| No Winners! New ACS Child Welfare Contracts |
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| Monday, 31 May 2010 13:01 |
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Overall, it is now clear that New York City’s total child welfare service capacity -- both in terms of helping families to avoid foster care placement and the number and types of placement options available -- will be significantly smaller than in recent years. As a result, say providers and advocates, the biggest losers of all may not be those nonprofit agencies without contracts but, rather, the children and families of New York who need these vital services. Click on the links to see these charts: ACS RECOMMENDED PREVENTIVE SERVICE CONTRACT AWARDS Reaction to the contract recommendations, which culminated more than a year and a half of procurement activity and will shape the child welfare service delivery system for the next decade, can only be described as grim. The policies embodied in the new award recommendations were generally seen as having been driven by a combination of hard economic times and ACS Commissioner John Mattingly’s overriding philosophy regarding what constitutes appropriate child welfare practices. The results aroused considerable concern among providers with respect to how a mixture of these two often irreconcilable forces could lead to safe and effective services for children and families. Even the Commissioner expressed disappointment – using much the same wording as his nonprofit colleagues. “These are pretty grim times,” said Mattingly in an interview with NYNP. “In general, the news is not good. We had to scale down much of what we had hoped to do and planned to do. None of us are pleased and everyone has a right to feel concerned about how we are going to manage in the course of the next few years to overcome the challenges that are facing us with fewer resources. We will continue to do whatever we can to alleviate problems as they come up and to seek more resources as we go forward.” Preventive service programs took an overall 21% hit with total new contract allocations of 10,795 slots, 2,995 less than the current system capacity of 14,060. General preventive service programs will see total contract allocations drop by 30% to 7,230 slots compared to a current program capacity of 10,290. Total capacity for new family foster care services will total 12,954, a decrease of 1,069 or 7.6% from the actual census as of January 2010. A 1,347-bed reduction in regular foster boarding home programs will be partially offset by a 278-bed increase in specialized and more intensive family foster care programs. Residential program contract capacity is expected to total 1,194 beds, a reduction of 451 beds, or 27.4%, compared to the census as of February, 2010. Group homes programs took the most significant cut, losing 182 slots, or almost two-thirds of the beds being utilized in February. Institutional/RTC programs lost 85 slots; maternity/mother-child programs, 100 slots; group residences, 16; and Agency Operated Boarding Homes, 35 slots. Specialized residential programs lost a net total of 33 slots relative to the February census with significant cuts in SILPs (102) and Rapid Intervention Centers (82) being partially offset by new programs for children with MR/DD diagnoses and other special programs. In total, ACS is recommending a contractual provider network of 67 nonprofit agencies. Twenty-seven agencies will have family foster care services; 20 will operate residential programs and 59 will offer preventive services. A number of current providers did not receive ACS recommendations for new contracts. Perhaps most shocking, given its size and history, was the absence of Little Flower Children and Family Services. “Little Flower is surprised and saddened by ACS’ decision not to renew our agency’s foster care services contract,” said Grace G. Lo Grande, LMSW, MPA, the agency’s Executive Director. “We will appeal the decision.” Rosalie Hall, a provider of residential services for pregnant teens, also did not receive a recommendation for a new contract. “We’re shocked,” said Executive Director Steven Parker, DSW, LCSW-R. “We have filed a protest. We feel our model of providing residential care to at-risk, pregnant teens is a viable one. Whatever the outcome, we plan to stay active in providing services to families in need in the community.” Cayuga Home for Children, Inc., an Auburn-based agency, was the only new provider recommended for a foster family or residential care contract. In addition to the overall reduction in preventive service capacity, ACS’ recommended contract awards resulted in the elimination of several current providers – several with long histories in the field. Not included in the current award recommendations were: • Alianza Dominicana • Dominican Women’s Development Center; • East Harlem Council; • Partnership with Children; • Southern Queens Park Association; • Steinway Children and Family; • Dominican Sisters, and • Child Development Support Corp. Several new providers were among those agencies recommended for preventive services contracts. These included: • Center for the