As we are still in the waiting period, I figured that I can begin to get a little knowledge about the rules and processes that govern the foster care system in general and how DFPS works specifically in Texas. It’s disheartening to hear the reports about the disproportionate numbers of African-American children in care and not understand the systemic issues behind it. I read about the frustrations people have with the foster care system and some of the decisions that are made but I also know from my work in HR that many times the intent behind the policy can sometime get confused in the execution. So, I’ll bring you along with me on my education journey. Feel free to chime in because there is a LOT that I don’t understand.
The state of Texas is redesigning the way it delivers Foster Care. What?? It seems they would have talked about that in PRIDE. Nope. Do not recall anyone mentioning this at all. *side eye*
Regions 2 and 9 started under the new system on August 26th. There is some great information on the webpage in the form of the Improving Child and Youth Placement Outcomes: A System Redesign (Foster Care Redesign) Report so feel free to read (if you are nerdy like me) or just chime in with your thoughts on my synopsis.
The main changes and rationale for the changes (as I understand them) are below:
- Procure for Single Source Continuum Contractor (SSCC) to provide a full continuum of foster care services in the area. This SSCC would be held responsible for the well-being and permanency outcomes.
Currently DFPS has an open enrollment process to procure foster care providers. The issue is that there is nothing in place to ensure that there is full coverage for all service levels (basic, moderate, specialized or intense) in combination with all the placement types (residential treatment center, general residential operations, emergency shelter or child placement agency) in a specific geographic area.
Often when a child needs a different level of service or placement type they will have to be moved to a new location in order to get the treatment they need. For instance, if a foster parent needs to place a child in a specific residential treatment center to deal with reactive attachment disorder, they may have to be moved to a different city. Depending on the situation, this may mean a different placement, new caseworkers, doctors, therapists, schools, etc. The family (foster or biological) may not have the ability to visit regularly because of the distance. Of course, all of these changes would have a negative impact on the child.
The SSCC will provide a continuum of services or form a network of providers for a certain geographic area. It can be for-profit or not-for-profit (really??). Additionally, some of the services that DFPS contracts for such as parent training, evaluation and treatment, adoption, preparation for adult living, etc, will be now assigned to the SSCC to handle. How is this different than what happens now?
But here is the kicker – the SSCC will be responsible for the initial placement and any subsequent moves instead of CPS. So help me out foster care advocates – what is the role of CPS in this new system?
- Change the reimbursement rate to create a single blended case rate versus the current system of reimbursement based on service level or placement type.
The way providers are paid now is based on a combination of the service level and the placement type. Of course, the more intensive service needed, the higher the reimbursement rate. These rates are determined by the Health and Human Services Commission (HHSC). Did you know they also determine the pass-thru rates for foster families?
Anyway, there really is no incentive for providers to improve the well-being of children in care. I’ve read stories from foster families that are *wink* encouraged to request services for their children so they can be considered special needs and get higher subsidies. Well, this incentive starts from the way providers are reimbursed. A higher service level means a higher billing rate for everyone involved.
Anywho, initially, HHSC will determine a blended rate for each day of service. This rate will be the average rate paid across all placement types and will be adjusted based on the service mix that is handled by that SSCC. Hmmm…that service mix clause seems like a loophole to a higher billing rate – need more info on that.
As the system is fully implemented, they would eventually move to a billing case rate where the SSCC receives a blended rate for each day of service provided to a child, but they would get rewards based on average length of stay. There will be a system where if average length of stay decreases, the SSCC receives a bonus, however, if average length of stay increases, DFPS has the ability to recoup a portion of funds paid. Interesting…there may be some unintended consequences there.
Check this out – HHSC will continue to determine a minimum pass-through amount for foster families. A minimum? Does this mean that agencies can pay more than what the HHSC recommends. I have ALL the questions.
There’s more information about catchment areas (big word for geographic area) and staged implementation (roll-out plan) but that’s the gist of it. Oh, there is one more thing but I’ll write about it another day. There are eight quality indicators to support improved outcomes. What I don’t see is how these things are defined and measured…but as I said, another day.