The Casey Center for Effective Child Welfare Practice

1
Financing Permanency and Post-Permanency Services
9/14/06
2
Welcome, Presentation Overview

• Reaffirm understanding of the growing need to
  support permanence for youth and services to
  sustain permanent relationships.
• Strengthen understanding of current federal
  funding streams that can be used to fund a
  comprehensive array of services to achieve and
  sustain permanence for youth in foster care.
• Review specific strategies for funding innovative
  permanency and post-permanency programs.
• Provide opportunity for sharing, networking
  related to financing permanency and
  post-permanency services.

3
The Urgent Need for Youth Permanence and
Post-Permanency Services

• 517,000 Children in Foster Care 9/04
• Half - 255,364 - were age 11 and older.
• One fifth not living with families.
• Over one half (58 percent) were from minority
  backgrounds (African American,34 percent
  Hispanic,18 percent Native American, 2 percent
  or Asian, 1 percent.
• The goal for 73,202 children and youth continued
  to be long-term foster care (40,832) and
  emancipation (32,270) despite ASFAs intent
  to eliminate this goal.
• Consequently, more than 27,000 adolescents left
  foster care to be on their own with no meaningful
  connection to a family member or caring adult
  23,121 left to emancipation and 4,261 ran away.
• Experienced the trauma of abuse and neglect
  exacerbated by the trauma of separation and loss.
• More likely to experience higher rates of severe
  emotional, behavioral, and developmental problems
  than children/youth who had not been in foster
  care.

4
Permanent Family Resources Report Needing an
Array of Services/Supports

• Before/after school services
• Behavioral/mental health treatment
• Case management/targeted case management
• Crisis intervention
• Crisis nurseries
• Educational advocacy
• Financial supports ongoing, flexible and
  emergency
• Family foster care
• Housing assistance
• Individual, family or group therapy
• Information and referral
• Legal services

• Parent aide
• Parenting education
• Respite care
• Recreational therapy
• Residential Treatment
• Special camps
• Substance abuse treatment
• Support groups
• Therapeutic foster care
• Transportation services
• Translation services
• Youth development/independent living services

5
Older Children and Youth In Foster Care Today
Need

• Families who can understand their past
  experiences and present adjustment needs, and who
  can form nurturing relationships that help them
  manage their feelings of loss and grief.
• An ongoing mix of services and supports that are
  family-centered, culturally sensitive and
  trauma-informed to sustain their permanent family
  relationships over time and prevent future family
  relationship disruptions and dissolutions.
• A network of community professionals who are
  non-blaming and can see beyond troubling
  diagnoses through the lens of the lifelong family
  adjustment process.

6
Yet, Without Adequate Permanency and
Post-Permanency Services and Financial Supports

• States will not be able to attract, support and
  sustain family resources for special needs
  children in need of permanent families.
• The children remaining in care are more likely to
  experience multiple moves, relationship
  disruptions and the negative emotional and
  behavioral impacts of this instability.
• Youth are more likely to exit foster care without
  an enduring family relationship to support a
  successful transition to adulthood and more
  likely to find themselves in adult correctional,
  psychiatric or homeless facilities with state
  and federal governments bearing the continued
  costs.
• Families who become permanent resources for older
  children/youth in foster care may experience more
  hardships and less positive child and family
  outcomes.
• And, parenting the more vulnerable children/youth
  with complex needs may be challenged by a high
  risk of family distress, relationship disruption
  or dissolution.

7
Federal Funding Streams That CAN Support
Permanency and Post-Permanency Services

• Title IV-E Adoption Adoption Assistance,
  Administration, Training
• Adoption Incentive Funding
• Title IV-B, part 1 Child Welfare Services
• Title IV-B, part 2 Promoting Safe Stable
  Families Program
• Chaffee Foster Care Independence Act Education
  and Training Vouchers for Youth Aging out of
  Foster Care
• Title XIX Medicaid (i.e. EPSDT Targeted Case
  Management
• Title XX Social Services Block Grant
• TANF/EA
• Other Child Welfare Related Funding Streams
  Title II of the Keeping Families and Children
  Safe Act (formerly CAPTA)
• Federal Cooperative Agreements and Discretionary
  Grants

8
Basic Requirements of IV-E Eligibility

• AFDC Relatedness
• Child was a recipient of/or eligible for AFDC (as
  was in effect in the state on 7/16/96) during the
  month the petition was filed with the court to
  remove the child (eligibility month) or the month
  a VPA (Voluntary Placement Agreement) is signed
• Family income limit
• Family resource limit
• Child must be a US citizen or a qualified alien
• Child must have lived in the home of a parent or
  the home of a specified relative within 6 months
  of the eligibility month
• Child must have been deprived of parental support
  during the eligibility month by any of the
  following
• Absence of a parent
• Death of a parent
• Incapacity of a parent (physical or mental)
• Unemployment or underemployment

