Managed Care in Michigans Child Welfare System

1
Managed Care in Michigans Child Welfare System

• William Meezan
• Bowen McBeath
• University of Michigan
• Paper Presented at
• CWLAs Tools the Work and National Research
  Conference
• Miami Florida
• November, 2003

2
Agencies Involved

• Catholic Social Service of Wayne County
• Judson Center
• Homes for Black Children
• Lutheran Child and Family Service
• Orchards Childrens Services
• Spectrum Human Services
• Evergreen Childrens Services
• Lutheran Social Services of Michigan
• St. Francis Childrens Services

3
Sources of Funding

• The Aspen Institute/Michigan Nonprofit Research
  Fund
• Michigan Family Independence Agency (FIA)
• W.K. Kellogg Foundation, Global Program for Youth
• The Skillman Foundation
• Horace H. Rackham Graduate School, University of
  Michigan
• Office of the Vice Provost for Research,
  University of Michigan
• Office of the Associate Dean for Research, School
  of Social Work, University of Michigan

4
New State Initiatives

• To control caseloads and costs
• Many states have requested federal Title IV-E
  waivers in order to set up innovative programs
• A few states have detached investigative from
  service delivery functions within their child
  welfare systems, and assigned the former to law
  enforcement agencies (e.g., Florida)
• Other states have embraced privatization, and
  have contracted out all or specific portions of
  their public child welfare systems to private
  nonprofit agencies
• Some states have adopted new service delivery
  models such as performance contracting and
  managed care

5
Spread of Managed Care in Child Welfare

• As of 1998, 29 states were operating one or more
  managed care initiatives for a total of 47
  managed care child welfare programs across the US
• These initiatives vary considerably in their
• Scope State initiatives covered anywhere from
  100 to 35,000 children
• Auspices State initiatives range from being
  entirely privatized to being fully
  publicly-provided
• Risk structure Performance contracting,
  capitation, case rate setting, and other
  financial principles are present across some but
  not all initiatives

6
The Wayne County Pilot Initiative

• A performance-based contracting approach to pay
  for foster care system which uses incentive
  payments to encourage better outcomes for
  children in the foster care system
• Restructures existing resources in Wayne County
  to
• Attempt to provide for the service needs of the
  family and the child
• Increase the percentage of youth who reach
  permanent placement
• Shorten the time needed to achieve permanence

7
Incentive Payment System in the Wayne County Pilot
8
Rationale for Pilot Payment Structure

• Initial and incentive payments are financed
  through savings achieved by diminishing
  administrative per diem
• Cost neutrality not assumed state willing to
  have increased costs should that be necessary to
  achieve better and more timely permanency plans
  for children

9
Evaluation Plan Three Simultaneous Studies

• Process Evaluation
• Qualitative interviews with key informants
  (complete)
• Quantitative data on services (analysis complete
  through 300 days data now being processed
  through 570 days data collection expected
  through 930 days)
• Output Evaluation
• Quantitative data on childrens movement through
  the system (analysis complete through 300 days
  data now being processed through 570 days data
  collection expected through 930 days)

10
Participatory Evaluation in Action

• Control of the evaluation project was jointly
  shared by researchers and participating agencies
• Meetings with cooperating agencies occurred every
  two weeks for 9 months to plan the project and
  its instrumentation every month thereafter to
  iron out problems, receive data, disseminate
  findings
• All decisions regarding all phases of the
  evaluation were discussed and approved by the
  cooperating agencies (major research questions,
  design, sampling, data collection instruments and
  techniques, etc.)
• All meetings are archived for future
  organizational learning
• Community Zero website for discussion, postings
  of instruments, data tracking, etc.

11
Qualitative Process EvaluationResearch
Questions

• What organizational accommodations did private
  nonprofits make when they shifted to a specific
  managed care contracting environment?
• What organizational accommodations did private
  nonprofits expect to make as they anticipated
  shifting to a specific managed care contracting
  environment?
• Were there differences between the pilots and the
  non-pilots in their expectations/realities?
• Were there differences between people at various
  levels and in various positions within the
  agencies in terms of their expectations/realities?
  

