The “scope” of an initiative refers to the proportion of children and families in a state that are covered by the initiative and is defined by both the geographic area and the populations served. An initiative may be implemented in a small, defined area or the entire state. It may serve a subgroup of the child welfare population, such as children in traditional foster care only, or the entire child welfare population.
The initiatives investigated represented a variety of approaches, from small, contained projects that either stayed small (such as Kentucky’s initiative) or eventually expanded (Illinois, Tennessee), to projects covering, nearly from the onset, most (Massachusetts) or all (Kansas) of the statewide child welfare caseload. Several of the initiatives covered most or all of the state geographically but included a smaller proportion of the child welfare caseload (Arizona, Georgia, Oklahoma).6 In Florida, a statewide fiscal reform is being implemented district by district, so it currently covers only part of the state but will target the entire child welfare caseload when fully implemented. In Missouri, the initiative is limited both to a narrower segment of the child welfare caseload and to a smaller area of the state. County-administered states such as California, Colorado, Minnesota, and Pennsylvania had county-designed and county-implemented projects that varied considerably in terms of populations and services covered. Some initiatives were designed for urban areas with large proportions of the states’ child welfare caseloads and specific system characteristics or needs (Baltimore, Detroit, Milwaukee, New York City). Title IV-E waiver demonstrations were implemented in limited areas of the states and/or targeted narrower segments of the child welfare population due to their waiver designs and the experimental nature of the demonstrations (California, Connecticut, Maryland, Michigan, Ohio, and Washington).
|Initiative||Geographic Coverage||Objectives||Year Implemented||Structural Model||Target Population||Caseload|
|Most of the state||Provide voluntary services for families previously unserved||1998||Lead agency||Low-risk and potential-risk families with reports||6000 referrals/year, 1900 family assessments, 1600 families receive services|
Project Destiny (W)
|Alameda County||Reduce length of stay in care, divert SED placement in residential facilities, serve children in the least restrictive environment||1997||Lead agency||SED children; those most at risk of placement in high level group homes||90 children enrolled at time of interview; budgeted capacity of 256 over entire waiver period|
Boulder County Managed Care Pilot Project
|Boulder County||Gain flexibility to enhance interagency partnerships and provide services in the community||1997||Public agency||Adolescents 12-18 in need of or at-risk of needing residential services||500 youth|
Continuum of Care (W)
|North Central and South Central regions of the state||Reduce length of time in care, develop a localized network of services, improve outcomes by establishing flexible incentive-oriented environment||1999||Lead agency||Children ages 7-15 with severe behavioral, mental health, or educational problems||Maximum of 70 children|
Coalition for Children and Familiesa/
|District 8 (Sarasota)||Provide services efficiently and effectively through community partnerships||1997||Lead agency||All children with founded neglect or abuse reports, regardless of whether in-home or out-of-home||1650 children|
Metropolitan Atlanta Alliance for Children (MAAC)
|Atlanta area||Place children in the best long-term and least-restrictive settings in a system that moves children out of high levels of care quickly and efficiently||1998||Managed care organization||Children needing residential care who are not eligible for Project Match||40 children|
|Statewide||Ensure more efficient use of limited resources, improve outcomes, control costs, increase permanency||1998 (across state)||Public agency||All children in relative, traditional, and specialized foster care||35,000 children and their families|
Public Private Partnerships
|Statewide||Improve client outcomes, increase permanency, better protect children at risk||1997 (total population)||Lead agency||All children in state custody and at risk of entering custody||3000 families|
|Jefferson County||Decrease length of stay in care, improve outcomes, improve quality of services, provide individualized care||2000||Lead agency||Adolescent girls in residential placement, children transitioning home, children entering care and in need of intensive services||30 children|
Baltimore Child Welfare Managed Care Project (W)
|Baltimore City||Reduce congregate care and enhance permanency for children ages 0-5; decrease length of stay and recidivism for children in care||2000||Lead agency||Children ages 0-5 in out-of-home care and siblings; newly dispositioned children of any age and siblings; kinship conversions and siblings in care||500 children|
|Statewide||Implement a collaborative, community-based approach utilizing state resources and maximizing the use of other resources||2000||Managed care organization/
|Primarily, children at risk of placement and their families; some children in care||3300 families|
Michigan Families (W)
|St. Clair, Monroe, Livingston, Van Buren, Jackson, and Newaygo Counties||Find innovative ways to serve and improve outcomes for children without necessarily putting them in foster care||1999||Lead agency||Children in out-of-home care or at risk of being placed||190 children|
Permanency Focused Reimbursement System
|Wayne County||Keep children out of residential facilities, provide as many services as possible in the community, allow flexibility in treatment approaches||1997||Lead agency||Children in care||4000 children|
PACT 4 Families Collaborative
|Four rural counties in western MN (Kandiyohi, Meeker, Renville, Yellow Medicine)||Ensure that children receive needed services, including mental health, and provide early intervention||1995||Lead agency||Children ages 0-21 and their families||NA|
Interdepartmental Initiative for Children with Severe Needs.
