[Federal Register Volume 63, Number 132 (Friday, July 10, 1998)]
[Notices]
[Pages 37387-37394]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-18437]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
[Notice of Program Announcement No. ACF/ACY/CB-98-05]
New Child Welfare Demonstration Project Proposals Submitted by
States for Waivers Pursuant to Section 1130 of the Social Security Act
(the Act); Titles IV-E and IV-B of the Act; Public Law 103-432
AGENCY: Administration for Children and Families, HHS.
ACTION: Notice.
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SUMMARY: This notice lists new proposals for child welfare waiver
demonstration projects submitted to the Department of Health and Human
Services pursuant to the guidance contained in Information Memorandum
ACYF-CB-IM-98-01 dated February 13, 1998, public notice of which was
given in the Federal Register of March 4, 1998, Vol. 63, No. 42, page
10637.
COMMENTS: We will accept written comments on these proposals, but will
not provide written responses to comments. We will neither approve nor
disapprove any new proposal for at least 30 days after the date of this
notice to allow time to receive and consider comments. Direct comments
as indicated below.
ADDRESSES: For specific information or questions on the content of a
project or requests for copies of a proposal, contact the State contact
person listed for that project.
Comments on a proposal should be addressed to: Michael W. Ambrose,
Administration on Children, Youth and Families, Children's Bureau, 330
C Street, SW, Mary E. Switzer Building, Room 2058, Washington, D.C.,
20201. FAX: (202) 260-9345.
SUPPLEMENTARY INFORMATION:
I. Background
Under Section 1130 of the Social Security Act (the Act), the
Secretary of Health and Human Services (HHS) may approve child welfare
waiver demonstration project proposals with a broad range of policy
objectives.
In exercising her discretionary authority, the Secretary has
developed a number of policies and procedures for reviewing proposals.
The most recent expression of these policies and procedures may be
found in the February 13, 1998 Information Memorandum cited above, a
copy of which may be found at the ACF website at http://
www.acf.dhhs.gov/program/cb/demonstrations or may be obtained from the
National Clearinghouse on Child Abuse and Neglect Information, (800)
394-3366, internet address <[email protected]>. We are committed to a
thorough and expeditious review of state proposals to conduct child
welfare demonstrations.
II. Listing of New Proposals
As part of our procedures, we are publishing a notice in the
Federal Register of all new proposals. This notice contains summaries
of 17 proposals received by April 30, 1998. Each of the proposals
contains an assurance that the proposed demonstration effort will be
cost neutral to the federal government over the life of the proposed
effort; and each proposal contains an evaluation component designed to
assess the effectiveness of the project.
State: Arkansas
Description: The State of Arkansas proposes to use title IV-E funds
to enhance mental health services available for children in foster care
and children at risk of being placed in foster care, and thereby reduce
barriers to permanency for those children. The State intends, in
October, 1998, to implement a system for mental health managed care for
all title XIX eligible children, and all children in DCFS foster care.
Under this demonstration, the State would use title IV-E funds to
[[Page 37388]]
provide supplemental payment to the managed care capitated rate to (1)
allow for previously unallowable services to title IV-E eligible
children (Managed Care component); (2) provide specialized,
collaborative case management services to a group of randomly selected
foster children (some of whom may not be IV-E eligible) and children
who are at risk for being placed in foster care because of their
service needs, to identify and address barriers to permanency (FOCUS
component); and (3) provide training to child welfare staff as well as
others in the community to enhance participation in the project from
agencies and persons outside DCFS.
Arkansas proposes to conduct a process evaluation as well as an
evaluation to produce outcome data, and a cost/benefit analysis. The
evaluation design for the collaborative case management services
portion of the project is proposed as a design based on random
assignment of children or families to treatment or control conditions.
The State requests waivers of title IV-E to allow the State to
conduct a portion of the Demonstration on less than a Statewide basis,
to allow the State to expend title IV-E funds for children and families
who are not normally eligible, to allow the State to make payments for
services that are not normally covered under Part E of title IV of the
Act, and to allow the State to expend title IV-E funds for training of
persons who are not normally eligible. The State also has requested a
title XIX waiver under the authority of section 1915(b) of the Social
Security Act to establish a mental health managed care system to reduce
costs, prevent unnecessary and inappropriate utilization, and ensure
access to quality mental health care for Medicaid recipients.
Contact Person: Lee Frazier, Director, Arkansas Department of Human
Services, 329 Donaghey Plaza South, P.O. Box 1437, Little Rock,
Arkansas 72203-1437, Phone: (501) 682-8650, Fax: (501) 682-6836.
State: Connecticut
Description: Connecticut's proposal has two distinct program
components. The first proposes to use title IV-E funds to implement a
subsidized guardianship program and to change case work practice to
provide increased emphasis and support for guardianship as a viable
permanency option for cases where reunification or adoption of children
living with relative care givers is neither appropriate nor feasible.