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Basic Requirements of IV-E Eligibility, cont

• Court Order Language
• Continuation in their own home would be contrary
  to the welfare of the child and
• Reasonable efforts were made to prevent removal
  of the child from their family and
• Placement and care of the child is the
  responsibility of the state IV-E agency or
  another public agency (including a Tribe or BIA)
  with whom the state IV-E agency has made an
  Agreement which is still in effect and
• Reasonable efforts were made to address the
  permanency goal at 12 month permanency finding
  (i.e. facilitate the return of the child,
  guardianship, adoption, placement with a relative
  or other permanent living arrangement

10
Title IV-E Foster Care and Adoption Assistance
Payments

• Open ended individual entitlement
• Payment is made to Foster Care Provider or
  Adoptive Family
• For adoption, amount may be as much, but not more
  than maintenance amount paid for family foster
  care (including difficulty of care payment)
• For foster care, base amount is set, but there
  may be an additional difficulty of care payment
• For adoption, amount is negotiated and may be
  changed via Adoption Assistance Agreement between
  IV-E agency and adoptive family
• FFP is between 50 - 83 (same as Medicaid
  provide for participating states)

11
Title IV-E Administration Open-Ended State
Entitlement

• Allowable activities include
• Referral to Services
• Determination and re-determination of eligibility
• Negotiation and review of adoption agreements
• Post placement management of subsidy payments
• Recruitment of foster and adoptive homes
• Foster care licensing and adoptive family home
  studies
• Adoption exchanges
• Preparation for and participation in judicial
  hearings
• Placement of the child into a foster or adoptive
  home
• Development of the case plan
• Case reviews for children in foster care
  including those conducted during a specific
  pre-adoptive placement for children who are
  legally free for adoption

12
Title IV-E Administration, cont

• Allowable Activities, cont
• Case management and supervision relating to
  foster children.
• Case management and supervision prior to the
  final degree of adoption.
• Case management performed to implement an
  adoption assistance agreement.
• Costs related to data collection and reporting.
• Proportionate share of related agency overhead.
• Other costs directly related only to the
  administration of the foster care and/or adoption
  assistance program.

• Formula
• FFP is 50
• Costs must be allocated based on IV-E Foster Care
  and/or Adoption Assistance penetration rate
• Provided by IV-E agency staff or contractors

13
Title IV-E Training Open-Ended Entitlement

• Includes training for
• Current or prospective foster/adoptive parents
  (short term), for example foster parent/adoption
  conferences, seminar or retreat or Specific to a
  childs needs
• Foster/Adoptive Parent basic training (i.e.
  PRIDE)
• Training for public IV-E agency staff or those
  preparing for employment
• Includes costs of
• Travel
• Per diem
• Registration fees
• Trainers
• FFP is 75
• Costs must be allocated based on IV-E Foster Care
  and/or Adoption Assistance penetration rate
• FFP for training staff of contractors is 50
  (administration)

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Title IV-B, Part 1

• NOT an entitlement
• May be spent on
• Wide variety of child welfare services
• Total authorized - 325 million
• FY 2006 total appropriation - 287 million
• Amount for each state primarily based on states
  comparative population under 21
• Federally recognized Tribes have direct access to
  state allotment
• Tribal allotment based on Tribal child population
  with increased weight for each child (3 times
• FFP is 75 - requires 25 match from State/Tribe
• State/Tribal share can be cash or in-kind
  including in-kind expenditures of private
  agencies
• States/Tribes must have federally approved 5 year
  (with annual reports) Child Welfare Services Plan

15
Title IV-B, Part 2

• Capped ENTITLEMENT 345 million plus authorized
  for additional non-entitlement funds
• 70 million appropriated in FY 2002
• 99 million appropriated in FY 2004
• 99 million appropriated in FY 2005
• 89 million appropriated in FY 2006
• FFP is 75 - requires a 25 match from
  State/Tribe
• State allocation must be spent (usually minimum
  of 20 on each) on
• Community-based family support services
• Family preservation
• Time limited family reunification services
• Adoption promotion and support

