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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

casey

family programs

DECEMbER 2012 | CASEy.ORG

(2)

We have a chance as public servants

and local government to change, to

transform or save people’s lives.

For me

in public service, it just doesn’t get

any better than that.

Michael Nutter MAyOR OF PHILADELPHIA

(3)

Table of Contents

The Smith Family Story ... 1

Introduction ... 1

Crisis and the Origins of Cultural Change ... 1

The Promise: Transforming Child Welfare Practice in Philadelphia ... 1

Getting to IOC ... 1

Adding the Details to Make It Work ... 1

The Power of the Union ... 1

The IOC Model: New Roles and a Focus on the Community ... 1

Tracking Progress: Data-Driven Decision Making ... 1

Support From the State ... 1

Financing IOC and a Waiver From the Federal Government ... 1

A Closer Look at Congregate Care ... 1

The Anderson Family Story ... 1

Family Team Conferences: The Heart of IOC ... 1

Strengthening Families: Parents Helping Parents ... 1

Role of the Courts ... 1

The First Two CUAs and their Community-based Philosophy ... 1

Rolling It Out: Technical Assistance and Training ... 1

Lessons Learned ... 1

Challenges and Concerns ... 1

A Family Story With a Promise for the Future ... 1

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The

Smith Family

Story*

Cordelia Smith’s life is full of uncertainty. Four of her children, ranging

from 18 years old to 21 months, are in the child welfare system, and

she has no home.

In 2010, the Department of Human Services (DHS) in Philadelphia

removed her daughter Kaiyah, then 16, for truancy, sending her first

to a 30-day shelter and then to a long-term group home. Kaiyah

now has a baby of her own and lives in another group home. At 18,

she has chosen to stay in the system and receive services.

In August 2012, DHS removed Smith’s son and daughter, ages 7

and 4 ½, after a report that she had left them home alone. The two

siblings are placed together in a foster home supervised by the

Asociación Puertorriqueños en Marcha (APM), a private provider.

The baby remains with her mother, who is receiving services through

the department’s In Home Protective Services (IHPS) program. An

IHPS worker from Presbyterian Children’s Village meets with Smith

and the baby twice a week.

Smith crosses the city twice a week to visit her two children in foster

care at the APM offices. She has no car, so she must take two

buses each way, with the toddler in tow. She is also required to go to

therapy and to an outpatient drug and alcohol program – each some

distance away. She takes the toddler to these programs, too. Smith

rarely misses her visits with the two children, but she is inconsistent

when it comes to therapy and drug treatment.

Smith has a DHS caseworker and an IHPS worker. She has a

therapist at the mental health facility and counselors at a drug and

alcohol program. Her daughter Kaiyah has a worker at the group

home and her own therapist. The two children in foster care have

their own worker at APM and a foster family and are receiving

services for developmental issues.

Each of these workers is committed to supporting this mother, who

struggles to bring her family back together. The workers do not

coordinate or even talk on a regular basis. Madusu Sackor, the IHPS

worker who sees Smith twice weekly, does not see the two children

in foster care at all and does not know how they are doing. Kaiyah’s

worker has no contact with either the IHPS or APM workers. Smith’s

IHPS worker did not even know the name of the group home where

Kaiyah lives. This family did not have a family group decision-making

meeting, which would bring all the workers together with the mother

and with other supportive people in her life.

The DHS worker, Taja Coleman-Jackson, holds the overview of

this family’s case. She sees Smith at least monthly and talks to her

more than that. but she has a caseload of 18, two families with

children placed outside Philadelphia and all with complicated issues.

She sees this case as “essentially three separate cases within one

family, each case with its own provider.” Sackor says, “I try to do

my best, because I understand what the mother is going through. I

just pray that she completes her treatment. She gets frustrated and

depressed, because there’s so much going on.”

For Smith, losing her children to DHS was trouble enough, but then

she was evicted. After living in a shelter and with various relatives,

she found a temporary room for herself and the baby, but she needs

a new home if she wants to reunify her family. She did the research

and lined up a four-bedroom, Section 8 apartment. She cannot

move in, however, until the apartment passes inspection by the

Philadelphia Housing Authority and then by DHS. There is a waiting

list for inspections, and the landlord did not process the papers.

Meanwhile, Smith found a bed in a residential drug-treatment

program where she and the toddler could live, but she left after

two weeks.

What’s wrong with this picture? Caring and committed professionals

are involved with this family; they are doing their jobs. The mother

wants to reunify her family, a goal that DHS supports, pending her

consistent attendance at counseling and drug treatment. yet this is

a system of silos, where workers in one part of this mother’s life do

not talk to or collaborate with those in another. Smith is left in the

middle, crossing the city twice a week to see her children, struggling

to maintain therapy and drug treatment, and searching for a place

to live with her family. Surely there is a better way to help this mother

build a stable future for her family.

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

one family,

one plan

Introduction

“I think too many hands in a pot makes things confusing for

our families. And I think we do a disservice to our families

when we are reinventing the wheel and families have to explain

their situation to various people over and over again.”

– SHONTAy TAyLOR, ADOPTION WORKER, DHS

The Smith family is unique, as are all families. Unfortunately, the missed opportunities to help this struggling mother are not at all unique. In Philadelphia, and in many child welfare systems across the country, it is commonplace for families to be involved with multiple systems and numerous workers – child welfare, juvenile justice, special education, public health, substance abuse, mental health, domestic violence – all at the same time. Parents get multiple, sometimes conflicting, instructions from multiple providers; often they do not know who is in charge. Workers do not talk regularly or coordinate services. If children have been removed from the home, court requirements for reunification sometimes add to the complications. These systems are failing the children and families who need help the most.

beginning in 2006, leaders in Philadelphia cast a critical eye on DHS and found a dysfunctional system in need of major reform. With support from Casey Family Programs, a national operating foundation that focuses on safe reduction of foster care placements, Philadelphia launched a research effort to study child welfare reform efforts across the country. by early 2011, DHS had a new direction and a tentative new model. It reached out to its partners on the ground in Philadelphia to help it plan the details. Together, they are reinventing child welfare in Philadelphia. DHS calls its package of reforms Improving Outcomes for Children, IOC for short. The name embraces the goal, an obvious one at first glance. After all, who is against improving outcomes for children? but in striving to reach that goal, leaders are moving far beyond restructuring or shaking up their organizational chart. IOC represents a profound transformation in one of the largest child welfare agencies in the country. It is a “severe disruption of the status quo,” says Mike Vogel, a fan of IOC and head of Turning Points for Children, a community provider in Philadelphia.

