Transcript Slide 1

Performance Contracting in Illinois Child Welfare
Using Leverage to Drive Results
June 6, 2006
Michael Shaver, Senior Consultant
Chicago Center for Child Welfare Strategies
Month, Year
The Results
 Increases in permanency through adoption
 Increases in permanency through subsidized
guardianship
 Reductions in the substitute care population
The Permanency Explosion
7000
14%
6000
12%
5000
10%
4000
8%
3000
6%
2000
4%
1000
2%
0
0%
FY93
FY94
FY95
FY96
FY97
FY98
FY99
FY00
FY01
% of In Care Adopted (Red Line)
Adoption Numbers (Blue Bars)
Cook County’s Record on Adoptions
Numbers
% of In Care
Cook County’s Record on Re-entries
Of all adoptions and reunifications achieved, what percentage
ruptured within 12 months of placement?
250
14%
10%
150
8%
6%
100
4%
Full year
not yet
observed
50
0
2%
0%
FY93
FY94
FY95
FY96
FY97
FY98
FY99
FY00
FY01
% of Permanencies
(Red Line)
Rentry Numbers (Blue Bars)
12%
200
Adoption ruptures
Reunification ruptures
% of Permanencies
The Drop in Substitute Care
Using Contracts to Drive Performance
The Keys
• Performance goals should be
linked to larger system
objectives
• Move beyond accountability
• Outcomes and provider
incentives are aligned
• The benefits of performing
and the consequences for not
performing should be selfenforcing
Performance goals should be linked to larger
system objectives
Rightsizing the Illinois child welfare system
The Growth in Substitute Care
Key Factors
• High profile media cases
• Kinship care policy
State of Illinois
SubstituteCare
CareCaseload
Caseload
Substitute
Fiscal Foster Inst/Grp
Year
Care
Home
88
13,819
1,745
89
15,711
1,908
90
17,505
2,072
91
20,480
2,361
92
25,961
2,803
93
29,825
3,263
94
36,572
4,259
95
42,819
4,854
96
45,346
4,692
97
46,489
4,238
98
42,165
3,947
99
34,164
3,781
00
27,229
3,438
01
23,394
3,226
02
20,338
2,897
03proj. 19,048
2,717
50,000
Foster Care Panic
Cost
$497 million
40,000
30,000
20,000
10,000
88
89
90
91
92
93
94
95
96
97
98
Fiscal Year
Inst. & Group Homes
Foster Care
99
00
01
02
03proj.
Inst./ Group Homes includes:
Institutions
Group Homes
Independent Living
Changes in the substitute care population due to;
* increased adoptions
* the federal guardianship waiver
* improved front-end protocols
have moved Illinois from the highest user of out of home care to one that is closer to the national median.
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Total
Csld.
15,564
17,619
19,577
22,841
28,764
33,088
40,831
47,673
50,038
50,727
46,112
37,945
30,667
26,620
23,235
21,765
ERR
The Impact of Uncontrolled Growth
Challenges
• Runaway budget
• Loss of public trust
• Rapid privatization
• Pressures at every level of the
system
Moving beyond accountability
When acceptable performance is not enough.
Aligning Outcomes and Provider Incentives
Like everyone else, service providers tend to act
in their own interest.
Contract consequences should be self-enforcing
Closing the gap between intention and action.
Engaging Providers
What to
bring
•Data, data and more data
•An appreciation for the systemic
barriers to improved
performance
•A willingness to realign
resources for better performance
•Decision making authority
Challenges in designing the contract
Objectives
•Reduce the number of children
in substitute care through
improved permanency
•Reduce the movement of
children to more costly
placements through increased
stability
•Align performance incentives
with desired outcomes
Challenges in designing the contract
Barriers
•
•
•
•
•
•
•
Contract and financing
emphasized process over results
Caseloads too high
Adoption contract structure
Resources for reunifying families
Access to counseling resources
Case referral process
Recruitment resources
Using the contract to drive results
Priorities
•
•
•
•
Focus on results, not process
Exchange flexibility for outcomes
Fund enhancements through
reallocation and improved
performance
Shift the risk of failing to perform
from the state to the provider,
ensuring budget neutrality
Contract Structure
Shift focus from:
Static to dynamic
Process to outcomes
Cook Relative Care
Entries
BARC
8 intake
(32%)
(caseload)
25 cases
Exits
6 permanencies (24%)
2 non-permanencies (8%)
(total=32%)
Contract Structure
Shift focus from:
Static to dynamic
Process to outcomes
Cook Regular Care
Entries
BAT
9 intake
(40%)
(caseload)
22.5 cases
Exits
5.5 permanencies (24%)
3.5 non-permanencies (16%)
(total=40%)
Home of Relative (HMR) Trend: Cook County
End-of-Quarter (EOQ) Caseload, Entries and Exits
25
EOQ
Caseload
Entries
5
Perf. Contract
Announced
HMR Reform
4
15
Waiver
3
10
2
5
1
Exits track entries
Mar-00
Jun-99
Sep-98
Dec-97
Mar-97
Jun-96
Sep-95
Dec-94
Mar-94
Jun-93
Sep-92
Dec-91
Mar-91
0
Jun-90
0
Sep-89
Thousands
Exits
Thousands
20
6
Regular Foster Care (RFC) Trend: Cook County
End-of-Quarter (EOQ) Caseload, Entries and Exits
8
3
7
EOQ Caseload
Entries
HMR Reform
Exits
RFC
Perf. Contract
Implemented
Waiver
4
3
1
2
1
Mar-00
Jun-99
Sep-98
Dec-97
Mar-97
Jun-96
Sep-95
Dec-94
Mar-94
Jun-93
Sep-92
Dec-91
Mar-91
0
Jun-90
0
Sep-89
Thousands
5
2
Thousands
6
State of Illinois
Substitute Care vs. Adoption/Guardianship Cases
FY90 - FY03
60,000
50,000
Fiscal
Year
90
91
92
93
94
95
96
97
98
99
00
01
02
03est.
40,000
30,000
20,000
10,000
0
90
91
92
93
94
95
96
97
98
99
00
01
02
Sub. Care Adop/Guard
Cases
Cases
19,577
4,697
22,841
5,037
28,764
5,239
33,088
5,926
40,831
7,011
47,673
8,174
50,038
9,736
50,735
11,539
46,125
17,160
37,945
25,709
30,667
32,489
26,620
36,156
23,235
38,816
21,765
41,470
03est.
Fiscal Y ear
Adoption Assistance and Subsidized Guardianship Cases
Substitute Care Population
In late FY2000 the number of children in state supported Adoption and Guardianship
settings exceeded the number of children in substitute care placements.
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For more information
Chicago Center for Child
Welfare Strategies
901 West Jackson, 5th Floor
Chicago, Illinois
Michael Shaver
[email protected]
773-213-1113
THE YOUTH CAMPUS