September 01, 2012

Eight States Seek Child Welfare Waivers

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

The Department of Health and Human Services has posted the state applications for waivers of Title IV-E foster care funding. Eight states have applied for waivers. HHS has the authority to award up to 10 per year. All eight states requested a waiver of the Title IV-E eligibility requirements currently tied to the 1996 Aid to Families with Dependent Children standards.

All eight states would like to spend funds on service not allowed currently due to eligibility restrictions. States generally describe strategies that would use additional services to reduce the foster care population by reducing initial placements, shorten length of stays in care or support families outside of foster care.

Perhaps the boldest state request is Illinois’ proposal to address the zero to three population of children in care with a goal to reduce length of stays and to reduce the number of reentries into foster care once a child has been reunified with his or her family.

Below are descriptions of the state proposals:

Arkansas focuses on three goals of preventing abuse and neglect and re-entries into care, improving positive outcomes for families, and increasing permanency. They will implement evidenced-based screening practices of families, family team meetings, evidenced-based parenting programs and differential response. They will focus attention on better and increased recruitment of foster homes to reduce turnover, create better matches and placements of children in care, and improve stronger family

To improve permanence they will use screening tools, better coordination between the foster and birth parents, evidenced-based parenting programs, permanency roundtables and trauma-informed care. The waiver request is statewide with studies and outcome matching previous patterns to results from the waiver. They project neutrality based on what was previously spent compared to what the new approach will spend. They are seeking a waiver of the eligibility link between IV-E foster care and the AFDC program (de-link) and seeking IV-E funding to covered services not currently covered. The state is seeking a fixed allocation of funding.

Colorado would implement four practices that include the Colorado practice model, Permanency by Design, differential response, and trauma-informed systems of care. The Colorado practice model involves workforce development, including peer-to-peer mentoring, a collaborative management model across systems, and coordination between child welfare and mental health to implement systems of care for children in care. Permanency by Design will focus on older youth in care. The goal will be to reduce use of congregate and group care.

Differential response (DR), now in five Colorado counties, would be expanded as part of the waiver. The final piece will be trauma-informed systems of care to better assess and address the needs of children and youth in care. This will involve better coordination of child welfare and behavioral health services based on evidence-based practices.
Like Arkansas, Colorado proposes to eliminate the AFDC eligibility link, and is asking to expand use of funds beyond foster care maintenance payments and the administrative costs. They are seeking a fixed allocation of funding. Evaluation will be based on comparisons between the first counties that implement the new practices and those counties that implement the practices later.

Illinois will focus on the zero-to-three population. The waiver will focus on children in the Cook County (Chicago) area. The state indicates that despite its progress in reducing placements and its success in reducing its removal rate, they are third highest in the length of stay in foster care and the third highest in the number of children who enter care between the age of zero through three. They highlight that 25 percent of the youth that age out of care had entered foster care before the age of five and that this infant population has a higher rate of re-entry into foster care.

They will use evidence-based interventions to identify children aged zero through three who enter foster care, with additional assessments for children exposed to trauma or loss. They will focus their initiative on intensive concurrent planning, parent training and support and therapeutic interventions where appropriate. They will test out the model in Cook County with comparisons to other non-waiver groups. They are requesting a waiver of IV-E AFDC eligibility and to more flexibly spend funding on services and therapies not currently covered.

Michigan seeks a waiver to extend funding to a collection of services that will target vulnerable families that have come to the attention of the child protective services system. They will focus efforts to try and prevent abuse and neglect and structure their prevention around secondary and tertiary prevention. Overall the state’s goal is to prevent abuse and neglect, decrease entry into foster care, increase positive outcomes for families and improve child well-being. Each waiver family will be offered support services for 15 months.

The state will use a number of screening tools and assess and screen families for child trauma, domestic violence, substance abuse and mental health needs. The target population will be those families with children under the age of five investigated by child protective services where there is evidence of abuse or neglect and the family is at high risk. The waiver will focus on Muskegon County in the west, Kalamazoo County in the south and Macomb County in the east. The state will evaluate its efforts by having control and experimental groups. The state is seeking a waiver of the IV-E AFDC eligibility and is seeking a waiver to allow funding to provide services not currently covered.