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Title IV-B, Part 2 cont

• Tribal allocation can be spent on any of the 4
  categories with no specific requirement
• State share is based on average monthly
  children receiving food stamp benefits for most
  recent 3 years
• Tribal share is based on Tribes number of
  children under age 21 as compared to all
  federally recognized tribes
• Tribe eligibility is limited to Tribes who would
  be eligible for at least 10,000
• Tribal allocation comes from a set aside
  separate from the state allotment
• 1 of first 305 million
• 2 of amount over 305 million
• States/Tribes must have federally approved 5 year
  (with annual reports) Child Welfare Services Plan

17
Title IV-B, Part 2 - cont.

• Rule of thumb a minimum of 20 is to be spent in
  each of 4 categories, with no more than 10 on
  Administration (no requirement for Tribes)
• FFP is 75 with 25 required match from
  State/Tribe
• State share is based on average monthly number of
  children receiving food stamp benefits for most
  recent 3 years Tribal allocation come from set
  aside, separate from State allotment.
• Linked to 5 year (with annual reports) Child
  Welfare Services Plan jointly developed (state
  and federal regional office)

18
Chafee Foster Care Independence Program

• 140 Million capped entitlement
• Requires a 20 state match
• General funds
• Private funds
• In-kind from a private agency
• Allocation formula is based on the number of
  children in foster care for the most recent
  fiscal year minimum of 500,000
• Use of funds any manner that meets purpose
• Eligible children
• Any foster child without regard to IV-E
  eligibility likely to remain in foster care until
  age 18
• Option for foster child in non-state agency
  custody
• States must serve former foster child age 18 21
  who left foster care before age 18 or aged out of
  foster care
• States may use up to 30 for room and board of
  former foster children age 18 21 who left care
  before age 18 or who aged out of foster care
• Optional Medicaid for youth up to age 21

19
Chafee Foster Care Independence Program
Education Training Vouchers for Youth Aging
Out of Foster Care

• 60 million Authorized Not an Entitlement
• State Allotment is on the same basis as Chafee
• Requires 20 non-federal match cash or in-kind
• Eligibility
• Youth otherwise eligible for Chafee
• Youth adopted from foster care after age 16
• Youth participating in the Voucher Program on
  their 21st birthday until they turn age 23 as
  long as they are in post secondary education or a
  training program and are making progress
• Maximum amount of the Voucher Up to 5000 per
  year
• Purpose Post Secondary Education Training
• Goal
• Help youth make transition to self-sufficiency
• Help youth receive education training so they
  can secure a job
• There is a provision for Re-allotment of funds

20
Title XIX - Medicaid

• Open ended individual entitlement
• Use this funding source whenever possible because
  of open ended status
• FMAP is based primarily on states per capita
  income and ranges between 50 and 83
• Provides broad range of mandated and optional
  medical services based on each states unique
  plan including Physical health Behavioral
  health, Rehabilitation Services and Targeted Case
  Management
• All IV-E eligible special needs adopted children
  have categorical eligibility
• Optional coverage for non IV-E eligible children

21
Title XIX Medicaid, cont

• Access through EPSDT (mandated service for
  eligible children)
• All IV-E eligible special needs adopted children
  have categorical eligibility
• Optional coverage for non IV-E eligible children
  adoption assistance agreement child has
  special needs for medical or rehabilitative care
• Services must be authorized by a practitioner of
  the healing arts
• New CMS proposals in Presidents FY 2006 Budget

22
Medicaid Impact of 2006 Deficit Reduction Act on
Targeted Case Management (TCM)

• Targeted case management services are case
  management services to specific classes of
  individuals - or to individuals who reside in
  specific areas - which will assist individuals in
  gaining access to needed medical, social,
  educational and other services including
• Assessment of an eligible individual to determine
  service needs
• Development of a specific care plan
• Referral and related activities
• Monitoring and follow-up activities
• With respect to the direct delivery of foster
  care services TCM does not include such services
  as
• Research gathering documentation required by
  Foster Care Program
• Assessing adoption placements
• Recruiting or interviewing potential foster care
  parents
• Serving legal papers
• Home investigations
• Providing transportation Administering foster
  care subsidies
• Making Placement arrangements
• States shall allocate the costs of TCM which are
  reimbursable under another federally funded
  program (OMB Circular A-87) under an approved
  Cost Allocation Program)

23
Title XX Social Service Block Grant

• NOT now an entitlement.
• Prior to Title XX, there was an open-ended
  service entitlement for current, former or
  potential recipients of AFDC and AABD (Aid to the
  Aged, Blind and Disabled).
• Very flexible and broad in how states can spend
  the grant
• Authorized for 2.38 billion Congress
  appropriated 1.7 billion in FY 2005 FY 2006 -
  1.2 billion (FY 2006 also included a 550
  million increase for hurricane stricken areas)
• Very vulnerable to reductions
• Can be spent on wide variety of permanency
  services