12
Method

• Telephone interviews were conducted with
  personnel from pilot and non-pilot agencies
• Administrators (N 45)
• Foster care supervisors (N 19)
• Foster care line staff (N 20)
• Agencies were asked to provide the research team
  with a list of respondents who would best be able
  to answer questions
• Sample chosen to maximize knowledge of foster
  care and the pilot process
• This sampling strategy allowed for the selection
  of respondents that could best speak to the
  organizational adaptations that nonprofits made
  (or were expecting to make) in implementing the
  pilot process

13
Sample Characteristics

• Pilot and non-pilot respondents had roughly 14
  years of experience in the social services, 13 of
  which were in the field of child welfare
• Pilot respondents had been at their agencies for
  nearly 10 years, six of which had been in their
  present position
• Non-pilot respondents had been at their agencies
  for about six years, with four years of
  experience in their present positions
• 60 of respondents were Caucasian and 35 were
  African American
• Non-pilot administrators were twice as likely to
  be African American as were pilot administrators
  (40 vs. 20)
• Non-pilot line staff were much more likely to be
  Caucasian than were pilot line staff (71 vs.
  39)
• Half of the administrators at pilot and
  non-pilots agencies were female, while nearly all
  supervisors and line staff were female
• Pilot administrators were more likely to have an
  advanced degree (76) than were non-pilot
  administrators (47)

14
The Interview

• Interviews were structured and contained mostly
  open-ended questions
• Interviews lasted between an hour and an hour and
  a half on average, and ranged in length from 30
  minutes to five hours
• Respondents were asked a series of questions
  about
• Service delivery
• Interdepartmental and interorganizational
  relations
• Staffing patterns
• Staff roles and responsibilities
• Financial management
• Technology use
• Due to the nature of peoples positions and
  responsibilities, not all respondents were able
  to answer all questions

15
Data Analysis Qualitative Data

• A cross-case matrix was constructed for each
  question. Each full data matrix contained all
  responses to the identified question, organized
  by respondent type and agency type
• Two staff independently read through the matrix
  and each constructed a preliminary list of codes
  that described common themes across individual
  responses.
• Staff compared their preliminary lists of themes
  and agreed upon a set of codes
• Staff independently applied the codes to the
  responses, with each staff member noting where a
  response contained one of the agreed upon themes
  
• Coders compared their judgments and resolved any
  differences regarding whether a theme was present
  or absent (initial reliability _at_ 75)
• Percentages were calculated for the presence of
  each theme across respondent type and agency
  type, thus allowing for comparisons between pilot
  and non-pilot respondents at various
  organizational levels.

16
Similar Perceptions Between Pilot and Non-pilot
Personnel

• Service delivery-related barriers
• Accessing community services
• Staff-related barriers
• Altering staffs philosophical beliefs concerning
  the appropriate goals of foster care and the
  difficulty in moving to a service delivery system
  emphasizing speed and immediacy of service
  provision
• Need for increased communication, cooperation,
  and/or meetings with FIA, the court, and other
  private agencies
• Understaffing and/or staff turnover

17
Similar Perceptions Between Pilot and Non-pilot
Personnel

• Agency Functions
• Need for changes in the area of budgeting and
  financial management
• Need for changes in MIS and the way they tracked
  children in care
• Administrators mentioned that cost centers and/or
  new accounts receivable and payable had to be (or
  would need to be) created

18
Different Perceptions Between Pilot and Non-pilot
Personnel

• Pilot respondents were more likely to see
  internal, systemic, operational changes
• More meetings, trainings, and communication
  involving different departments within the agency
  
• Conflict between units within the agency
• Particularly between foster care and clinical
  units
• New staff positions had to be created
• Need for communication about MIS, and
  communication between MIS and other agency
  departments
• Changes both within the foster care department
  and in interactions with other agency department
• Changes that would have to occur in
• Budgeting
• Forecasting
• Tracking
• Accounting systems

