When Child Welfare Works A P R O P O S A L F O R FI N A N C I N G B E S T P R A C T I C E S
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Transcript of When Child Welfare Works A P R O P O S A L F O R FI N A N C I N G B E S T P R A C T I C E S
When Child Welfare WorksA P R O P O S A L F O R FI N A N C I N G B E S T P R A C T I C E S
Presentation for National Organization of State Associations for Children March 27, 2014
THE ANNIE E. CASEY FOUNDATION
Agenda
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• Why the urgency: The cost of doing nothing
• Likelihood of congressional action
• Overview of intent of proposal
• Summary of recommendations
• Feedback already received
• Limitations to the proposal that require creative solutions
The Cost of Doing Nothing: Decline in Federal foster care participation rates
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The Cost of Doing Nothing: Decline in Federal foster care funds
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The Cost of Doing Nothing: Decline in Federal funds for child protective services and family support
The Cost of Doing Nothing: Decline in flexible Federal funds for child and family services including prevention
Title IV-B Funding(Constant FY2012 Dollars)
19851987
19891991
19931995
19971999
20012003
20052007
20092011
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Social Services Block Grant Appropriations
$bill
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P.L. 104-193 sets new ceiling of $2.38 billion
P.L. 105-178 sets new ceiling of $1.7 billion
H.R. 5652 repeals SSBG
H.Rept. 112-58 recommends
repeal of SSBG
President’s budget
included $.5 billion cut
“The Committee…has determined that the SSBG program has critical program flaws that argue for its elimination…The following key flaws in the SSBG program reflect how it clearly does not serve taxpayers well: No focus… Duplicative…No state partnership…No accountability”
Subject to sequestration
Likelihood of congressional action
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• Changes in Senate leadership
• Significant bi-partisan staff-level interest in financing reform
• End of waiver authority
• Potential for budget reconciliation in next congress
• Growing consensus on principles for reform
Intent of proposal
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• Target federal funds to support what works best for children and families with a focus on enhancing permanency and well-being
• Protect the entitlement, ensures that all children in foster care are included in the entitlement
• Make achieving timely permanency for children and maintaining them in families the fiscal responsibility of states AND make the federal investments necessary to allow states to achieve these key outcomes
• Invest to increase the quality and capacity of family foster care, support a qualified workforce, and ensure that adequate therapeutic and family support services are available to address children’s needs
• Maintain the current level of federal investment in child welfare
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Children do best in families
Areas where financing can make a difference
There are four key areas in which financing changes can make a difference:
Permanence and well-being
Foster and kinship care Workforce
Therapeutic and supportive
services
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Improving permanence and well-being for children
Kids have families they can rely on to
help them become
successful adults.
VISIONTIME IN FOSTER CARE
SHELTER CARE,GROUP HOMES
RESIDENTIAL TREATMENT
INDIVIDUAL DEVELOPMENT
ACCOUNTS
NOW Reimbursement unlimited
Reimbursement unlimited
Reimbursement unlimited
No IDA Accounts
IDEAS Limit number of years of
federal reimbursement
Not reimbursable
Not reimbursable for children under 13;
Limit time in residential
treatment for older youth
IDA program for youth in
care at age 16
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Improving family foster care
Foster families have the training and support they need to help kids
grow up in families.
Relatives have resources to care for their
own.
KINSHIP CARE FOSTER PARENTS
STATE SUPPORT OF FOSTER PARENTS
TAX INCENTIVES
NOW Using unlicensed kin with TANF
grants acceptable
Only reimbursed
when child is in home
Reimbursed as administrative
costs
$1,000 tax credit for foster children
in home for six months
IDEAS All children required to be
in licensed homes, with
different standards for
kin acceptable
Allow forreimburse-
ment even if child needs
to be in residential
treatment for a limited time
Enhance reimbursement for recruitment, development
and support of foster families
Increase tax credit for teens, sibling groups and children with special
needs
VISION
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Building a more capable workforce
VISION
More experienced workers
focus on directly helping kids.