Integration & Advancement of New Americans • Mental Health Association • Sauti Yetu Center for African Women • The Family Center • Unitas Therapeutic Community • University Behavioral Associates How Did It Happen? Most child welfare executives were hard pressed to understand how the RFP evaluation process could have led to what they generally viewed as a relatively chaotic reshuffling of contract allocations by program category and Community District. Nor could they explain why ACS would have completely denied contracts for foster care and/or residential services to agencies such as Little Flower and Rosalie Hall. In the case of Little Flower, for example, the mere size of the agency and the number of children which ACS had entrusted to its care in recent years seemed at odds with the RFP results. “We have more than 1,200 children living in foster boarding homes right now and another 200 for whom we are responsible that are in various stages of trial discharge, at college or in hospitalization,” said Lo Grande. The agency’s census has been increasing steadily over the past several years as ACS continued to refer more and more children to its care. If Little Flower was not a quality provider, why had the City made such great use of its services, wondered many child welfare executives? ACS’ own “Scorecard” contract agency evaluation system, which has generally been seen as the most robust performance assessment tool in the field, certainly had not singled out Little Flower as an agency with problems. Its three “C”s and a “B” rating for 2009 placed it approximately on par with many other providers. Even more ironically, Rosalie Hall was the only agency out of all ACS providers to receive straight “A”s on its scorecard for that year. “It certainly seems odd that your performance as measured in Scorecard – something for which we all have developed some respect – seemed to have had no impact on your RFP score,” says Jim Purcell, CEO of the Council of Family and Child Caring Agencies (COFCCA). “The evaluation appears to have emphasized proposal writing skills over proven ability to meet the real needs of real children,” says Lo Grande. “For more than 80 years, Little Flower has provided New York City’s foster care children with safe, stable and loving homes – and the chance for a bright future… The evaluation and scoring of the RFP were not transparent. The contracts were awarded arbitrarily and capriciously.” Lo Grande argues that the City’s decision to close Little Flower will have a detrimental impact on the lives of the more than 1,200 children in its care – as well as on the estimated 188 staff members who will likely lose their jobs. One question buzzing through the child welfare community is the extent to which the contract recommendations actually reflect ACS policy priorities …or whether a rigid, bottom-up RFP review process – which begins with teams of readers who score individual contract proposals – arrived at decisions that came as a shock to Mattingly and ACS’ senior leadership. “After all these years of reform and trying to move the system, did he really just throw up his hands and leave this to a bunch of low level bureaucrats,” asked one executive director. “All of us were surprised a bit by some agencies being cut so dramatically,” said Commissioner Mattingly, emphasizing that he was speaking generally rather than addressing agency-specific cases. “This is a process that is driven by a primary commitment to make the process fair. There is a very clearly defined, bureaucratically-driven, step-by-step process that takes out a lot of flexibility.” In many cases, he noted that agencies may have applied for contract slots in same CDs as a large number of other providers whose proposals were scored higher on an initial review. “The problem with this system of contracting is that someone like myself cannot sit at the table and move everything around to make sense,” he said. As for the role of Scorecard, “it wasn’t designed as a Vendex,” said Mattingly. “The Scorecard would have been in there but it was only one part of the areas we had to consider.” The RFP itself stated that scoring would be based on three separate components, each accounting for a specific weighting in the final evaluation: • Demonstrated quantity and quality of successful relevant experience – 20%; • Demonstrated level of organizational ability -- 40%; • Quality of proposed approach – 40%. Providers question the logic of these criteria and weightings. Why would demonstrated service quality count for less than a proposed approach to providing services, particularly in a field as heavily regulated and with such an overarching series of service mandates as foster care? In fact, the service requirements were spelled out in significant detail in ACS’ 700-page RFP. “All you have to do is cite the regs,” said one executive director. “They are your approach to services; they are everyone’s approach to services.” Providers will ultimately be able to learn how their proposals were scored through individual “debriefings” – but only after a public hearing at which ACS formally announces its contract awards. In the meantime, both Little