Foster Care

Children’s Home Society of Florida

Briefing Paper – 2010Extending Florida’s Title IV-E Waiver 

Issue:

Florida’s Title IV-E Waiver proposal was developed jointly by DCF and its CBC Lead Agencies and approved by the U.S. Department of Health and Human Services’ Administration for Children and Families (ACF) in April 2006.  Florida is the only state in the nation to receive the Waiver for Title IV-E; California has 2 counties that participate.  However, the Waiver is a five year demonstration project and is set to expire in 2011.  

 Discussion:

Approximately half of all funding for child welfare services in Florida (and every other state) comes from the federal government. The largest source of federal funds for child welfare services is Title IV-E of the Social Security Act. Title IV-E funds are mainly restricted to paying for the cost of removing children from their own homes and keeping them in another setting (foster or group care). Florida’s Title IV-E Waiver allows federal foster care funds to be used for any child welfare purpose rather than being restricted solely to funding out-of-home care, as generally required under federal law. Thus, the Waiver enables funds to be used for a wide variety of child welfare services including prevention, intensive in-home services to keep children safe in their own homes, reunification and foster care. Prior to the Waiver, Florida could only use IV-E monies for services to children already removed from their homes so the IV-E formula essentially created a disincentive to reunifying children with their families and to keeping children from ever entering the foster care system.  The Waiver agreement stipulated that Florida must meet a consistent funding commitment to children’s services and, by complying, would receive an annual 3% increase each year; this commitment was capped using the number of children in care at the time of signing.  Since 2006, Florida has made great progress in reducing the number of children in out-of-home care but still receives steady funding from the federal government due to the Waiver’s annual 3% increase.  More families are being served at home in preventative settings as a direct result of this Waiver; an estimated 52,000 children were served in their homes with diversion services in FY 09-10. 

 Florida’s IV-E Waiver will expire in 2011. Reverting back to pre-Waiver activities will negatively impact Florida’s progress in serving children and families.

 Recommendation:

Children’s Home Society of Florida recommends the extension of the Florida Waiver for an additional five years with a plan to implement nationwide.

 Reference Materials:

University of South Florida, Florida Mental Health Institute, Evaluation Brief 2, January 2010

Florida Coalition for Children, Night & Day Illustration of Waiver Impact, 2010

Senate Foster Care Caucus

Work Session on Family Preservation, Permanency and State Waivers

August 27, 2010

David A. Bundy, President and CEO

Children’s Home Society of Florida

It is my pleasure to participate in Senate Foster Care Caucus work session on Permanency, Family Preservation, and State Waivers to provide encouraging information on Florida’s experience with our Title IV-E demonstration waiver, and the transformation of child welfare services that this has brought about in our state.  I am David Bundy, President and CEO of the Children’s Home Society of Florida.  I am representing the Crittenton Family of Agencies, a partnership of organizations providing innovative services to girls and young women.  Children’s Home Society of Florida is the largest private, not-for-profit child welfare organization in Florida.  CHS offers services to abused, neglected and at-risk children and families in all of Florida’s 67 counties including foster care, in-home services, counseling and many others.  Last year our 2,000 staff and over 5,000 volunteers served 97,885 children and family members. 

 

INTRODUCTION 

Federal funding for child welfare programs is substantial and complex.  For example, current federal funding streams for child welfare come primarily from HHS but also from eight other federal agencies.  Federal funds account for 48% of all child welfare expenditures in the U.S.  The primary funding streams include:

