2010 10-22 foster-redesign

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2010 10-22 foster-redesign

  1. 1. Improving Outcomes for Children and Youth: Foster Care Redesign Texas Alliance Child Care Administrators’ Conference October 15th, 2010
  2. 2. Agenda <ul><li>Project Overview </li></ul><ul><li>Quality Indicators </li></ul><ul><li>Stakeholder Involvement </li></ul><ul><li>Status </li></ul><ul><ul><li>Preliminary Model </li></ul></ul><ul><ul><li>Issues </li></ul></ul><ul><ul><li>Next Steps </li></ul></ul>
  3. 3. Overview <ul><li>Goals </li></ul><ul><ul><li>Improve outcomes for children and youth </li></ul></ul><ul><ul><ul><li>Permanency </li></ul></ul></ul><ul><ul><ul><li>Well being </li></ul></ul></ul><ul><li>Parameters </li></ul><ul><ul><li>Neither requires nor precludes additional funding </li></ul></ul><ul><ul><li>Does not include transfer of case management responsibilities </li></ul></ul>
  4. 4. Quality Indicators <ul><li>Children are placed in their home communities. </li></ul><ul><li>Children are appropriately served in the least restrictive environment that supports minimal moves for the child. </li></ul><ul><li>Connections to family and others important to the child are maintained. </li></ul><ul><li>Children are placed with siblings. </li></ul><ul><li>Services respect the child’s culture. </li></ul><ul><li>To be fully prepared for successful adulthood, children and youth are provided opportunities, experiences and activities similar to those experienced by their non-foster care peers. </li></ul><ul><li>Children and youth are provided opportunities to participate in decisions that impact their lives. </li></ul>
  5. 5. Project Objectives <ul><li>Determine Where And What Kind Of Services Are Needed. </li></ul><ul><li>Determine How To Contract For Those Services: </li></ul><ul><ul><li>Outcomes </li></ul></ul><ul><ul><li>Performance Measures </li></ul></ul><ul><ul><li>Procurement Processes </li></ul></ul><ul><li>Determine How To Pay For Those Services: </li></ul><ul><ul><li>Rate Structure </li></ul></ul><ul><ul><li>Fiscal Implications </li></ul></ul>
  6. 6. Process <ul><li>Review of Previous Work, Recommendations and Plans </li></ul><ul><li>Coordination with Other Groups Working On Foster Care Related Issues </li></ul><ul><li>Review and Analysis of Other States’ Experiences in Performance-Based Contracting </li></ul><ul><ul><li>Calls with Missouri and Tennessee </li></ul></ul><ul><ul><li>Review of Kansas, Illinois, Florida and other Models </li></ul></ul><ul><ul><li>National Reports </li></ul></ul><ul><li>Extensive Stakeholder Involvement </li></ul><ul><li>Internal and External Implications Workgroups </li></ul>
  7. 7. Stakeholder Involvement <ul><li>Guiding Body: Public-Private Partnership </li></ul><ul><li>Other Involvement To Date </li></ul><ul><ul><li>2,210 stakeholders participated in 132 meetings, focus groups or presentations </li></ul></ul><ul><ul><li>2,659 webpage views </li></ul></ul><ul><ul><li>2,057 visitors to webpage </li></ul></ul><ul><li>CPS/Provider Meetings in Every Region </li></ul><ul><li>Texas Council of Child Welfare Boards </li></ul><ul><li>Judicial Commission for Children, Youth and Families </li></ul>
  8. 8. Stakeholder Involvement <ul><li>Texas Network of Youth Services (TNOYS) </li></ul><ul><li>Statewide Youth Leadership Council </li></ul><ul><li>Advocates </li></ul><ul><ul><li>Texas Court Appointed Special Advocates </li></ul></ul><ul><ul><li>CPS Statewide Parent Collaboration Group </li></ul></ul><ul><ul><li>Public Forum </li></ul></ul><ul><ul><li>Texans Care for Children </li></ul></ul><ul><ul><li>Advisory Committee for Promotion of Minority Adoption </li></ul></ul><ul><ul><li>Texas Association for the Protection of Children </li></ul></ul><ul><li>Other Workgroups/Legislatively Mandate Committees </li></ul><ul><li>Internal DFPS and HHSC Staff </li></ul>
