Reduction of Children Looked Reduction of Children Looked AfterAfter

throughthroughPerformance Based Contracting Performance Based Contracting

(PBC)(PBC)

Ken Taylor Ken Taylor ––DartingtonDartington--ii

May 30, 2006May 30, 2006

ProgrammeProgramme

1.1. Describe The Performance Contracting ModelDescribe The Performance Contracting Model2.2. Evidence of improved outcomes for children Evidence of improved outcomes for children

and applying the modeland applying the model3.3. Replicability Replicability ––

Steps to successfully applying the modelSteps to successfully applying the modelStrategies for institutional careStrategies for institutional care

AssumptionsAssumptions

Goal: reduce the number of looked after childrenGoal: reduce the number of looked after childrenToo many looked after children are in institutional careToo many looked after children are in institutional careWant to shift resources from Want to shift resources from ““heavy endheavy end”” to to preventionpreventionImproving Improving outputsoutputs allows for the redeployment of allows for the redeployment of inputsinputs, both of which lead to improved , both of which lead to improved outcomesoutcomes

ILLINOIS ILLINOIS CONTEXTCONTEXT

19961996

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

*

0

10

20

30

40

50

60Th

ousa

nds

Home of Relative (HMR) CareNon-Relative and Group Care

Not

Ava

iliabl

e

*As of December 31, 2002

HMR Reform

The implementation of HMR Reform in FY96 reduced the intake of children in safe kinship care but did not impact the backlog of children in long-term state custody.

Falling Permanency Rates

Sep-89 Sep-90 Sep-91 Sep-92 Sep-93 Sep-94 Sep-95 Sep-96 Sep-97

Quarter Ending

0

1

2

3

4

5

6

7

8

Qua

rterly

Exi

ts p

er 1

00 C

hild

ren

Reunification Rate Adoption Other Closings

Problem DefinitionProblem Definition

System focused on inputs, not outputsSystem focused on inputs, not outputsNo repercussions for poor performanceNo repercussions for poor performanceThe per diem structure of contracts has a perverse The per diem structure of contracts has a perverse incentive for children to remain looked afterincentive for children to remain looked afterGovernment staffing structures do not reward better Government staffing structures do not reward better performanceperformanceWorkers do not have the structures, processes or Workers do not have the structures, processes or resources needed to improve their performanceresources needed to improve their performanceThere is no additional funding availableThere is no additional funding available

Performance Contracting General Performance Contracting General ApproachApproach

Create systems that better support the good intentions Create systems that better support the good intentions of the people who work in childrenof the people who work in children’’s servicess servicesIncentives (financial or otherwise) properly aligned with Incentives (financial or otherwise) properly aligned with the right outcomes have a positive effect on the right outcomes have a positive effect on performanceperformanceIncreased focus on outputs, decreased focus on processIncreased focus on outputs, decreased focus on processExchange improved performance for the resources to Exchange improved performance for the resources to achieve itachieve itBudget neutralBudget neutralPublic/ Private collaborationPublic/ Private collaboration

General Approach General Approach -- FlowFlow

Focus on case flowFocus on case flowDecrease the number of cases coming inDecrease the number of cases coming inIncrease the number of cases going outIncrease the number of cases going out

Focus on resources needed to improve case flow Focus on resources needed to improve case flow and barriers that impede appropriate flowand barriers that impede appropriate flow––create a dynamic caseloadcreate a dynamic caseloadDecrease unnecessary movementDecrease unnecessary movement

Ground RulesGround Rules

Level playing fieldLevel playing fieldAll information/ data sharedAll information/ data sharedInterest based negotiationsInterest based negotiationsOngoing discussions post implementation Ongoing discussions post implementation –– the the contract is just the starting pointcontract is just the starting point

Performance Barriers Performance Barriers -- ILIL

Number of casesNumber of casesAdoption contract structureAdoption contract structureReunification aftercare resourcesReunification aftercare resourcesAccess to counselingAccess to counselingReferral opportunitiesReferral opportunitiesLimited ability to place upon entryLimited ability to place upon entryFoster care recruitment resourcesFoster care recruitment resources

Contract StructureContract Structure-- IL (1997)IL (1997)

Shift focus from:Shift focus from:Static to dynamicStatic to dynamicProcess to outcomesProcess to outcomes

Caseload 25 cases

Exits

(total=32%)