The second component proposes to conduct pilot demonstrations of a
service delivery model in which a single lead agency would organize,
manage and provide an array of services to address the specific needs
of children who require placement in residential or group homes.
The goal of the proposed guardianship program is to provide another
means of attaining permanency for children who would otherwise remain
in foster care. The program would be implemented state-wide and would
focus on children residing with relative caregivers. It would provide:
(1) A monthly subsidy on behalf of the child payable to the guardian
equal to the prevailing appropriate foster care rate; (2) a medical
subsidy comparable to the medical subsidy for subsidized adoption (if
the child has no private health insurance); and (3) a lump sum payment
for one-time expenses resulting from the assumption of care for the
child (when other resources are unavailable). Waivers would be required
to allow for Federal IV-E reimbursement for payments to relative
caregivers when a child leaves legal custody of the State agency, and
for program administration and services that are not currently
allowable under IV-E.
The proposed ``single contact/continuum of care'' program's goal is
to test the effectiveness of the service delivery model in which the
State's Child and Family agency (DCF) would contract with a single Lead
Service Agency that would manage subcontracts and create an expanded
network of regular and specialized services for children and youth with
behavioral problems who are referred to residential or group homes.
The State hypothesizes that this demonstration project would
decrease the length of stay in restrictive settings; increase treatment
options for children and families; improve permanency outcomes for
children and provide long-term stability in the community; and
establish a more flexible, incentive-oriented fiscal environment for
service providers. One or two pilot programs would be established to
serve 30 children per pilot over a five year project period. The
program would be targeted to DCF children aged 7 to 15. A 15 month
service period, which includes a minimum of 3 months of aftercare, is
projected for each child. Waivers are requested to allow the
administrative and services costs to be IV-E reimbursable.
Contact Person: Robert Dakers, Department of Children and Families,
505 Hudson Street, Hartford, CT 06106-7107, Phone: (860) 550-6542, Fax:
(860) 566-7947.
State: District of Columbia
Description: The District of Columbia proposes to test the ability
of a partnership between the Child and Family Services Agency (CFSA)
and neighborhood-based community collaboratives to improve service
delivery for children in kinship placements. Teams of CFSA social
workers matched with trained collaborative community workers would
provide family preservation services to the kinship triad: the kinship
caregiver, the parent and the child. CFSA hypothesizes that this
public-private partnership would increase the number of children who
achieve permanency, speed the permanency process, increase stability in
kinship care families, increase outreach and education that promotes
child safety and reduce the incidence of further abuse or neglect for
children and families receiving these services, and reduce time in out-
of-home placements and the number of new foster care placements.
To test its hypotheses, CFSA has requested waivers to permit title
VI-E funds to be expended for services and individuals that are not
eligible under existing law. The requested waiver would allow the
District to be reimbursed for foster care services provided to children
who are not IV-E eligible, including those who are living with kinship
caregivers, and to allow adoption subsidy payments for children who are
not IV-E eligible.
The District's proposed evaluation design would randomly assign
eligible kinship triads to experimental and control groups. The
experimental group would receive the team approach and the control
group would receive traditional services from a social worker. The
evaluation would measure: Changes in Child Safety through the number of
new allegations, allegations after a case is closed, disruptions in
placement, entries or re-entries into non-kinship foster care; Child
Well-Being through the Child and Adolescent Functional Assessment
Scale; and Child Permanency as indicated by adoption, legal custody or
re-unification.
Contact Person: Ernestine Jones, General Receiver, Office of the
General Receiver, Child and Family Services Agency, 900 Second Street,
N.E., Suite 221, Washington, DC 20002, Phone: (202) 842-0888, Fax:
(202) 842-2335.
State: Florida
Description: Florida proposes to demonstrate whether children and
families can achieve better outcomes through: privatization, managed
care, and Medicaid therapeutic service
[[Page 37389]]
integration. In response to a 1996 legislative mandate to private child
welfare services, the Florida Department of Children and Families
allowed community-based providers to operate five pilot projects.
Waivers under a demonstration project would enable these providers to
use State funds and federal title IV-E funds to purchase therapeutic
services for children who do not meet Medicaid ``medical necessity''
restrictions for therapeutic services. In addition, at least one
demonstration site would receive a capitation payment linked to the
number of children living in poverty. Each site would then utilize this
funding flexibility to reconfigure services. The state hypothesizes
that this would expedite all aspects of permanency, improve family
capacity to care for children, increase family involvement and the
range of supports available to families, and increase youths'
preparation for independence.
Florida proposes to compare the performance of selected comparison
counties to the performance of the demonstration counties. The State's
evaluation design would include outcome evaluation, process evaluation,
cost analysis and cost benefit analysis. Outcome measures include
safety and protection, permanency goals, stability and functioning and
customer satisfaction. Process measures would examine policies,
procedures, client flow, staffing expertise and levels, service types,
duration, mix, timing and accessibility, assessment processes, and
court, community and media relationships. A cost analysis would study
all costs associated with the project and comparison counties. The
cost-benefit analysis merges cost data with outcome data to determine
the overall value of the outcomes.