19
Different Perceptions Between Pilot and Non-pilot
Personnel (cont)

• Non-pilot respondents did not anticipate the
  scope of operational changes in service delivery
  and agency administration it would take to move
  to the pilot
• Less likely to anticipate that their agency would
  have to alter their procedures when dealing with
  foster care cases
• Less likely to anticipate changes in roles and
  responsibilities
• Did not see that new linkages within the agency
  would have to be created
• Personnel in non-pilot agencies were less
  optimistic about the impact of the pilot on the
  clients it served
• Those in non-pilot agencies tended to see the
  move to this system of reimbursement as more
  difficult than it had proven to be in the pilot
  agencies
• Those in non-pilot agencies had a fear of revenue
  loss that was not experienced by the pilot
  agencies

20
Similar Perceptions Among Staff at Various
Organizational Levels

• Agencies would have to do business differently in
  order to succeed in the managed care environment
• Inter-agency interactions increased as a result
  of entering the pilot process
• These increased interactions were not easy
• The court was seen as a significant, and possibly
  deliberate, obstacle to progress
• Problems with interactions with FIA were seen as
  being generally less severe and difficult to
  overcome
• Supervisors roles did not (would not) change
  regarding foster families
• Supervisors roles would change in terms of
  responsibilities regarding children and families

21
Different Perceptions of Staff at Various
Organizational Levels

• Administrators had a wider lens on the movement
  toward managed care, and were more concerned
  about the fundamental changes that would have to
  take place
• More concerned with how the pilot required
  fundamental transformations in how staff viewed
  the goals of foster care and the primary target
  of foster care services
• More likely to mention that there were few
  avenues for interdepartmental communication
• More concerned about conflict between various
  departments
• More concerned about the substantial changes in
  how services were delivered

22
Different Perceptions of Staff at Various
Organizational Levels

• Supervisors and line workers tended to focus more
  on service delivery issues and the ability to
  provide adequate service
• More likely to mention that there were changes in
  how the agency interacted with FIA, the court,
  and/or other agencies
• More aware that there were problems with
  accessing community resources and services
• More concerned about issues of efficiency and
  speed in assessment and service delivery

23
Implications

• Managed care contracting requires service
  providers to quickly diagnose clients needs,
  focus additional resources on collecting client
  and service information in databases, and pool
  funds to address the multiple needs of clients
  systematically and simultaneously
• New types of positions within foster care
  departments often need to be created case
  aides, family engagement workers, and relative
  assessors whose jobs are specifically designed
  to provide a set of services to move children
  through the system more efficiently
• Changes in financial management and accounting
  procedures are needed to succeed under managed
  care

24
Implications (cont)

• Collaboration is needed between foster care and
  accounting departments, as well as with other
  agencies, in order to provide information, secure
  collateral services, settle financial issues, and
  resolve case-related concerns
• Regular communication between departments reduces
  payment complications with FIA and maintains
  accurate client status and service information
  within the agency
• Knowledge sharing, resource sharing, and common
  problem solving reduce the need for new agencies
  entering this arena to reinvent the wheel
• Technical assistance can help agencies to install
  systems that smooth the transition to managed care

25
Research Questions Quantitative Data

• What was the effect of the shift to this managed
  care contracting environment on the services
  provided to children and families in the first
  300 days of foster care?
• Which variables explain differential service
  patterns between the pilot and non-pilot
  agencies?
• Which children reached the first pilot
  performance point of placement with a parent,
  relative, guardian, or in independent living
  within 290 days?
• Which variables explain differential outcomes
  between the pilot and non-pilot agencies?