• Title IV-E of the Social Security Act, which represents 49% of federal funding for child welfare, guarantees funding for all eligible children (based on parents’ income using 1996 standards), but can be used only to pay for foster care maintenance, administrative costs, and some related training.  
• Title IV-E Adoption Assistance funds one-time adoption costs as well as monthly subsidies to adoptive families.  (1% of federal child welfare funding)
• Title IV-B funds, Promoting Safe and Stable Families,  are intended to prevent the unnecessary separation of children from their families, improve the quality of care and services to children and their families, and ensure permanency for children by reuniting them with their parents, by adoption, or by another permanent living arrangement. (5% of federal funding for child welfare)
• TANF, Temporary Assistance for Needy Families, provides assistance in order that children may stay in their own homes. (19% of federal funding for child welfare)
• Title XX, Social Service Block Grant, funds the prevention of child abuse and increased availability of child care. (13% of federal funding for child welfare)
• Medicaid provides medical assistance to low-income families and their children. (11% of federal funding for child welfare)
• Title II or SSI Survivors Insurance
• Chafee Foster Care Independence Program provides independent living services for children who are likely to remain in foster care until age 18 or former foster youth up to age 21.

Each of the funding streams has its own allocation provisions, matching rates, cost-allocation rules and reporting requirements.  Time and effort spent on multiple, often convoluted processes for reimbursement divert resources away from direct services to children and families.

 

COMMUNITY-BASED CARE

Florida’s path to reform did not begin with the IV-E Waiver. Over the past decade, Florida has transformed its approach to child welfare through the transition from state-run child protective services to community-based care lead agencies. These not-for-profit organizations are led by community boards of directors representing key stakeholders in their respective communities. These include business leaders, leaders in the volunteer community, Guardians ad Litem, law enforcement officials, and representatives of local government.  

The 20 lead agencies provide child welfare services throughout the state of Florida and are essential to ensuring our services are effectively integrated into the fabric of our local communities.  Florida child welfare has evolved to embrace an inclusive strength-based, family-centered practice model that promotes family preservation and permanency.

 

THE WAIVER IN BRIEF

Florida was granted a Title IV-E Waiver on March 31, 2006, as a statewide flexible funding demonstration. The waiver allows federal foster care funds to be used for a wide variety of child welfare purposes rather than being restricted to out-of-home care.

In exchange for the flexibility in the use of funds, Florida receives a defined amount of federal funds over a five-year period. We receive a small annual increase based on projections of what the state would have received in the absence of the waiver. Funding does not change if out-of-home care costs increase or decrease. Adoption assistance funds continue to be earned on a matching basis, but are subject to an aggregate cost-neutral cap over the five-year demonstration period.

The waiver terms and conditions specify that the state must invest any savings in improving the child welfare program, regardless of whether those savings are in federal or state funds.

Florida, like many states, has faced extreme budget stress in the past few years. In spite of the very difficult budget environment, the Florida Legislature has respected its waiver commitment to sustain funds for child welfare even as out-of-home caseloads have fallen. This is evidence of the program’s significance and the results achieved under the waiver.

Our waiver has allowed us to maximize resources, as well as other private support because we can respond with much greater flexibility in addressing specific family needs.

 

FLORIDA’S RESULTS UNDER THE TITLE IV-E WAIVER

                The flexibility allowed by the Title IV-E Demonstration Waiver in Florida has resulted in remarkable outcomes.  Florida has safely reduced the number of children in out-of-home care by 36% while achieving record-setting levels of adoptions and permanent guardianships.  Florida has increased its ability to keep children safe, enhanced family preservation efforts, substantially reduced the recurrence of abuse, and achieved permanency for children at record levels. In December 2006 there were 29,000 children in out-of-home care in Florida. That number now stands at less than 19,000 children.   Florida has been able to re-invest the savings realized by the reduction in the use of foster care into community based services delivery, increased our ability to keep children safe, enhanced family preservation efforts, substantially reduced the recurrence of abuse, and achieved permanency for children at record levels.  

                Over 12,000 Florida children have been adopted in the last three and a half years, and our state is number one in the country in federal adoption measures.  CHS is proud to have been a major player in this accomplishment, having finalized 928 adoptions last year, 1090 in 2008, and 902 in 2007.

