 2006.  Projects approved before that time were allowed to be complete demonstration and be amended or extended.

5. New Waiver Authority Authority for new waiver demonstrations re-established through the Child and Family Services Improvement and Innovation Act (P.L. 112-34), signed into law September 30, 2011. Re-authorized HHS to approve up to 10 new waivers in each of Federal Fiscal Years (FFYs) 2012 through 2014. Major new provisions include:  Tribes, tribal organizations/consortia approved to directly operate title IV-E may apply  IV-E agencies must implement at least two child welfare Program Improvement Policies (from a list provided in the statute) All waivers (both existing and new) must end by September 30, 2019.

6. New Waiver Authority: Statutory Goals Section 1130 of the SSA now requires that all new projects must address one or more of the following goals:  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.

7. HHS Priorities under Waiver Authority Address trauma experienced by maltreated children through trauma- informed programs/practices. Improve social, emotional, behavioral, cognitive well-being and functioning of children, with a particular emphasis on children in long- term foster care or hardest to place in permanent homes. Yield more than modest improvements in the lives of children and families through the implementation of evidence-based programs and practices. Leverage involvement of other resources and organizational partners to make concurrent improvements in child welfare and related program areas (e.g., partnerships with state Medicaid and mental health agencies).

8. Status of Past and Current Waivers Since 1994, 23 States have implemented one or more demonstrations under the original waiver authority in multiple areas (e.g., subsidized guardianship, flex. funding, managed care, substance abuse services). 6 States (CA, FL, IL, IN, OH, OR) have active demonstrations that began under the original waiver authority. 9 States (AR, CO, IL, MA, MI, PA, UT, WA, WI) received approval in FFY 2012 to implement demonstrations under the new waiver authority. All are currently in developmental phase. Several proposals for new waivers for FFY 2013 are currently under review by HHS.

9. CA MI VA MA PA UT Completed Demonstrations Continuing Demonstrations Concurrent Continuing and New Demonstrations New Demonstrations * California, Illinois, Michigan, Oregon, and Wisconsin also have completed demonstrations

10. Overview of Ongoing Demonstrations State Demonstration Focus Evaluation Design CaliforniaFlexible Funding Longitudinal/ Time Series FloridaFlexible Funding Longitudinal/Time Series Illinois (AODA) Recovery Coach Services for Parents with Substance Use Disorders Experimental IndianaFlexible Funding Longitudinal/ Time Series Ohio Flexible Funding (Core Interventions: Family Team Meetings and Kinship Supports) Comparison Group/Site OregonRelationship-Based Visitation and Parent Mentoring Experimental

11. Overview of New Demonstrations State Demonstration Focus Evaluation Design Arkansas Enhanced Assessment, Family Engagement, and Differential Response Longitudinal/ Time Series Colorado Enhanced Family Engagement, Assessment, Kinship Supports, and Trauma-Informed Services Matched Case and Longitudinal/Time Series Illinois (IB3) Illinois Birth to Three: Parenting Education and Support Services for Families with Children 0-3 Experimental Massachusetts Enhanced Residential and Community-Based Services to Reduce Use of Congregate Care Matched Case and Longitudinal/ Time Series Michigan Intensive Early Intervention and Case Management and ServicesExperimental Pennsylvania Enhanced Family Engagement, Assessment, and Service ArrayLongitudinal/ Time Series Utah Enhanced Assessment, Caseworker Tools and Training, and Evidence-Based In-Home Service Array Longitudinal/ Time Series Washington Differential ResponseMatched Case Wisconsin Post-Reunification Case Management and ServicesMatched Case

12. Waiver Demonstrations: Overview of Programmatic Elements Expanded use of clinical/functional assessments (e.g., CANS) Evidence-based/trauma-informed programs and practices (e.g., Parent-Child Interaction Therapy, Multi-Systemic Therapy, Nurturing Parent Program) Parent education and mentoring programs Family Finding, Kinship Navigator programs Intensive family preservation and stabilization Family-centered case management models (e.g., Family Team Meetings, Family Group Decision Making) Permanency Roundtables Enhanced/supervised visitation Alternative/Differential Response Time-limited, case-specific concrete goods and services (e.g., assistance with transportation, child care, rent or utility payments)

13. For More Information on Child Welfare Waiver Demonstrations For more information about waiver demonstrations, please see Children’s Bureau website: http://www.acf.hhs.gov/programs/cb/programs/child- welfare-waivers http://www.acf.hhs.gov/programs/cb/programs/child- welfare-waivers  Information Memorandum ACYF-CB-IM-12-05  Sample Waiver Terms and Conditions  Summaries of Projects  Technical Assistance Materials

14. For more information (continued) Contact Children’s Bureau Regional Office Send e-mail to cwwaivers@acf.hhs.govcwwaivers@acf.hhs.gov