Contact Person: Margaret Taylor, Florida Department of Children and
Families, 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700,
Phone: (850) 922-0149, Email: Taylor __M[email protected].
State: Iowa
Description: Iowa proposes to fund community-based services to
improve outcomes for children and families in the child welfare system
using title IV-E funds. The State plans to build on the existing
Decategorization Project areas and Innovation Zones to increase the
capacity of local organizations to care for children and families and
build service strategies for children and families in the child welfare
system. The State believes this demonstration would efficiently reduce
the amount of time children spend in out-of-home care and move children
into permanent placements more quickly.
The State proposes to implement this demonstration in several
counties or clusters and use a comparison group of counties to evaluate
both the impact and the cost of using title IV-E funds flexibly. Under
the State's plan, counties would present proposals for participating in
the IV-E demonstration that focus on: (1) Diverting children from out-
of-home care, including foster care, group care, residential care, and
mental health or juvenile justice institutions; (2) providing for
permanency for children quickly and effectively; and/or (3) reducing
re-entry into out-of-home care. For each county's or cluster's
proposal, the State is proposing that the eligibility determination for
title IV-E be eliminated under the demonstration. To assess the
demonstration project, the State proposes to compare demonstration
counties or clusters to children in comparison counties or clusters.
The evaluation would produce process, outcome, and cost/benefit
information.
The State is requesting waivers of certain provisions of title IV-E
which would allow Iowa to: (1) Use title IV-E funds to pay for
additional services for children and families; and (2) spend title IV-E
funds on children and families who would not normally be eligible for
title IV-E.
Contact Person: Mary Nelson, Division Administrator for Adult,
Children and Family Services, Iowa Department of Human Services, Hoover
State Office Building, Des Moines, IA 50319-0114, Phone: (515) 281-
5521, Fax: (515) 281-4597.
State: Kansas
Description: Kansas proposes to fund a demonstration project
intended to ``support and enhance'' the new performance-based
administration of the Kansas Child Welfare System. The Kansas
Department of Social and Rehabilitation Services (SRS) intends to
conduct a multi-faceted project consisting of a subsidized guardianship
program, integrated child welfare training, enhanced drug/alcohol
services, and subsidized family reintegration upon return home
(aftercare). In addition, the initiative would compare the new case
rate, performance-based payment system (already in place statewide)
with the traditional fee-for-service payment system in order to
determine which payment method produces better outcomes.
The State hypothesizes that: (1) The subsidized guardianship
project would facilitate the permanency of children when adoption and
reunification with their family is not feasible; (2) an integrated
child welfare training project for private and public social service
professionals aimed at supporting an integrated social service model
with a ``single worker per family'' concept would provide social
service staff with the tools needed to meet the needs of families,
including preventing out-of-home placement; (3) a strengthened approach
to drug and alcohol dependency assessment and treatment planning
directed to IV-E eligible children and families would decrease the
number of disruptions to placement and decrease the length of stay in
out-of-home placement; and (4) a project making resources and services
such as respite care, family support services, parenting education,
family, individual, and group therapy, available to families upon
reintegration of a child would prevent further disruption.
The proposed evaluation design would compare the fee-for-service
delivery system to the case rate performance based delivery system.
Since the SRS has already shifted all of the adoption and foster care
delivery systems into the latter, it would be necessary to randomly
select children to be placed ``outside the case rate.'' The random
selection process would be applied to selected area offices which
collectively represent 40% of the children served, and three of the
five foster care regions. The State would measure outcomes such as
amount of time for children to be placed with adoptive families,
percentage of finalized adoptions within 12 months, disrupted
placements, number of siblings placed together, number of placement
changes, new substantiated claims of abuse or neglect, percentage of
children placed within Regional boundaries, percentage of children
returned to family or achieving permanence, re-entry into foster care,
percentage of children achieving permanency and family satisfaction
with services.
The proposed project would be cost neutral and would run for five
years.
Contact Person: Teresa Markowitz, Commissioner, Kansas Department
of Social and Rehabilitation Services, 915 SW Harrison Street, Topeka,
Kansas 66612, Phone: (785) 368-6448, Fax: (785) 368-8159, Email:
tamasrcfs.wpo.state.ks.us.
State: Maine
Description: Maine proposes a two-phase demonstration project. The
first phase would involve the design and implementation of an adoption
training
[[Page 37390]]
curriculum for mental health professionals and other service providers
who would become expert in working with families in need of post-
adoption services. The second aspect of the demonstration would phase
in the purchase and delivery of post-adoption support services for
families who adopt special needs children. The overall goals of the
project are to increase the number of special needs children who are
adopted and to decrease the number of disrupted adoptions. It is the
State's hypothesis that increasing the array of supportive services
available to families who elect adoption would promote family stability
and reduce disruptions, as well as encourage other community members to
consider adopting children with special needs. The State has proposed a
five-year demonstration period.
