State Innovations in Child Welfare Financing. Monitoring Mechanisms

04/01/2002

Many state administrators seem to expect that the reduced role in case decisionmaking will allow state agencies to focus more of their energies on ensuring child well-being through more rigorous monitoring processes. Many of the states retain traditional modes of accountability, including monthly reports to contract monitors or quarterly case review meetings. Some contractor supervisors have noted that the monitoring mechanisms impose another level of bureaucratic paperwork on their workers. In one state, a contractor complained that the state monitors focused on items like staffing patterns and turning case plans in on time instead of whether the child was safe.

In spite of these enduring processes and the complaints that go with them, new monitoring mechanisms have been devised by some of the states, although little is conclusively known about the effectiveness of the various monitoring systems. The two most prominent features of these systems are collaborative reviews and the integration of management information systems. As noted earlier in regard to the pre-authorization process, collaboration between state and contractor has become quite common in both case decisionmaking and performance monitoring. In Massachusetts, for example, there are several sets of meetings to discuss case issues. There is a weekly meeting between core team members to discuss current case issues. Then every 6 weeks, all of the relevant staff and the family review case plans and goals. The contractor is responsible for monitoring the specific aspects of the case such as level of involvement and the use of community resources.

Privatization in Baltimore

Privatization of child welfare is viewed as a threat by many public child welfare workers, who fear their jobs will be abolished or at least extensively changed. In Baltimore, 500 cases were privatized through the Baltimore Child Welfare Managed Care Project, and no public agency layoffs were needed. Instead, vacant positions were eliminated, turnover was not replaced, and some staff were reassigned to areas more suited to their skills and areas of expertise. There actually may be more need for caseworkers under privatization, if caseworker/client ratios improve – for example, the caseworker/client ratio in Baltimore’s public agency is 1/20 while the contractor maintains a ratio of 1/16. However, this may not reassure caseworkers who are unwilling or unable to leave public employment for private.

Another variation on collaborative monitoring was established in Maryland, which has two committees to review program progress. The Managed Care Committee looks at global program issues and includes staff from Baltimore City’s child welfare staff, state child welfare workers, lawyers from the state attorney general’s office and Baltimore City, as well as the evaluators. The Partners Committee meets regularly to review case plans and other details of service provision. This committee consists of city and state child welfare workers plus staff from the lead agency.

Some states have contract monitors that work with the contractors on an ongoing basis. For example, in Wisconsin there are two types of program evaluation monitors--one examines service provision, and the other looks at the fiscal component of the program. There is a formal quarterly review for each aspect of the program where they discuss program quality, patterns of expenditures, and permanency plans.

Another feature of some of these programs, as in Arizona, New York, and Ohio, is the greater importance given to management information systems for case decisionmaking and contractor monitoring and accountability. Our information is tentative, but some administrators indicated a frustration that current information systems did not put useful information in the hands of the workers. Sometimes the system is difficult to access, other times the data are not broken down in such a way as to guide decisionmaking in immediate case situations. New York’s initiative probably has the most highly developed data system; it incorporates a unique interactive system that allows the public agency to tie agency reimbursement to the outcomes for children.

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