DFPS Rider 29 Report for Foster Care Redesign August 2015 As required in Sections (c) and (d) of Rider 29 (page 11-45) in Article II of The General Appropriations Act, 83rd Texas Legislature, the Texas Department of Family and Protective Services (DFPS) shall, on August 1 and February 1, “Report selected performance measures identified by the Legislative Budget Board (LBB) that will allow for comparative analysis between the legacy foster care and redesigned foster care systems”. Additionally DFPS shall, “Provide a report that contains the most recent data for the selected comparative performance measures, an analysis of the data that identifies trends and impact occurring in the redesigned foster care system, identification and analysis of factors negatively impacting any outcomes, recommendations to address problems identified from the data, and any other information necessary to determine the status of the redesigned foster care system”. To meet these requirements DFPS is using a report format specified by the LBB. The format is the same as that used to meet the requirements of Rider 25 (page 11-44) in Article II of The General Appropriations Act, 82nd Texas Legislature. Accompanying the data report is a narrative that discusses trends, impact, analyses of the factors that affect the outcomes, and recommendations to address problems that have been identified, if any. Limitations for the Rider 29 Report The initial Single Source Continuum Contract (SSCC) for DFPS Region 2/9 was fully executed on February 1, 2013. That contract was awarded to Providence Services Corporation of Texas (PSC). PSC did not accept its first referral to place a child until August 26, 2013. On August 1st, 2014, PSC provided formal notice to the department of its intent to terminate services provided under the SSCC contract in Region 2/9. The department had been working with PSC to address performance concerns and therefore accepted the notice of termination. This report does not contain performance data for PSC for this reason. The process evaluation section below addresses the implementation of the contingency plan in Region 2/9. The second SSCC contract was executed on January 1, 2014 for DFPS Region 3b. ACH Child and Family Services (ACH) was awarded that contract. This SSCC catchment area includes Tarrant, Erath, Hood, Johnson, Palo Pinto, Parker, and Somervell counties in DFPS Region 3. The Region 3b SSCC (identified as SSCC A) did not accept its first referral for new and subsequent placements on September 1 st 2014. As noted previous Rider 29 Reports, the SSCC*A percentages for some of the LBB measures appeared significantly different from the catchment 3b and statewide percentages. This remains true for the current report. The differences in performance measure results can be attributed to both the number of clients placed with the SSCC*A (a small percentage of legacy children placed during the initial months that grew over time) and when those clients were placed (some children had longer service experiences with the SSCC than others). Not until an SSCC has served all catchment area children in paid foster care for a sufficient amount of time will the data clearly reflect performance. Chapin Hall data and performance experts define “sufficient” time as a period of two years of full implementation. Evaluation of Foster Care Redesign Evaluation of Foster Care Redesign is on-going. Both process and outcome components are included. DFPS will use evaluation findings, as well as the data provided later in this report, to cx 0
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DFPS Rider 29 Report for Foster Care Redesign
August 2015
As required in Sections (c) and (d) of Rider 29 (page 11-45) in Article II of The GeneralAppropriations Act, 83rd Texas Legislature, the Texas Department of Family and ProtectiveServices (DFPS) shall, on August 1 and February 1, “Report selected performance measuresidentified by the Legislative Budget Board (LBB) that will allow for comparative analysis betweenthe legacy foster care and redesigned foster care systems”. Additionally DFPS shall, “Provide areport that contains the most recent data for the selected comparative performance measures,an analysis of the data that identifies trends and impact occurring in the redesigned foster caresystem, identification and analysis of factors negatively impacting any outcomes,recommendations to address problems identified from the data, and any other informationnecessary to determine the status of the redesigned foster care system”. To meet theserequirements DFPS is using a report format specified by the LBB. The format is the same asthat used to meet the requirements of Rider 25 (page 11-44) in Article II of The GeneralAppropriations Act, 82nd Texas Legislature. Accompanying the data report is a narrative thatdiscusses trends, impact, analyses of the factors that affect the outcomes, andrecommendations to address problems that have been identified, if any.
