Performance Contracting for Foster Care

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Performance Contracting for Foster Care
in Philadelphia
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Overview

• Why Performance Contracting?
• Success Factors
• Flexibility
• Shared Responsibility and greater clarity of
  roles
• Enhanced Investments
• How does a performance contract work?
• Performance Expectations
• Finance
• Administrative Payment, including enhancements
• Foster Parent Payment

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Why Performance Contracting for Foster Care?

• Performance-based contracting promotes permanency
  for children in foster care by
• exchanging heightened performance expectations
  for the resources to achieve those expectations,
  and
• realigning contracts to provide financial
  incentives for providers to achieve timely
  permanencies, and financial disincentives for
  falling short of permanency performance
  expectations.
• Creating a system wide multi-level dialogue to
  support the design and implementation of system
  reform efforts.
• Expected benefits include
• More families safely reunified
• More children who cannot return home adopted or
  in subsidized permanent legal custody
• Increased placement stability
• More rationality in system
• Relief of pressure on some parts of system allows
  increased focus on others, such as prevention and
  diversion

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Key Concepts

• Performance contract model has several key
  elements
• Outcome expectations
• An investment in capability needed to secure
  higher results
• A commitment to public/ private partnership in
  securing permanency
• A commitment to increasing the flexibility and
  discretion of providers to craft more effective
  care arrangements
• A shift in the distribution of risk and benefits
  of performance
• A commitment to rational clinical and decisional
  processes
• Timely dispute resolution so that child and
  family outcomes are not delayed

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Success Factors

• Flexibility
• The need for additional flexibility is reflected
  in the revised performance standards, through
  changes including the elimination of hours
  requirements and greater discretion to tailor
  services to needs.
• Shared responsibility
• DHS will work with providers to clearly
  articulate the roles and responsibilities of
  public and private workers.
• Enhanced investment
• Contract provides agencies with additional
  investment, targeted to support increases in
  permanency
• Emergency care resources
• Foster parent recruitment
• Permanency workers
• Aftercare for reunification

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What Will Be Covered by the Year One Performance
Contract?

• Dependent Family Foster Care and Kinship care
• What is now levels I, II, and III combined as
  general foster care
• Agencies with combined FFC and Kinship caseloads
  of 52 -- these agencies serve more than 80 of
  the children in FC levels I, II, and III

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How Does a Performance Contract Work?(The DHS
Version)
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Performance Expectations

• Contracts will include performance expectations
  for each contracted Dynamic Caseload (DC). There
  will be standard expectations for case
  acceptance, permanency, and non-permanency
  transfers.
• Due to different baselines, different
  expectations will be set for family foster care
  and kinship care.
• Performance expectations are designed to be
  realistic and attainable and are assessed against
  patterns of goal achievement within the
  Philadelphia system and the use of comparative
  reference points in other urban systems.

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Performance Expectations Family Foster Care

• Family Foster Care Baseline Performance (FY 2002)
• Ending Caseload 2347 / 13 cases 180.5
  caseloads
• Entries 1311 entries / 180.5 7.26 entries per
  caseload
• Permanencies 547 permanencies / 180.5 3.03
  permanencies per caseload (23.3)
• Instability 708 moves / 180.5 3.92 moves per
  caseload (30.2)
• Family Foster Care Expected Outcome Standard
  (FY2003)
• 5 permanencies per caseload (38.4)x 180.5
  caseloads 902 (65)
• 2 moves per caseload (15.4) x 180.5 caseloads
  361 moves -(51)
• A caseload standard of 13 is assumed this
  creates higher baseline funding for each
  caseload. Agencies that beat the standards will
  be able to work their way to lower caseloads and
  retain the savings.

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Performance Expectations Kinship Care

• Kinship Care Baseline Performance (FY 2002)
• Ending Caseload 1850 / 13 cases 142 caseloads
• Entries 976 entries / 142 6.87 entries per
  caseload
• Permanencies 289 permanencies / 142 2.03
  permanencies per caseload (15.6)
• Instability 366 moves / 142 2.57 moves per
  caseload (20)
• Kinship Care Expected Outcome Standard (FY2003)
• 3.5 permanencies per caseload (26.9) x 142
  caseloads 497 (58)
• 2 moves per caseload (15.4) x 142 caseloads
  284 moves -(31)
• A caseload standard of 13 is assumed.

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How Realistic are the Performance Expectations?