26
Research Design

• Data were collected on a quarterly basis on a
  sample of 244 children that came into foster care
  between May 1, 2001 and October 1, 2001
• 175 children from the pilot agencies and 69
  children from the non-pilot agencies
• This phase of the study took advantage of the
  conditions for a natural experiment in order to
  isolate the effect of managed care from other
  possible influences on service delivery and child
  outcomes
• Differences in service patterns and placement
  status between the pilot and non-pilot groups,
  where found, can be attributed to the type of
  agency responsible for the child since the design
  is the equivalent of a true experiment
• Data collected at 30 days after childs entry
  into care, and then for each 90 days thereafter

27
Sample Identification

• Children were admitted into the study sample if
  they met the following criteria
• The child was a resident of Wayne County
• The child was under the age of 13 or was part of
  a sibling group in which there was at least one
  child under the age of 13
• The child was assigned to agencies through the
  Family Assignment System or was a must take for
  the agency
• At least 365 days had passed since the childs
  last non-relative out of home placement (if the
  child had previously been in care and had come
  back to the agency)
• The child was assigned to the agency that had
  supervisory responsibility of first origin
• The child was ordered into relative or foster
  care at the preliminary court hearing

28
Child Characteristics(no significant differences
between pilot and non-pilot children)

• Mean Age 6
• 51 female
• Race
• 78 African American
• 18 Caucasian
• Previously Placed 8
• Drug/Alcohol Pre-natal Exposure 34

• Assessment at Intake ( with needs)
• Behavior/Coping Skills 30
• Education 29
• Family Relational Problems 19
• Non-Family Relational Problems 18
• Health 17
• Life Skills/Development 16
• Sexual Adjustment/Victimization 12
• Cultural Identity 8

29
Primary Caregiver Characteristics

• Age 31 years
• Gender 94 female
• Single Female Headed Families 64 (PgtNP)
• Marital Status 84 Not Currently Married
• Mother Married at First Birth 11 yes
• Age of Mother at First Birth 21 (large SD)
• Formal Education
• lt 9yrs 10
• non-HS grad 44
• HS grad 31
• Total Income 643/mo

• Relation to Child 88 biological mother
• Number of Children Now in Home 2.7 (NPgtP)
• Average Number of Children Removed from Household
  3.1
• Prior CPS Involvement 53
• Involvement in Criminal Justice System 26
• Hospitalization in Adult Mental Health System
  16
• History of Being Maltreated 43 (NPgtP)
• History of Domestic Violence 51

30
300-day Child and Family Service Delivery Patterns

• Two major sets of analyses were conducted to
  examine patterns of service delivery to sample
  children and their families
• Analyses of in-agency services to foster children
  and families
• In-person, non-therapeutic services to the child
  and/or the foster family over the first 300 days
  of care
• In-agency therapeutic services to the child
  during this time period
• Phone calls to FIA and other collateral contacts
  during this time period
• Analyses of out-of-agency services to foster
  children and families
• The total number of referrals made over the first
  300 days in care
• The total number of out-of-agency services that
  had begun during this time period.
• For both sets of analyses, descriptive analyses
  were followed by multivariate statistical testing
  in order to determine what factors were
  associated with service delivery patterns

31
Services at 300 Days

• On average, non-pilot agencies provided
  significantly more in-agency services than did
  pilot agencies
• Non-pilot agencies made an average of 85
  in-person non-therapeutic service contacts for
  each foster child and/or foster family, as
  opposed to 51 such contacts per child by pilot
  agencies
• Non-pilot agencies had roughly six therapeutic
  service contacts with each foster child, as
  opposed to one therapeutic service contact per
  child made by pilot agencies
• Non-pilot agencies made roughly 23 successful
  phone calls and other collateral contacts per
  child, compared to 17 such contacts made per
  child in pilot agencies.

32
Services at 300 Days

• There were no statistically significant
  differences between pilot and non-pilot agencies
  in terms of the amount of out-of-agency services
  provided
• On average, pilot and non-pilot agencies made 13
  referrals for each foster child over the first
  300 days in care.
• On average, foster children and their families
  were involved in seven out-of-agency services at
  the 300-day mark

33
Factors Associated with Service Provision at 300
days Regression Analyses

• Pilot status was a powerful and consistently
  negative predictor of receipt of in-agency
  services over the childs first 300 days in
  foster care, controlling for other factors.
• Very few other variables (including reason for
  removal, strengths/ needs at time of removal,
  child, family, and worker demographics) were
  statistically related to any of the service
  utilization variables.
• Client age was a significant and negative
  predictor of two categories of service receipt.
  Children with older primary caregivers received
  fewer in-person non-therapeutic services, and
  older children received fewer in-person
  therapeutic services.
• Children whose primary caregivers had been
  diagnosed with chronic mental health problems,
  and children whose primary caregivers had
  previously been involved with child protective
  services, received more in-person non-therapeutic
  services and in-person therapeutic services,
  respectively.
• More phone calls to FIA and other collaterals
  were completed on behalf of children whose
  primary caregivers scored low on the
  worker-completed assessment of primary caregiver
  needs and strengths.