Limitations for the Rider 29 Report
The initial Single Source Continuum Contract (SSCC) for DFPS Region 2/9 was fully executedon February 1, 2013. That contract was awarded to Providence Services Corporation of Texas(PSC). PSC did not accept its first referral to place a child until August 26, 2013. On August 1st,
2014, PSC provided formal notice to the department of its intent to terminate services providedunder the SSCC contract in Region 2/9. The department had been working with PSC toaddress performance concerns and therefore accepted the notice of termination. This reportdoes not contain performance data for PSC for this reason. The process evaluation sectionbelow addresses the implementation of the contingency plan in Region 2/9.
The second SSCC contract was executed on January 1, 2014 for DFPS Region 3b. ACH Childand Family Services (ACH) was awarded that contract. This SSCC catchment area includesTarrant, Erath, Hood, Johnson, Palo Pinto, Parker, and Somervell counties in DFPS Region 3.The Region 3b SSCC (identified as SSCC A) did not accept its first referral for new andsubsequent placements on September 1st 2014.
As noted previous Rider 29 Reports, the SSCC*A percentages for some of the LBB measuresappeared significantly different from the catchment 3b and statewide percentages. Thisremains true for the current report. The differences in performance measure results can beattributed to both the number of clients placed with the SSCC*A (a small percentage of legacychildren placed during the initial months that grew over time) and when those clients wereplaced (some children had longer service experiences with the SSCC than others). Not until anSSCC has served all catchment area children in paid foster care for a sufficient amount of timewill the data clearly reflect performance. Chapin Hall data and performance experts define“sufficient” time as a period of two years of full implementation.
Evaluation of Foster Care Redesign
Evaluation of Foster Care Redesign is on-going. Both process and outcome components areincluded. DFPS will use evaluation findings, as well as the data provided later in this report, to
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assist in identifying performance, trends, changes, and any problems and issues in the redesigncatchment areas.
Process Component
The 841h Legislature supported implementation of FCR into one additional catchment area overthe FY 2016-2017 biennium. The Legislature approved increases to some of the residentialfoster care rates which subsequently raised the blended foster care rate in catchment 3b. Inaddition, funds were appropriated to support fringe and benefits associated with the resourcetransfer, FCR Network Support Funding at $1200 per child FTE, start-up funding for the newcatchment area as well as approval to hire a performance and evaluation lead.
In April 2015, in accordance with the recommendations of the Sunset Committee, DFPSpublished a draft Implementation Plan for Foster Care Redesign. As a part of theimplementation DFPS considers the following criteria in determining selection of the nextcatchment area:
• Minimum of 500 new entries of children per year• Proximity to existing catchment area• Local community support• Regional readiness and stability• Placements in and out of catchment area• Challenges with capacity• Affordability
Information obtained through the on-going evaluation of FCR will be used to inform furtherimprovements to the procurement and implementation processes in the next catchment area.
Areas of focus for continuous quality improvements include resource transfer, data andinformation technology.
Continuous Quality Improvement Process
Area of Focus Current Challenges Identified Solutions
Resource Transfer • Resources have Short Term:transferred based on • Mapping of roles andtransfer of entire responsibilitiesfunction (i.e. • Focus groups (both inplacement staff, and outside offoster/adopt, contracts catchment area)staff) but does not • Define methodologyaccount for staff for resource transferspecific transfer of based on actual taskfunction distribution
• SSCC hasresponsibility for some Long Term:tasks for which no • Use results of timetransfer of resources study both in and outhas occurred, this will of catchment areasespecially be true in • Cost ReportsStage_II_of
Implementation• Reconciling numbers
across multiplesystems (mechanicsissue)
• Disentangling 55CCperformance from theperformance of thelegacy system duringthe time of transition(conceptual issue)
• Point-in-timemeasures complicateCQI process
• Lag in Data Entry• Ever changing entry
data• Definitions used
across systems
• Development of a datadictionary (defines keyterms to the codinglevel)
• Address lag in entrythrough improvedtracking, training andIT system changes
• Recalibration of somemeasures- adds somenon-Point in timemeasures to moredirectly measureSSCC specificactivities.
