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Date: Friday, December 19, 1997 FACT SHEET Contact: ACF Press Office (202) 401-9215
HHS has approved demonstration projects in the following 10 states: California, Delaware, Illinois, Indiana, Maryland, Michigan, New York, North Carolina, Ohio and Oregon. The projects, which must be cost neutral with regard to federal funds, will last for no more than five years and will include a third-party evaluation.
As part of the new Adoption and Safe Families Act signed into law by President Clinton on November 19, 1997, HHS has new authority to offer up to 10 additional states waivers for innovative demonstrations each year.
BACKGROUND
Recent studies have shown a dramatic increase in the rise of child abuse and neglect, adding pressure to state child protective systems. The Third National Incidence Study (NIS) of Child Abuse and Neglect estimates that child abuse and neglect nearly doubled in the United States between 1986 and 1993. The report estimates that the number of abused and neglected children grew from 1.4 million in 1986, when the last NIS report was conducted, to over 2.8 million in 1993. During the same period, the number of children who were seriously injured quadrupled from about 143,000 to nearly 570,000.
At the same time, across the country, states have experienced a tremendous growth in the number of children in foster care. The national foster care caseload grew from 340,000 cases in 1988 to 460,000 cases in 1996, an increase of 40 percent. The cost of the foster care program, both in maintenance payments and administrative costs, has grown from $800 million in 1988 to $3.7 billion in 1996, an increase of 462 percent in federal expenditures. The rise of children in protective care has been attributed to family breakdown and drug use, among other factors.
STATE INNOVATIONS
Under the demonstrations, states are testing several model initiatives. For example, federal funds that previously were used primarily to pay for the room and board of children in out-of-home care are now being used for intensive early intervention services that could help prevent children from being placed in foster care in the first place. In addition, some of these states are using managed care principles of cost efficiency and incentives to counties to improve the management of local services. Successful counties will be able to reinvest savings into improved family services. One state is also using federal funds to provide substance abuse services for parents of children in the child welfare system to help them become better parents and providers. Another state is directing services to adolescent youths who are either at risk of or have been through the juvenile justice system.
Descriptions of the state demonstrations approved to date follow:
California
Under its demonstration, California will implement three programs: the Kinship Permanence program, the Intensive Services program and the Extended Voluntary Placement program. Each program will test a different strategy for protecting children and providing a secure and stable home.
The Kinship Permanence program, beginning in four to 10 counties, will place adolescents with relatives in a guardianship arrangement. The program intends to provide an alternative long-term, stable, permanent placement for children.
To minimize the need to remove children from their homes, the Intensive Services Program will provide individualized services to children and families. This program, to be implemented initially in as many as 12 counties (and affecting as many as 1,665 cases), will ensure that the child's and family's basic needs, such as a place to live and a family or surrogate family, are met, along with other social, recreational, educational, vocational and medical needs.
The Extended Voluntary Placement program, limited to 10 counties in the first year, will keep children in placements for up to 12 months in the hope that more children will be able to return home rather than be declared dependent and placed in out-of-home care.
California's demonstration was approved on August 19, 1997.
Delaware
Delaware will use federal foster care funds for assisted guardianship placements for children who cannot be reunited with their parents. The guardianship project provides a much-needed placement option for children in foster care, many of whom are already in the care of relatives. The state will also use federal funds to provide substance abuse treatment for parents, in order to reduce the need for placing children in foster care. The goal of Delaware's innovative projects is to encourage and strengthen the child's immediate and extended family in order to provide a stable home.
Delaware's demonstration was approved on June 17, 1996.
Illinois
The demonstration creates a subsidized guardianship option for children who have been in foster care for at least two years, have been in their current home for at least one year, and for whom adoption or reunification with parents within one year is unlikely. This option will give increased autonomy to guardians while continuing to provide sound social service and financial support to caregivers. Guardianships will be established by a court order.