• There are significant opportunities for
  improvement in both reunifications and adoptions.
  Some agencies already achieve the standards.
• Reunification
• High rates of placement intervention and low
  rates of early reunification presents an
  opportunity to attain these goals.
• Adoption
• The employment of permanency specialists has
  demonstrated success. For example, in Illinois,
  permanency rates increased significantly, despite
  higher work load burdens and lower funding
  levels.
• Foster parent rates in Philadelphia, the
  benchmark for adoption subsidy, are generous in
  comparison with many other localities.
• The permanency worker needs to achieve
  performance benchmark of 3.7 additional adoptions
  -- a mark that is readily achievable.

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Sample Movement On Target
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Sample Movement Exceed Target
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Sample Movement Falling Short
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Finance

• Payment under performance-based contracting
  includes the following components
• Administrative payment
• Including support for
• Emergency Care
• Foster Parent Recruitment
• Permanency Worker
• Aftercare for Reunification
• Standard baseline foster parent payment

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Administrative Payment

• The administrative portion of the payment
  includes the following components
• Average of the administrative portion of levels
  1, 2, and 3. This totals 26.40 per diem, or
  9,616 on an annualized basis.
• Under performance-based contracting, levels 1, 2
  and 3 foster care will be combined into general
  foster care.
• Additional Support (see details on following
  pages)
• Emergency Care 420 per family foster care
  referral
• Foster Parent Recruitment 50,000 per 3 teams
• Permanency Worker 50,000 per team
• Aftercare for Reunification 4,000 per child
• Note that emergency care and foster parent
  recruitment resources will be built into the
  administrative rate, while resources for
  permanency workers and reunification funds will
  be provided separately.

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Emergency Care Resources

• Under the new referral system, which assigns
  cases on a family based, geographic, rotational
  basis, agencies will need expanded emergency
  capacity to provide rapid placement. Some
  referrals will require emergency care, while
  others will need pre-placement visits for planned
  moves.
• 420 per Family Foster Care referral will be to
  the administrative rate to manage these
  transactions.
• This number is based on an estimate that 20 of
  emergency care resources will be required for the
  first 21 days of each FFC placement.
• Agencies will have flexibility to determine how
  to best to allocate these funds and to organize
  and manage this program internally. Possible
  expenditures include, but are not limited to, the
  following
• Time limited increase for emergency foster parent
  board rates
• Vouchers for food and clothing to ease placement
  transition
• Foster parent on-call payments
• This funding will be built into the
  administrative rate.

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Foster Parent Recruitment

• Performance contracting places three types of
  recruitment pressure on agencies
• it requires the rapid assignment of a case from
  the point of referral
• it will require the replacement of foster parents
  as they leave the system through adoption, and
• it places the expectation that children in
  family foster care are placed in their home
  community.
• Payment for one recruitment specialist at a level
  of 50,000 for every three Family Foster Care
  teams will support these expanded efforts.
  Partial FTEs are funded for agencies with less
  than three teams worth of cases.
• This will support and put person-power behind
  other recruitment efforts engaged in by the
  provider agency and DHS.
• This funding will be built into the
  administrative rate

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Permanency Workers

• Permanency workers will facilitate permanency by,
  for example, assisting case-carrying staff to
  focus on permanency opportunities, tracking and
  managing the movement of cases through the
  permanency process, helping to prepare the child
  and the biological and adoptive families for
  adoption, and performing other tasks unique to
  the adoption process, help workers write
  reunification plans and support case carrying
  workers in preparation for court. Permanency
  specialists could be staff hired for this purpose
  or particularly skilled existing staff assigned
  to the permanency worker role.
• One permanency worker per team (i.e. one for
  every 65 cases) will be funded at a rate of
  50,000.
• Funding for this worker will likely be blended
  from various sources.

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Aftercare for Reunification

• A maximum of 4000 per child will be made
  available to support family reunification. With
  this funding, agencies will be able to craft
  services and safety plans for children returning
  home.
• Issues that could be addressed by this finding
  may include, but are not limited to, the
  following
• Safety
• Subsistence
• Behavior health
• Physical health
• Education/ vocation training
• Social issues
• These funds are not in the administrative fee,
  but are claimed separately once a child has been
  reunified.

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Baseline Foster Parent Payment

• Under performance based contracting, levels 1, 2
  and 3 are being combined into general foster
  care.
• A baseline foster parent rate, representing the
  minimum that agencies must pay foster parents,
  is being set at 20.24.
• This figure represents the foster parent portion
  of the current per diem for level 2 foster care.
• An additional one-time payment for FY03 will be
  made to each agency based on the actual number of
  children currently in level 3 foster care. This
  will allow enable agencies to hold harmless
  level 3 foster parents at the current per diem
  for the remainder of FY03.

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Thank You (for what?) )