The demonstration would be conducted in four test sites, two urban
and two rural, from among the Department of Human Services district
offices. At present, Maine has about 535 IV-E eligible children free
for adoption.
The evaluation design calls for establishing a control and
experimental group in each pair of selected sites, i.e., one urban
control, one urban experimental, one rural control and one rural
experimental. The State expects that a total of 200 children and
families (100 control and 100 experimental) would participate in the
study over the life of the demonstration. The experimental group would
receive the expanded post-adoption services, while the control group
would receive the current service mix.
Outcome measures would include the number of special needs
adoptions, the incidence of disrupted adoptions, the average length of
stay in foster care and the stability of the adoptive families.
Waivers are requested to enable the State to use title IV-E funds
to provide services which are not normally allowed under title IV-E
Adoption Assistance or title IV-E Foster Care.
Contact Person: Dawn Stiles, Department of Human Services, State
House Station #11, Augusta, Maine 04333, Phone: (207) 287-5060, Fax:
(207) 287-5282, TDD: (207) 287-4479.
State: Mississippi
Description: Mississippi proposes to expand the use of title IV-E
funds to non-IV-E eligible children and families and to use title IV-E
funds for any items or activities that would eliminate or reduce harm
to children and families. The demonstration proposes to implement a
Child-Focused Family Centered Practice Methodology, which emphasizes
the safety and best interests of children through the elimination of
harm-causing factors. The proposed project involves using title IV-E
funds to provide services for children and families whether children
are in State custody or not, including children in residential care.
This project would involve the identification of services, the
development of a service delivery system, the development of a business
plan, the building of multi-disciplinary case management teams, and
ongoing evaluation and program modification. It is the State's
hypothesis for the demonstration that the expenditure of funds to
benefit any child, regardless of IV-E eligibility, to reduce or
eliminate factors that cause harm to that child, would demonstrate a
reduction in harm to children. The demonstration would result in safer
children due to the reduction of harm to children who are a part of the
demonstration. The State has proposed a five year demonstration period.
The demonstration would be conducted in eight selected counties, which
are located in two Division of Family and Children's Services' (DFCS)
regions.
The State proposes an evaluation design in which eligible children
and families would be randomly assigned to experimental and control
groups. The experimental group would receive a combination of existing
or modified services along with newly created services. The control
group would be served by the existing services only. The evaluation
would compare results from the experimental group and control group.
Outcome measures include: decrease in the proportion of children who
experience subsequent abuse or neglect; increase in the proportion of
children who remain permanently with their parental family; among those
children placed outside of their parental home, increase in the
proportion who are in placements in the community of their parental
family and who are placed with relatives; decrease in the proportion of
children placed in foster care; decrease in the average number of
placements for children in foster care; decrease in the amount of time
spent in foster care; an increase among children awaiting adoption in
the proportion of children adopted and the speed of the process; where
two or more siblings are placed outside of their parental home,
increase in the proportion of sibling groups where siblings are placed
in the same setting; and increase in the well-being of children.
Waivers are requested to allow the State to use title IV-E funds
for children and families who are not normally eligible under title IV-
E and to use title IV-E funds, including funds which would be
reimbursed as costs of administration, for the provision of services.
Contact Person: Henry Goodman, Department of Human Services, 750
North State Street, Jackson, Mississippi 39202, Phone: (601) 873-6144,
Fax: (601) 359-4477.
State: Montana
Description: Montana's Department of Public Health and Human
Services (DPHHS) is requesting approval of a Child Welfare
Demonstration Project, which would allow title IV-E funds to be used
for a subsidized guardianship program. The demonstration would
authorize a subsidized guardianship program for eligible children;
provide a monthly guardianship subsidy, Medicaid and non-recurring
costs associated with establishing legal guardianship, and provide
federal financial participation in the costs of administration and
training associated with the guardianship program.
Montana postulates that guardianship provides the child and family
a legally recognized relationship, increases the sense of family by
granting the caretakers in the family the right and responsibility to
make important decisions regarding a child in their home, provides a
more stable placement than does long term foster care and is less
costly, due in part to a reduction in the administrative costs
associated with foster care. The demonstration project would be
statewide, for five years, and would include children on the state's
seven reservations. The project would serve children 12 years old or
older and would mirror the adoption assistance program as much as
possible. The project is expected to be cost neutral. Comparison of the
costs associated with the demonstration group and the control group
will be used to determine the fiscal effect of the demonstration.
The Montana DPHHS is also considering joining a consortium of
states in Region VIII, which would seek to demonstrate the impact of
allowing IV-E funds to be provided as a direct pass through of federal
funds to one or more tribes in Montana and in each of the other
consortium States.
