Evaluation of the New York City Home Rebuilders Demonstration. 2.7 Public and Private Agency Perspective on HomeRebuilders

09/14/1998

Despite the early termination of the HomeRebuilders initiative, state and city officials and private agency staff were excited about it. The private agency administrators saw the program as a catalyst to think differently about case planning. Because these agencies volunteered for the program, the administrators believed that HomeRebuilders was a sound method for working with children and their families. One administrator stated that one of the biggest accomplishments of the program was that "it proved to be a successful tool in reuniting families." Another accomplishment mentioned was that in some cases the birth parents remained in contact with the foster families. Another administrator stated that good casework makes sense programmatically and fiscally. The children served needed the clinical services and the foster care. When the children are discharged, the state or city can save money if an investment is made up front. Some of the administrators spoke about the important role aftercare played in reducing the recidivism rate.

Finally, the administrators believed the HomeRebuilders model was a sound foundation for managed care. One administrator summed up by saying, "Any model of managed care must be established on primary fiscal principles which embrace issues related to working with multi-problem families in economically deprived communities." He believed that one lesson learned was the importance of working closely with the state, city, and other participating agencies. This collaborative arrangement can lead to creative management, shared resources, and training opportunities. HomeRebuilders also brought attention to the point that greater efforts must be made to engage other entities such as housing departments, courts, schools, and other social services and welfare departments to make managed care a success for families.

While administrators believed the demonstration tested some managed care principles, they cautioned against calling the project a managed care demonstration. They noted that agencies cannot be held fiscally responsible for outcomes over which they have little control. Whereas they are able to recommend a family be reunified, the city and court make the ultimate decision on placement.

Most state officials were also supportive of the demonstration. One state administrator noted that, in New York State, the child welfare system provided little in the way of aftercare services. This meant that workers had to hold off on discharges until all problems were solved. The aftercare component of HomeRebuilders made it possible for workers to stay with families and return the children to foster care if necessary. He believed that as agencies became more aware that discharge involves a risk, aftercare became more important. It helped clients maintain their gains.

Some officials indicated that one of the most important effects of HomeRebuilders was an unanticipated change in the role of the case managers from the city's Office of Case Management (OCM). Case managers played a more integral role in developing and monitoring service plans. They had lower caseloads, were allotted time to sit in on case reviews at the agencies, and were assigned to the cases served by one agency rather than cases that were served in different agencies. This involved a major realignment of cases for OCM, creating direct communication among public and private agency workers, so they were able to form good working relationships. In addition, HomeRebuilders created good checks and balances regarding early discharge, which was associated with reentry. The OCM staff had to approve discharges and HomeRebuilders held agencies accountable for reentry costs. Thus, unlike other programs, risks and benefits were carefully calibrated in HomeRebuilders.

This collaboration extended beyond the OCM office. In general, HomeRebuilders was viewed by both state and city people as a positive example of city-state collaboration. A high ranking city official said that this was one of the most collaborative ventures that the city and the state had ever had. This person said that this level of collaboration occurred because for the first time, state personnel approached the city as equal partners. Usually state officials approach city-state interactions solely in terms of the need to monitor the city's work. The private agencies also believed that for a time there was a close collaborative effort between the city and the state. It was positive for a while and there was a sense of "we are all in this together" for children and families.

All of the agency staff interviewed felt that the demonstration was cut midstream and that the city had not lived up to its commitment. The resulting low morale at several agencies was palpable. Some of the remaining caseworkers and administrators felt abandoned. Furthermore, some agencies expressed a lack of faith in promises made by the city and state. This, in part, may explain why some agencies have not kept components of the program, such as enhanced case planning, although the components were not dependent upon the fiscal aspects of the HomeRebuilders model. Although other training efforts continue at the agencies, little or no training continues on the HomeRebuilders model. Two administrators stated that the staff hired for the experimental group were greatly affected by the abrupt ending. The staff had been brought together for HomeRebuilders and then were reintegrated into the general structure of the agency. Workers in the experimental group felt disappointed and disillusioned. After making a commitment to learn and implement the HomeRebuilders philosophy, they were told the program was no longer being funded. This caused some staff to seriously question the philosophy, initial creation, and implementation of the project.

State officials unanimously stated that the program should not have been terminated early by the city. Some city officials shared this view. One city official who is no longer with ACS indicated that early termination occurred because another city official unrealistically thought that it would be possible to implement a managed care approach for the whole agency in 6 months.

Agency fiscal staff report several unresolved issues from HomeRebuilders. They include unpaid foster care reimbursement from the city and unpaid Medicaid per diem reimbursement from the DSS. Fiscal staff produced voluminous documentation required by the city to justify and reconcile payment for the three years of HomeRebuilders. All interviewed directors agreed that the payment issues continued to be burdensome for two years past the end of the program, with still some bills remaining in 1998. They all recommend that a new payment method is necessary if such a project is replicated.

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