24
Title IV-A TANF

• Replaced AFDC Capped STATE entitlement (not
  individual entitlement)
• Block grant of 16.7 billion, plus some
  supplemental and incentive grants per year
• Four Purposes
• Provide assistance to needy families (means test)
• End the dependence of needy parents by promoting
  job preparation, work and marriage (means test)
• Prevent and reduce out-of-wedlock pregnancies (no
  means test)
• Encourage the formation and maintenance of
  two-parent families

25
Title IV-A TANF, cont.

• Great latitude in determining eligibility,
  benefit levels and services provided to families
• Services for 3rd and 4th purpose include
• Mental health treatment
• Counseling recreation therapy
• Social skills training
• Special camps
• Adoption/Relative search
• MOE (Maintenance of Effort) requirement
• Prior Emergency Assistance program
• EA related services based on what was in state
  EA plan in FY 1995 or 1996
• Not every state had a EA plan

26
Title IV-A TANF, cont

• Under EA very broad eligibility policy - could
  include a child who has been adopted, is with a
  guardian or has been reunified with their birth
  family
• Services could include
• Case management
• Counseling
• Training
• Respite care
• Child care
• Family support

27
Two Examples of Permanency and Post-Permanency
Services/Programs How to Fund Them

• Family Resource Centers
• Respite care
• Pre post permanency case management
• Information Referral
• Research
• Crisis Intervention
• Behavioral Management Treatment
• Training Opportunities
• Child Welfare Training Institute for
• Foster/Adoptive/Guardian Families
• Staff
• Providers

• These 2 service categories can all be funded with
  current funding sources
• The funding sources of preference are usually
  Titles IV-E and XIX because they are open ended
  entitlements

28
Family Resource Centers (FRC)

• Provide range of services to current and
  foster/adoptive/guardian parents including
  recruitment, home studies, referral, training,
  case management, research, respite care and
  treatment
• A variety of federal revenue sources can be used
  for these services, but in so doing the FRC must
  be able to allocate the time and costs to the
  various services
• Staff that provide more than one service can
  allocate their costs based on time studies

• FRCs that serve all resource families including
  those that adopt children who are not special
  needs must include all children served when
  calculating the IV-E penetration rate
• Costs are then isolated and allocated to the
  various funding sources based on appropriate
  formulas

29
FRC Recruitment, home studies, referrals,
research case management

• Funding Source
• Title IV-E administration
• Formula
• Cost X Foster Care IV-E penetration rate X 50
  administration FFP
• Foster care non IV-E penetration rate portion can
  be claimed to other federal sources i.e. IV-B or
  Title XX

30
FRC Respite Care

• Funding Source
• IV-B, subparts 1 2
• Title XX
• TANF/EA
• Formula
• Costs (often respite care is a contracted/invoiced
  service from a private provider) X the FFP for
  whatever funding source is used

31
FRC Behavioral Treatment

• Funding source
• Title XIX or
• IV-B, subparts 1 2, Title XX and TANF/EA
• Formula
• Cost (usually based on units of care) X federal
  funding source regulations for FFP

32
FRC Training

• Funding Source
• Title IV-E training
• Title IV-B subpart 1 2 and Title XX can be
  claimed for non IV-E eligible ratio
• Formula
• Same formulas as the Child Welfare Training
  Institute

33
Training Child Welfare Permanency Training
Institutes

• University-based with IV-E Funds
• Training for current and prospective
  foster/adoptive parents (IV-E Training)
• Adoption Certificate Programs for public agency
  staff (IV-E Training) and contract providers
  (IV-E Administration) non-clinical focus
• Training for private agency foster care/adoption
  staff on non-clinical skills (IV-E
  Administration)
• Train clinical staff who provide treatment to
  foster and adopted children clinical and
  non-clinical issues (IV-E Administration and IV-B
  1 2, Adoption Incentive, Title XX)
• Referral booklets/websites with resources for
  foster/adoptive parents (IV-E Administration)

34
Train current and prospective foster/adoptive
parents

• Funding Source
• Title IV-E training
• Formula
• Direct costs X Foster Care/Adoption Assistance
  blended IV-E penetration rate X 75 FFP plus
• Direct costs X University indirect rate for
  instruction X Adoption Assistance IV-E
  penetration rate X 50 FFP
• Adoption Assistance Non IV-E penetration rate
  portion can be claimed to other federal sources
  i.e. Title IV-B