The State requests waivers to allow title IV-E funds to be used for
children who are not IV-E eligible and for services which are not
ordinarily reimbursable under title IV-E. The DPHHS intends to use
random assignment of children to either a service or a control group,
and will use an independent contractor to conduct the required
evaluation.
Contact Person: Hank Hudson, Administrator, Child and Family
[[Page 37391]]
Services Division, Department of Public Health and Human Services,
State of Montana, P.O. Box 8005, Helena, Montana 59604-8005, Phone:
(406) 444-5900, Fax: (406) 444-2547.
State: Nebraska
Description: The Nebraska Health and Human Services System proposes
to test local approaches to child welfare system change through a
demonstration project. It is the State's hypothesis that the
combination of flexible use of title IV-E funds and local integrated
networks would: (1) Promote positive social and health outcomes and
prevent negative outcomes for children and families; (2) improve the
well-being of children who are at risk of, or actually require out-of-
home placement; and (3) improve the family functioning and
participation of child welfare involved families. The project would
involve entities across the State, including three which have existing
relationships with the State system, by forming local integrated
networks to facilitate a better use of resources. The State would
provide technical assistance, support and expectations for systems
management. The effort is part of an ongoing Network Development
Strategy that is being implemented Statewide.
The state estimates that a total of 3,240 children would be served
through the demonstration project. Each site would utilize the flexible
funds differently, so the outcome measures for each would be different.
Sites are expected to use the waiver authority for purposes which
include: promoting the wraparound process for each child and adolescent
at high risk of out-of-home placement; focusing on community-based
prevention, intensive community-based services, community re-
integration of out-of-area high-needs children, and child and community
safety and community ownership by developing a Managed Care Child
Welfare system in the third year of the project; sustaining and
enhancing the local service network, increasing parental, family and
civic involvement, co-locating staff and integrated services, expanding
choice and opportunities, and increasing communication and networking.
Nebraska is requesting waivers of title IV-E to permit
reimbursement for expenditures made on behalf of children who are not
IV-E eligible, and for purposes that do not ordinarily qualify for
reimbursement under IV-E.
The State proposes to compare the demonstration sites with
geographical areas that do not have flexible use of funds. The State
would examine child safety, permanence, child and family well-being and
community safety and responsibility outcomes.
Contact Person: John Mader, Program Specialist, Protection and
Safety Division, Nebraska Health and Human Services System, 2345 North
60th Street, Lincoln, NE 68507, Phone: (402) 471-9364, Fax: (402) 471-
9034, Email:[email protected].
State: New Hampshire
Description: New Hampshire proposes to use title IV-E funds to hire
a substance abuse specialist with expertise regarding child protective
services who would conduct substance abuse assessments of parents where
alcohol or other drug abuse is believed to be a factor contributing to
the child's abuse or neglect. For those families in need of ongoing
services, this staff person would also assist them in accessing
intensive, community based substance abuse treatment services. It is
the State's hypothesis that the provision of these immediate, targeted
and intensive services would enable families better to provide a safe,
nurturing environment for their children, resulting in the prevention
of placement or a reduction in the length of time children remain in
out-of-home care. The State has proposed a five year demonstration
period.
The demonstration would be conducted in two District Offices of the
State's child welfare agency: those located in Manchester and Nashua.
December 1997 statistics showed 245 children in foster care in these
districts who were IV-E eligible. Of these, 56% had caretakers in which
substance abuse was a factor in their maltreatment.
The State proposes an evaluation design in which eligible families
would be randomly assigned to experimental and control groups. The
experimental group would receive the services of the substance abuse
specialist while the control group would receive the current services
mix. Outcomes for each group would be tracked. The State would examine
outcomes including placement prevention, more timely reunification,
more timely alternate permanency planning for children unable to return
home, and cost savings as a result of improved permanency planning. The
State expects approximately 120 children in the experimental condition
and 120 in the control condition.
Waivers are requested in order to (a) serve children not otherwise
eligible for IV-E (children at risk of but not in foster care); and (b)
provide services not normally covered by IV-E (substance abuse
assessment, referral and case management services).
Contact Person: Nancy Rollins, Division for Children, Youth and
Families, New Hampshire Department of Health and Human Services, 6
Hazen Drive, Concord, NH 03301-6522, Phone: (603) 271-4451, Fax: (603)
271-4729, Email: [email protected].
State: New Jersey
Description: New Jersey seeks to implement concurrent permanency
planning and the use of the fost-adopt model of foster care. In New
Jersey, the average length of stay for children who are six years old
or less with a goal of adoption is 25 months in their current
placement. The State proposes to use title IV-E funding for services
and activities designed to reduce to 15 months, the time in foster care
preceding the initiation of termination of parental rights/initiation
of permanency, for children whose permanency goal is adoption as
envisioned by the Adoption and Safe Families Act. The state would hire
case managers specifically dedicated to the project to apply the
permanency reform/fost-adopt model for both title IV-E eligible and
non-eligible children. Funds would also be used for enhanced legal
services and substance abuse services.