  9. 9. Work Groups <ul><li>Public-Private Partnership and Other Stakeholders </li></ul><ul><ul><li>Fiscal Matters Workgroup </li></ul></ul><ul><ul><li>Services Workgroup </li></ul></ul><ul><ul><li>Assessment Focus Group </li></ul></ul><ul><ul><li>Collaboration Focus Group </li></ul></ul><ul><ul><li>Accountability </li></ul></ul><ul><ul><li>Performance Measurement </li></ul></ul><ul><li>Internal Workgroups </li></ul><ul><ul><li>Contract </li></ul></ul><ul><ul><li>Procurement </li></ul></ul><ul><ul><li>Placement </li></ul></ul><ul><ul><li>Disproportionality </li></ul></ul><ul><ul><li>Utilization Review </li></ul></ul>
  10. 10. Report: Request for Proposal Responses
  11. 11. RFI Responses <ul><li>Respondents </li></ul><ul><ul><li>Twenty Responses </li></ul></ul><ul><ul><ul><li>19 Texas Providers </li></ul></ul></ul><ul><ul><ul><li>15 Currently Licensed By DFPS, Some Multiple Licenses </li></ul></ul></ul><ul><ul><ul><li>5 Were COA Accredited </li></ul></ul></ul><ul><ul><ul><li>1 Self-identified As Medicaid Provider </li></ul></ul></ul><ul><li>Overarching Themes </li></ul><ul><ul><li>Ensure Accountability </li></ul></ul><ul><ul><li>Improve Assessment Process </li></ul></ul><ul><ul><li>Provide Flexibility </li></ul></ul><ul><ul><li>Improve Collaboration </li></ul></ul><ul><ul><li>Improve Use of Technology </li></ul></ul>
  12. 12. Improving Contracting <ul><li>Improving Availability/Developing New Capacity </li></ul><ul><ul><li>Contract For Continuum </li></ul></ul><ul><ul><li>Use Case Rates </li></ul></ul><ul><ul><li>Provide Incentives For Exceeding Performance Measures </li></ul></ul><ul><ul><li>Develop Partnerships/Networks </li></ul></ul><ul><ul><li>Contract For Specific (Minimum) Number Of Beds, Specific Services </li></ul></ul><ul><ul><li>Provide More Flexibility To Meet Unique Needs </li></ul></ul><ul><ul><li>Continue to Use Medicaid Services </li></ul></ul>
  13. 13. Improving Services <ul><li>Engage Communities </li></ul><ul><ul><li>Use Team Approach </li></ul></ul><ul><ul><li>Use “Wrap-around” Services </li></ul></ul><ul><ul><li>Develop Community Partnerships To Establish Network </li></ul></ul><ul><ul><li>Contract With A Community Development Organization </li></ul></ul><ul><li>Improve Assessment Processes </li></ul><ul><li>Use Trauma-informed Care </li></ul><ul><li>Have Foster Care Providers Work With Families </li></ul><ul><li>Encourage, But Don’t Require Accreditation (Until It Can Be Funded) </li></ul>
  14. 14. Improving Accountability <ul><li>Use RFP to Select Providers </li></ul><ul><li>Contract for Specific Outcomes, Measure Achievement of Outcomes </li></ul><ul><li>Implement Objective, Measurable Performance Measures (Based On Quality Indicators) and Align ASFA and CFSR Requirements </li></ul><ul><li>Implement UR Process with Benchmarks </li></ul><ul><li>Require Continuum Contract Agency to Demonstrate Capacity to Develop, Manage and Maintain Subcontracting Relationships </li></ul>
  15. 15. Status Preliminary Design
  16. 16. Preliminary Design Elements <ul><li>Building the Infrastructure </li></ul><ul><ul><li>How to Contract </li></ul></ul><ul><ul><li>Where to Contract </li></ul></ul><ul><ul><li>How to Pay </li></ul></ul><ul><li>Improving Efficiency </li></ul><ul><ul><li>Increased Coordination of Services to Families </li></ul></ul><ul><ul><li>Enhanced Collaboration </li></ul></ul><ul><ul><li>Engagement of Community </li></ul></ul><ul><li>Improving Outcomes </li></ul><ul><ul><li>Enhanced Role in Working with Families </li></ul></ul>
  17. 17. Preliminary Design <ul><li>Basic Elements </li></ul><ul><ul><li>Contract for Continuum of Care </li></ul></ul><ul><ul><li>RFP for Continuum </li></ul></ul><ul><ul><li>Increased Family Involvement </li></ul></ul><ul><ul><li>Better Collaboration </li></ul></ul>
