State Innovations in Child Welfare Financing. Performance and Outcome Measures

04/01/2002

Perhaps the most important change is in what gets monitored. In many traditional child welfare programs, monitoring mechanisms focused on process issues, i.e., were certain tasks performed (evaluations, number of visits and therapy sessions, etc.)? The new initiatives are part of a broader trend in child welfare that seeks to follow client outcomes instead of process. Performance contracting is the most direct example of this, but outcome measurement is integrated into almost every initiative. However, despite this shift in emphasis toward outcome measurement, no state has thus far completely abandoned process measures because of the continuing state responsibility to ensure quality services.

Information Flow Helps Accountability in Kansas

In 1997, Kansas initiated its comprehensive privatization program that divided the state into four regions and established private agencies as the main provider of services for each region. These agencies had the freedom to provide services as they saw fit, and they received case rate payments. One agency used the flexibility to revamp its management information system and to devise extensive post-permanency services. The management information system compiles data on a daily, weekly, and monthly basis. Each division of the agency has clearly defined goals and there is a monthly meeting to see if each unit’s goal for the month is achieved. If not, there is a brainstorming session to determine what needs to be changed so that the goals are reached. With this increased flow of information, there is now more accountability within the agency. The emphasis on post-reunification services has kept the rate of disrupted adoptions at around 2 percent, much lower than average. There is a strong financial incentive for the agency to keep the disruption rates low because the agency is responsible for servicing the case without receiving further state funds if the child re-enters the child welfare system within 2 years.

Specific outcome measures used by the states vary according to the target population served by the initiative. Initiatives that work with the general child welfare population have outcome measures such as the numbers of adoptions, children returned home without re-entering the system, and at-risk children safely maintained in their own homes. Programs that work with children with high-end needs have outcome measures that focus on placing the child in the least restrictive setting (including returning the child home).

Both state administrators and contractors indicated that this shift toward outcome measurement has been a positive step but that the process has been uneven. Some administrators noted that this has caused temporary difficulties for state personnel. As one administrator observed:

It’s been hard to get the monitoring staff around the state to look at things differently than how they’re used to. They’re used to just checking off on a list whether or not a provider did a service. Now they have to look at the providers’ work; did they do a good job? And they may need to interview kids, caseworkers, and parents. It’s a different mindset.

In addition to the changes in the mindset of workers, there has been a real revision in the responsibilities of state agency caseworkers. Another administrator noted that it is difficult for some caseworkers to relinquish the actual case decisionmaking authority in favor of a strictly monitoring relationship.

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