The proposed demonstration builds upon and further elaborates the
permanency reform project underway in Union, Middlesex and Essex
counties funded by the Children's Bureau under the Adoption
Opportunities program. Now completing its second year of a planned
three years of operation, this program utilizes a variety of methods
including concurrent permanency planning by child protection and
adoption staff, mediation services, recruitment and training of special
fost-adopt homes, and use of post-adoption counseling therapists to
address the issues of the birth and fost-adopt families. By building on
the curriculum development, cross training, outreach to the legal
community, and recruitment and support of fost-adopt homes already
underway, the demonstration project would facilitate acceleration of
the project schedule to Essex county, which contributes the largest
number of children to the State's foster care caseload.
New Jersey hypothesizes that allocating case management staff and
other resources to the dedicated units would reduce foster care costs
and lengths of stay and lead to more adoptive placements and/or more
stable relative placements than would occur in the comparison groups
over the five years of the project. Assignment to comparison groups
will be randomized,
[[Page 37392]]
and the evaluation would produce process and outcome data, as well as
cost/benefit information.
The State requests waivers to permit the use of title IV-E funds
for purposes not ordinarily eligible for federal funding, and for
children or families who are not IV-E eligible.
Counties not involved in the project would serve as the control
group, and after the first year the project would be extended to other
randomly selected counties.
Contact Person: Michele K. Guhl, Deputy Commissioner, Division of
Youth and Family Services, P.O. Box 717, Trenton, New Jersey 08625-
0717, Phone: (609) 292-6920, Fax: (609) 984-0507.
State: New Mexico
Description: The New Mexico project would provide title IV-E
funding as a direct pass through of federal funds to identified Tribes,
simulating direct federal funding of Tribes under title IV-E in order
to test this concept. In addition, the State is proposing the
establishment of a subsidized guardianship program for Tribal children,
which the State says would allow permanency while respecting Tribal
customs. The demonstration project would test both simulated direct
funding and flexible use by Tribes of IV-E funds.
Currently, title IV-E funding is extended by the State to five
Indian Tribes through a Joint Powers Agreement (JPA). The JPA spells
out procedures to be followed in cases of child abuse and neglect,
including how investigations are to be conducted, how and when
jurisdiction is to be transferred, and how and when parties are to be
notified. It also provides that the State would pay Tribes to cover the
foster care maintenance and adoption assistance for IV-E eligible
children in Tribal custody.
The State proposes a comparison design for the evaluation. The five
Tribes currently operating under JPA's would serve as the comparison
sites. Five additional Tribes would be selected as the pilot sites. The
selection of the pilot sites would be purposive, based on the Tribes'
willingness to participate and their capacity in terms of the human and
material resources and infrastructure currently in place to manage the
IV-E Program. A five year project is proposed.
Title IV-E waivers are requested to allow for the provision of non-
recurring expenses and ongoing assistance payments for guardians
assuming responsibility in those instances where Tribal Courts are
reluctant to terminate parental rights, to provide Federal Financial
Participation for individuals and purposes that are not IV-E eligible.
Contact Person: Maryellen Strawniak, Acting Director, Protective
Services Division, PO Drawer 5160, Santa Fe, New Mexico 87502, Phone:
(505) 827-8400, Fax: (505) 827-8480.
State: Oklahoma
Description: Oklahoma proposes a project to provide assisted
guardianship to the permanency continuum for long-term foster care
children for whom adoption or reunification is not an option. The goal
of the project is twofold: to determine if quality, permanency outcomes
can be achieved for these children; and to assess the impact of
providing services, e.g., post-placement services, on achieving these
outcomes.
The State anticipates that assisted guardianships would provide a
permanency plan option for children in long-term foster care; alleviate
the financial barriers for persons who desire to obtain guardianship,
thereby enhancing the prospects of permanency for these children; and
provide stability for children. In addition, the demonstration would
provide an opportunity to test the impact of different levels of
services and supports to children and families served by the project in
achieving quality permanency outcomes for children. The State also
anticipates that the project would reduce the workload for child
welfare staff, allowing them time to do expedited permanency planning
for the remaining children.
The State currently has approximately 1,100 children statewide in
long-term foster care; 15 percent of these children are Native
American. Some of the Native American children are in the legal custody
of the Department while others are in tribal custody. The State
estimates that 550 of these children would be potentially eligible for
this project, with approximately 200 children and families actually
served under the project. The State proposes three different levels or
categories of services and supports to children and families who
participate in the demonstration, with each category having 50-100
children and families assigned to it. The State would test the
permanency outcomes for children in relation to the level or category
of services provided to each family. The State proposes a statewide,
five-year demonstration project.
