State Innovations in Child Welfare Financing. Connecticut: Continuum of Care


Connecticut implemented the Continuum of Care pilot project in 1999 to reduce the entry and length of stay of children in residential treatment facilities. The state contracts with two lead service agencies (LSAs), one each in the North Central and South Central regions, to develop a network of providers and coordinate community-based services for children assigned to the program. The program targets children between the ages of seven and fifteen who are referred to the state’s central placement team for residential treatment. Overall, the program can serve a maximum of 70 children.

Cases are referred from the two state regional offices to the central placement team for review. Based on a review of information pertaining to the child’s functioning, the placement team determines whether the child is eligible for the program. Aside from determining that the child’s acuity level is high enough to warrant treatment in a residential facility, the placement team does not recommend specific service plans. Eligible children are randomly assigned to residential treatment or one of the two LSAs.

LSAs are paid a case rate based on the average annual cost of in-state residential treatment. The case rate, $5000, is intended to cover all administrative, case management, and service costs for 15 months. LSAs receive payment in four installments -- at case assignment, 50 days, 180 days, and discharge. Payments may be withheld if a case review determines that the treatment plan, services being provided, or progress toward goals are unsatisfactory. Providers are also required to maintain invoices that are audited by the state’s independent evaluator. To discourage providers from under-serving children and families, LSAs are required to use 90 percent of the case rate, and any unexpended funds are returned to the state.

Within two weeks of receiving a referral, the LSA meets with the family and other service providers to assess the child and develop a treatment plan. LSAs may use the case rate flexibly to deliver, or purchase from other providers, a range of services needed to maintain children in community settings. Ideally, children will be returned to their communities prior to the end of the 15 months so that after care can be provided in the last several months of the treatment period. The decision to close a case is made jointly between the state and the LSA.

An independent consultant is evaluating the pilot project. The evaluators are monitoring both program processes and outcomes including child and family well-being, child functioning, education, safety, health, caseload size, number of client contacts, and costs.

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