Flower and Rosalie Hall have indicated that they will be filing formal protests and are hoping to overturn their results. Concerns Providers found much to question in the recommended contract awards – above and beyond how they were determined. Chief among their concerns were: • The significant reduction in preventive service system capacity; • The apparent need for rapid, large scale transfers of foster care children and their foster homes between agencies; • The elimination of substantial residential program capacity, including almost two-thirds of all community-based group homes, all Supervised Independent Living Programs (SILPs) and specialized programs for Lesbian Gay Bisixual Transgender and Questioning (LGBTQ) youth; • Reduced levels of reimbursement for family foster care; and, • A general lack of confidence in the extent to which ACS had fully thought through – let alone actually tested -- the potential challenges and consequences of implementing its new service delivery model. Preventive Service Cuts The one aspect of the new contract awards which appeared most clearly driven by budget pressures was a 21% reduction in overall preventive service capacity – 2,995 slots. The cuts represented a 30% cut to general preventive program capacity. Even prior to announcement of the RFP results, providers and advocates were warning of the risks such a move posed for children and families. “ACS and its preventive service providers are the city’s emergency responder for children,” said Jennifer March-Joly, Executive Director of Citizen’s Committee for Children, at an April 12th City Hall press conference. “Sadly, this city already knows the tragedies that befall us when child welfare services are cut. We must not let the budget deficit leave children at risk and we must not wait until there has been another tragedy before restoring these funds.” “Families in my community are being hit hard by the economic downturn and they often have very limited resources to care for their children -- so preventive services may be the only available venue for parents to keep their children safe,” said Elizabeth Croban, the Preventive Service Director at Catholic Guardian Society and Home Bureau. “Downsizing of preventive services increases the risk of child maltreatment and foster care.” And, say advocates, the proposed cuts are counter-productive from a financial standpoint. “Preventive service programs have saved the City hundreds of millions of dollars in reduced foster care costs by keeping thousands of children safely at home,” said COFCCA’s Jim Purcell. “These drastic cuts to Preventive Services will result in more pain for vulnerable children and families, more children in foster care and more homelessness in our city.” ACS believes that faster and more focused casework will allow preventive programs to serve the same number of families as in the past – just more efficiently. The objective is to reduce average lengths of stay to twelve months. “There is very little evidence that keeping families in care for long periods of time -- rather than setting clear goals at the outset and working to achieve them at the three- and six-month intervals -- produces better results,” says Mattingly. “We just have a history here of long lengths of stay. If you look at the statistics, it is clear that certain agencies have done quite well in bringing the numbers down and others, who have said that they don’t agree with this approach, have not.” At the same time, however, Mattingly acknowledges that this was a budget-driven decision. “None of us wanted to cut preventive service, but we just couldn’t find other places to make cuts beyond what we had already done. We worked hard to try to keep this from happening,” he said. Foster Care Transfers The new ACS contract recommendations would seemingly force a rapid and large scale transfer of foster children and their foster homes between agencies – and all by October 1st, barely four months away. In addition to the estimated 1,200+ children currently being served by Little Flower, the new contract allocations have cut hundreds of additional slots from some providers and added to others. In some cases, agencies which remained relatively stable in terms of total bed allocations – or even saw increases – will still be required to uproot their operations as their contracts shift out of their current CDs s and into others. In all, it appears likely that well over 2,000 children and their foster parents will shift agencies in the coming months – more than 14% of all kids currently in foster care. Providers maintain that this turmoil will be bad for children and families. Changes in the foster care caseworkers assigned to a case will almost certainly disrupt progress towards permanency goals, they say. “Decisions to discharge a child home are based on the confidence level of the caseworker that the child will be safe,” says Jim Purcell. “A new caseworker coming on to a case is going to need that extra time to get to know the child and the family and develop that confidence. If you are transferring the case, it certainly is not going to speed up the discharge.” Family courts also rely on