Oklahoma proposes to randomly assign children to one of the
following: a control group, which would receive the current service
mix; Target Group I, which would receive all identified waiver services
and a full range of on-going post placement services; or Target Group
II which would receive all initial services included in the waiver, but
limited on-going post placement services. To assess the project,
Oklahoma proposes to measure outcomes, processes and cost-benefits.
The State requests waivers of title IV-E provisions regarding use
of title IV-E funds to pay: a monthly subsidy for children in
guardianship arrangements; the cost of legal fees required to obtain
guardianship; and the costs of providing a range of services and
supports to families and children in guardianship situations (similar
to the services received by adoptive families and children).
Contact Person: Mike Moore, Division of Children and Family
Services, P.O. Box 25352, Oklahoma City, OK 73125, Phone: (405) 522-
4487, Fax: (405) 521-4373.
State: Texas
Description: Texas proposes a Child Welfare Demonstration project
with three components over five years. The components affect kinship
care, adoption and Texas' Permanency Achieved through Coordinated
Efforts (PACE) project.
First, Texas proposes to implement a kinship care program as part
of Protective and Regulatory Services (PRS) and requests a waiver of
title IV-E to utilize otherwise restricted funds for foster care
assistance, in conjunction with title IV-B funds, to provide upfront
financial assistance and services for kinship care placements. The
state hypothesizes that if families are provided financial assistance
for the costs of integrating the child into the home during the first
year of care and then supplementing caretaker expenses thereafter to
support the child's care, are trained, and take part in support groups,
more placements would be made and would succeed, to the benefit of the
families and children served by PRS. The length of time in foster care
would decline, freeing up funds devoted both to staff and foster care
maintenance.
Texas proposes to implement the kinship initiative in El Paso and
in Corpus Christi, Laredo and the Lower Rio Grande Valley. To evaluate
this component, the State would implement a matched-group comparison of
three groups: (1) Those that received the Integration Package, which
would consist of startup money, and the Training and Services Package;
(2) those that received only the Training and Services Package; and (3)
those that receive neither package. The state
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would measure: implementation through qualitative means; process
outcomes through the provision and use of incentives, provision and use
of services and parenting skills and knowledge; and outcome through
case flow, duration of time in care, patterns of disruption and rate of
dissolution and/or re-entry. A cost-benefit analysis would asses
whether the costs of the demonstration project are justified by the
benefit produced.
The second proposed component of Texas' demonstration project is to
use title IV-E funds for the assessment of prospective adoptive
children and families and to allow for joint training with Child
Placing Agencies (CPA) of CPA professionals providing adoption and
permanency services. The state's hypotheses are that a more
comprehensive assessment would reduce the disruption and dissolution
rate of PRS adoptions, decrease the average length of time that
children spend in foster care prior to adoptive placement, increase
satisfaction among children and families, decrease the number of
placements before placement in an adoptive home, and increase the
number of children leaving foster care for placements with adoptive
families. These improvements would speed permanency and reduce
expenditure of IV-E funds.
Texas proposes to implement this demonstration project in Harris
County, Houston and the counties surrounding Houston. To evaluate this
project, the state proposes to compare one region which would receive
an Enhanced Training condition and an Enhanced Assessment condition, to
other regions and to statewide historical data. The evaluation would
include implementation measures of a qualitative nature; process
measures including pool of potential families, assessment, quality of
placements and extension of training; and outcome measures such as case
flow, duration of time in care, patterns of disruption and rate of
dissolution and/or reentry into the Child Protective Services System. A
cost benefit analysis would assess whether the costs of the project are
justified by the benefits produced.
The third component of the proposal is to utilize title IV-E funds
flexibly as part of Phase II of the State's PACE project. The state-
funded Phase I of PACE is designed to contract for a network of private
providers to provide a continuum of services designed to improve
substitute care service and enhance PRC permanence initiatives. The
State requests a waiver of title IV-E for Phase II of PACE, to pay for
foster care services and child and family services on a per-child case
rate or capitated rate, to the network of providers established in
Phase I. PRS would test the impact of the case rate on an expansion of
service delivery model that is developed in Phase I.
The state hypothesizes that the new service delivery system would
result in improved child functioning, increased stability of
placements, shortened duration of care, reduced rate of return to
foster care, and maintenance of least restrictive placements. The state
hypothesizes that for Phase II, capitated rates would result in: cost
neutrality, the ability to provide a case rate for daily care and
supervision reimbursement, increased incentives for providers to
provide treatment and services to improve children's level of care
(LOC), increased ability to provide wraparound services for children
for quicker movement to permanency or for placement in the least
restrictive environment and increased incentive to provide preventive
services to lessen the need for high cost treatment/residential
services. Children would be placed by random assignment into an equal
number of PRS and Primary Contractor foster homes.
