Appendix I - Demonstration Topics of Interest to the Department

Appendix I

Demonstration Topics of Interest to the Department

This list of possible Demonstration topics is offered to provide examples of the types of novel child welfare projects in which the Department may be most interested.

Comprehensive Health Systems. States may wish to propose demonstration projects aimed at improving the access, quality, comprehensiveness and continuity of health and/or behavioral health (mental health and substance abuse) services to meet the unique needs of children, youth and their birth families who are in or at-risk of entering foster care. This population has multi-faceted problems that demand a comprehensive and integrated health delivery system to address their needs. The Department would encourage States to submit proposals for projects that approach the needs of this population in a coordinated way that could be supported by a combination of Federal, State and local funds, including child welfare, Medicaid, mental health, substance abuse and domestic violence dollars.

Projects of this nature would demonstrate how flexible use of IV-E funds could be used at the State or local level to create comprehensive, coordinated assessment, treatment, and health-related case management services for children, youth and their parents while maintaining cost neutrality for title IV-E. A demonstration in this area would be based on the premise that improved access to mental health, substance abuse treatment, domestic violence support and other services for children, youth and their families could prevent the need for foster care, reduce foster care lengths of stay and re-entry rates after reunification.

The following provides additional detail on potential components to a comprehensive, integrated health delivery system proposal.

Substance Abuse. States might propose projects that improve the identification, referral, and procurement of appropriate, comprehensive treatment services for birth parents of children in, or at risk of entering foster care with alcohol and/or drug dependence and/or for youth in foster care who have alcohol and/or drug dependence. Demonstrations may choose to focus on any one or all of the needs of parents and/or youths including: prevention activities; intake screening and comprehensive substance abuse assessments; identification and linkages to available funding streams or services; and initial and follow-up treatment services in an in- or out-patient setting. States might propose to combine child welfare funds with other Federal, State and local funds to more effectively and quickly provide assessment and treatment services.

Mental Health. States may wish to propose projects that improve the identification, referral, and procurement of mental health treatment services for children and youths in or at risk of entering foster care and their birth parents. This population of children and youth, as a group, is more likely to have developmental problems, serious emotional disturbances and mental health needs. Outside of residential treatment facilities, limited mental health services are currently available to assess risk, prevent problems or effectively treat children, youths and their parents with behavioral health or developmental problems. States could propose how child welfare funds could be combined with other Federal, State and local funds to stimulate supply and more effectively assess and provide treatment to this population.

Performance-Based Financing. States may want to test an outcome-based performance approach to the management and delivery of child welfare services that would use IV-E funds to create incentives to produce better or more timely results for children, youths and their families. States may choose financial incentive models that range from a capitated payment approach that allows the provider to retain savings; to a bonus approach that rewards the attainment of specific goals. All applications would, however, use a performance measurement system as the basis for testing the use of financial incentives. States might, for example, use the proposed HHS child welfare measures (developed in response to ASFA), State-designed measures, or a combination of the two, and design a financial incentive system around the measures to encourage providers to maximize performance. In light of the fact that it is more difficult to control for multiple variables affecting performance in a demonstration of this nature, it will be especially important to incorporate a random assignment evaluation design that would preferably be tested on a smaller scale basis.
Adoption/Post Adoption Services. States may wish to propose demonstrations using title IV-E funds to speed the adoption process and/or support adoption/guardianship placements. With the emphasis in ASFA on moving children and youth more quickly to permanency, States may wish to focus on the provision of post-adoption/guardianship placement services. A wide range of options for post-adoption services exists from targeted services such as therapy/support groups and respite care to on-going case-management with support from multi-disciplinary service teams to meet the physical, psychological and behavioral needs of the child and family. Such a demonstration would test the assumption that post-placement supportive services provided to adopted children, youth (or those in guardianship placements) and their families would improve the long-term success of adoptions, reduce the rate of disruptions and dissolutions and reduce re-entry into the foster care system.
Service Improvements for Children in the Placement and Care Responsibility of Tribes. States may wish to propose a project testing new approaches to improve the delivery of child welfare services for American Indian families. Such a proposal could involve the use of both State-administered and Tribally administered funds or "direct funding" of title IV-E to one or more Tribes for foster care and/or adoption and Independent Living. These demonstrations would test whether better coordination with the State, and/or delegation of authority for the title IV-E program would produce better results for children, youth and families, enable Tribes to manage social services programs better, and reduce child welfare costs.

Service Improvements for Adolescent Youth. States may wish to propose a project to improve service delivery for adolescents to better meet the needs of this unique group, facilitate placements in the least restrictive setting possible and/or promote their adoption opportunities. The project would test the premise that by providing concentrated services for adolescents, the State will be able to reduce the level of care needed, particularly for institutionalized youth and/or enhance their permanency options. States might also consider using IV-E savings derived from these or other demonstration-related activities to expand independent living services to youths

Appendices

Appendix II - Names and Addresses of ACF Regional Administrators
Appendix III - Summaries of the first 18 Child Welfare Waiver Demonstration Projects Approved by the Department
Appendix IV - Summary of IV-E Waiver Demonstrations

Last Updated: March 13, 2007