|Urban eastern region and rural central region||Provide better coordination of services to reduce barriers, enhance effectiveness and efficiency, and prevent children from falling through the cracks||1999||Managed care organization/
administrative services organization
|Children ages 4-18 in or at risk of long-term residential placement and with serious behavioral health needs as measured by a standardized instrument||250 children|
Safe and Timely Adoptions and Reunifications (STAR)
|New York City||Enhance permanency outcomes by providing flexible dollars based on agencies’ improvement in outcomes||2000||Public agency||All children already in care||40 out of 44 providers participate|
|Franklin County||Use performance bonuses and managed care to reduce length of stay in care and increase flexibility of services||1999||Public agency/lead agency||All children and families with reports||Performance bonuses (public agency): 5100 children; managed care (contractors): 1200 children|
Oklahoma Children’s Services
|Statewide||Keep families together, bring about reunification quickly, prevent disruption of placement||1992 (across state)||Lead agency||Children at home and at risk of placement; children in care working toward reunification||2000 families|
|Berks County||Develop an efficient public-private partnership model using a network of local agencies to provide services||1997 (ceased in 2000)||Lead agency||Any family with at least one child in the child welfare system||24 families|
Continuum of Care
|Statewide||Provide services in the least restrictive and lower cost settings, as well as reduce length of stay and recidivism||1995||Lead agency||Children in state custody who require a level of care higher than regular foster care||4400 children|
Permanency Achieved Through Coordinated Efforts (PACE) (W)b/ (C)
|10-county area around Fort Worth||Improve outcomes, ensure efficient use of limited resources, decrease lengths of stay, provide coordinated services||1999 (ceased in 2001)||Lead agency||Children needing a level of care higher than regular foster care||600 children at its peak|
IV-E Waiver Demonstration (W) (C)
|Spokane County||Ensure placement in the least restrictive setting, decrease length of stay, improve permanency outcomes||2000 (operated 6 months)||Lead agency||Children ages 8-17 likely to enter high-cost care with a DSM diagnosis and with mental health or special education needs||30 children at its peak (50 overall)|
Bureau of Milwaukee Child Welfare
|Milwaukee County||Reform the child welfare system in Milwaukee County (the State took over the county's system)||1998||Managed care organization||All children in the county who are identified as at-risk of abuse or neglect, and all children in out-of-home care||Ongoing Case Management (children in out-of-home care): 6000 children; Safety Services: 200 children; Wrap-around: 1000 children|
|a/ Florida was granted a title IV-E waiver for its privatization initiative, but the waiver was never implemented.
b/ PACE began under a title IV-E waiver, then it was withdrawn from the waiver in 2000.
Missouri Changes Mindsets About Children in
In the belief that many youth stay in residential treatment too long and could safely go or stay home with appropriate services, Missouri implemented a comprehensive care management initiative for children with behavioral needs and their families. The initiative integrates funding from state social services, mental health, health, and education agencies. It provides coordination of services and funding to keep children and youth from falling through the cracks. One challenge has been changing the mindset of how to serve children with severe needs. As one program administrator said, “Some just don’t believe you can move these kids out. But how much of these kids’ behavior in residential treatment is just in response to being in residential treatment?” The state hopes to change this viewpoint and use residential placement only for brief periods when a child needs to be stabilized.
Federal court orders or state legislation requiring changes in child welfare systems often prompted initiatives targeting a large proportion of the child welfare population. A court order or legislative mandate ensured that funds were appropriated to implement the changes. The earliest of these was in Oklahoma, where an initiative was designed in response to a consent decree involving adolescents in state custody. Kansas’s initiative was implemented as a result of a lawsuit regarding timely service provision as well as pressure from the governor and legislature to privatize services. In Florida, legislation requiring districts to contract with lead agencies for child welfare services was passed in a general climate of reducing government and providing more services at the local level. The initiative in Wisconsin was the result of a court order and a legislative change in which the state, previously entirely county administered, took over child welfare in Milwaukee County. In Berks County, Pennsylvania, the growing complexity of regulations and standards, as well as anticipation of state imposition of managed care requirements, prompted child welfare service providers to develop a local managed care pilot.
In several states (Arizona, Illinois, Kansas, Maryland, and Oklahoma), the initiatives started out as limited pilot projects. All but one have become permanent and expanded beyond the original geographic area to the entire state (although not the entire child welfare caseload, except for Kansas). The exception is the managed care initiative in Baltimore (a title IV-E waiver demonstration). The state plans to carefully examine indicators of service quality to assess its success before deciding about making the project permanent.