the first hand testimony of caseworkers for a variety of court actions, including Terminations of Parental Rights. “This will slow down progress towards adoptions,” said one executive director. “Family Court Judges don’t want to just read progress notes. They want to ask questions of the actual caseworker who has made the observations.” “Foster parents who have moved from one agency to another have told us that this is incredibly painful for children,” says Little Flower’s Grace Lo Grande. “In addition to the loss of the caseworker, who is a very important person in the life of the child, there is the loss of physicians, nurses, therapists and clinicians, all of whom know that child.” Lo Grande cites an internal Little Flower study showing that transferring cases between agencies delays reunification with birth families an average of 4.4 years and slows down adoptions by 2.6 years. “I certainly don’t think that need happen in this case. Agencies have a track record,” says Mattingly, noting previous large scale case transfers following past terminations of foster care contracts with St. Christopher’s and Miracle Makers. At the same time, Mattingly acknowledges the legitimacy of provider concerns. “I would rather not have to do this, but you have to fairly contract out your system. This is something we are just going to have to do with minimum harm to children and families,” he said. “In cases where the numbers are large, it is going to be very challenging. We are going to have to get the numbers to where we need to be, but that doesn’t mean we can’t find ways to make it work as best we can on a case-by-case basis.” Residential Reductions The contract award recommendations also advance Commissioner Mattingly’s longstanding commitment to reducing the relative size and role of congregate residential programs. Total residential contracts will decline by 451 beds – or 27.4% -- relative to the actual census as of February, 2010. The ACS strategy is based on the Commissioner’s strongly held and oft-stated belief that “children do best when living with families.” Provider executives agree just as strongly. At the same time, however, they worry that these residential care cuts – coming on top of a 38% reduction since 2005 -- are eliminating critical treatment and placement resources needed to serve certain children. They base this belief, at least in part, on the fact that all 451 beds being cut were occupied in February by youth placed there by ACS. Many if not all, they say, are still occupied today. The real question is whether these programs will still be housing ACS children next March 31st when current contracts expire. Providers claim that prior rounds of residential bed closings have fallen short of their targets as both agencies and ACS struggled to find alternative placements for older teens and high needs youth. “That is something that ACS has actually acknowledged,” said Dianne Heggie, Deputy Executive Director of COFCCA. Many of the youth who were transferred to family-based settings or reunited with their own families either “disappeared” by going AWOL or “reappeared” in other group programs, say providers. COFCCA’s Residential Care Committee has been asking for an analysis of what happened to each of the kids involved in prior bed closings, explains Heggie. “We have been waiting for a many months now to get final numbers,” she says. As we went to press, ACS had reportedly completed the analysis but had yet to make it available. Providers argue that this residential program capacity is essential to meeting a variety of placement needs. They maintain that many children with serious emotional and behavioral challenges cannot be served adequately in a regular foster boarding home (FBH) or even a therapeutic foster boarding home (TFBH). “These are very challenging kids who need structure, supervision and a lot of clinical services,” says one executive director. “Placing them in a family-based setting is not fair to the child and it’s not fair to the foster parent.” Providers point to a 2005 survey of the congregate care population commissioned by ACS which found significant numbers of youth with histories of multiple psychiatric hospitalizations, multiple mental health diagnoses and multiple problem behaviors, including gang involvement, substance abuse, assaultive behavior, fighting and high-risk sex. While the highest incidence rates were found in Residential Treatment Centers (32% with multiple psychiatric hospitalizations, 42% with three or more mental health diagnoses and 47% with three or more problem behaviors), even regular Group Homes/Group Residences/AOBHS were caring for exceptionally high needs youth (18% with multiple psych hospitalizations, 32% with multiple mental health diagnoses, 42% with three or more problem behaviors). If that was a snapshot of the psychiatric and behavioral challenges back then, say providers, what must it look like now after a 38% reduction in census – presumably the 38% with the lowest level needs? “We have been asking ACS to repeat the Westsat survey,” says Dianne Heggie. Providers also note the recent Legal Aid lawsuit against ACS which charges that, all