IOC is also a story of transformation among community providers and other partners that have long worked with DHS, too often without clear lines of authority. In the past, community providers implemented decisions made by DHS. In the future, community providers will be decision makers, along with the families they serve.

This report chronicles the history of Improving Outcomes for Children. Why was reform of such scale necessary? What are the core components of IOC, and who are the people at the heart of the reform? Which community organizations are stepping up to the challenge to build a new kind of partnership with DHS? Finally, what have the leaders in Philadelphia and the state learned so far about ramping up large-scale change in their child welfare practice?

Glossary

Every child welfare agency has its own language, replete with abbreviations that seem to outsiders like alphabet soup. Key terms and phrases that are used in this report include:

Dhs: Department of Human Services, the child welfare agency in Philadelphia.

ioc: Improving Outcomes for Children, the package of reforms that is transforming practice.

cua: Community umbrella agency, the private providers partnering with DHS to change child welfare practice in Philadelphia.

ocyF: The state Office of Children, youth and Families.

Net: NorthEast Treatment Centers, the first CUA to come onboard.

aPM: Asociación Puertorriqueños en Marcha, the second CUA to come onboard.

ihPs: In Home Protective Services, services for families and children in their own homes when children are not removed.

Qsr: Quality Service Review, a methodology that assesses the effectiveness of service delivery in randomly selected cases and helps leaders make recommendations for system reform.

Crisis and the Origins of Cultiral Change

“The death of a child is always tragic. When a child dies from intentional

abuse, the tragedy is an outrage against humanity. When a child dies

while under the protective supervision of the government, outrage should

shake the very foundation of our community. Sadly, that outrage is too

often buried in governmental bureaucracy.”

– PROTECTING PHILADELPHIA’S CHILDREN: THE CALL TO ACTION*

The path to child welfare reform in Philadelphia began with a tragedy. Danieal Kelly, a 14-year-old with cerebral palsy, died of starvation and infection in her own bed in August 2006. She had been left alone, with large, untreated bedsores, to lie in her own waste. She was not taken to a doctor. She was not enrolled in school, although she was capable of educational success and had done well in a special-education class before moving to Philadelphia. When she died, Danieal weighed 42 pounds. She was 3 feet, 6 inches tall.

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

one family,

one plan

The Kelly family was reported to DHS numerous times and accepted for services in the fall of 2005. but the private-provider staff assigned to the case rarely visited the home, and when they did, they did not see Danieal. In 2008, a grand jury recommended criminal charges, not only against the mother, who was most directly responsible for the girl’s death, but against staff from

the provider agency and DHS as well. “The dysfunction at DHS goes deep, down to the bone,” the grand jury said. It called on the city of Philadelphia and DHS to institute large-scale reform to improve accountability and transparency and, in essence, to change the culture at DHS and sharpen its focus on its core mission, which is to protect children.

The grand jury was not alone in its scathing indictment of the system, nor was Danieal’s death the first crisis to result in an urgent call to action. Frank Cervone, executive director of the Support Center for Child Advocates, was part of a 1990 federal class-action lawsuit that found DHS had “lost” children in the system; workers did not know where they were. As part of a settlement of that lawsuit, DHS added data and tracking systems, but they were not adequate or were used inefficiently.

Internal dysfunction at DHS led to several high-profile tragedies, despite the fact that most social workers at DHS, as well as their counterparts in community agencies, care deeply about the children and families they serve. Workers believed then, as they still do, in providing support to ensure child safety. These workers were employed by a system that not only failed the children and families, but also failed the workers.

The Philadelphia Child Welfare Review Panel

In 2006, soon after Danieal Kelly’s death, Philadelphia Mayor John Street bore witness to the pain and began the move from outrage to action. Pennsylvania has a county-administered child welfare system, so the mayor was in a position to make a difference. He changed the leadership at DHS. He appointed a high-level panel of experts and charged them with recommending reforms focused on everything about DHS, from its mission to its policies and practices to accountability.

The panel made 37 recommendations for both DHS and the private providers that are its partners in the community. The recommendations were measurable; the panel intended for DHS to be held accountable for improvement. The recommendations, the panel said, were “imperative to improving the safety of children in Philadelphia” (panel’s italics). Several of the recommendations spoke directly to the large-scale reforms that are embedded in IOC.

Street was determined that this report would not get a splash of publicity and then sit on a shelf until the next crisis. DHS embraced the reality of its problems and set out to fix them. Little did the agency know at the time how big a fix it would develop.

Recommendations of the Philadelphia Child Welfare Review Panel

The panel listed its recommendations with a time frame, those that must be addressed within a year and those that would take longer to implement. before the panel’s report was even released, DHS began tackling the problems. The most immediate accomplishment was development of a safety assessment tool for use with intake and investigation and throughout the life of a case.

The panel’s recommendations, some already implemented and some reflected in IOC, included: • Development of a new mission statement and values centered on child safety.

• Implementation of a safety model of practice.

• More frequent visits by DHS with all children and families.

• Development of a comprehensive internal strategy to monitor DHS performance. • Improved oversight of contracted provider agencies.

• Clarification of roles and responsibilities between DHS workers and supervisors and their counterparts at private providers.

• Alignment of prevention programs and in-home service programs with the mission and values of DHS and with child safety.

• Expansion of family team decision-making meetings.

• Development of a process for ongoing community oversight of improvements at DHS. (This recommendation resulted in the formation of a Community Oversight board appointed by the mayor; this board continues to meet on a regular basis.)

A Portrait of Child Welfare in Philadelphia

With a population of 1.5 million, Philadelphia is the fifth-largest city in the U.S. but among the 10 largest cities, it has the highest poverty rate, 25 percent, according to a Pew Charitable Trusts report titled “Philadelphia 2011: The State of the City.” In some neighborhoods, the poverty rate rises to 56 percent. Nearly half of Philadelphia’s population, 48 percent, earns less than $35,000 a year. Infant mortality, at more than 10 deaths per 1,000 births, is considerably higher than in other cities of comparable size and is well above the national average of 6.8 per 1,000. This is the context for child welfare in Philadelphia, where one in three families is involved with the child welfare system at some point in their children’s lives. As Deputy Mayor Donald Schwarz said, “In a city with poverty rates like ours, it’s a substantial challenge to families if they have a kid who has physical or behavioral health challenges. It’s a real hard thing not to need the support of the child welfare system.”

DHS has reduced the numbers of children in care substantially since 2006. but the agency still struggles with challenges, such as the high proportion of older youth in out-of-home care and a high rate of children in congregate care. DHS hopes that IOC will help it address those problems, while maintaining the safety of children and families in their own neighborhoods.