Outcome Component
ACH Child and Family Services began offering SSCC services in the 3b catchment area inSeptember 2014. Some of the key responsibilities of the SSCC include:
• Taking physical custody of children within 4 hours of referral• No eject/no reject of all referrals received
In its first year of operation, ACH has demonstrated:
• 16% improvement in placements made within 50 miles of home of removal• Improved rural capacity (anticipated 400% increase in Palo Pinto County by 12/31/1 5)• Expansion of therapeutic foster care• Activated disruption mitigation groups to help proactively preserve placements• Implemented the Quality Parenting Initiative• Gone live with network information exchange• Implemented the CANs assessment• Praesidium Risk Management Assessment have been completed for all network
providers
Data
Information Technology • Federal SACWIS rules • Federal SACWIS ruleCompatibility did not support changes to support
interoperability of interoperabilitysystems without • Bi-monthly meetings tohuman intervention explore best manner to
• IMPACT entry requires proceed with buildingSSCC manual data interoperable systemsentry of information,which results induplication of effortand_time_lag
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Implemented the Every Child A Priority (ECAP) placement matching system
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Data Report
The remainder of this report provides the data requested by the LBB with a short narrativeprovided in Section C.
DFPS Rider 29 Foster Care Redesign Data Report
Please note that the Single Source Continuum Contractor (SSCC* A) in DFPS catchment 3b beganaccepting referrals for placements on September 18t 2014. If SSCC-specific data were notavailable at the time the report was prepared, data cells in the report were intentionally left blank.
Not all measures can be reported on for SSCC placements and will be designated as “n/a”.
Section A.
Report LBB Performance Measures Statewide and by RegionISSCC*, starting with FY 2010
Data Source: IMPACT Data Warehouse2010 2011 2012 2013 2014 2015
Report SSCC Performance Measures Statewide and by RegionISSCC*
Data Source: Information Management Protecting Adults and Children in Texas (IMPACT) based ondata for the contractors in the reciions. not the children from those re. ions.
SSCC* A 100.0%2. Percent of children with no placement changes in previous 12 months (only while placed with
I— . . SSCC*) —
Data Source: Information Management Protecting Adults and Children in Texas (IMPACT) based ondata for the children from the regions.
20i0 2011 2012 2013 2L4 2015(3td Quarter Year
to Date)Statewide 59.1% 60.2% 60.4% 61.7% 59.4% 59.3%Region3B 60.7% 65.1% 63.9% 65.1% 64.6% 44.1%SSCC* A 89.0%
Percent of children placed within 50 miles of their homeData Source: Chapin Hall
2010 2011 2012 2013 2014 2015(as of (as of (as of (as of (3rd Quarter Year
08/3112011) 08I31!2012) 08131/2013) 08/31/2014) to Date)Statewide 66.9% 65.0% 64.8% 64.4% 62.5%Region 3B 75.2% 71.4% 70.9% 71.5% 68.4%SSCC* A 87.5%
(First PlacementsOnly)
Percent of cases where all siblings are placed on DerformanceData Source: Information Management Protecting Adults and Children in Texas (IMPACT) based ondata for the children from the regions.
4a Percent of youth in foster care who have a regular job at some timeduring the yearData Source: Performance Management Evaluation Tool (PMET); measure unique to SSCC.
2010 2011 2012 2013 2014 2015: (3rdQuarter.year
StatewideRegion 3B
SScCA 21.9%4b. Percent of 17-year-old ‘ have completed i.
Data Source: Information Management Protecting Adults and Children in Texas (IMPACT) based ondata for the children from the regions.
4c. Percent of youth 16 or older who have a driver’s license or state ID carlast day of,performarn,e: .1
Data Source: Performance Management Evaluation Tool (PMET); measure unique to SSCC.2010 2011 2012 2013 2014 20.15’
.. . .
. (3rd Quarter. Yearto Date)
StatewideRegion 3BSSCC* A 28.7%
5. Percent of children in foster care placi (on last day of performance
Data Source: Information Manageme in Texas (IMPACT)2010 2011 2014 2015
(3rd Quarter Yearto_Date)
Statewide 69.5% 70.5% 69.7% 1 70.6% 70.3% 68.7%Region 3B 73.2% 76.0% 75.2% 74.7% 75.8% 49.6%SSCC* A 73.7%6a. Percent of children age or ol o pa the development of a service plan that
.. .. . was approved . .