By assigning guardianship to caregivers, many of whom are relatives, both children and caregivers will benefit. Under guardianship, children are discharged from the care and custody of the state, and guardians gain the right of family privacy to make major decisions about the care, education, and medical treatment of children without the necessity of terminating parental rights. Guardians and children will also receive a financial subsidy as well as supportive services they need to maintain permanent placement.
The emphasis on relatives as foster parents addresses the chronic shortage of licensed foster homes, particularly in large urban centers. It also reflects the knowledge that placement with relatives eases separation trauma and helps preserve cultural and community ties. By creating formal, subsidized guardianship arrangements, Illinois will test its hypothesis that such placements will improve service delivery and enhance permanency planning for children and families.
Illinois's demonstration was approved on Sept. 18, 1996.
Indiana
Indiana is using this waiver to design its child protection and child welfare systems in a way that will better ensure the safety of children in troubled families, offer preventive services that will intervene early to better address the needs of families at risk, and improve the efficiency and effectiveness of child welfare services.
In order to meet the need to place children, for whom family settings were not appropriate, Indiana has placed children in institutional facilities, some of which are out-of-state. The state expects that the demonstration will increase its capacity for community-based placements of children which will be more appropriate for the children's needs. The demonstration invests in recruitment, training and support of family foster care providers. Community-based placement is expected to reduce the current costs of care as well as family disruption, and in some cases prevent removal from the home, where it is safe for children to remain.
The state will track and measure three child welfare outcomes: family stability, family safety, and child development. The project will focus on improving outcomes for children and families and the efficacy with which services are provided; and at the same time, maintain the safety of the children as the primary concern. The demonstration will allow the state to expand Title IV-E eligibility and services to children and families not now eligible for Title IV-E funds and programs. Previously, these funds could be used primarily to pay for the room and board of eligible children in out-of-home care.
Four thousand children will be covered by this demonstration project. The state will provide appropriate protections for the children, ensure reasonable efforts to prevent placement in out-of-home care or to reunify the family, and make the most appropriate, least restrictive placement possible. A full range of health and mental health care services under the Medicaid program as well as appropriate case management services will be available to the children participating in the demonstration.
Indiana's demonstration was approved on July 18, 1997.
Maryland
Maryland's program demonstrates the use of subsidized guardianship arrangements, with an emphasis on kinship care for children who have been in foster care for six months or more and in the current home for at least that long. The children must meet criteria which indicate that neither return to the parent(s) nor adoption is likely. Each guardianship will be established by court order. The emphasis on relatives as foster parents is intended to address the chronic shortage of licensed foster homes, particularly in large urban centers. It also reflects the knowledge that placement with relatives eases separation trauma.
By providing financial incentives for foster caregivers to become private guardians, Maryland hopes to encourage permanence for children in foster care, reduce the time children spend in long-term foster care, reduce the number of disrupted placements, and produce more positive outcomes for children and families. By creating formal, subsidized guardianship arrangements, Maryland expects that such placements will improve service delivery and enhance permanency for children and families.
Maryland will use federal funds to support the care of children in private guardianship. Previously, these funds could be used primarily to pay for the room and board of children in foster care only.
Maryland's demonstration was approved on April 17, 1997.
Michigan
Michigan's demonstration has two components. The Michigan Intensive Family Preservation Initiative will support a range of services intended to strengthen and assist families. Participating counties will receive a fixed amount of child welfare funds, and have authority to use the funds in ways that best meet the specific needs of individual families. Counties can design their child protection and child welfare systems in ways that better ensure the safety of children and improve the efficiency and effectiveness of child welfare services. Services may include child care, home visiting, family planning, home management, parent education, respite care, transportation, job training, educational, and other forms of assistance. Counties that achieve savings will be able to reinvest in additional services. The waiver is for four years.
A second component, to be implemented initially in Wayne County (Detroit), will provide better services for adolescents who are in the child welfare system and have been or are in danger of being adjudicated delinquent. The Community Services for Delinquent Youth component requires each child to have a plan that identifies the needs of both the child and the family, sets clear goals for the child, and describes the services and treatments needed to meet those needs and goals. A broad range of child welfare services will be available, including family preservation, substance abuse treatment, family foster care, residential treatment, reunification, and independent living services. This waiver is for five years.
