Appendix_A.pdf

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 1

Appendix A: Summary of State Child Welfare Waiver Demonstrations

Introduction: A total of 22 States are currently implementing 23 child welfare waiver demonstrations: Eight new demonstrations were approved for implementation in fiscal year (FY) 2013; nine new demonstrations received approval to implement in FY 2012; four demonstrations are operating under five-year extensions; and two demonstrations are operating under short-term extensions pending approval of five-year extensions. As summarized in the three tables below, States will implement or have implemented a wide range of interventions, including specific evidence-based or promising programs that improve child safety and permanency, with a special emphasis on trauma and increased child and family well-being. States will use a variety of screening and assessment tools to assess and measure changes in child and family development and functioning over time. The waiver demonstrations will expand the child welfare knowledge base regarding what works to improve safety, permanency, and well-being for children and their families.

Table 1. Child Welfare Waiver Demonstrations Approved in FY 2013

State

Target Population &

Geographic Scope

Core Interventions, including

Evidence-Based or Promising Programs

Key Outcomes

Method to

Measure Cost

Neutrality and

Included Cost

Categories

DC District-wide

Targets all children and families involved with the

District of Columbia’s

Child and Family Services

Agency (CFSA) including those who come to the attention of CFSA and are diverted from the formal child welfare investigation track to community-based services (Family

Assessment).

Expand the use of evidence-based family preservation, post-reunification, and prevention services through contracts with private community-based agencies.

Prevention services to be expanded include those focused on:

Parent education and support programs

Home visiting

Father-child attachment

Older youth ages 10–17 who have committed status offenses.

The District will also implement the following two new evidence-based programs:

Homebuilders (intensive in-home family preservation services)

Project Connect (intensive in-home family preservation and/or reunification services)

Decreased new reports of maltreatment

Decreased repeat maltreatment

Decreased time to exit/permanency

Increased exits to permanency

Decreased entry rates

Decreased re-entry rates

Improved family functioning

Improved educational achievement

Improved social and emotional functioning

Capped allocation of title IV-E funding.

Foster care maintenance costs

Foster care administrative costs (excluding

SACWIS and training)

Includes costs associated with youth ages 18–21.

HI

Begins on two islands

(O‘ahu and Hawai‘i) with possible expansion to additional islands.

For target population #1:

Crisis Response Team

Intensive Home-based Services: Intervention includes the use of Rapid Assessment Instruments

(e.g., Child Behavior Checklist)

Decreased entry rates

Decreased re-entry rates

Decreased length of stay

Improved child and family well-being costs

In this document the term “State” may refer to both States and the District of Columbia.

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 2

Measure Cost

Neutrality and

Included Cost

Categories

HI

cont.

Two target populations:

1) Families who come to the attention of Child

Welfare Services through a hospital referral or police protective custody and who are likely to be placed into care for fewer than 30 days; and 2) children and youth who have been in foster care for 60 days or longer.

For target population #2:

Safety, Permanency, and Well-Being Roundtables

(multi-disciplinary case staffing to facilitate permanency for youth who have been placed out of the home for more than 9 months)

Wraparound Services (multidisciplinary, comprehensive service planning and delivery to keep youth in the home or in the community)

Increased frequency and duration of enhanced visitation (`Ohana Visiting Time)

Rapid Assessment Instruments (e.g., Child

Behavioral Checklist)

Foster care administrative costs (excluding training, SACWIS, and non-SACWIS automated systems costs)

Excludes costs

ID Statewide

Targets children ages 0–18 with an open child welfare case and their families.

Phase I will focus on children who are in or enter out-of-home placement during the course of the demonstration; Phase II will include children who are at risk of removal from home.

Family Group Decision Making

An evidence-based family life skills training and parent education program (TBD)

Trauma-informed system of care

The trauma-informed system of care will include training and workforce development in trauma-informed practices; implementation of a universal trauma screening instrument; and implementation of trauma-informed evidence-based programs and practices (e.g., Trauma-

Focused Cognitive Behavioral Therapy and Parent-Child

Interaction Therapy). Individual regional child welfare districts may implement additional interventions.

Increased number of families served in-home

Decreased entry rates into foster care

Increased exits to permanency through reunification, adoption, and guardianship

Decreased time to exit/permanency

Increased placement stability

Decreased congregate care placement rates

Improved child well-being costs

Foster care administrative costs (excluding

State law does not allow most child welfare services beyond age 18.