CASEWORKERLOAN
FORGIVENESSCASE
WORKERS
TRAINING OF CHILD PROTECTIVE SERVICES STAFF
ADMINISTRATION ELIGIBILITY
NOW Allowed after 10 years
Non-clinical counseling to children
and families not allowed
Not reimbursable
Overhead and direct service
costs combined
Tied to 1996 AFDC
standards
IDEAS Allowed after four years
Allow reimburse
-ment for all
activities for
primarycase-worker
Allow reimburse-ment for
competency-based training
Separate overhead from direct service (casework)
Phased-in elimination of income eligibility
requirementwith
reduced federal match
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Funding social and therapeutic services
VISION
Increased funding and flexibility for services to
prevent placement,
promote reunificationand provide therapeutic
intervention.
THERAPEUTIC SERVICES FAMILY SUPPORT SERVICES
NOW Enormous variation in states’ use of Medicaid
Title IV-B, SSBG and TANF at state discretion
IDEAS Require state plan for using Medicaid to meet
therapeutic needs of child welfare-involved families;Provide TA to implement
recent HHS guidance
Sustain and reconfigure existing funds for
child welfare;Require greater
accountability for TANF funds
Feedback Received
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Recommendations receiving widespread agreement/support
• Eliminating income test for IV-E eligibility
• Reconfiguring SSBG
• Foster parent and workforce investments
• Medicaid Plan for meeting the needs of child welfare families
Recommendations met with greatest concern
• Limiting federal funds for long-term foster care
• Limiting federal funds for non-therapeutic group and residential care
• Lack on investment in prevention and post-permanency services, support for tribes
Limiting federal funds for long-term foster care
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Rationale• Incentivize, free-up necessary resources to invest in achieving timely permanency
• Represents best practice even in challenging situations
• TPR after 15 of the last 22 months + time to achieve alternative permanency arrangement < 3 years
Potential Impact• Number of children in care for more than 3 years: 18% of children currently in care, 9.5% of entrants,
32.5% of children awaiting adoption
• Permanency: “Children 12 years or older who continued to live in foster care after 3 years were nearly certain to age out of care before finding a permanent placement alternative.” [NSCAW]
• Stability: Stability of care drops sharply after 3 years
Concerns• Reimbursement will drive
placement decisions rather than best interests (compare to deinstitutionalization)
• Slippery slope
Suggestions• Graduated decline in
reimbursement rates• Reimbursement for children
re-entering care• Exceptions to time limit
Questions• Lifetime limit?• What about kids already in
care?• What about youth in care
after age 18?
Limiting federal funds for non-therapeutic group and residential care
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Rationale• Recognition of the need for and benefits of family, and that children should not “grow up” in group homes• Many/most children are referred to group care because of a lack of alternative placement and not to meet
their therapeutic needs
• Research findings on poor outcomes, potentially adverse impact of group care for many children
• Recognition of the developmental needs of younger children
• Feedback from residential providers on time needed to address therapeutic needs, data showing diminishing returns from residential treatment after a period of time
Potential Impact• Number of children experiencing group care
15% of foster children are currently in group care 25% of all children spend some time in group care 20% of all children initially placed in group care
• Number of teens experiencing group care 33% of foster teens currently in group care 57% of teens spend some time in group care 40% of teens initially placed in group care
• Enormous variation among and within states demonstrating significant differences in practice
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Concerns• Where will children go for
emergency placement?• Where to find foster parents for
older children?• Residential providers often get
children who have already been in several group settings
• Existing family options unable to meet needs of children with MH
• Possible unintended consequence may be short-sighted frequent replacement of children to multiple homes because the child isn’t getting the necessary level of care, increased state expenditures lead to decreased funds for other services and supports
Suggestions• Allow reimbursement for
very short-term shelter care that meets therapeutic standards
• Exceptions for both age and time limits, types of treatment facilities
• Require comprehensive MH assessment prior to group care placement
Questions• How to define non-
therapeutic? • Why age 13? • Why set 1 year as time
limit?
Limiting federal funds for non-therapeutic group and residential care
Lack on investment in prevention and post-permanency services, support for tribes
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• AECF has a much larger agenda to support low-income families
• Caseworker support for candidates (both in-home and post-permanency)
• Medicaid access, ACA implementation could have dramatic impact
• Protection of SSBG and IV-B key
Limitations to the proposal that require creative solutions
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• Exceptions to limitations on federal funding Identify specific groups of children Identify specific criteria for children Allow a preset percentage of exceptions
• Services What specific services Individual entitlement, funding entitlement, capped funding
program Time limited
Please contact us with additional feedback:
[email protected](410) 547-3679
http://www.aecf.org/OurWork/ChildWelfarePermanence/WhenChildWelfareWorks.aspx
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