Michigan's demonstration was approved on Dec. 19, 1997.
New York
Under New York's waiver, participating counties will receive a fixed amount of federal funds under Title IV-E of the Social Security Act, and have greater flexibility in using them. Counties can design their child protection and child welfare systems in ways that best ensure the safety of children and improve the efficiency and effectiveness of child welfare services. Services may include child care, home visiting, family planning, home management, parent education, respite care, transportation, job training, educational, and other forms of assistance. Counties that achieve savings will be able to reinvest in additional services. State officials have worked closely with New York City child welfare officials to assure that this demonstration project will support the child welfare reforms already underway there.
New York's demonstration was approved on Dec. 19, 1997.
North Carolina
Under the demonstration, North Carolina can use Title IV-E foster care funds to provide a broad range of new services to children and families. Funds can be used for services that can prevent the need for placement of children in foster care or to relieve the problems that caused the child to be removed from the home.
North Carolina's project consists of two parts. In part one, the state will change foster care financing to create incentives for participating county agencies to improve performance, making North Carolina the first state to use performance bonuses as part of a child welfare waiver. When a participating county achieves savings through better management or better service delivery (including reducing the number of children in foster care; how long they stay there; and increasing the number of children diverted from foster care through kinship placement with relatives) they will retain the value of the savings and reinvest them in child welfare services and prevention. For example, this bonus can be used for intensive family preservation and reunification services, respite care, family mediation, court-approved assisted guardianship, and post-placement support.
In the second part, participating counties will use federal Title IV-E maintenance funds to develop effective strategies for preventing out-of-home placement of children without jeopardizing their safety. County departments of social services will be encouraged to shift expenditures away from foster care maintenance to prevention, returning children to their families, and adoption. Emphasis will be placed on kinship ties when making decisions on long-term placement of children.
In as many as five counties, additional funding flexibility will be combined with a Kellogg Foundation initiative, "Families for Kids" which is designed to reform the non-financial aspects of the foster care system, such as policy formulation, legal process, communications infrastructure, and advocacy.
North Carolina's demonstration was approved on Nov. 14, 1996.
Ohio
Ohio is the first managed care demonstration project to improve child welfare services. In this unprecedented managed care approach, federal and state foster care and administrative funds will be combined with county funds into a fixed amount for each participating county. With this fixed amount, counties will provide all the services needed by children and families in their child welfare system. Counties will have the financial and regulatory flexibility to develop new program approaches and incentives in order to improve performance and reduce costs. As the counties insure the protection of children and services for families with fewer funds spent for foster care, the county will be able to re-invest savings in other child welfare services. The counties will focus on early intervention efforts with families to prevent child abuse or neglect. Other services could include intensive case management, respite care, parenting skills development and family counseling.
Under the demonstration, the state will use Title IV-E foster care funds for these services. Previously, these funds could be used primarily to pay for the room and board of children in out-of-home care. Ohio will also use funds currently invested in out-of-home care to develop community based services which will keep children safe and help families resolve problems. The goal is to help families earlier and to better manage costs.
Ohio's demonstration was approved on February 14, 1997.
Oregon
Under the demonstration, Oregon will use Title IV-E foster care funds to provide a broad range of services to children and families at risk. Oregon is testing whether flexible funding and a new casework approach, called "System of Care," will allow caseworkers to more closely match services to needs, and to serve more children safely in their homes rather than placing them in foster care.
Services will be tailored specifically for each family's needs, and will include child protection, crisis intervention, and support services to allow children to stay safely in their homes. Building on family strengths, the project will seek to maximize extended family and community resources. Social workers and the family will cooperatively develop a plan to keep the child safe, and the state will provide services to support the plan. Such services could include substance abuse treatment, domestic violence counseling and respite care.
Oregon's demonstration was approved on Nov. 22, 1996.