“The dysfunction

at DHS goes

deep, down to the

bone,” the grand

jury said. It called

on the city of

Philadelphia and

DHS to institute

large-scale reform

to improve

accountability

and transparency

and, in essence,

to change the

culture at DHS

and sharpen its

focus on its core

mission, which

is to protect

children.

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

one family,

one plan

Placement Population in Philadelphia, 2005 - 2012

source: DHS Division of Performance Management and Accountability. youth in placement are ages 13-21.

The Promise: Transforming Child Welfare Practice in Philadelphia

“How many chances does a child welfare agency have to

remake an entire system with full support of the city and state

government?”

– bRIAN CLAPIER, IOC IMPLEMENTATION OFFICER, DHS DEPUTy COMMISSIONER FOR PERFORMANCE MANAGEMENT AND ACCOUNTAbILITy

DHS worked through the recommendations of the Child Welfare Review Panel one by one. by the time leaders began detailed planning for IOC, most of the panel’s recommendations had been addressed. A big exception was clarification of case management roles between DHS and community providers.

Current child welfare practice at DHS – a dual case-management system – means families have at minimum two main caseworkers, one from DHS and another from a private provider agency under contract with DHS to deliver services. For a family with numerous children, the workers multiply. Lack of communication between DHS and the provider agencies abounds, often with

7000

6000

5000

4000

3000

2000

1000

0

2005 2006 2007 2008 2009 2010 2011 2012

6,467

3,267

5,899

3,046

6,089

2,989

5,742

2,677

5,289

2,527

4,679

2,259

4,140

2,006

4,041

1,909

CHILDREN IN PLACEMENT yOUTH IN PLACEMENT

negative consequences on the timing and delivery of services. With IOC, says Philadelphia’s current mayor, Michael Nutter, “We’re going to cut out all this finger-pointing. No more, ‘I thought you had it.’ ‘No, I thought you had it.’ ‘Well, didn’t you call?’ ‘I thought you called.’ ”

DHS Commissioner Anne Marie Ambrose, who arrived in 2008 with a mandate for change, likes to say, “When everybody’s responsible, nobody’s responsible.” This one sentence became the mantra at DHS during the planning period for IOC.

Dual case management was not working, not for families, for children and not for the line staff at DHS or the providers who dedicate their careers to protecting children. Under IOC, DHS will implement a “single case-management” system, in which DHS transfers primary responsibility for a family’s case to a lead agency in the community where that family lives. These lead agencies are called community umbrella agencies (CUAs). A case manager from the CUA becomes the family’s main worker, team leader and coordinator of all services throughout the life of the case. Those services will be delivered in the community whenever possible, eliminating the need for parents without cars to spend hours on public transportation. If children must be removed from their home, they will be placed in the community. DHS staff will facilitate family team decision-making meetings, bringing parents and their chosen support network together with their workers to make decisions about the family’s service plan. DHS will also expand its oversight and monitoring roles.

With IOC, DHS intends to achieve four outcomes:

• More children and youth will be maintained safely in their own homes and in their own communities while their families get services.

• More children and youth will achieve timely reunification or other permanence. • Use of congregate care will decrease.

• Child, youth and family functioning will improve.

IOC in Philadelphia is more than an initiative. Some at DHS don’t like to call it an initiative at all. Anyone who has logged a few years in child welfare knows that initiatives come – and they go. DHS intends for this effort to last. Kimberly Ali, operations director for DHS, likes to call it a movement. Nutter wants to institutionalize IOC so it becomes the new standard operating procedure for DHS and for the city.

Implementing change as big as this is risky, of course, and the leaders in Philadelphia – including the mayor, the courts, DHS and the providers – are under no illusion that the path will be easy. It will affect the lives of all families in the system, not to mention the jobs of those who provide services, both at DHS and in the community. “It was clear that huge, transformational change was necessary,” Nutter says. “We’re willing to take on the fight when the fight is worth fighting for. And this one is.”

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

one family,

one plan

Getting to IOC

“IOC is righting the system. We need to make sure our

hot line and intake and investigation is bulked up and

strengthened. We need to make sure we’re accepting cases for

services that absolutely need to be accepted. We need to better

monitor the system, and in order to do that, we need to let go

of case management.”

–SAMUEL HARRISON, HUMAN SERVICES PROGRAM ADMINISTRATOR, DHS

A shift in culture as large as IOC could come only from an in-depth planning process. In this case, the road to reform was paved with intense discussions and debate that began with DHS and city leaders and spread to include more than 150 outside stakeholders.

The process took root in 2008 with appointment of a new DHS commissioner. After a 19-month, nationwide search reviewing more than 100 candidates, Nutter hired Ambrose.

Schwarz, the deputy mayor, was on the search committee and recalls that Ambrose’s interview “cohered beautifully” with the recommendations of the Child Welfare Review Panel. “Clearly, she had thought about it, and she had a really fresh perspective,” he says. Moreover, she had worked at DHS in the past and was, at the time she was appointed, the director of Child Welfare and Juvenile Justice Services at the state Department of Public Welfare. She knew the politics of the state and the city, and, of course, she knew the issues. This matters, because in Pennsylvania’s state-run, county-administered child welfare system, close coordination between DHS and the state is essential.

“I did not want this job at first,” Ambrose says now. “I knew the history of the agency. I knew the good and the bad, the wonderful and the sometimes ugly history of this agency.” but she was up to the challenge and she knew that this opportunity could make a difference in the lives of a lot of children and families.

Ambrose began work in June 2008, just one month before the grand jury released its report on Danieal Kelly’s death. “When you read the grand jury report,” Ambrose says, “it sort of hits you in the gut. I think it’s fair to say we were a national disgrace.” The report motivated her to push for large-scale change. Facing down skeptics, Ambrose held up a vision that DHS would be “a,” if not “the,” leading child welfare agency in the country.

Building Blocks of Reform: Using Data to Drive Decisions

One of the first things Ambrose did was to establish a new division, Performance Management and Accountability (PMA), to collect and organize data on outcomes for children and families so that the department could use lessons from those data to increase accountability to the

families it serves. Susan Kinnevy, former DHS deputy commissioner and currently director of special projects, came onboard in 2009 to oversee PMA. She found multiple databases in various departments across the agency, and most did not “speak” to the others. Kinnevy and her colleagues addressed that issue and then layered the data within substantive or clinical information, so the quantitative data would have a qualitative context. “It was all to improve practice,” she says.