MT

Begins in 4 counties

(Cascade, Lewis and Clark, Missoula, and Yellowstone

Counties) with possible expansion statewide.

Three target populations:

1) Children ages 0–5 who are at risk of out-of-home placement due to neglect;

For target population #1:

Intensive In-Home Services, including Family Group

Decision Making; concrete support services; and in-home promising or evidence-based interventions that provide parenting education and support such as Safe

Care, Family Spirit, and Parents as Teachers.

For target population #2:

Intensive Family Re-engagement Services, including

Decreased out-of-home placement rates

Decreased time to exit/permanency

Increased exits to permanency through reunification, guardianship, and adoption

Decreased repeat maltreatment

Increased kinship placement rates

Decreased congregate care placement rates

Decreased length of stay in congregate care

Increased step-downs from congregate care to costs

Foster care administrative costs (excluding

SACWIS,

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 3

Measure Cost

Neutrality and

Included Cost

Categories

MT

cont.

2) Children ages 0–12 who are in kinship foster care;

and

3) Children ages 0–18 placed in residential treatment centers or therapeutic group homes.

Team Decision Making; in-home visits; and other evidence-based services such as Trauma Focused

Cognitive Behavioral Therapy; Parent Child

Interaction Therapy; Positive Parenting Program-

Triple P (parenting education); The Incredible Years

(parenting education); the Attachment, Self-

Regulation, and Competency (ARC) model

(comprehensive framework for intervention with youth exposed to trauma); and High Fidelity Wrap-

Around Services.

For target population #3:

Intensive Family Reintegration Services that include the Family Find model (a process to identify family members and other supportive adults who are willing to become permanent connections for a child placed out of the home); High Fidelity Wrap-Around

Mental Health Services; and youth-centered meetings and youth engagement.

less restrictive placement settings

Improved child well-being and family functioning training, and agency administration) youth ages 18–21 and Tribal/State title

IV-E agreements.

NE

Begins in five counties

(TBD) and will expand statewide.

Two target populations:

1) All children ages 0–18 who can remain safely at home through the provision of in-home services; and

2) All children ages 0–18 served by the child welfare agency.

Alternative Response (AR), a differential response pathway for screened-in allegations of abuse and neglect as an alternative to traditional Child

Protective Services investigations (For target population #1). AR will include linkages to an expanded array of evidence-based programs and services such as:

Parent Child Interaction Therapy

Positive Parenting Program-Triple P

Wraparound Services

The state will incorporate Results Based

Accountability into the State’s contract and performance management systems for contracted child welfare service providers in order to improve

Decreased repeat maltreatment, allegations, and substantiated reports

Decreased entry rates into foster care

Increased placement stability

Decreased time to exit/permanency

Decreased re-entry rates following exits to permanency

Decreased time to adoption after termination of parental rights

Improved child and family well-being costs

Foster care administrative costs (excluding

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 4

Measure Cost

Neutrality and

Included Cost

Categories

NE

cont.

key child safety, permanency, and well-being outcomes achieved through the services provided to children and families.

NY

Begins in New York City and may expand to additional counties or jurisdictions.

Targets all children/youth ages 0–21 years currently in out-of-home placement in regular family foster care or at home receiving post-reunification aftercare services.

A new city-wide model of foster care services called

ChildSuccessNYC. Primary components include:

Parenting Through Change (parenting education and support)

Family Finding

Keeping Foster and Kin Parents Trained and

Supported (parenting education and support for foster parents)

Youth Development Skills Coaching

Any additional participating counties or jurisdictions will implement a different package of interventions that may include:

Functional Family Therapy

Parenting with Love and Limits (a combination of group and family therapy for youth with severe emotional and behavioral problems and their families)

Multi-Systemic Therapy for Child Abuse and

Neglect

Multidimensional Treatment Foster Care (therapeutic foster care to decrease problem behaviors in children/youth)

Increased child social and emotional well being

Decreased time to exit/permanency

Increased placement stability

Decreased re-entry rates

Capped allocation of title IV-E funding

(based on claims submitted for program costs expended by New

York City

Administration for

Children’s Services) costs

Foster care administrative costs (excluding

Includes costs

RI

Statewide

Targets children and youth primarily between the ages of 6 and 18 that are in or are at significant risk of going into congregate care and their families.

