If you look back over the past decade, the use of residential facilities to house children in the child welfare system has dropped continuously. In 2013, there were 402,378 children in the child welfare system – this is a 22% decrease from 2004, when there were 517,000 children in the child welfare system. In 2004, roughly 8% of children in out-of-home placements were in group homes, 10% were in institutions, 24% were in relative foster homes, and 46% were in non-relative foster homes. In 2013, roughly 6% of children in out-of-home placements were in group homes, 8% were in institutions, 28% were in relative foster homes, and 47% were in non-relative foster homes (see Foster Care Statistics 2013).
This change has been due to the continued focus on keeping children with their families, the increased use of kinship care models, and the use of enhanced foster care models. There have been a number of policy and advocacy organizations that have supported this move – see National Resource Center for Family-Centered Practice & Permanency Planning – Kinship Care, Supporting Kinship Care:Towards A New Practice Framework, and Congregate Care Placements Average 14% For U.S. Children In State Custody.
The most recent example of this evolution in the child welfare field is in California. The California Department of Social Services is planning to implement a “continuum of care” reform initiative for foster care that will eliminate lower level group homes and put restrictions on the use of out-of-state placements.
Currently, Assembly Bill 403: Foster Youth: Continuum of Care Reform, is making its way through the state legislature, and would establish a core practice model to govern all services, whether delivered by a county or licensed provider organization, to create consistency and continuity of care. It also ensures that medically necessary mental health services will be made available to children and youth in foster care, regardless of their placement setting (see California Launching “Continuum Of Care” Reform Initiative For Foster Care). The bill has the following provisions to create the Continuum of Care Reform (CCR) initiative:
- CCR will establish a core practice model that requires that service delivery is orchestrated through a Child and Family Team (CFT) process. The CFT will conduct an assessment of the child’s safety, permanency, and well-being to determine what services are needed. The CFT will then create a plan that outlines the most appropriate family-based or placement setting, the services and supports needed to achieve permanency, and treatments and therapies needed for the child to achieve well-being. The plan will include performance measures to increase accountability for provider organizations.
- All services and placement decisions will be based on a comprehensive, trauma-informed Assessment Process. The needs of the child or youth will determine services and placement; not costs, available space, social worker preferences, or probation officer preferences.
- The CCR will remove barriers for serving children/youth in licensed, certified, adoptive, kinship, and non-related extended family members families.
- Access to mental health services will be standardized across each county; children and youth will not need to be placed in a certain type of program in order to receive necessary services.
What does all that mean for provider organizations? This is the perspective of my colleague and OPEN MINDS Senior Associate, Howard Shiffman:
I believe the phrase that will define the residential market in the future is, “a small percentage of children.” Only a small percentage of children will be placed in residential care and only for the purpose of either crisis stabilization or to get them prepared for treatment in a community setting. These realities must be recognized and understood by the executives of child serving organizations.
Why is this happening? Payers recognize the high cost of group care and are moving toward utilizing treatment foster care and providers that offer lower cost community-based services. This is happening because the analytics are now available that show outcomes are comparable. Right now, kinship care is the preferred placement option in many states and millions of dollars are being spent to influence policy and fund alternative services. Contract awards are going to the provider organizations that can demonstrate their ability to keep children in the community, achieve outcomes, and accept different pay for performance reimbursement.
For more on the changing landscape in the child welfare field, check out these resources:
- The Future Of Child Welfare Services – What The Thoughtleaders Think
- Making Foster Care & Managed Care Work
- A New (& Sometimes Uncomfortable) Combination – Children’s Services, Medicaid, & Managed Care
- The Brave New Title IV-E World
- A Child Welfare Funding Change – For The Better
- Managed Care In Child Welfare – An Encore
- Will The Massachusetts Model Be THE New Child Welfare System Management Model?
- Narrow Networks & Children’s Services: Another Perspective
- Big Changes In Federal Child Welfare Funding
- Growth & Opportunity In Kinship Care
And make sure to join me and my colleague Howard Shiffman on August 26 at The 2015 OPEN MINDS California Management Best Practices Institute for his session, Increasing Challenges & Opportunities In The California Children’s Service Market.