DHS introduced ChildStat and Quality Service Reviews (QSR), two methodologies for analyzing individual cases in depth and looking at trends over time. Ambrose herself conducted a QSR that put a spotlight on the disconnect among DHS, a provider agency and a family. She reviewed the case of a child in foster care, one of three unrelated children in a foster home. Six workers were in and out of that home. The foster mother did not even know the name of the DHS worker for this child. As far as the foster mother could tell, the DHS worker was doing the same job as the worker from the private provider. The fact that so many strangers were coming into this home really hit home for Ambrose. “Not just one or two workers,” she says, “but six. Are we crazy? What could be more intrusive than something like that?” And this foster child was doing fine and the house was fine. Ambrose adds, “If our work is all about kids and families, we couldn’t have set up a more confusing and inefficient and crazy system to try to help them do the right thing.” After that QSR, Ambrose says, planning for IOC “kicked into high gear.”

Learning From Other States and Jurisdictions

DHS knew that other large child welfare jurisdictions had taken on major reform efforts, and Ambrose did not want to reinvent the wheel. Casey Family Programs was on the scene in Philadelphia before Ambrose came onboard, working with DHS leaders to implement various reforms. When Ambrose arrived in 2008, she welcomed and expanded this relationship with Casey leaders, who had firsthand knowledge of reform initiatives across the country.

Ambrose and a team of stakeholders from inside and outside the agency hit the road to find the best practices in the field. Casey helped fund these visits to New york City, Florida and Illinois, and also supported peer technical-assistance exchanges in which leaders from other systems came to

Philadelphia. Each site was different from Philadelphia, with different assets, problems and lessons. but each offered some key ingredient that found its way into the Philadelphia IOC package. Early visits to New york City were critical turning points. DHS looked at New york’s transfer of case management to providers in the community. And Philadelphia leaders liked New york’s emphasis on family team decision-making meetings held at key points during the life of a case, in which families involve their own support systems and help develop their own service plans. From Florida, DHS took notice of lead agencies based in the community and focused on work with families and children in the neighborhoods where families live.

DHS added conference calls and Internet searches to its research list and invited leaders from other systems to visit Philadelphia and share their experiences around implementing major

Casey Family

Programs was

on the scene in

Philadelphia

before Ambrose

came onboard,

working with

DHS leaders

to implement

various reforms.

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

one plan,

one case manager

one family,

one plan

reforms. DHS learned from Milwaukee the importance of giving lead agencies enough money to do the work. From KVC, a lead agency in Kansas, it learned a host of lessons, including keeping the vision and values front and center at all times and analyzing data on a daily basis. DHS looked to Illinois for a community-based initiative called Strengthening Families, an approach that helps families improve parental resilience, build social connections and access concrete services in times of need.

A New Model Emerges

Ambrose led her internal DHS leadership in ongoing discussions of a vision that would transfer case management to community providers. They asked themselves: Were there enough private providers in Philadelphia with the right stuff that, with the right training, could take over case management responsibilities? There was some understandable skepticism at first. Paul bottalla, director of policy and planning at DHS, recalls a retreat of DHS leadership in which they outlined the key components of IOC and tried to build consensus around whether to move forward or not. The question was whether providers would become single case managers. “On my Post-it,” bottalla says, “I drew a little fence, and I put myself sitting on the fence. I was saying, ‘I’m not real sure about how this is going to work, but I’m not certain as to why we can’t do it.’” He says now, “I’ve come a long way from that retreat.”

The vision was gaining traction. IOC was ready for specifics.

Adding thr Details to Make it Work

“There are a hundred ways to address the Child Welfare

Review Panel’s recommendation to streamline the roles

between foster care agencies and DHS. IOC is a very dramatic

way to do it. There is tremendous promise in the entire

restructuring, but it is all in the details.”

– KATHERINE GOMEz, MANAGING ATTORNEy, FAMILy ADVOCACy UNIT, COMMUNITy LEGAL SERVICES

The vision and concept were on the table. Single case management in the community was the goal. The next step was to get a map. Ambrose and her leadership team moved quickly, appointing a steering committee and a variety of work groups to define every aspect of IOC. The steering committee included the social workers’ and supervisors’ union, individual providers and the association of providers, advocates, community leaders, academics, the mayor’s office, the state and other critical stakeholders who work with children and families in Philadelphia. Ambrose herself met one-on-one with key leaders in the city, explaining the vision and where they hoped to take it.

The steering committee was launched in December 2010. Wanda Mial, a consultant supported by Casey Family Programs, came onboard as project manager and facilitator and worked with Samuel Harrison of DHS, who served as the internal project manager. The pace was intense. “It was like a campaign,” Mial recalls, describing the rapid evolution of the work.

The intensity was by design. Child welfare systems across the country have a reputation for starting reforms and not always delivering on the details. Ambrose intended to deliver. And she did not want to waste time.

Six Work Groups Add Depth

The steering committee identified six interlocking work groups to define the work. Each would be co-chaired by a DHS staff person and an outside stakeholder. In all, around 150 different community stakeholders were engaged over the course of a year. Work group members had permission, even a mandate, to hold deep and lively debates. They knew a lot was at stake, and all wanted this effort to succeed. It took a lot of trust.

The work groups, created to cover all aspects of IOC, were: • Practice Model

• Community and Systems Engagement • Data and Performance Management • Policy and Legislation

• Financing and Contracts

• Staff Development and Capacity building

The first three work groups began meeting in April 2011; the others got under way in June of that year. In all the meetings, facilitators made sure everyone’s voice was heard, but also kept the focus on the goals of IOC. Harrison pointed out that work group members “are folks at the top of their field, and to get them on the same page is a tremendous challenge. If you can keep them focused on the purpose of what this is all about, they can put the egos and the personal stuff aside and work more collaboratively.”

Ali, the DHS operations director, and Raheemah Shamsid-Deen from the state Office of Children, youth and Families (OCyF) co-chaired the Practice Model work group, a team of 30 vocal, engaged stakeholders. Ali called the process “grueling,” adding, “There was never a dull moment.” Shamsid-Deen agreed. Meetings were so lively and full of healthy debate, she recalls, that “some days we walked out with headaches.” Their goal was to air the debates and differences of opinion early on, and they did just that. They knew that sweeping disagreements under the rug for the sake of a shallow consensus would do no one a favor in the long run. The end product was a safety practice model that put family team conferencing front and center. Teaming meetings will be held at key points throughout every case. DHS will retain responsibility for the hot line, investigations and intake, and will participate with the CUA in the initial safety plan, but at that point will hand over the case to the CUA. (See section on family team conferencing.)