34
Comparison of Multivariate Analyses of Service
Data at 120 and 300 Days

• The effect of pilot status had a comparable
  negative effect on service provision at both the
  120-day and 300-day marks
• Certain child and primary caregiver variables
  were significant predictors of service receipt at
  120 days but not at 300 days.
• Older and African American children received more
  services in certain areas, including in-person
  non-therapeutic services as well as therapy, at
  120 days.
• Children from drug-impacted homes, and children
  whose caregivers had abandoned them, received
  fewer non-therapeutic services at 120 days.

35
Implications of the Service Findings

• There are a number of explanations for these
  results which cannot be dismissed at this stage
  of the research
• Pilot agencies, either formally or informally,
  choose to bring services to bear only as
  performance deadlines approach, which would
  explain the narrowing of the gap between the two
  groups in later time periods
• Pilot agencies provide only those services that
  are seen as absolutely necessary to achieve
  performance payments and/or improve client
  outcomes
• Pilot agencies choose to save the initial
  lump-sum payments rather than spend them on
  out-of-agency services
• Pilot contracting leads to service rationing
• The fact that service provision cannot, in
  general, be predicted based on case
  characteristics suggests that case assessment and
  planning is not as refined as it should be
• Some families (drug impacted, those that abandon)
  are difficult to engage, and therefore may be at
  jeopardy for TPR given current ASFA timelines.
  Such families may face double jeopardy in a
  managed care system.

36
Child Outcomes at 300 Days

• In general, there were no statistically
  significant differences in the placement status
  of children from pilot and non-pilot agencies
• 36 of the full sample was returned to a
  relative, 21 was returned home to a parent, six
  foster children (3) were placed with a guardian
  during this time, and no child was placed into
  independent living
• 55 of the children served by pilot agencies and
  45 of children served by non-pilot agencies
  reached this first pilot payment milestone --
  this trend is not statistically significant

37
Child Outcomes at the 300 Days

• Pilot agencies were significantly more likely
  than non-pilot agencies to have their agency
  supervision terminated (15 as opposed to 3)
• Children from pilot agencies were more likely
  than those from non-pilot agencies to have their
  court supervision terminated (19 versus 4)
• Only two children reentered care over this time
• 30 children (12) experienced more than one
  placement with parents, relatives, or guardians
  by the end of their 300th day in care
• While children from pilot agencies were roughly
  twice as likely as children from non-pilot
  agencies to have experienced multiple placements
  (14 versus 7), this trend was not statistically
  significant

38
Factors Associated with the Achievement of the
First Incentive

• Pilot status was not a statistically significant
  predictor of the achievement of the first pilot
  milestone
• Only a few variables were statistically
  associated with the achievement of the first
  pilot performance payment
• Children that had experienced prenatal drug
  and/or alcohol exposure were less likely to reach
  the first performance point
• Children that had been neglected or abandoned
  were also less likely to achieve the first pilot
  milestone
• Children whose primary caregiver scored highly on
  the worker-completed assessment of needs and
  strengths were more likely to reach the first
  performance point

39
Factors Associated with Other Child Outcomes at
300 Days

• Children were less likely to be returned home
  over this time period if they had been neglected,
  removed from a drug-abusing household, had been
  abandoned, or if their primary caregivers scored
  high on the worker-administered assessment of
  primary caregiver needs and strengths
• Older children, and children whose primary
  caregivers had previously been involved with
  child protective services, were more likely to be
  placed with a relative
• Court supervision was less likely to be
  terminated if the foster child had been removed
  from a drug abusing household or a household with
  inadequate housing. Additionally, the more
  in-person non-therapeutic services that were
  given to children and their families, the less
  likely it was that court supervision was
  terminated. Court supervision was more likely to
  be terminated if children had primary caregivers
  scored highly on the worker-administered
  assessment of primary caregiver needs and
  strengths.

