Specific Recommendations Recommendation 17

Charge the State Collaborative for Children and Families with studying the potential decategorization of a small percentage of funding (e.g., 1 to 3%) of key child-related state agencies.

The SCCF should also offer recommendations for implementation for Oversight Committee consideration.

The State Collaborative offers an excellent forum to explore relevant challenges and opportunities. It should examine what possibilities exist for decategorizing a small percentage of funding (e.g., 1 to 3%) of key child-related state agencies to support more flexible provision of services at the local level. Even very small percentages of several different funding streams can provide local caregivers with significant flexibility that they now lack. This flexibility would allow creative and innovative purchase of services or supports that could have a very positive effect on outcomes. Innovation could ultimately produce longer-term savings to the agencies and the state as a whole.

Recommendation 17.2

Legislatively mandate that agencies demonstrate collaboration in budget development before budgets can be passed.

The budget development process offers a significant opportunity for coordinated planning and development among agencies that often serve the same children and families. It is a demanding and time consuming process in which each agency is attempting to create a budget that will be seen as reasonable and enhance its ability to achieve desired goals and objectives. While agencies have the opportunity to actively collaborate with other agencies and seek opportunities for more coordinated budget planning, coordination often does not occur as much as would be desired.

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By tying expectations of substantial and demonstrable collaboration to the budget process, the General Assembly can efficiently and effectively encourage greater coordination among state agencies. The standards of collaboration that must be met can evolve over time as experience is gained.

5.5.4 Suggested Time Frame

State Collaborative for Families and Children (SCCF) Study

and Implementation Report to Oversight Committee March 2002

Implementation July 2003

5.6 Recommendation 18

Regionalize and begin to privatize Whitaker and Wright Programs.

5.6.1 Goal

Develop a regionally based and integrated system of residential schools for the highest risk children in the state.

5.6.2 Findings

The Wright and Whitaker schools offer important safety net services for North Carolina youth. The Wright School, a state facility that serves children ages 6 to 12, serves children who have been most difficult to treat in the community and/or have failed several treatment attempts in other settings. Wright is seen by most as the residential placement of last resort for most of these children. In general, other treatment services have failed to meet the needs of these children or they have been rejected for treatment at private facilities due to the intensity of clinical management required to effectively manage their care.

Similarly, the Whitaker School, serving adolescents ages 13 to 17, is a state facility designed to serve adolescents who have been through multiple out-of-home placements and treatment settings before referral to Whitaker. Whitaker also is seen as

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other treatment services have failed to meet the needs of these adolescents or they have been rejected for treatment at private facilities due to the intensity of clinical management required to effectively manage their care.

In general, both programs are well respected, but questions have arisen regarding the need to keep them open, whether their services could be provided in a state hospital setting, the wisdom of locating services in just one setting, the condition and future viability of the buildings and property, and so forth.

In the current system, each school provides a level of care and type of programming that is unparalleled in the state and thus earns their status as the placements of last resort. As state facilities, however, they are vulnerable to a reforming system facing budget challenges. It is a legitimate question to ask if they should indeed be closed as the state moves from a more state facility-based system to a more community treatment-based system.

If they were to be closed, we believe that it is likely that the children and adolescents served would generally not be successfully transferred and managed into other service settings, given the mostly unmanaged nature of the current system. The impact of this potential outcome would lead to significant dangers for the youth and, in some cases, to the community. Furthermore, the potential cost-savings from closing these facilities at this time could very likely be more than offset by additional costs incurred by other systems (e.g., DJJDP, out-of-state placements).

Currently, the “front door” of their services is managed by well-established teams of individuals who review and prioritize admissions. This utilization management system for the front door to the services is well regarded and perceived as useful. However, no external utilization management process is used to determine how long they stay at the facility and when they are discharged. It is probable that a more comprehensive

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utilization management system could make better and more efficient use of these beds. It should also be noted that that each of these programs is sited in a single location, close to one another. The impact of this central location on consistency of access and family involvement is obvious.

The viability of the facilities is presented in detail in Chapter 8.0, but suffice to say here that the Whitaker facility is beyond repair and renovation and should be closed, while the Wright facility still remains viable.

The question as to whether the services offered should be state facility-based services or purchased services revolves around three more fundamental questions. In general, the three questions are:

! Should the state be providing, rather than purchasing, services

currently provided in the schools?

! Are the services offered at Wright and Whitaker reasonably

purchasable (i.e., could the state write a Request for Proposals (RFP) and execute a service contract describing exactly what was desired)?

! If purchasable, can they be purchased now with a high degree of

confidence in a positive outcome?

In regards to the first question, as stated elsewhere in this report, North Carolina is in general over-reliant on state facilities and should move actively in the direction minimizing state facility services and maximizing purchased services. It is in this role as a purchaser that the state can join others who have or are moving from “regulating” entities to “strong purchasing” entities. However, given the uncertainties of the early reform, this process should be spread over three or four years to allow sufficient time for development and preparation. In regards to the second question, the services are probably purchasable if the related RFPs were clear in their expectations and the state

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were willing to pay market value for the services.3 In regards to the third question, an

approach that simultaneously maintained state school functioning while at the same time allowing for the systematic purchase of similar services over time should inspire a certain degree of confidence that the reform process will be sound and successful.

5.6.3 Specific Recommendations