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IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA:

one family,

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one case manager

one family,

one plan

Role of the Provider Community in the Planning Process

Except for DHS itself, no other organizations will be more affected by IOC than private providers. In the current dual case-management system, DHS partners with hundreds of providers in the community. With IOC, it will focus on 10 community umbrella agencies, with 10 major contracts. The CUAs will subcontract with other providers for services the CUA does not provide. Provider representatives sat on all the work groups. It was not always easy.

Margaret zukoski, associate director of the Pennsylvania Council of Children, youth and Family Services (PCCyFS), a consortium of provider agencies, is a member of the IOC steering committee and participated in work groups as well. “Everyone agreed that there are too many people going into a family’s home,” zukoski says in discussing the CUAs’ new roles, “but you still need to have other professionals in the community involved with oversight and direct care of children.” zukoski says PCCyFS members “support getting more services directly to the community,” but when it comes to the methodology for doing that, she says, there is a wide range of opinion among its membership.

The work groups aired those opinions. The consensus they reached in the end was all the more valuable because of the presence of private providers.

Parent and Child Advocates in the Planning Process

In developing the practice model, advocates who stressed the importance of child safety sometimes sparred with those whose primary goal was family reunification. These positions are not mutually exclusive, of course, and all agree that safety should be at the center of all decision making. That said, the practice model got into the weeds on this issue. Ali remembers a very tough conversation about reunification. “DHS wants reunification to be paramount, the first line of permanency,” she says, emphasizing that safety is a critical component of permanency. Some of the discussion was theoretical. Child advocate Cervone wonders if reducing foster care “is the right goal, or if it is just trendy.” Rather than focusing on foster care reduction, he is more interested in whether the incidence of abuse is going up or down. “We think it will go down,” he says, “because we’re not just sending kids home, we’re sending kids home with support and we’re helping families, rather than cutting them loose. No one wants to reduce foster care numbers by sending kids into unsafe conditions. So we have the roots of it; we have the stuff of the soup.” both child and parent advocates can agree on this point, and it is the heart of IOC. Parent advocate Gomez is passionate about supporting parents caught in the system. “Part of my job as a parent attorney,” she says, “is to make sure that when a parent is in a deep hole, we’re not throwing over dental floss, that we’re really throwing over a ladder. If we are serious about helping children reunite safely with their families without unneeded delay, we must provide their parents with very significant, individualized help upfront.” She is adamant that framing child welfare in a “parents versus children debate does a horrible disservice to everybody, especially children.” In the end, the work groups became a place of trust for both child and parent advocates. They felt free to air their strong opinions, to listen to each other and to find resolution.

The Power of the Union

“Once we got an iron-clad agreement in writing that there

would be no layoffs, we could talk about what the DHS jobs

would be.”

– RITA URWITz, VICE PRESIDENT, AFSCME LOCAL 2187

The union at DHS has the power to make or break an initiative, especially one as large as IOC, in which many social workers’ responsibilities will be transferred to CUA case managers. Ambrose knew from the start that “getting the union to support this would make all the difference in the world.” Rita Urwitz, who passed away in December 2012, was vice president of the union and wielded the power of labor at DHS. She was initially skeptical of IOC. Her concern focused on two key issues:

• Could the community agencies carry the weight and the responsibility? “These agencies traditionally have tremendous staff turnover and young, inexperienced staff,” she says. • If CUA workers took over case management, what jobs would DHS workers have? “This

was a bread-and-butter issue to us,” she explains.

Ambrose and her leadership team met regularly with Urwitz, asking her to sit on the steering committee and ensuring that union representatives had seats on all the work groups. Early on, DHS agreed that there would be no staff layoffs, even though ongoing casework would be transferred out. Urwitz was fully aware that when New york City privatized its casework, extensive layoffs followed. This was not her idea of successful reform.

There were some tense moments. The union wanted DHS to sign off on the family service plan every six months. DHS leaders thought that if they agreed to that, it would simply be a continuation of the current dual case-management system. “This was where we started drawing a line in the sand,” Ambrose says. Having DHS facilitate family team meetings helped address this impasse, as did the promise of targeted training for CUA workers and expanded oversight and monitoring on the part of DHS. In the end, Urwitz says, “We got together as union and management to just negotiate, and I think the nuts and bolts were worked out at that time.” What DHS leaders could tell the staff and when they could tell them became a problem for both the union and management. The staff knew that change was under way. They knew the basic framework of IOC, that community providers would be taking over ongoing casework. The commissioner had promised no layoffs, but it was clear that jobs would not remain the same, and the DHS staff did not know how they would be affected. This caused understandable anxiety. At the point when the commissioner was ready to present the details to the staff, the union was still insisting that DHS sign off on the family service plans and held up any announcement. As Urwitz herself acknowledges, “When people don’t know what’s going on, they hear rumors.” In this case, the rumors grew to fill a muddled void. When the Philadelphia Inquirer heard about

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IOC and called the commissioner, she went on the record and IOC became public. This meant some workers learned about DHS job changes from the newspaper, not an ideal form of internal communication for staff members who were already nervous.

both DHS leaders and Urwitz agree now that their negotiations over IOC were successful. Urwitz says of Ambrose: “She had a vision, and she moved that vision. I have a lot of respect for her for that.” Ambrose says of Urwitz: “It made a huge difference for her to support this, because she could have held it up. At the end of the day, she stood by our side, and I admire and appreciate that, because I think it has been hard for her.”

It helped that the union shares with DHS the common goal of doing what is best for children and families. Urwitz began her career as a social worker at DHS and worked in family preservation services, so she knows the value of supporting families and children in their own homes and communities. Schwarz, the deputy mayor, gives Urwitz credit “for also believing that doing right by children promoted the best interest of her workforce. you have to have people who believe that to make meaningful change.”

The bottom line here is that DHS made sure the union was at the table during the planning process. It was a lesson it had learned from other states that did not engage their union and paid for it. If DHS had not reached out to the union and held fast to the dialogue, IOC might have been over before it started.

The IOC Model: New Roles and a Focus on the Community

“Our big DHS building is in the middle of Center City,

where none of our families live. If we want to make this

family-focused, shouldn’t we be in the communities to make

it easier for families to access services? And shouldn’t we be

putting work in the hands of providers who actually have some

credibility and where families might actually go for help?”

– ANNE MARIE AMbROSE, COMMISSIONER, DHS

IOC grew out of the effort to address role confusion between DHS and its private providers. As the vision expanded and DHS and its partners began to develop a map, it became obvious that the work itself needed to be planted securely in the community. “DHS has horrible credibility in the community,” Ambrose says. but more important than addressing their reputation, she adds, IOC is a chance to really support families where they live and, at the same time, to support those communities.