40
Implications of the Output Analysis

• Children from non-pilot agencies were being
  placed with parents, relatives, or guardians at
  rates comparable to that of children from pilot
  agencies controlling for other factors
• Possible explanations for these results include
• Non-pilot agencies made unusually intense efforts
  to reunify children with parents and assess
  potential relative placements
• The courts were unable or unwilling to rule
  expeditiously on petitions brought by pilot
  agency staff
• Pilot agencies were unable to effectively
  coordinate the necessary resources to place
  children with parents and relatives
• Neglectful, drug-impacted families, and families
  who abandoned their children need more careful
  attention if a permanent plan with family or
  relatives is to be achieved within the acceptable
  timeframe

41
Comparison of Findings To Those From Other Systems

• Findings and Implications Conform With What is
  Known From Behavioral Health and Health Care
  Managed Care Studies
• Requires agencies to recognize that the meter is
  running and to initiate quick and accurate
  diagnostic processes that result in immediate
  service provision
• Risk-averse managed care agencies may avoid
  providing services or serving clients that they
  deem unprofitable, particularly those with
  special needs
• Leads to delivery of fewer services in general
• Outcomes are mixed generally works well but
  some fall through the cracks or are denied needed
  services

42
Comparison of Findings To Those From Other
Systems (cont)

• Associated with a greater focus on the management
  of service delivery through utilization review
  techniques, and thus requires a heavy IT
  investment
• May initially strain public-private
  relationships, but such relationships may
  ultimately improve as a result of increased
  inter-agency communication
• Requires agencies to invest in staff training in
  order to respond to staff turnover and managed
  care phobia, particularly among clinical
  departments
• Places a heavy emphasis on financial management,
  particularly in terms of data collection,
  actuarial analyses of agency caseloads, and
  prospective budgeting

43
Conclusions To Date Service Delivery

• Contract incentives directly influence the work
  environment, employee behavior, job satisfaction,
  and employee retention
• Performance deadlines must be set up with enough
  time to allow employees to conduct thorough
  assessments, provide necessary in-agency
  services, access community resources, and place
  children in appropriate living situations
• Monitor in-house service delivery to ensure that
  decreased client contact, if it occurs, is
  warranted by efficiencies achieved in service
  provision rather than cost considerations
• Consider formalizing relationships with
  collateral service providers in order to bring
  necessary services to bear in a timely way
• Assess the availability of high-demand,
  out-of-agency services. If such services are
  unavailable, document this shortage and convey
  this information to court officials and the
  public agency so that the managed care contract
  can reflect this reality.

44
Conclusions To Date Information

• Agency managers need to agree on what information
  is important, how this information is to be
  collected, whether agency staff have the
  resources and knowledge necessary to input such
  information in a timely and accurate manner,
  whether the requisite expertise exists to analyze
  trends in the data, and how the results of these
  analyses will be disseminated
• Agencies should not pour effort into establishing
  tickler based systemsin which workers and
  accounting staff are reminded of impending
  performance and billing deadlineswithout first
  carefully considering how staff behavior will
  respond to such a system. Tracking systems should
  not be a surrogate for careful case planning and
  the implementation of appropriate case plans for
  all clients

45
Conclusions To Date Interdepartmental Relations

• Managed care requires increased vertical
  communication executives must listen more often
  and more closely to front line staff in all
  departments to ensure that managed care service
  delivery strategies are working as intended and
  are not jeopardizing the quality of service
  provided to the client
• Managed care requires increased horizontal
  communication. Key departmentsfoster care, IT,
  and accounting in particularcannot operate on
  opposite sides of the hall
• Consider implementing interdepartmental meetings
  and other mechanisms so that staff can gain a
  holistic sense of how departments must balance
  competing pressures and responsibilities