Pennsylvania will address the entire child welfare population but would limit the waiver to five counties in the state: Philadelphia, Allegheny, Dauphin, Lackawanna, and Venango. The state will use various evidence-based services and programs. The five counties may have services and approaches that are more targeted to that county’s differences and challenges. The state hopes to see a 30 percent reduction in congregate placements and reduce the number of re-entries and total number of days spent in care.

They seek to increase measured positive outcomes in the areas of physical health, early learning, and academic skills. Some of the services to be used or expanded include family finding, Family Group Decision Making, group conferencing, team decision making, and family engagement. The state is requesting a waiver of Title IV-E AFDC eligibility link, and the ability to use funds for services in place of foster care placement costs. They are requesting a fixed allocation with adjusted increases over the course of the five-year demonstration.

Utah is seeking a waiver to increase the use of evidence-based child and family assessment tools, develop and implement caseworker training and tools, and increase community coordination and evidenced-based services. The state will phase-in services to the entire state over five years. In the first year the state will focus on the Northern region of five regions. All children will be covered in the demonstration areas and the state may expand services to cover children and youth at risk of foster care placement through the juvenile justice system. They may also seek to expand services for post-reunification services.

Utah is seeking a waiver of the Title IV-E AFDC eligibility so the entire population can be covered and seeks to extend spending to services not currently covered. The state is requesting a capped annual allocation of funding. They will evaluate the waiver by comparing information and data before and after the waiver is implemented;  examine outcome measures including data around child well being and foster care placements; and do a cost analysis with an evaluation of the increases in in-home services compared to out of home care costs.

Washington’s waiver would expand its Family Assessment Response (FAR) program. FAR is a version of differential response/alternate response. They propose to focus their waiver on families coming to the attention of the child protective services (CPS) system except abuse and neglect cases involving physical or sexual abuse. The goals include permanence for children, positive outcomes, and  child abuse and neglect prevention. FAR/DR attempts to create an alternate path for families that are reported for child abuse or neglect. Those families where the child is not endangered but the family needs basic services will not be substantiated for abuse and neglect and instead the worker will help the family address their needs.

As part of this effort the state will seek to expand its use of the family preservation model, Homebuilders. As a measure of success, the state will examine data on reducing referrals or re-referral for abuse and neglect, the number of placements and the number of removals. The state will also use a control and treatment group to assess the success of the waiver. Washington seeks to waiver the Title IV-E AFDC eligibility and expand the use of Title IV-E funds to services beyond just foster care maintenance payments. The state does not seek to waiver the eligibility/requirements for youth in care over age 18.

Wisconsin is seeking a waiver to focus on reunification services. The state is asking for a waiver that would allow them to continue case management and services for families that have reunified. They will focus on the first 12 months post-reunification. The waiver will allow the state to screen those families that are being reunified and are at the greatest risk of failure.

As part of a package of services, they will focus on evidenced-based services such as Parent-child Interaction Therapy or Child-Parent Psychotherapy. As part of their plan, they will coordinate other reforms and services including health services planning to carry out various health screenings and services to address such challenges as the overuse of psychotropic medication.

The state is seeking a waiver to bypass the IV-E AFDC eligibility for the foster care population. They are also seeking a waiver to allow continued case management and services for 12 months after the child reunifies with the family. The state will start to implement the waiver by age group, starting first with the zero through five population. They will later expand to later age groups depending on the cost and ability to expand over the five- year period. They will evaluate by comparing those families that receive services and those that do not. They will also examine the re-occurrence of abuse and neglect, re-entries into care, placement stability, exposure to trauma, health outcomes and enrollment in Head Start and other education outcomes for K through 12.

Adapted with permission from Capitol View On Kids 1(19), August 20, 2012.