“you can’t have gray areas in this work,” Nutter says. “There are real consequences to dropping a ball. With IOC on the ground, active, engaged community partners who know these

neighborhoods like the back of their hands, who deal with cultural issues and language issues all the time, will work with families. The responsibility of DHS is to monitor them, to stay on top of what’s going on.”

The CUAs are expected to ensure that families get services in the community. If children need to be removed, they will be placed in the community. No more public transportation nightmares for parents trying to get to visit their children in foster care or to get to therapy or parenting classes on the other side of the city. Ali, the DHS operations director, explains what this will mean to a family: “The CUAs will be able to contract with the grassroots agencies in the community who will come knock on the door and take you to an appointment. And you can walk out your door, walk five blocks and you’re at your mental health provider. That’s who the families trust. They don’t trust big, old DHS and our ‘I-can’t-get-through-to-anybody’ bureaucracy.”

The community piece is why IOC is so much more than privatization. In fact, DHS does not use the term privatization. Ambrose explains that DHS officially privatized 20 years ago when it first contracted with private providers to deliver services. “but we never got rid of the role confusion,” she says. Privatization is a buzzword in the child welfare field. Harrison, the former DHS project manager for IOC, explains, “We wanted to focus our language on improved outcomes for children and families instead of privatization.” Each CUA will have a community advisory board selected by the

community and will develop and implement a community engagement plan. The first two CUAs have long been deeply engaged in their communities. The expectation is that the other eight will be as well. “The community, not the government, should inform what the service delivery continuum looks like for the people who live there,” Ambrose says.

Joanna Otero-Cruz of Concilio, the Council of Spanish-Speaking Organizations, adds that it will take a lot of collaboration and partnership with local groups to make it work. New resources will have to be pulled into the continuum of care. “It’s a different level of ownership,” she says. “It’s like going back to the proverb of ‘It takes a village to raise a child.’ It is our – plural – responsibility to ensure this child is safe, ensure that this child has access to adequate services, including education and health care, to ensure that this child has a better outcome.”

One ‘Go-To’ Case Manager in the Community

With IOC, each family will have their own case manager from the CUA in their community. This case manager will be the family’s main link to all services, their “go-to” person throughout their

“You can’t have

gray areas in this

work,” Nutter

says. “There are

real consequences

to dropping a

ball. With IOC

on the ground,

active, engaged

community

partners who

know these

neighborhoods

like the back

of their hands,

who deal with

cultural issues

and language

issues all the

time, will work

with families.

The responsibility

of DHS is to

monitor them,

to stay on top of

what’s going on.”

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one family,

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time in the system, the person who ensures that the children are safe and that the parents get the services they need. This is the essence of a single case-management model.

To Otero-Cruz, the IOC case-management system “is like a primary health-care model. you have one primary care doctor who is your overall, head doctor. And as he sees the need for specialists, he gives you the referrals.” The case manager will take the lead in locating the right services for each family. No more one-size-fits-all service plans. The CUA will supervise any necessary subcontracted services that it does not have in-house.

The CUA will also oversee visitations. Foster parents will mentor biological parents. The CUA case manager will be present at all court hearings and will present to judges. When families are reunified, the CUA will provide aftercare.

Having one CUA in charge can make a big difference not only for families, but also for workers from different provider agencies who provide different services to the same family. The current system does not encourage workers from one agency to reach out to those from another. Kimberly Walker, an IHPS worker at Turning Points for Children, explains: “We don’t know the other workers, and we don’t communicate. They wouldn’t feel comfortable with me calling them and asking them about the services they are providing.” With IOC and within a CUA, this kind of collaboration and communication will be more natural, which will help the workers do their jobs better and, of course, help the family.

Who Does What at DHS Within the IOC Continuum of Care?

DHS and the union agreed there would be no layoffs among the DHS staff. but as the core of ongoing casework is transferred to the CUAs, job titles and functions at DHS will change. The new framework at DHS looks like this:

• Hot line, investigation and intake responsibilities remain with DHS and will be strengthened. These units will change very little under IOC, although some workers and supervisors will be stationed in offices in the community. DHS will strengthen its investigations of repeat abuse or neglect cases, a critical safeguard for children.

• DHS intake workers will partner with the CUAs on development of the initial family service plan. Using family team conferencing, DHS and CUA workers will meet with families and the families’ own support systems to develop the initial plan. DHS will then hand the case over to the CUA case manager, who will lead the work until the case is closed.

• DHS staff will facilitate ongoing family team conferences at critical decision points. Team coordinators, a new position for DHS social workers, will organize these family meetings, engage the families in the process, identify extended family members and other key people to attend and support the family, and track the progress of all meetings. At the supervisory level, DHS practice specialists will facilitate the team meetings and help identify strengths and barriers to reunification and permanence. (See section on family team conferencing.)

• Oversight and monitoring are enhanced under IOC and remain a DHS responsibility.

based in the Division of Performance Management and Accountability, DHS quality visitation reviewers and practice monitors will evaluate the CUAs’ provision of services

to families. Program analysts and supervisors will assess the CUAs in terms of contract compliance related to safety, permanency and well-being.

• All CUA case managers and supervisors will take the required Pennsylvania Charting the Course training for child welfare social workers. In addition, DHS learning specialists will develop and evaluate training for both DHS and CUA staff in their respective new roles. DHS social workers will also be available to provide onsite and ongoing support for CUA staff on such topics as safety assessments, service plans, permanency, navigating court processes and data entry.

Roles and Responsibilities of DHS and CUAs

source: DHS

10 CUAs, 10 Jurisdictions

With IOC, DHS will go from more than 250 contracts with provider agencies to just 10, one for each lead agency in 10 jurisdictions, each representing approximately 10 percent of the city’s child welfare population. The CUAs will subcontract to get additional services for families. The 10 jurisdictions are geographically based on police precincts. The first two CUAs cover three police precincts, which have the highest reports of abuse and neglect in the city. These are the toughest communities, the areas of greatest need, which is why DHS is starting there. Child advocate Cervone suggested an additional reason for starting there: “There’s a time clock on governments. you have to be able to deliver within the life of one executive administration. If DHS held off doing the hardest communities until the end, I believe they wouldn’t have time.”