35
Train IV-E agency foster care/adoption staff on
non- treatment (clinical) skills

• Training Focus
• Recruitment, home studies, case management,
  federal regulations and special needs adoption
  and foster care issues
• Funding Source
• Title IV-E training
• Formula
• Same as training foster/adoptive parents

36
Train private agency foster care/adoption staff
public or private clinicians on non-treatment
(clinical) skills

• Training Focus
• Recruitment, home studies, case management,
  federal regulations and special needs adoption
  and foster care issues
• Funding Source
• Title IV-E administration
• Formula
• Direct costs X IV-E foster care, Adoption
  Assistance or blended IV-E penetration rate X
  50 administration FFP plus
• Direct costs X University indirect rate for
  instruction X IV-E foster care, Adoption
  Assistance, or blended IV-E penetration rate X
  50 administration FFP
• Non IV-E penetration rate portion can be claimed
  to other federal sources i.e. IV-B

37
Train clinical staff who provide treatment to
foster and adopted children on clinical issues as
well as general non-treatment adoption issues

• Funding Sources
• Title IV-E administration and
• One or combination of IV-B, subpart 1 and IV-B,
  subpart 2
• Adoption Incentive
• Title XX

38
Train clinical staff who provide treatment to
foster and adopted children on clinical issues as
well as general non treatment adoption issues,
cont.

• Formula
• Evaluate course content and allocate into
  allowable IV-E training (i.e. understanding
  foster care/adoption, special needs children,
  etc.) and treatment skills training
• IV-E Administration Portion () that is IV-E
  allowable X direct costs University indirect
  rate for instruction X appropriate foster
  care/adoption/blended IV-E penetration rate X 50
  FFP
• IV-B subparts 1 or 2, Adoption incentive or Title
  XX Portion () that is not IV-E allowable
  (treatment) X direct plus actual University
  billed indirect X FFP rate for funding source

39
Create and distribute a referral booklet or make
a web page listing referral resource including
trauma-informed clinicians

• Funding Source
• Title IV-E Administration
• Formula
• Direct costs university indirect rate for
  administration x appropriate foster care/Adoption
  Assistance/blended IV-E penetration rate x 50
  IV-E FFP
• Non-IV-E penetration rate portion can be claimed
  to other federal sources, i.e. IV-B

40
Our Premise Every State Can Increase Federal
Revenue

• Some states may need to amend their cost
  allocation plan (CAP) to allow for their
  increased claim.
• States should work with their federal regional
  office seek PRIOR approval of the CAP
  amendment.
• States can review Random Moment Time Study (RMTS)
  definitions, training of those participating, and
  process for collecting the results of the RMTS.
• States can review their Eligibility Quality
  Assurance Process
• IV-E eligibility determination process for foster
  care.
• Program review of previously-determined not-IV-E
  eligible foster care cases to identify potential
  error.
• States can review how purchase of service
  contracts are funded.

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The Challenges of Revenue Maximization

• What happens in your state to the increased
  federal revenue?
• Does it stay in child welfare, and if so, is some
  or all of it targeted to specialized permanency
  and post-permanency programs?
• Or, will the money be used for some other purpose
  within the Department?
• Or, does it revert to the General Funds?
• Start with a PLAN a VISION not the money!
• Then when the money comes, there will be a
  specific need identified to use the money for.
• If there is not a plan, you can count on the
  money being spent by someone else!

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Next Steps

• Casey Family Services wants to help YOU to
  Permanency and Post-Permanency Services for older
  children and youth a priority in YOUR state!
• Providing technical assistance for strategic
  planning
• Providing permanency teaming services training
  and coaching
• Providing post-permanency training and
  consultation
• Ongoing support with selected states where there
  is commitment to making permanency and
  post-permanency a priority!

43
Positive Results for Families and Children

• With access to quality permanency and
  post-permanency services and financial supports,
• More families will come forward to make the
  lifelong commitment to parent older children and
  youth from the child welfare system.
• Families who choose to parent older children and
  youth with special needs will have access to
  competent post-permanency education, support, and
  mental health services.
• Permanent family relationships will be sustained
  over the lifetime of the child/youth.

44
Contact Us

• Don Schmid, Consultant
• Sarah B. Greenblatt, Director
• The Casey Center for Effective Child Welfare
  Practice
• Casey Family Services
• 127 Church Street
• New Haven, CT 06510
• 203-401-6917
• sgreenblatt_at_caseyfamilyservices.org
• donschmid_at_bis.midco.net
• THANK YOU!