How do states get there from here?
The fiscal reform initiatives described here often required complex system changes and resolution of major interorganizational issues. Reforming the fiscal structure does not automatically bring about changes in performance, efficiency, or cost. Those require fundamental changes in both people and organizations. When reforms are implemented, many forces are put into play, not all of which are under the control of policymakers. Organizations and individuals often seek adaptations to altered structures that result in minimizing changes. They seek to regain the previous equilibrium and revert to doing what they are accustomed to rather than really creating change. Success depends on the receptiveness and capacity of organizations and people to make the desired changes.
Privatization, team decisionmaking, outcome measurement, and organizational collaboration were the primary changes incorporated into the 23 initiatives. Each requires complicated change processes as relationships, roles, and responsibilities evolve. This process includes the following:
- Shifting service delivery from public agencies to private contractors requires that (1) public agency staff switch their role from delivering services to monitoring service delivery and (2) provider staff change their service delivery, funding mechanisms, and reporting requirements. Often different sets of staff skills are required, and retention may become a problem as staff decide that the change process is too difficult and move on to other jobs.
- Implementing collaborative or team decisionmaking about cases takes the responsibility away from individual caseworkers, who often are then expected to take on responsibility for case management and provider monitoring. Again, a different set of staff skills is required and a different “culture” for case decisionmaking is created. Sometimes staff turnover is required in order to bring in new staff who support the innovations.
- Switching from a system that measures processes and outputs to one that emphasizes outcomes represents a paradigm shift. It requires letting go of a preoccupation with prescribed processes and moving to a focus on achieving desired outcomes and results. It often requires changes in priorities and business procedures, including major redesigns of data collection systems. Initiatives that feature performance contracting in which payments are tied to outcomes most explicitly require this shift, but other types of initiatives also monitored outcomes and had expectations for performance and results. Although for several years a focus on outcomes has been expected(18), the actual operationalization has been inconsistent and is still in process.
- Bringing together a range of participating organizations to design and implement an initiative requires clear communication channels and mechanisms for negotiating disputes. Depending on the range of stakeholders involved in the initiative, there may be major philosophical differences to be resolved. This process can take a long time and require extensive negotiation. Collaboration is popular in social services today; it is thought to help in making the best use of available resources, leveraging an agency’s resources, and expanding the range of organizations concerned with child welfare--and working together is valued as a good thing to do. However, all parties must perceive benefits, give up some autonomy, and be willing to invest time and energy.
Community Ownership Paves the Way in Florida
Florida is implementing Community-Based Care (CBC) privatization initiatives throughout the state using a lead agency model to provide child welfare services. The Coalition for Children and Families in Sarasota County was the first to implement the model. A major goal was to build community ownership of child welfare services by having the community, rather than the state, decide what should be done. The Coalition’s belief that families have more trust in services that are provided by community agencies is bringing positive results: nearly 400 citizens, business people, and volunteers across Sarasota County are involved in a community coalition that seeks solutions to child maltreatment. Achieving such extensive involvement was a major challenge — dealing with multiple agendas and stakeholders required ongoing negotiation, mutual respect, and strong leadership at every level.
State and federal involvement can support the necessary change processes by providing training and technical assistance, disseminating written products, allowing sufficient start-up funds (including funds for MIS development and implementation), adopting realistic implementation schedules, and convening forums to discuss emerging issues and needed policy decisions. This support will help the child welfare system of the future evolve in ways that correct current inadequacies and benefit children and families.