Hotline, investigations & intake

Financing/contract mgmt Data, perfomance mgmt & accountability

Professional development, training & system capacity Support Centers

Full case mgmt responsibility -Safety assessment -Service plans Court Participation

Coordination of all services

Family Team Conferencing Community partnerships & engagement Case transition

DHS

Community

Umbrella Agency

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Each CUA, whether concentrated in one or two police precincts or more, will represent an area with a more or less equal number of families in the system. DHS is rolling out IOC one community at a time, from 2013 to 2015. beginning with the first two CUAs, cases will roll out in a managed way, first with in-home cases, then in three months adding families with children in foster care, and finally adding families whose children are in treatment foster care or congregate care. In addition to taking new referrals, each CUA will receive 10 to 20 percent of the existing cases in its jurisdiction; the rest will remain in the old dual case-management system until they naturally close. Training and hands-on support for CUA staff will be a key part of the picture throughout.

Geographic boundaries of Community Umbrella Agencies in Philadelphia

Spreading the Word About IOC

With changes so big that affected so many individuals and organizations, communication took on a star role in the planning process. “you can never have enough,” Ambrose says. DHS Deputy Commissioner Vanessa Garrett Harley notes: “It’s a fine line you walk. you have to be as transparent as possible, but also have to be able to filter that transparency so that you don’t scare people.”

DHS mobilized a communication team that included Communications Director Alicia Taylor and outside consultants. Casey Family Programs supported the work of John beilenson, president of the firm Strategic Communications and Planning, to help DHS prepare a package of materials about IOC for use in speeches and presentations. He also organized listening sessions with staff and stakeholders, provided support for the Community Engagement work group and helped that group develop a communication plan for the CUAs to take the message to their constituents. His current work with IOC includes development of regular newsletters for the IOC website, as well as support for the internal DHS communication team.

Internal Communication: It makes sense for large systems such as DHS to engage the people most affected by major changes early on. DHS knew that, but it lost some time during union negotiations. (See section on The Power of the Union above.) When it was able to go public with the details, the rumor mill was already activated. The commissioner set up a series of large staff meetings to reach everyone who worked at DHS. This was a logistical challenge in itself, since DHS has no single space large enough for all 1,700 staff members at one time, and it took several days of meetings to make sure every staff person could attend. The IOC website and newsletters were, and remain, helpful tools in answering the questions of nervous workers. Getting DHS workers and supervisors who were still enmeshed in the day-to-day issues of their current caseload to focus on the future was, of course, a challenge. As more case management is transferred to CUAs and jobs begin to change around them, their attention will no doubt grow. In the meantime, DHS leaders continue to spread the word to the staff. “If you take the time to explain to people what we’re doing, more times than not, they will get it,” Taylor says. When Garrett Harley talks with anxious workers, she uses stories to describe the importance of IOC. She cites a typical case, a mother of numerous children, with numerous workers telling her what to do, carrying her kids on buses all over the city to meet the requirements of her service plan. Garrett Harley asks the workers, “Do we or do we not set this mother up for failure?” For staff, this is often a “eureka moment,” she says.

External Communication: DHS reached out to providers from the beginning. In addition to selecting providers to sit on the work groups and steering committee, DHS organized a series of provider round tables to explain IOC to the many nonprofits in the community whose work will be affected. Some of them will become CUAs. Most will not. but the round tables give providers – particularly some of the smaller, more focused nonprofits – an opportunity to explain their work to the larger community. CUAs will need to subcontract for services that they don’t have within their own network. The round tables were a three-way information exchange among DHS, potential CUAs and other nonprofits.

Department of Human Services Improving Outcomes

for Children Community Umbrella Agency Zones

Department of Performance Management & Accountability January 14, 2013

Prepared by The Data Integration Management Unit

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The Community Engagement work group focused on outreach to the community and was pumping out the elements of a local communications plan when the city’s legal department intervened and shut down all the work groups. Since some providers on the work groups might apply to become CUAs, the lawyers reasoned, it was a potential conflict of interest for them to serve on the work groups as the RFP was developed. The early demise of the work groups was a particular blow to communication efforts. “We were developing a lot of nice momentum,” says beilenson, who worked with the community engagement group. “Providers were stepping up generously to use their standing in the community to get the word out.” He says he understands the legal rationale, however, adding, “No energy is ever wasted.”

Otero-Cruz of Concilio, who co-chaired that work group, shares both the frustration and the faith in its work. “When we had a lot of our ducks lined up, that’s when we had to dissolve,” she says. but it developed a communication plan and, in the first two CUA districts, had already begun to collect names of faith-based organizations, block captains, owners of corner grocery stores and more. They gave that information to the first two CUAs. Taylor points out, “The work we did set the groundwork for all the future CUAs.” They have a communications framework that all CUAs will be able to use.

Tracking Progress; Data-Driven Decision Making

“In this field and as a CUA, you need to have real-time data,

and you need to make informed decisions based on data. If

you err on one side, it can be financially disastrous. If you err

on the other side, a child’s life could hang in the balance.”

– MIKE VOGEL, CHIEF ExECUTIVE OFFICER, TURNING POINTS FOR CHILDREN

The success of IOC will depend on using data to make decisions. Social workers deal with life-and-death issues every day. Without good use of data, the IOC reform will have no teeth, no way of knowing what’s working or not. One of the first IOC work groups focused on using data for performance management.

This work group wanted to make sure both the CUAs and DHS use advanced technology to track the progress of families in the system. The work group created a grid that includes all the elements it wants to be able to measure. This tells it what kind of IT work will be required. A lot of the elements are around timing and deadlines, says Kinnevy, the DHS special projects director. “If we really want to shorten the time the kids are with us,” she says, “we have to shorten every increment. We have to make sure that things are not bottlenecked and that we have a way of finding out if they are.”

Electronic case management is embedded in the CUA contracts, which means CUA staff must be able to use the DHS data system. DHS has already conquered some of the crucial

confidentiality hurdles around sharing data with the CUAs. This is a major leap forward. “The CUAs will be acting as our representatives,” Kinnevy says. “It’s an issue of what they need to see in order to do their job.” DHS social workers will be on hand to help the CUAs with data entry. In the fall of 2012, a lead community agency in Kansas City, KVC Health Systems, came to Philadelphia to share its lessons in putting together a package of reforms. The key to its success, it says, has been monitoring its data every day at 8:10 a.m. DHS got the message. It is lining up the measures for its own data dashboard, with a goal of using it daily. Child advocate Cervone says, “IOC built in the solution to the 20-year problem of being overwhelmed by information and failing to use it in a way to not only know where the kids are, but to have a sense of how well they are doing.” This is praise indeed from an advocate who 20 years ago advanced a class-action lawsuit against the department.