  18. 18. Project Objectives: December 2010 <ul><li>Determine How To Contract </li></ul><ul><ul><li>How to Procure </li></ul></ul><ul><ul><li>What to Procure </li></ul></ul><ul><ul><li>What Performance Measures </li></ul></ul><ul><li>Determine Where To Contract </li></ul><ul><ul><li>Gap Analysis (Where Services Are Needed) </li></ul></ul><ul><li>Determine How To Pay </li></ul>
  19. 19. How To Contract: Decisions <ul><li>How to Procure </li></ul><ul><ul><li>Performance-Based Contract </li></ul></ul><ul><ul><ul><li>Established Outcomes </li></ul></ul></ul><ul><ul><ul><li>Maximum Flexibility </li></ul></ul></ul><ul><ul><ul><li>Incentives with First Year “Hold Harmless” </li></ul></ul></ul><ul><ul><li>Request for Proposals (Competitively Procured) </li></ul></ul><ul><ul><ul><li>Open to For and Not For Profits </li></ul></ul></ul><ul><ul><ul><li>Open to In-State and Out-of-State Providers (with preference for Texas Experience) </li></ul></ul></ul><ul><ul><ul><li>Open to a Variety of Networking/Contracting Models </li></ul></ul></ul>
  20. 20. How to Contract, Continued <ul><li>What To Procure </li></ul><ul><ul><li>Continuum Of Foster Care (All Levels Of Foster Care) </li></ul></ul><ul><ul><li>Separate Allocation For Services To Families Of Children In Provider’s Care (Currently Contracted Services) </li></ul></ul><ul><li>What Performance Measures </li></ul><ul><ul><li>Outcomes </li></ul></ul><ul><ul><ul><li>Days In Care - Time To Permanency </li></ul></ul></ul><ul><ul><ul><li>Improvement In Child Functioning/Service Level </li></ul></ul></ul><ul><ul><li>Quality Indicators </li></ul></ul>
  21. 21. Where to Contract <ul><li>Decided </li></ul><ul><ul><li>Continuum Contract in Geographic Catchment Areas </li></ul></ul><ul><ul><li>Multiple Contracts for “Fall Back”/Contingency Plan </li></ul></ul><ul><ul><li>Catchment Area Large Enough to Minimize Financial Risk </li></ul></ul><ul><li>In Process </li></ul><ul><ul><li>Other Criteria for Catchment Areas </li></ul></ul>
  22. 22. How to Pay <ul><li>Decided </li></ul><ul><ul><li>Eliminate Link Between Billing And Authorized Levels Of Care </li></ul></ul><ul><ul><li>Rate Includes Consideration Of Blend Across Levels Of Service </li></ul></ul><ul><ul><li>Resources Will Be Transferred Equivalent To Transferred Responsibilities </li></ul></ul><ul><li>Still In Process </li></ul><ul><ul><li>Consideration Of Expected Utilization </li></ul></ul><ul><ul><li>Incentives Based On Reductions Of Days In Care </li></ul></ul>
  23. 23. Other Decisions <ul><li>No Child Will Be Moved From Stable Placement To Accommodate “Close Proximity” Requirement </li></ul><ul><li>Decisions Will Be Made On “Best Interest Of The Child” </li></ul><ul><li>Implementation Will Be Gradual; No Statewide “Flip The Switch” </li></ul><ul><li>Various Models May Be Used For Delivering Continuum </li></ul><ul><li>Continuum Will Include All Levels Of Foster Care </li></ul><ul><li>Funds For Services To Families Will Not Be Part Of Blended Rate; Will Be Separate Allocation </li></ul><ul><li>DFPS Will Commit Resources For Administrative Costs “Trade-offs” </li></ul>
  24. 24. Next Steps <ul><li>Implementation Issues </li></ul><ul><ul><li>Implications Workgroups </li></ul></ul><ul><ul><li>Report </li></ul></ul><ul><ul><ul><li>PPP Recommendations </li></ul></ul></ul><ul><ul><ul><li>Stakeholder Participation/ Input </li></ul></ul></ul><ul><ul><ul><li>High Level Implementation Plan </li></ul></ul></ul><ul><ul><li>Innovation Zones </li></ul></ul><ul><ul><ul><li>Governance </li></ul></ul></ul><ul><ul><ul><li>Criteria for Decision-Making </li></ul></ul></ul>
  25. 25. Questions?

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