6 permanencies (24%)2 non-permanencies (8%)

Entries8 intake(32%)

Cook Relative Care

Sample Movement: On TargetSample Movement: On Target

Year 1 children served:396

96 additional childrenthroughout the year

End of year starting caseload:

300 children

Starting caseload,300 children

Entries

Exits

72 children achieve permanency

24 children leave for a non-permanent outcome

24%

8%

Sample Movement: Sample Movement: Exceed TargetExceed Target

Year 1 children served:396

96 additional childrenthroughout the year

End of year starting caseload:

282 children

Starting caseload,300 children

Entries

Exits

90 children achieve permanency

24 children leave for a non-permanent outcome

30%

8%

Sample Movement: Sample Movement: Falling ShortFalling Short

Year 1 children served:396

96 additional childrenthroughout the year

End of year starting caseload:

312 children

Starting caseload,300 children

Entries

Exits

60 children achieve permanency

24 children leave for a non-permanent outcome

20%

8%

Measuring and ReportingMeasuring and Reporting

Objective OutcomesObjective OutcomesAchievable OutcomesAchievable OutcomesReliable DataReliable DataRank Order PerformanceRank Order PerformancePublish PerformancePublish PerformanceGrowth/Cuts based on PerformanceGrowth/Cuts based on Performance

Kin Permanency Performance

PBC Permanency Performance FY04-05

AgencyContracted Caseload

Full Year Expect

Actual POs

Contracted Caseload

3/4 Year Expect

3/4 yr actual POs

Kin returns from

previous FY

Net FY05 POs

FY05 Kin %

FY04-FY05 Kin

%

Larger of FY05 or FY04-5

A 13 3.5 3 23 4.6 11 11 236.9% 171.9% 236.9%B 44 11.8 10 37 7.5 15 15 200.8% 129.4% 200.8%C 30 8.1 21 42 8.5 11 11 129.7% 193.3% 193.3%D 86 23.2 27 81 16.4 29 29 177.3% 141.7% 177.3%E 74 19.9 36 77 15.5 24 24 154.4% 169.2% 169.2%F 45 12.1 13 43 8.7 14 14 161.2% 129.8% 161.2%G 110 29.6 31 105 21.2 35 1 34 160.4% 127.9% 160.4%H 43 11.6 24 43 8.7 9 1 8 92.1% 157.9% 157.9%I 46 12.4 21 46 9.3 13 1 12 129.2% 152.3% 152.3%J 43 11.6 14 48 9.7 14 14 144.4% 131.6% 144.4%K 36 9.7 9 35 7.1 10 10 141.5% 113.4% 141.5%L 103 27.7 48 106 21.4 19 19 88.8% 136.4% 136.4%M 152 40.9 50 160 32.3 44 1 43 133.1% 127.0% 133.1%N 36 9.7 18 42 8.5 6 6 70.7% 132.1% 132.1%O 30 8.1 13 36 7.3 7 7 96.3% 130.3% 130.3%P 168 45.2 57 163 32.9 44 2 42 127.6% 126.7% 127.6%Q 54 14.5 17 66 13.3 17 17 127.6% 122.0% 127.6%R 44 11.8 18 44 8.9 8 8 90.0% 125.4% 125.4%S 58 15.6 23 65 13.1 10 10 76.2% 114.8% 114.8%T 320 86.2 113 316 63.8 57 57 89.3% 113.4% 113.4%U 149 40.1 58 152 30.7 26 4 22 71.7% 113.0% 113.0%V 149 40.1 47 152 30.7 22 1 21 68.4% 96.0% 96.0%W 66 17.8 22 68 13.7 8 8 58.3% 95.2% 95.2%X 74 19.9 19 77 15.5 14 14 90.0% 93.0% 93.0%Y 40 10.8 15 48 9.7 4 4 41.3% 92.9% 92.9%

Total 2013 542 727 2075 419 471 11 460 109.8% 123.5% 123.5%

FY04 Kin FY05 KIN

Agency Performance DataAgency Performance Data

Agency performance factors include:Agency performance factors include:PermanencyPermanency

ReunificationReunificationAdoptionAdoptionGuardianshipGuardianship

StabilityStabilitySteps to higher levels of care or outside the agencySteps to higher levels of care or outside the agencyStability within the agencyStability within the agency