The flexibility provided by the waiver spawned many innovative practices that support and strengthen families and help to keep children in their own homes.  Before the IV-E Waiver, Florida spent $7.96 on out-of-home care for every dollar we spent on in-home services, family preservation, prevention and diversion. By 2009, this ratio had dropped to $3.60 for every dollar spent preserving families.   Innovations include:

• Family Team Conferencing  and other family-centered practices;
• Job training and referral services;
• Aftercare and daycare programs;
• Intensive in-home case management;(e.g., the Strengthening Ties and Empowering Parents [STEPS] Program which provides assessment, referral, a family support worker, intensive case management, in-home parenting, in-home money management skills training, and in-home behavior management strategies, and Mobile Crisis Support Teams which provide expanded prevention and diversion strategies aimed at providing immediate crisis intervention services),
• Expedited court hearings and reunification for qualified foster care cases;
• Intensive family finding services;
• Aftercare support to prevent foster care re-entry;
• Parent support groups;
• Process mapping from adoption through post-adoption;
• Respite care for foster and adoptive parents;
• Educational liaisons located at high schools to develop educational plans, provide educational/vocational counseling and support services, and to serve as advocates for the foster children,  
• Flexible, one-time funds to prevent out-of-home placement (rental payments, purchase cribs, utility bills, food, or clothing),
• Integration of domestic violence prevention, mental health and substance abuse treatment with child welfare practice;
• Establishment of resource/diversion specialists who are co-located with child protective investigators to allow for immediate discussion of a family’s needs and available services as a case is opened with the goal of connecting families with services in the community that can safely prevent the need for out-of-home placement;
• Foster parent mentoring and other strategies to improve the recruitment and retention of foster parents;
• Parent skill development to improve family functioning with children suffering extreme emotional or behavioral problems;
• High school educational liaisons to serve as advocates for foster children; and
• “Passport programs” for youth preparing for life after foster care provide financial literacy education and facilitate access to banking and other business transactions;

                The IV-E Waiver has allowed us to align our program goals with program funding. More children can safely remain at home through provision of intensive in-home services, those families can now be served under our IV-E waiver.  Where children cannot safely remain at home, family-centered practices are used to speed reunification.  When circumstances are such that the home cannot be made safe for children to return, we help the child transition to a permanent family through adoption or guardianship. 

                Florida’s IV-E Child Welfare Waiver is being evaluated by the Florida Mental Health Institute at the University of South Florida.  The most recent findings published in January of this year show these key results:

• Since waiver implementation, the average number of children served in out-of-home care has been reduced by about one-third.
• Compared with FY 07-08, there was a significant increase in the number of children reunified or placed with relatives.
• Among youth who exited care during FY 07-08, the average proportion of children who re-entered out-of-home care within 12 months after their discharge was substantially reduced.
• Since implementation of the IV-E Waiver, all of the community-based lead agencies have reported an expansion of their service array. In addition, several innovative practices have been implemented or expanded since the waiver.
• Front-end service expenditures nearly doubled from FY 05-06 to FY 08-09. Additionally, licensed out-of-home care expenditures have steadily decreased since waiver implementation, both in total and compared to relative spending on front-end services.[1]

Support Needed but not Available, from the Congressional Coalition on Adoption Institute’s 2010 Foster Youth Intern Report, suggests what could have been for one young person who did not have the advantage of flexible child welfare funding.  LaTasha, a young woman from a small town in Northern California, says that if her family would have had access to support services, such as counseling and substance abuse treatment, before she entered the foster care system or as her family worked toward reunification, her two years in foster care could have been avoided.