The state evaluation proposal would compare the outcomes of four
subgroups of LOC children in PACE Phase II, to three types of
comparison groups: randomly assigned control groups, statistically
matched cross-sectional comparison groups, and historical comparison-
sectional comparison. The state would measure: implementation through
qualitative means; process through continuity of care, expanded
services and satisfaction with services; and outcome through change in
LOC, change in level of care domains, change in rated individual goals,
duration of time, patterns of disruption, rate of reentry and rate of
maltreatment recurrence. A cost-benefit analysis would assess whether
the costs of the demonstration project are justified by the benefits
produced.
Contact Persons: Texas Department of Protective and Regulatory
Services, 701 W. 51st Street, P.O. Box 149030, Austin, TX 78714-9030,
Karen Eells (Kinship Care & Adoption), Judy Rouse (PACE), Phone: (512)
438-5712, Fax: (512) 438-3394.
State: Washington
Description: Washington State proposes to adopt a managed care
approach for services such as mental health and family preservation to
children who are IV-E eligible and children who are not. Under the
demonstration project, the State would make monthly payments for the
care of children with complex needs who have been screened into the
project. These funds would be pooled with other resources to contract
with local service providers for oversight of treatment plan
development, implementation, screening and training. The State
postulates that such coordination between the State and various local
service providers might result in a better use of resources, while also
providing individualized and comprehensive wraparound services. The
State hopes that such an approach would enable it to tailor services to
meet the real needs of families and children particularly those
children with special needs and problems.
Washington State would begin the project in Spokane county and
phase in other counties until a maximum of ten counties were included
in the demonstration project. The State would randomly assign children
to either the control or demonstration. The State proposes to evaluate
the project through random assignment comparison, pre/post comparison
and a cost-benefit analysis.
The State requests waivers of certain sections of title IV-E and
related regulations to allow expenditures on behalf of children and
families not normally eligible under title IV-E, and to allow
expenditures for services not normally permitted under title IV-E. The
State is also considering the possibility that it might request a
waiver of title XIX pertaining to Behavioral Rehabilitation Services.
Contact Person: Tammi Erickson, Office Chief, Office of Federal
Funding and Victims' Assistance, State of Washington Department of
Social and Health Services, P.O. Box 45710, Olympia, WA 98504-5710,
Phone: (360) 902-7936, Fax (360) 902-7903.
State: West Virginia
Description: West Virginia proposes a school based services
project, the Cabell County Adopt-A-Middle-School project. The project
would provide a variety of services for children in middle schools
(grades 6, 7, and 8) and their families, whether or not they would
otherwise qualify for the title IV-E. The purpose of the service
provision is to create a seamless social support system that
strengthens the ability of children and families to handle stress
affecting their lives by: facilitating school-based support for child
victims of abuse and neglect who can be kept in the home and community;
providing early identification of youth with delinquent tendencies in
order to link the child and family with services prior to the
initiation of court action; utilizing home
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and community-based services whenever possible; ensuring EPSDT
screening and appropriate treatment for children in foster care; and
assisting the Department in maintaining linkages with schools for out-
of-home placement, facilitate return to school for the child and
family, and assist students who are new to the school district due to
foster or adoptive placements.
To accomplish these services, WV proposes a two-phase
demonstration. Phase one would pair community social services agencies
with middle schools in Cabell County as resources for information,
assessments, and referrals. Phase two proposes the hiring of full-time
prevention coordinators for each school, beginning with two schools and
phasing in additional schools as resources permit. Coordinators would
be school-based during the school year, would serve as initial case
managers and advocates for the child/family, provide direct services,
and provide follow-up with families over the summer months.
The State's hypothesis is that middle school-based prevention and
early intervention programs would result in a reduction of the number
of children in foster care, the average expense and intensity of foster
care, and the average number of days children are in foster care. This
project would be limited to Cabell County, in southwestern WV, which
includes six middle schools. The project is proposed to begin in
September 1998 and would run through August 2003.
The State requests waivers of title IV-E to permit reimbursement
for amounts expended for children and families and for purposes that
are not normally eligible under IV-E.
For evaluation purposes, the state proposes to identify a control-
group county. Outcome measures would include the number of children
entering foster care, the number of placements in community-based or
family settings, and the number of days the children are in foster
care. Process evaluation components include frequency and types of
intervention activities. An outside evaluator would conduct the
evaluation.
Contact Person: Joan E. Ohl, Secretary, Department of Health and
Human Resources, Bureau of Children & Families/Office of Social
Services, Charleston, West Virginia 25305, Phone: (304) 558-0684, Fax:
(304) 558-1130.
Dated: June 25, 1998.
James A. Harrell,
Deputy Commissioner, Administration on Children, Youth and Families.
[FR Doc. 98-18437 Filed 7-9-98; 8:45 am]
BILLING CODE 4184-01-M