Expand the Rhode Island Wraparound Services model to include children in congregate care placements and their families. Depending on the needs of each child and family, additional interventions that may be offered include:

Multi-Systemic Therapy for Child Abuse and

Neglect

Parenting with Love and Limits

Enhanced Family Support Services

Strengthening Families (a family skills training

Increased placement stability

Increased discharges from congregate care to permanent placement with a family

Decreased proportion of discharges from congregate care to non-permanent settings

(e.g., runaways, transfer to the custody of another agency)

Decreased time to exit/permanency

Decreased re-entry rates following exits to permanency title IV-E funding costs

Foster care administrative costs (excluding

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 5

Measure Cost

Neutrality and

Included Cost

Categories

RI

cont.

program)

Preserving Family Networks (a flexible service model to prevent placement or assist with successful transitions from residential or hospital settings into the community)

Decreased initial and repeat maltreatment

Improved child well-being

TN

Statewide, with implementation staggered by county or State

Department of Child

Services (DCS) Region

(schedule TBD).

Targets all children ages 0-

17 who are in the non-custodial (non-placement) care of DCS at the time of the demonstration’s implementation or who are referred to non-custodial care throughout the course of the waiver demonstration.

Expand the existing In-Home Tennessee initiative, including the expansion of a wraparound service framework consisting of the following components:

Statewide Risk and Safety Assessment Protocol using the Family Assessment and Screening Tool

(FAST)

Intensive In-Home Services (for family preservation)

Referral to other services as indicated by FAST assessment and identification of child and family needs

Decreased repeat maltreatment

Decreased re-entry rates following exits to permanency

Improved child and family functioning and well-being title IV-E funding costs

Foster care administrative costs (excluding

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 6

Table 2. Child Welfare Demonstrations Approved in FY 2012

Core Interventions, including

Evidence-Based or Promising

Programs

Method to Measure Cost

Neutrality and Included Cost

Categories

AR Initial implementation in

Year 1 focused on 8 counties with statewide expansion planned.

Targets all children referred to child welfare services for child abuse/ neglect or already receiving services.

Improved array of community based services, including:

Nurturing Parenting Program (a parenting education and support program)

Enhanced assessment (Child and

Adolescent Needs and Strengths, or

CANS)

Permanency Round Tables (multi-disciplinary case staffing to facilitate permanency)

Team Decision Making

Targeted recruitment of foster care providers

Differential Response (a program to divert families from the formal child welfare investigative track and connect them to community resources)

Improved child and family well-being

Increased exits to permanency

Decreased repeat maltreatment

Capped allocation of title IV-E funding

Foster care maintenance costs

Foster care administrative costs

(excluding training, SACWIS, and non-SACWIS automated

Excludes costs associated with

CO Statewide for 3 core interventions; individual counties to implement additional programs/interventions.

Targets children with screened-in reports of abuse/neglect and those already in open child welfare cases.

Primary Interventions:

Family engagement

Trauma informed child assessment

Trauma focused behavioral health treatment, such as Trauma Focused

Cognitive Behavior Therapy and

Coping Cat (a cognitive-behavioral treatment for children with anxiety)

Additional interventions to be determined based on specific needs of counties

Improved child emotional, behavioral, and social functioning

Increased parenting skills and capacity

Decreased entry and re-entry rates

Increased placement with kin caregivers

Decreased new and repeat maltreatment

Decreased congregate care placement rates

(excluding training, SACWIS, IL

(IB3)

Cook County

Nurturing Parenting Program Improved developmental progress for children and toddlers

Experimental design

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 7

Core Interventions, including

Neutrality and Included Cost

Categories

IL

(IB3)

cont

Targets children ages 0–3 entering out-of-home placement for the first time.

Child Parent Psychotherapy

Increased reunification rates

MA

Targets youth transitioning out of congregate care or at risk of congregate care placement.

Follow Along (intensive home-based family interventions and supports to children and their families and caregivers)

Stepping Out (comprehensive case management services for youth transitioning to independent living after receiving congregate care services)

Continuum Services (Family treatment, care coordination, outreach and crisis support services to enable family preservation)

Family Partners (a peer mentoring program for parents and caregivers)

Improved youth well-being

Decreased time in congregate care

Increased placement stability

(excluding SACWIS and youth ages 18–21

MI Begins in three counties, with possible expansion to three additional sites in year three of the demonstration.

Targets families with children ages 0–5 that have been investigated by child welfare and are determined to be at high risk of child maltreatment.