Data Source: Information Management Protecting Adults and Children in Texas (IMPACT).2010 2011 :2012 2013 . :2014 2015. .
6b. Percent of children who participated in at least one discussion about placement optionsData Source: Performance Management Evaluation Tool (PMET); measure unique to SSCC.
2010 2012 2013 2014 2015(3rd Quarter Year
toDate)StatewIa
Region 3BSSCC*A Not Cr””
6c Percent of children age 10 or older who attended their court hearingsData Source: Performance Management Evaluation Tool (PMET); measure unique to SSCC.
p
2010 2011 2012 2013 2014 5(3rd Quarter Year
to Date)
32.1%
Section C.
SSCC Organization, Network and Provider Payments
ACH Child and Family Services has implemented the Our Community-Our Kids (OCOK) model.Under this model ACH delivers a limited number of services itself and manages and oversees anetwork of providers to deliver the full continuum. It is a community engagement model.
The ACH organizational structures assumed the IT, intake and placement, utilization management,quality assurance, data management, and contracting and oversight functions for the SSCC’ssystem of care. For all reimbursable services provided through the ACH network, ACH was paiddirectly by the state. The contracted service providers in the ACH networks were paid by ACH.DFPS ensured payments and payment processes meet all statutory requirements, rules, andpolicies.
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Section 0.
Report DFPS Foster Care Redesign Expenditures (All Funds) For AY 2013
TotalDFPS/HHSC Pr. re ACH Child andServi Family Services
Corporation of
Daily foster care$372,074,071 $4,163 $372,078,234
CPS purchased (B.1.3) $12,319,992services by (B.1.6) $7,272,978 $21,377,419
Note: Other Administration includes salary, travel and overhead for Kaysie Reinhardt.
Note: Costs shown in B.1.8 only includes costs for Preparation for Adult Living (PAL) life skillsservices.
Section E.
* Foster Care Redesign Expenditures (All Funds) For AY 2014
Daily foster carepayments
VACH Child andFamily Services
$333,352
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Note: Other Administration includes salary, travel and overhead for Foster Care Redesign Staffand the resource transfer amounts.
Note: Costs shown in B.1.8 only includes costs for Preparation for Adult Living (PAL) life skillsservices. Costs shown in B.1.10 only include PAC 203000 for utilization management for level ofneed determinations.
1 2010 2011 2012 2013 2014 2015Statewidj n/a n/a n/a n/a n/a n/aRegion*3b n/a n/a n/a n/a n/a n/aSSCC*A nlaiioi OP 10 Numerator/Denominator for Average Monthly Number of Children in FPS ConsData Source:
Numerator/Denominator for Values Listed in Section B. of the DFPS Rider 25 Foster Care
Redesign Report
Section B.
1. Nume. , neglect, or eoitation while with_the_SCç
Data Source: Information Management Protecting Adults and Children in Texas (IMPACT) based on data for the contractors in theregions, not the c nfrom those regions.
JNJJmerator/Oeno for cases where all siblings are placed tData Source: Information Management Protecting Adults and Children in Texas - ..n from theregions.
ran in foster care with at least one montht etc.it Evaluation Tool (PMET), methodology unique to SSCC.
1 2012 2013
441/477r,for children in foster care who have at least monthly pers tjact with each sibling in, foster care •-
ment Evaluation Tool (PMET), methodology unique to SSCC.• 2011 2012 2013 2014 2015
355/387
4a. Numerator/Der I$Oster care who have a regulêjiO.b at some tirrData Source: Performance M nagement Evaluation Tool (PMET); measure unique to SSCC.
2010 11 2012 2013 2014StatewideRegion 3bSSCC* A 58/265
.. - -
- hhae comple i/IJ..LiiData Source: Information Management Protecting Adults and Children in Texas (IMPACT) based ondata for the children from the regions.