SafetySafetyAbuse/ neglect while in foster care or in the first year after pAbuse/ neglect while in foster care or in the first year after permanency ermanency

Sibling placementSibling placementGeography of placementGeography of placement

PBC FinancePBC Finance

Administrative payment (based on previous per diem Administrative payment (based on previous per diem payment) with additional resources targeted to:payment) with additional resources targeted to:

Emergency CareEmergency CareFoster Parent RecruitmentFoster Parent RecruitmentPermanency WorkerPermanency WorkerStabilityStabilityCounselingCounselingEducationEducation

Board Payment (to foster parents)Board Payment (to foster parents)AftercareAftercare

ReferralReferralALL cases referred centrallyALL cases referred centrally

New process to enhance information provided to New process to enhance information provided to agencies at time of referralagencies at time of referral

Each agency has referral expectation, based on Each agency has referral expectation, based on caseload sizecaseload sizeAgencies expected to accept all appropriate Agencies expected to accept all appropriate referralsreferrals

Additional resources provided to build capacityAdditional resources provided to build capacityAcceptance of referrals is monitoredAcceptance of referrals is monitored

Refusal triggers contract adjustmentRefusal triggers contract adjustment

ReferralReferral

Equitable, automated assignment of cases Equitable, automated assignment of cases based on the following factors:based on the following factors:

Sibling placementSibling placementPrior knowledge of childPrior knowledge of childPrior knowledge of familyPrior knowledge of familyLanguageLanguageGeographyGeography

PBC AftercarePBC Aftercare

Designed to support successful transition to Designed to support successful transition to permanency and prevent reentrypermanency and prevent reentry

InIn--home, communityhome, community--based servicesbased servicesIndividual plan tailored to needs of child/familyIndividual plan tailored to needs of child/familyFlexible fundingFlexible fundingGoods/ services by placement provider Goods/ services by placement provider

ENDENDPART IPART I

PART IIPART II

Evidence of improved Evidence of improved outcomes and applying outcomes and applying

the modelthe model

Sep-

89

Jun-

90

Mar

-91

Dec

-91

Sep-

92

Jun-

93

Mar

-94

Dec

-94

Sep-

95

Jun-

96

Mar

-97

Dec

-97

Sep-

98

Jun-

99

Mar

-00

0

5

10

15

20

25

Thou

sand

s

0

1

2

3

4

5

6

Thou

sand

s

EOQCaseload

Entries

Exits

Home of Relative (HMR) Trend: Cook CountyEnd-of-Quarter (EOQ) Caseload, Entries and Exits

HMR Reform

Waiver

Perf. ContractAnnounced

Exits track entries

Indicator: Of all children who returned home, what percentage returned home within 12 months of the latest removal from home?

15

Permanence after reunification

The percent of children reunified and not re-entering increases after two (red), five (blue), and

ten years (pink)

72

81 79

64

64

75

7765

6361

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02

Num

ber o

f Reu

nific

atio

ns (

bars

)WW

40

50

60

70

80

90

100

Reunification

Children reunified within three years of entering foster care Note: The line at 3,000 represents the reunification glass ceiling

49%45%

38%31%

24% 24%30% 31% 32%

02,0004,0006,0008,000

10,00012,00014,00016,000

FY85FY86FY87FY88FY89FY90FY91FY92FY93FY94FY95FY96FY97FY98FY99FY00FY01FY02

0%

10%

20%

30%

40%

50%

60%

Entering Care Number Reunified 3 Year Perm

Stable, permanent placements through reunification, adoption or guardianship

Children that remain in permanent homes increases two (red), five (blue), and ten years (pink) after discharge

82%

92%

73%

89%

66%74%

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03

Num

ber o

f Per

man

enci

es (b

arW

W

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Children entering care find permanence (reunification, adoption, or guardianship)

Children moving to permanent homes increases one, (blue) two (red) and three (pink) years after entry*

36%

19%

54%

30%

21%

14%

02,0004,0006,0008,000

10,00012,00014,00016,000

FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04

*Note: permanency at one year is reunification only, at two years reunfication and adoption and at three years reunification, adoption and subsidized guardianship

Chi

ldre

n En

ter

Subs

titut

e C

ar(B

lueW

Bar

s)WM

0%

10%

20%

30%

40%

50%

60%

Perc

ent A

ttani

ngPe

rman

ence

(lin

es)