 

RECOMENDATIONS

Federal budget outlays totaled $3.5 trillion in 2009, of which less than 10% ($334 billion) was devoted to children.  Despite increased spending on children under the American Recovery and Reinvestment Act of 2009 (ARRA), total outlays for children’s services actually fell modestly to 9.5% in 2009, down from 9.8% the previous year.[2]  Nevertheless, given the current economic environment, increased federal financial support for child welfare is not the only answer to improve outcomes for children.  Substantial improvement can be achieved by streamlining federal funding sources and increasing flexibility in the use of those funds.  We recommend:

1. Extension of the IV-E Waiver.  Florida’s IV-E Waiver that has resulted in remarkable changes in child welfare in our state expires on September 30, 2011. Florida has requested that the Administration for Children and Families extend the waiver for five additional years to September 30, 2016.  An extension of the Waiver is the only way we can continue our reforms under current law.
2. Alignment of funding.  The lessons that Florida has learned point the way to urgently needed comprehensive federal finance reform.  We need a blending of the various child welfare funding streams and associated usage restrictions and reporting requirements.  The result would be a significant savings in administrative costs for the federal and state governments as well as child welfare service providers.  This reform would also give the states the ability to invest existing federal funds in different ways to address the specific needs of the individual children and families they serve. 

Although a change of this magnitude might take years to achieve, as an interim measure, the restoration of the IV-E Waiver capability to the Department of Health and Human Services would allow additional areas of the country to enjoy the benefits of keeping families together. 

A yet more significant step would be to expand the allowable use of IV-E to include services to families whose children are at risk for child abuse or neglect or for foster care placement, or for children who were previously placed in foster care.  This would eliminate an implicit incentive to remove children from their homes. 

1. Eliminate eligibility linkages.  Funding should be tied to a child’s need and not the income of his/her parents.  Eligibility for IV-E foster care reimbursement is based on each state’s former Aid to Families with Dependent Children (AFDC) income need standards.  Specifically, states receive federal IV-E funding only for children whose biological families would have been eligible for AFDC as the program existed July 16, 1996.

1. Technical Assistance to the states.  Along with other Florida child welfare leaders, I have traveled to other states to share our experiences with the IV-E Waiver.  This technical assistance process should be formalized and coordinated to ensure effective implementation of IV-E Waivers across the country.  The formation of a National Technical Assistance Center for Title IV-E could serve to provide information, technical assistance, and training to states, Tribes, territories, and communities to encourage thoughtful, creative and quality child welfare practices and improve outcomes for children, youth and families using the flexibility offered by a IV-E Waiver.
2. Clearinghouse of Innovative Practices.  In like manner, a national clearinghouse for sharing best practices could be a cost-effective way for encouraging innovation and replication of proven best practices.
3. Explore other opportunities to seek flexibility in funding.  For example, Florida is using a portion of IV-E in a manner consistent with Title IV-B funding to keep children in their own homes.  Folding IV-B into IV-E would simplify administration and result in increased flexibility.

We recommend that Congress consider fundamental reform in the financing of child welfare so that all states have the ability to implement the types of changes we have seen in Florida.  In the absence of a waiver, the goals of child welfare and the funding restrictions of Title IV-E are substantially in conflict.  States should be able to implement policies and practices that support and strengthen families without sacrificing essential federal support. Our service strategies should start with the challenges and opportunities facing families instead of trying to fit families into a rigid category that might not fully promote the goals of safety, stability and permanency for children.

With increased flexibility comes the need for increased, data-driven accountability.  States should be held accountable for child outcomes, and incentives should be tied to desired outcomes including:

• stabilizing and supporting families in order that children may remain with their families in a safe and healthy environment;
• timely permanence in safe and appropriate homes;
• improved outcomes for youth transitioning to adulthood (education, housing, mental health and employment); and
• diminished recurrence of maltreatment.

In conclusion, children do best when they are safely supported in their own homes and communities.  With flexibility and accountability for outcomes, it is possible to substantially improve outcomes for children and families. 

 

APPENDIX

 

---

[1] M.I. Armstrong, Vargo, A.C. Jordan, N. Sharrock, N. Sowell, C., Yampolskaya, S., Kip, S. Evaluation Brief on the Status and Activities Related to Florida’s IV-E Waiver Demonstration Project: Two Years Post-Implementation. January 2010.

[2]Julia Isaacs, Steuerle, C. E., Rennane, S., Macomber, J.  The Urban Institute and Brookings. kids’ share 2010, report on federal expenditures on children through 2009.  July 2010.