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APPENDIX III
To date, 18 States have received approval for demonstration projects intended to test new approaches to the delivery of child welfare services in order to improve outcomes for children. The demonstration projects involve waivers of certain provisions of title IV-E of the Social Security Act and related regulations.
The waivers provide States with greater flexibility to use title IV-E funds for services that can facilitate permanence for children. At a minimum, all the demonstrations are expected to be cost-neutral and most expect to reduce title IV-E costs. Collectively, the demonstration projects are aimed at reducing the number of children in foster care, the length of time in foster care, the use of more restrictive and costly placement settings, re-allegations of abuse and neglect, and re-entry to foster care. Some States have proposed discrete interventions focused on a specific child welfare population, while others are experimenting with system-wide reform.
An overview of each State's demonstration is provided in the attached exhibit. Among the common themes across demonstrations are the following:
Assisted Guardianship/Kinship Permanence: Six States (California, Delaware, Illinois, Maryland, Montana, and North Carolina) have proposed programs that are intended to provide relatives and foster parents, who are providing care for children in the custody of the child welfare agency, with the opportunity to become the child's legal guardian. This option would be offered to relatives and foster parents who have been providing a stable home for at least one year (six months in North Carolina) for a child for whom adoption or reunification is not an option. While children of all ages will be eligible for this program in Illinois, Maryland, and North Carolina; Delaware, Montana, and California are focusing on older children (12 and over in Delaware and Montana, and 13 and over in California). The Montana demonstration also includes children under the jurisdiction of tribal courts. All States propose a monthly payment that is less than or equal to the current foster care payment. States expect additional savings to accrue from reduction in case management and court costs.
Systems Reform: Five States (Mississippi, New York, North Carolina, Ohio, and Oregon) are providing counties or other entities with the opportunity to use IV-E funds more flexibly to enhance the array of services available to prevent foster care placement, facilitate reunification and otherwise ensure safe, permanent outcomes for children. In New York, North Carolina, and Ohio, counties will be able to use IV-E funds for an array of services, but their total IV-E allotment will be fixed by agreement with the State, or will be determined by the experience of comparison counties. These States are entering into various arrangements with participating counties to share risks and rewards if expenses are either below or above their planned IV-E allotment. Some counties may enter into managed care contracts with private agencies. In Oregon, the State and County negotiate a budget for flexible funding, which is allocated from the county's foster care budget. If the County spends less of their flexible funds than budgeted, the difference reverts to their foster care budget. If additional foster care funds are needed, the State makes up the difference. Mississippi is using a new, child-focused family-centered practice approach in eight counties to target factors that contribute to abuse and neglect.
Capitated Payment: Four States (Connecticut, Kansas, Michigan, and Washington) are providing an array of services under fixed-price arrangements. These demonstrations are designed primarily to test different financing mechanisms for specific services or populations. In Connecticut, the State will contract with a lead service agency in one or two sites to provide a continuum of care to children, ages seven to 15, who are in group or residential care and have behavioral problems. Washington will pay fixed rates to Regional Support Networks to provide services to children, ages eight to 17, who are likely to enter group care and already are involved with the mental health or special education system for comprehensive services. Kansas, already in a statewide capitated payment system, will compare case rates to fee-for-service payments for enhanced service provision by private providers. In Michigan, six counties are establishing capitated-payment programs for wrap-around services for foster children at high risk or children at imminent risk of entering foster care.
Intensive Service Options: Three States have proposed demonstrations that increase the nature and extent of available services in an effort to reduce foster care placements and achieve permanence and safety for a particular segment of the child welfare population. These include:
Indiana is focusing their demonstration on providing community-based alternatives to group and institutional care, especially out-of-State care. Each county will develop its service plan designed to support home-based alternatives to placement (including the child's own home or foster family home in the community).
California will allow 12 counties to develop their plans for intensive service programs to prevent foster care placement.
Michigan will use funds in the pilot county to provide intensive services to adolescents adjudicated, or at risk of being adjudicated.
Adoption-Related Activities: Two States have demonstrations designed to increase adoptions of children for whom reunification is unlikely:
Maine will provide training on special-needs adoption to mental health and other professionals that work with adoptive families, adoptable children, and public and private adoption providers, and subsequently will use IV-E funds to provide post-adoptive services.
New Jersey will establish a unit within its Adoption Resource Centers responsible for concurrent planning, providing enhanced services for eligible children, and recruiting, training, and supporting fost-adopt homes with enhanced support services.
Substance-Abuse Services: Two States (Delaware and New Hampshire) are providing services for caretakers with substance abuse problems. Each State has hired substance abuse counselors to work with the Child Protective Services (CPS) staff working with families with a substance abuse problem by arranging treatment and accessing other needed services.
Extension of Voluntary Placement Agreements: The California demonstration waives the requirement to go to court for a hearing within 180 days of executing a voluntary placement agreement, extending the hearing date to 365 days after voluntary placement. The intent is to allow child welfare staff to continue to work with families in a non-adversarial way when reunification appears imminent. The extensions are expected to reduce court-related costs and shorten the time necessary to achieve reunification.
All of the demonstrations have comprehensive evaluation plans that include process, outcome and cost-benefit components. Fourteen States are implementing evaluation designs based on random assignment for at least one component of their demonstration. In four States the evaluation designs use comparison groups. Demonstrations vary in the type of designs proposed for their outcome evaluations. All of the assisted guardianship programs (except Delaware) have a design based on random assignment of eligible families to treatment and control groups. All will measure the degree of stability and safety achieved for children in the program and the reduction in costs.
Most of the States proposing county-based system reform/managed care demonstrations will compare outcomes achieved by counties in the demonstration with a group of counties (with comparable characteristics) that continue to provide traditional services. In New York, participating counties will develop their own evaluation plans that must include either a random assignment design or a comparison group. All States testing capitated payment systems will use random assignment to experimental and control groups within the demonstration sites.
States with targeted, intensive service demonstrations differ slightly in their outcome evaluation designs. Delaware's evaluation of their substance abuse services is based on assigning substance abuse treatment workers to only one of two CPS units in each county. Families in the units without substance abuse workers will serve as the control group. California will use a random assignment model for their intensive preventive service demonstration. Indiana has proposed to select a maximum of 4,000 children to receive demonstration services and then retrospectively select a matched comparison group. Mississippi and New Hampshire will randomly assign children to experimental and control groups. Both Maine and New Jersey also use random assignment for their adoption-related demonstrations.
At this time the degree of details about the evaluation plans varies. States that have recently been awarded waivers have not hired their evaluators. More detailed comparisons of evaluation plans will be prepared when the evaluation plans are submitted.
Appendices
Appendix I - Demonstration Topics of
Interest to the Department
Appendix II - Names and Addresses of ACF
Regional Administrators
Appendix IV - Summary of IV-E Waiver
Demonstrations