too often, children are forced to remain in psychiatric hospitals beyond medical necessity due to a lack of available placement options. ACS’ residential program cuts fall heaviest on community-based congregate care programs. The contract recommendations would close almost two-thirds of all group homes - 182 beds in all. (See “Bringing Down the House” on page 10.) For some teens, a final step in care might have been transfer to a Supervised Independent Living Program (SILP). These small apartment programs provide the housing, financial support and ongoing counseling necessary for a planned transition to complete independence as youth age out of care. In late March, however, even prior to the contract award recommendations, ACS announced that it would be completely ending the SILP programs in which 102 youth are currently living. “Our decision for the SILPs is also related to our belief that most youth who currently reside in SILPs can be supported with resources and services in other parts of the ACS and other systems,” wrote Executive Deputy Commissioner Belinda Conway at that time. “We will be working with our foster care provider partners to transition from a reliance on SILPs to a model of stronger youth development that is permanency and family focused, and helps each youth develop connections to a caring, loving adult.” “We have felt that the SILP model of care has been very beneficial to many youth moving toward independence from residential care,” said Joseph Whalen, Executive Director of Green Chimneys Children’s Services. “The contracts really hit programs for older teens very hard,” said one executive director. Reduced Funding While increasing its reliance on foster boarding home programs, ACS’ new contracts will cut much of the enhanced funding originally intended to support these efforts. ACS will be delaying the implementation of the $34 per diem rate originally cited in the RFP until Fiscal Year 2013. “Pending adoption of the City budget, the rate for FY 2011 will be $31.77 and for FY 2012 will be $33.50 per day,” said Conway. Based on the 12,745 children in family foster care programs at the end of February, the reduction would mean a loss of approximately $10 million to the system as a whole. An agency with 600 children in care would see a budget reduction of almost $500,000 compared to the original RFP assumptions. ACS will also be eliminating several “supplemental” funding streams which support a number of services and activities not covered by the basic per diem rate: • “Reinvestment funding” which supported after-care programs and services for families of children coming out of residential programming will no longer be available; • Discharge Grants are being eliminated for all foster care programs. • Special Allocations, which are used to cover the costs of a wide range of miscellaneous purchase, ranging from graduation caps and gowns to music lessons, are being ended. “We all understand the City’s budget problems, but these cuts are contradictory and self defeating,” said Jim Purcell. “Eliminating aftercare while you are trying to discharge kids home more quickly is not a wise decision.” “These changes will be devastating to the children and families we serve as caseloads increase and we struggle to reunite families without the supports necessary to keep them intact,” said Anstiss Agnew, Executive Director of Forestdale, following the ACS announcement. The Big Move Getting from the current contract structure to ACS’ vision of the future – which starts for foster family care on October 1st -- is not going to be easy, say providers. Everything aspect of the transition -- from foster care case transfers to group home closings, staff layoffs and new hires – poses significant challenges and no small amount of risk to children, families and the agencies themselves. The system-wide scale of the changeover is likely to make matters even worse. Several thousands of foster care cases are likely to be transferred. Estimates of total staff losses at individual agencies are likely to exceed 1,000. The timing of a transition is almost certain to be more messy than ACS might hope. Staff in programs targeted for closure are likely to begin looking for new, more secure positions as quickly as possible. With virtually no close-out funding available, agencies themselves may opt to begin closing programs at points where it makes the most sense fiscally and operationally. In the face of these challenges, providers complain that many critical policy questions remain unanswered. “We’ll get back to you,” is apparently the most common ACS response to issues raised at individual contract transition meetings. “We’re getting platitudes, not answers,” says one agency executive.
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There were no winners following the Administration for Children’s Services’ late April announcement of recommended new contract awards for foster care, residential and preventive services. That is the general consensus among nonprofit agency executives -- including those who could be seen as having added to their contracts. 
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