Trauma Focused Cognitive

Behavioral Therapy

Parent Child Interaction Therapy

Parent Infant Psychotherapy

Nurse-Family Partnership (home visits by registered nurses)

Healthy Families America (intensive home visiting program)

Enhanced assessment (e.g., Trauma

Screening Checklist for Young

Children, Protective Factors Survey, and Devereux Early Childhood

Assessment Tool)

Improved child and family well-being

PA

Begins in 5 counties and may expand to additional counties over time.

Family engagement strategies, such as Family Group Decision Making and Family Team Conferencing

Enhanced child and family

Decreased entry and re-entry rates

Decreased time to exit/permanency

Increased exits to permanency

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 8

Core Interventions, including

Neutrality and Included Cost

Categories

PA

cont

Targets all children ages 0–

18 in or at risk of foster care placement.

assessments based on specific needs of counties.

Improved child and adolescent emotional, behavioral, developmental, academic, and social functioning

Improved parent functioning

Foster care administrative costs

(excluding training and non-

SACWIS automated systems costs)

Excludes title IV-E claims from counties not participating in the demonstration.

Includes costs associated with youth ages 18–21 unless State amends its title IV-E State plan.

UT

Begins in two child welfare offices (one serving an urban area and one serving a rural area), followed by statewide expansion.

Targets all children and families entering the child welfare system due to substantiated child abuse/neglect or dependency and are identified (via standardized assessment tools) as requiring ongoing services.

Improved array of community based services, including:

Enhanced child and family functional assessment

Systematic Training for Effective

Parenting (a parenting education and support program) based on needs.

Decreased repeat maltreatment

Decreased entry rates

Improved child and family well-being

(excluding training, SACWIS, and non-SACWIS automated

WA Statewide

Targets families entering the child welfare system due to substantiated child abuse/neglect that are determined to present a low to moderate risk to the child’s immediate safety, health and well-being.

Differential Response, which includes the expansion and provision of services such as:

SafeCare (parenting education)

Incredible Years (parenting education)

Positive Parenting Program -Triple P

(parenting education)

Promoting First Relations

Improved child and family well-being

(excluding SACWIS and

WI

Begins in one county and will expand statewide

Post-reunification supportive services, such as:

Decreased repeat maltreatment

Decreased re-entry rates

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 9

Core Interventions, including

Neutrality and Included Cost

Categories

WI

cont

Targets families with children ages 0–5 who have reunified with their families after temporary placement in out-of-home care and are at risk of reentry into care.

Trauma Focused Cognitive

Behavioral Therapy

Parent Child Interaction Therapy

Child Parent Psychotherapy

Improved early education outcomes

Decreased exposure to trauma

Improved child health and emotional, behavioral, and social functioning

(excluding training, SACWIS, Table 3. Child Welfare Demonstrations Approved Under Previous Waiver Authority

Core Interventions, including

Neutrality and Included Cost

CA

Alameda and Los

Angeles Counties;

includes Department of

Children and Family

Services (DCFS) and

Probation Department for both counties.

Children ages 0–19 currently in out-of-home placement or who are at risk of entering or re-entering foster care, regardless of title IV-E eligibility.

Alameda County DCFS and Probation:

Expand and strengthen programs to provide children and families medical, mental health, education, and social, and self-sufficiency supports, including:

Another Road to Safety (alternative response program)

Paths to Success (focused on reducing the number of youth re-entering care after reunification)

Parent Advocate Program

Family Preservation Units

Los Angeles DCFS:

Community-based prevention programs

Family Team Decision Making

Conferences

Specialized permanency unit focused on family finding and engagement

Enhanced assessment

Decreased re-entry into care

Decreased time to permanency

Increased exit to permanency

Increased placement stability

Improved appropriateness and decreased restrictiveness of new and existing out-of-home placements

Improved child well-being

Capped allocation of title IV-E funding

Foster care maintenance costs

Foster care administrative costs

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 10

Core Interventions, including

Neutrality and Included Cost

Categories

CA

cont

Probation:

Cross-system case assessment and case planning

Multi-Systemic Therapy

Functional Family Therapy

Aftercare support services

FL Statewide

1) Children ages 0–18 who are currently receiving in-home child welfare service or who were in out-of-home placement at the start of project implementation;

2) all families entering the State child welfare system with a report of alleged child maltreatment

Contracts with Community-Based

Care (CBC) Lead Agencies responsible for coordinating and providing services and supports

Improved array of community-based services, which include:

Intensive early intervention services

One-time payments for goods and services that help divert children from out-of-home placement

(e.g., rental assistance and child care)

Family Finding

Improved needs assessment;

Long-term supports to prevent placement recidivism.