WM

Applying the model in Applying the model in PHILADELPHIAPHILADELPHIA

2002 2002

PhiladelphiaPhiladelphia

Similar general problem definitionSimilar general problem definitionSame general approachSame general approachSame Ground rulesSame Ground rulesDifferent specificsDifferent specifics

Performance Barriers Performance Barriers -- PhilaPhila

Potential for delay due to disagreements Potential for delay due to disagreements between DHS and provider workersbetween DHS and provider workersOrganization of Law Department and Court Organization of Law Department and Court processesprocessesUnmanaged referralUnmanaged referral-- agencies were selectiveagencies were selectiveAdoption payment systemAdoption payment systemBehavioral health services external to DHS/ Behavioral health services external to DHS/ private agencyprivate agency

Contrasts between Illinois and Contrasts between Illinois and PhiladelphiaPhiladelphia

Phila all private, IL public and private Phila all private, IL public and private Case management structureCase management structure-- shared case management shared case management system (Phila.)system (Phila.)StateState--run (IL) v. Countyrun (IL) v. County--run (Phila.)run (Phila.)Differences in case flowDifferences in case flowBehavioral health resourcesBehavioral health resourcesSizeSize

1997 IL kin and reg. foster care was 40,000 (Cook County 1997 IL kin and reg. foster care was 40,000 (Cook County 32,000), 49 agencies including 3 DCFS Regions32,000), 49 agencies including 3 DCFS Regions2003 Philadelphia regular foster care population was 4,200 2003 Philadelphia regular foster care population was 4,200 children, 27 agencieschildren, 27 agencies

Contract Structure Contract Structure –– Phila (FY04)Phila (FY04)

Shift focus from:Shift focus from:Static to dynamicStatic to dynamicProcess to outcomesProcess to outcomes

Caseload 13 cases

Exits5 permanencies (27%)

(total=42%)

3.2 non-permanencies (15%)

Entries5.5 intake

(42%)

Phila Relative Care

Permanency and Stability FY02Permanency and Stability FY02--0505

892

579

877

690

1463

393

1352

361

0

200

400

600

800

1000

1200

1400

1600

Permanency Instability (Non-Permanency)

FY02FY03FY04FY05

** ** NonNon--permanency figures represent moves to higher levels of permanency figures represent moves to higher levels of care and to other agencies. FY05 figures are annualized based oncare and to other agencies. FY05 figures are annualized based on¾¾ year of data. PBC was implemented in FY04.year of data. PBC was implemented in FY04.

PBC CaseloadPBC Caseload

4178 4214 42903994

3709 3582

0500

100015002000250030003500400045005000

Mar.2003

Jun.2003

Dec.2003

Jun.2004

Dec.2004

Mar.2005

FFCKinTotal

Success of ReunificationsSuccess of Reunifications

0%

2%

4%

6%

8%

10%

12%

14%

16%

FY02 FY03 FY04

Returns CPS (Abuse)GPS (Neglect)

What percentage of children reunified had returned to DHS care OR had a substantiated report of abuse or neglect within 12 months of the permanency. (For children reunified Jan-June data is through the end of the calendar year). PBC was implemented in March 2003.

Internal Placement StabilityInternal Placement Stability

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

7/01 -12/01

1/02 -6/02

7/02 -12/02

1/03 -6/03

7/03 -12/03

1/04 -6/04

7/04 -12/04

FFCKin

What percentage of children had more than one foster home placement during each 6 month period. PBC was implemented in March 2003.

Philadelphia Next Steps & Philadelphia Next Steps & ChallengesChallenges

Structuring adjustments in shrinking systemStructuring adjustments in shrinking systemSustaining permanency performanceSustaining permanency performanceOlder youth in dependent placementsOlder youth in dependent placementsCongregate care utilization and stepCongregate care utilization and step--downdownFunding for prevention programsFunding for prevention programs

SummarySummary

Performance Contracting in Illinois and Performance Contracting in Illinois and Philadelphia:Philadelphia:Increased permanency Increased permanency Increased stability of permanencyIncreased stability of permanencyIncreased stability of placementsIncreased stability of placementsContributed to decreasing caseloadsContributed to decreasing caseloadsAllowed for reinvestment of resourcesAllowed for reinvestment of resources

