Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Performance Contracting in Illinois Child Welfare Using Leverage to Drive Results June 6, 2006 Michael Shaver, Senior Consultant Chicago Center for Child Welfare Strategies Month, Year The Results Increases in permanency through adoption Increases in permanency through subsidized guardianship Reductions in the substitute care population The Permanency Explosion 7000 14% 6000 12% 5000 10% 4000 8% 3000 6% 2000 4% 1000 2% 0 0% FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 % of In Care Adopted (Red Line) Adoption Numbers (Blue Bars) Cook County’s Record on Adoptions Numbers % of In Care Cook County’s Record on Re-entries Of all adoptions and reunifications achieved, what percentage ruptured within 12 months of placement? 250 14% 10% 150 8% 6% 100 4% Full year not yet observed 50 0 2% 0% FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 % of Permanencies (Red Line) Rentry Numbers (Blue Bars) 12% 200 Adoption ruptures Reunification ruptures % of Permanencies The Drop in Substitute Care Using Contracts to Drive Performance The Keys • Performance goals should be linked to larger system objectives • Move beyond accountability • Outcomes and provider incentives are aligned • The benefits of performing and the consequences for not performing should be selfenforcing Performance goals should be linked to larger system objectives Rightsizing the Illinois child welfare system The Growth in Substitute Care Key Factors • High profile media cases • Kinship care policy State of Illinois SubstituteCare CareCaseload Caseload Substitute Fiscal Foster Inst/Grp Year Care Home 88 13,819 1,745 89 15,711 1,908 90 17,505 2,072 91 20,480 2,361 92 25,961 2,803 93 29,825 3,263 94 36,572 4,259 95 42,819 4,854 96 45,346 4,692 97 46,489 4,238 98 42,165 3,947 99 34,164 3,781 00 27,229 3,438 01 23,394 3,226 02 20,338 2,897 03proj. 19,048 2,717 50,000 Foster Care Panic Cost $497 million 40,000 30,000 20,000 10,000 88 89 90 91 92 93 94 95 96 97 98 Fiscal Year Inst. & Group Homes Foster Care 99 00 01 02 03proj. Inst./ Group Homes includes: Institutions Group Homes Independent Living Changes in the substitute care population due to; * increased adoptions * the federal guardianship waiver * improved front-end protocols have moved Illinois from the highest user of out of home care to one that is closer to the national median. Page 2 Total Csld. 15,564 17,619 19,577 22,841 28,764 33,088 40,831 47,673 50,038 50,727 46,112 37,945 30,667 26,620 23,235 21,765 ERR The Impact of Uncontrolled Growth Challenges • Runaway budget • Loss of public trust • Rapid privatization • Pressures at every level of the system Moving beyond accountability When acceptable performance is not enough. Aligning Outcomes and Provider Incentives Like everyone else, service providers tend to act in their own interest. Contract consequences should be self-enforcing Closing the gap between intention and action. Engaging Providers What to bring •Data, data and more data •An appreciation for the systemic barriers to improved performance •A willingness to realign resources for better performance •Decision making authority Challenges in designing the contract Objectives •Reduce the number of children in substitute care through improved permanency •Reduce the movement of children to more costly placements through increased stability •Align performance incentives with desired outcomes Challenges in designing the contract Barriers • • • • • • • Contract and financing emphasized process over results Caseloads too high Adoption contract structure Resources for reunifying families Access to counseling resources Case referral process Recruitment resources Using the contract to drive results Priorities • • • • Focus on results, not process Exchange flexibility for outcomes Fund enhancements through reallocation and improved performance Shift the risk of failing to perform from the state to the provider, ensuring budget neutrality Contract Structure Shift focus from: Static to dynamic Process to outcomes Cook Relative Care Entries BARC 8 intake (32%) (caseload) 25 cases Exits 6 permanencies (24%) 2 non-permanencies (8%) (total=32%) Contract Structure Shift focus from: Static to dynamic Process to outcomes Cook Regular Care Entries BAT 9 intake (40%) (caseload) 22.5 cases Exits 5.5 permanencies (24%) 3.5 non-permanencies (16%) (total=40%) Home of Relative (HMR) Trend: Cook County End-of-Quarter (EOQ) Caseload, Entries and Exits 25 EOQ Caseload Entries 5 Perf. Contract Announced HMR Reform 4 15 Waiver 3 10 2 5 1 Mar-00 Jun-99 0 Sep-98 Dec-97 Mar-97 Jun-96 Sep-95 Dec-94 Mar-94 Jun-93 Sep-92 Dec-91 Jun-90 0 Mar-91 Exits track entries Sep-89 Thousands Exits Thousands 20 6 Regular Foster Care (RFC) Trend: Cook County End-of-Quarter (EOQ) Caseload, Entries and Exits 8 3 7 EOQ Caseload Entries HMR Reform RFC Perf. Contract Implemented 5 Waiver 2 Thousands Exits 4 3 1 2 Mar-00 Jun-99 0 Sep-98 Dec-97 Mar-97 Jun-96 Sep-95 Dec-94 Mar-94 Jun-93 Sep-92 Dec-91 Jun-90 0 Mar-91 1 Sep-89 Thousands 6 State of Illinois Substitute Care vs. Adoption/Guardianship Cases FY90 - FY03 60,000 50,000 Fiscal Year 90 91 92 93 94 95 96 97 98 99 00 01 02 03est. 40,000 30,000 20,000 10,000 0 90 91 92 93 94 95 96 97 98 99 00 01 02 Sub. Care Adop/Guard Cases Cases 19,577 4,697 22,841 5,037 28,764 5,239 33,088 5,926 40,831 7,011 47,673 8,174 50,038 9,736 50,735 11,539 46,125 17,160 37,945 25,709 30,667 32,489 26,620 36,156 23,235 38,816 21,765 41,470 03est. Fiscal Y ear Adoption Assistance and Subsidized Guardianship Cases Substitute Care Population In late FY2000 the number of children in state supported Adoption and Guardianship settings exceeded the number of children in substitute care placements. Page 4 For more information Chicago Center for Child Welfare Strategies 901 West Jackson, 5th Floor Chicago, Illinois Michael Shaver [email protected] 773-213-1113 THE YOUTH CAMPUS