46
Conclusions To Date Public/Private Contracting

• Managed care contracts should be negotiated
  rather than dictated. Agencies should perceive
  the playing field as level, and all parties
  voices should be heard in contract negotiations.
• Public agencies, in conjunction with the
  nonprofit sector, should consider establishing
  different performance expectations for more
  difficult-to-serve children
• Public agency managers must recognize that
  overdue reimbursements jeopardize private
  agencies cash flow, and possibly impact the type
  and amount of services that agencies are able to
  offer clients
• Other systems that are essential to the provision
  of service (drug rehabilitation, domestic
  violence, metal health, etc.) and the movement of
  children thought the system (courts) must be
  aware of the new fiscal arrangements and be
  prepared to operate to accommodate them
• Any future changes should be carefully considered
  and based on data

47
Conclusions To DateMoving Systems to Managed
Care

• Joint strategic planning may help contracting
  agencies better understand the common problems
  they will face
• Joint agency education and training programs at
  all levels might lead to efficiencies in the
  transition to managed care
• Managed care may not promote a one size fits
  all strategy, where agencies respond uniformly
  to new fiscal and programmatic challenges.
  Agencies should recognize that the wholesale
  adoption of another agencies service delivery
  strategy, MIS, and training programs may result
  in both benefits and costs
• Some smaller agencies are already signaling that
  they cannot survive in this managed care
  environment
• Viability of agencies must be carefully
  considered, for it may impact the mix of services
  available in the system

48
Looking Forward Research Analyses Underway 570
Days

• Continued analysis of service data
• TPR at 515 days and factors related to it
• Return to care after timely discharge to family
  or relatives and factors related to this
  phenomena
• First payment for sustainability for children
  returned within 290 days and factors related to
  reaching this milestone
• 290 180 days at home

49
Looking Forward Future Analyses Year Three Data
-- 935 Days

• Continued analysis of service data
• Positive outcomes and factors related to them
• Second payment for sustainability for children
  returned home/relative within 290 days (655 days)
• 6 and 12 month sustainability payments for
  children who did not return home/relative in a
  timely way
• Termination of parental rights in 515 days and
  are adopted within seven months (725 days)

50
Looking Forward Future Analyses Year Three Data
-- 935 Days

• Children who achieve TPR in a timely way but are
  not adopted within a year (880 days) and factors
  related to this phenomena
• Children who reenter foster care after return
  home or adoption and factors related to this
  phenomena
• Remain in the foster care system past all of the
  incentive deadlines and factors related to this
  phenomena

51
Looking Forward Future Analyses Year Three Data
-- 935 Days

• Children with other negative outcomes and factors
  related to these phenomena
• have psychiatric placement or go AWOL from the
  foster care system during their stay in foster
  care
• have a psychiatric placement or go AWOL after
  returning home or adoption
• have unstable placement histories in the foster
  care system within same agency
• escalate to more restrictive settings
• move from one foster care agency to another

52
For More Information

• Meezan, W. McBeath, B. (2003). Moving Toward
  Managed Care in Child Welfare First Results from
  the Evaluation of the Wayne County Foster Care
  Pilot Initiative. Ann Arbor University of
  Michigan School of Social Work.
  http//www.gvsu.edu/philanthropy/managedcare.doc
  http//gpy.ssw.umich.edu/projects/foster/Moving_to
  _Managed_Care_in_ Child_Welfare.pdf
• Meezan, W. McBeath, B. (2003). Moving Toward
  Managed Care in Child Welfare A Process
  Evaluation of the Wayne County Pilot Initiative.
  Final Report Submitted to The Aspen Institute.
  http//gpy.ssw.umich.edu/projects/foster/Wayne20C
  ounty20-20Feb202003.pdf
• Dissemination Conference funded by the Office of
  the Vice Provost for Research, University of
  Michigan Wayne County Foster Care Pilot
  Initiative First Research Results. University
  of Michigan, School of Social Work, October 2003.
  http//gpy.ssw.umich.edu/projects/foster/
  firstConference.htm