ENDENDPART IIPART II

PART III PART III -- ReplicabilityReplicability

Steps to successfully applying the modelSteps to successfully applying the model

Steps for applying the modelSteps for applying the model

1.1. What part of the system?What part of the system?2.2. Gather data and assess needs Gather data and assess needs 3.3. Define problemsDefine problems4.4. Decide outcome levels and work out caseDecide outcome levels and work out case--flow flow

numbersnumbers5.5. Identify barriersIdentify barriers6.6. Collaborative problem solvingCollaborative problem solving7.7. Write the agreementWrite the agreement8.8. Remove barriersRemove barriers9.9. Monitor outputs and qualityMonitor outputs and quality

1. What part of the system?1. What part of the system?

Where is the greatest need for change?Where is the greatest need for change?Where is the best opportunity for Where is the best opportunity for change?change?

2.A Gather Data2.A Gather Data

Flow DataFlow DataStarting CaseloadStarting CaseloadIntakeIntakeCase MovementCase MovementPlacement movement (instability)Placement movement (instability)OutflowOutflowEnding CaseloadEnding Caseload

2.B Assess Need2.B Assess Need

Needs DataNeeds DataMNSMNSLACLACCANSCANSCase record reviewsCase record reviews

3. Define Problems3. Define Problems

Based on findings in #2 (combination of flow Based on findings in #2 (combination of flow data and child needs), you need to decide where data and child needs), you need to decide where the main challenges liethe main challenges lie

4. Decide Outcome Levels4. Decide Outcome Levels

Understanding current system performance is critical to Understanding current system performance is critical to setting new, more aggressive goalssetting new, more aggressive goalsBase new standard on an agreed level of improvementBase new standard on an agreed level of improvementImprovement pays for redeployed resourcesImprovement pays for redeployed resourcesNew expectations must be achievableNew expectations must be achievablePerhaps raise expectations gradually over timePerhaps raise expectations gradually over timeObjective measures are easier to implementObjective measures are easier to implement

5. Identify Barriers5. Identify Barriers

Barriers are not always resource driven Barriers are not always resource driven –– but but they sometimes/often arethey sometimes/often arePut as much control of resources in the hands of Put as much control of resources in the hands of those responsible for resultsthose responsible for results

6. Collaborative Problem Solving6. Collaborative Problem Solving

Public, Voluntary and other participants all have Public, Voluntary and other participants all have experience and expertise that are essential for successexperience and expertise that are essential for successIssues on all sides will likely need to be addressedIssues on all sides will likely need to be addressedDiscussions must be forward looking, while blaming Discussions must be forward looking, while blaming and past grievances should be set aside, past problems and past grievances should be set aside, past problems should not be ignoredshould not be ignoredLook to other systems who have successfully addressed Look to other systems who have successfully addressed similar challengessimilar challenges

7. Write the agreement7. Write the agreement

Make the agreement as simple to understand and Make the agreement as simple to understand and monitor as possiblemonitor as possibleLevel playing field for all participantsLevel playing field for all participantsEmbed incentives in the agreementEmbed incentives in the agreementBe very clear about additional resources being Be very clear about additional resources being includedincluded

8. Remove Barriers8. Remove Barriers

This is ongoing work and new, unanticipated This is ongoing work and new, unanticipated issues will ariseissues will arise

Change worker philosophy and practiceChange worker philosophy and practicePartner systemsPartner systemsReferral Referral Payment issuesPayment issuesCommunicationCommunication

9. Monitor Outputs and Quality9. Monitor Outputs and Quality

New monitoring systems will likely need to be New monitoring systems will likely need to be set upset upThey should be both robust and minimalistThey should be both robust and minimalistOutputs should be objectively measurableOutputs should be objectively measurableQuality is less objective, but its measurement Quality is less objective, but its measurement can be standardizedcan be standardized

For more information:For more information:

Joe Loftus: Joe Loftus: jloftus@theyouthcampus.orgjloftus@theyouthcampus.orgKen Taylor: Ken Taylor: ktaylor@dartingtonktaylor@dartington--i.orgi.orghttp://www.innovations.harvard.edu/awards.html?id=3879http://www.innovations.harvard.edu/awards.html?id=3879

http://www.fels.upenn.edu/fgrs_reports.htmhttp://www.fels.upenn.edu/fgrs_reports.htm

THANKTHANKYOUYOU