Decreased re-entry rates

Decreased time to permanency

Increased exit to permanency through reunification or adoption

Improved child well-being

Capped allocation of title IV-E funding

Foster care maintenance costs

Foster care administrative costs (excluding SACWIS)

IL

(AODA)

Implementation in three counties (Cook, Madison, and St. Clair

Counties). Enhanced

RCP services begins in

Cook County and may expand to additional counties over time.

Target population for standard RCP services includes custodial parents residing in demonstration counties whose children are in or

Enhance the Recovery Coach Program

(RCP) implemented under the State’s previous waiver demonstrations through

(1) the development and use of proactive and flexible early engagement and assessment practices, and (2) the establishment of a program to provide intensive planning, assessment, and pre-and post-reunification services for families who are identified as candidates for earlier reunification.

Standard RCP services provided under the demonstration include clinical assessment and identification, recovery plan development, intensive outreach and

Improved rates of treatment access

Increased participation in substance abuse treatment

Decreased time between referral to and entry into substance abuse treatment

Increased number of children who exist foster care and are reunified with their custodial parent

Decreased time to exit/permanency

Decreased repeat maltreatment

Decreased re-entry rates into out-of-home placement

Decreased births of substance-exposed infants

Improved child and family well-being

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 11

Core Interventions, including

Neutrality and Included Cost

Categories

IL

(AODA)

cont.

enter out-of-home placement on or after

July 1, 2013, including custodial parents who deliver infants testing positive for substance exposure.

Target population for enhanced RCP services includes families residing in Cook County who meet the requirements for standard services and who are identified by the

State’s Juvenile Court

Assessment Program as low risk and likely candidates for expedited reunification.

engagement to facilitate parents’ treatment participation and recovery, random urinalyses, housing resources, mental health services and recovery, domestic violence services, and ongoing follow-up after reunification to promote and sustain recovery and ensure child safety.

Enhanced RCP services include:

Benchmarking (refers to a set of casework practices)

Recovery and Reunification Plan

(developed in collaboration with family court judges, caseworkers, and

Recovery Coaches)

Strengthening Families (a strategy focused on increasing family strengths and building protective factors)

IN

Children at risk of out-of-home placement and their families.

Increase the array, intensity, and accessibility of services to prevent out-of-home placement, which may include:

Healthy Families America (intensive home visiting program)

Homebuilders (intensive in-home family preservation services)

Substance use disorder assessments

Outpatient and residential substance abuse treatment

Decreased initial and repeat maltreatment

Decreased time to exit/permanency

Increased exits to permanency through reunification, adoption, or guardianship

Improved child and family well-being

(excluding SACWIS and non-

SACWIS automated systems costs) youth ages 18–21

OH

17 counties

Targets all children ages

0–17 who are at risk of, currently in, or who enter out-of-home placement during the

Family Team Meetings

Kinship Supports (activities specifically related to the kinship caregiver including home assessment, needs assessment, support planning, and service referral and provision)

Proportion of children with substantiated or indicated dispositions of child abuse or neglect who do not experience a placement episode

Decreased time to exit/permanency

Decreased repeat maltreatment

Decreased re-entry

Comparison county approach

Appendix A: Summary of Child Welfare Waiver Demonstrations by State 12

Core Interventions, including

Neutrality and Included Cost demonstration period, as well as their parents or caregivers.

Any county that implemented Supervised

Visitation in a previous phase of the

States demonstration may continue.

Counties may implement additional supportive services that prevent placement and promote permanency for children in out-of-home care.

OR Selected child welfare districts throughout the

State depending on the intervention

1) Families with a child under age 13 that is in foster care and that have been approved for visitation outside of the child welfare agency

2) Families with an active child welfare case who have been identified as in need of substance abuse treatment

Relationship-Based Visitation

(enhanced supervised visitation program to promote reunification )

Parent Mentoring (a peer mentoring program for caregivers to assist with completion of substance abuse treatment, sobriety, and family preservation and/or reunification)

Increased exits to permanency through reunification, adoption, or guardianship