Support from the State

“It’s important for the state to have an open collaboration with

DHS and open conversations and for us to be as supportive as

we can be to DHS throughout IOC implementation.”

– RAHEEMAH SHAMSID-DEEN, SOUTHEAST REGIONAL DIRECTOR, STATE OFFICE OF CHILDREN, yOUTH AND FAMILIES

because Pennsylvania has a state-supervised, county-administered child welfare system, the state is an essential partner in everything DHS wants to do. The state can, and has in the past, cracked down on DHS if it is not performing up to required state standards. When Ambrose became commissioner in 2008, for example, DHS was on a provisional license for failing to comply with certain regulations. This was lifted as DHS began to improve outcomes steadily. There are layers and layers of detail in this reform once you dig beneath the surface, and many of them touch on state-mandated policy and regulations. Could Philadelphia make such sweeping changes without policy changes at the state level? Would it need legislative approval? bottalla, the DHS policy and planning director, who also served on the Policy and Legislation work group, went through every state regulation on the books to see which would be affected by IOC. The main question concerned the issue of turning over case management to the CUAs. “As it played out,” bottalla recalls, “the state did not see any regulatory reason why we could not have providers acting on our behalf.” The only regulation DHS could not touch concerned investigations, which by law had to remain at the department. but DHS wanted to keep that part of the continuum anyway, and to strengthen it.

IOC did require, however, a signed protocol and constant communication between DHS and the state. beverly Mackereth, secretary of the state’s Department of Public Welfare, came onboard well into IOC’s planning period and “had to play catch-up,” as she says. “Sometimes the state

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wasn’t on the same page as DHS,” she recalls. “We weren’t always sure what Philadelphia was asking for. What regulations did they really need us to waive? We had to focus on a lot of definitional things.” Constant communication and shared goals saved the day.

Along with DHS, Mackereth keeps her eyes on outcomes: “The bottom line for us is family engagement, drilling down to the real needs of the families and using evidence-based

intervention strategies to solve problems. It’s as simple as that.” She is a realist, however, and knows that “it’s not going to be simple to implement.”

Shamsid-Deen, of the state Office of Children, youth and Families, is based in Philadelphia and worked closely with DHS throughout the IOC planning process. To her, this work was like another full-time job beyond her current responsibilities for the state. She says the move from dual case management to 10 community umbrella agencies will be “interesting,” a rather large understatement. but to her, and to so many of the leaders in Philadelphia, this work is a ministry. “Either you do this work because it’s mandated and is the mission of the agency,” she says, “or you do it because it’s a ministry. This work is a ministry for me, and the moment that stops I need to look for something else to do.”

Financing IOC and a Waiver from the Federal Government

“There were a lot of providers on the Finance work group, and

that was helpful because we got a lot of provider feedback.

Their feedback made us think of things differently.”

– JENNIFER bIETER, FORMER SENIOR ANALyST, PUbLIC FINANCIAL MANAGEMENT, CURRENTLy STRATEGy ANALyST, PHILADELPHIA SCHOOL DISTRICT

Transferring case management to the community requires a new way of paying for child welfare services. The overall DHS budget is $650 million, a combination of federal, state and local dollars. This total will not change under IOC. Cost neutrality was a requirement of IOC from the beginning. What will change is how DHS spends its money, since large amounts will be shifted to the CUAs.

Configuring the funds for something as complex as IOC is a herculean task, involving a

complicated financial model developed by Public Financial Management, a consulting group that works with governments. This financial model had to take into account such things as staffing needs at the CUAs, training for both CUA and DHS staff for new positions, costs of services per family and per child, and even the cost of office space. It is a dynamic model that is used to test assumptions, such as the difference in costs based on caseloads of varying sizes. “Philly has a very large budget, and there are a lot of pieces to their budget,” says Lori Partin, who is now an IT project manager at DHS but who was an analyst with PFM when it was developing the model. “The model put decisions into real dollars,” she says.

PFM built the model to project costs on a quarterly basis and let it look all the way out to the year 2019 so that DHS could use it as a decision-making tool. “We have a lot of dynamic parts in IOC; everything is moving,” says Finance Chief of Staff Chanell Hanns. The model itself does not build in cost neutrality, but it can project costs quarterly and allows officials to change the assumptions and see the financial changes instantly. Thus a decision maker at DHS is able to determine which mix of assumptions will result in cost neutrality.

Some providers from the beginning raised questions about whether, given the need for cost neutrality and no DHS layoffs, there will be adequate funding for IOC. The cost neutrality requirement, however, does not mean lack of flexibility in how money will be spent. And in this case, DHS is getting big-time help from the federal government and the state with a Title IV-E waiver (see below). In addition, DHS is determined to reduce the number of youth in congregate care, a cost-savings measure that is also better for families.

both Casey Family Programs and the Annie E. Casey Foundation are providing technical assistance to help DHS work through the financial puzzles of IOC. For the CUAs, at least at first, DHS will continue to bear the financial risk, paying the actual cost of services delivered. The goal in the future is to share the cost with the CUAs. DHS is looking at various scenarios that would transfer sums to the CUAs to use for all services. If a CUA is able to maintain more children in their own homes safely, close more cases, decrease re-entry or decrease placements in expensive levels of congregate care, the money that is saved can be reinvested in other community-based support services for families and children.

Regan Kelly, vice president of NorthEast Treatment Centers (NET), the first CUA to go online, in January 2013, talks about what this funding arrangement will mean to its work. Successful reunification is one of her prime goals, which means supporting families with ongoing services after the children are returned home. This helps families and makes sense financially, too, she says. “If that reunification fails, the child comes back to you with no additional funding. The funding arrangement incentivizes two things: not sending kids home too early, but also really making sure the family is stable for a period of time after reunification.”

What Is a Title IV-E Waiver and Why Did Pennsylvania Want One?

Child welfare services are funded by a complicated amalgam of federal, state and local funds. With IOC, DHS will be helped by a five-year, Title IV-E waiver from the federal government that gives the state and five of its counties, including Philadelphia, flexibility in how they spend foster care funds. Without this federal waiver – or capped child-welfare demonstration project, as it is called in Philadelphia – DHS would be allowed to spend foster care funds only on placement, after children are removed from the home. The waiver allows the state to use this money for prevention, reunification or other interventions that will benefit children and families. The caveat is that the funds are capped, so if for some reason DHS needs to place more children in care, no additional money would be available.

Over the past six years, as DHS reduced the number of children in out-of-home care and increased permanency, it could not access the money that was targeted for placement only. Now, as Garrett Harley, the deputy commissioner, points out, “The waiver will allow us to invest

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