New Player on the Scene in Michigan

West Michigan Partnership for Children (WMPC) -- a new nonprofit organization in Kent County which is the first in Michigan to pilot a performance-based case rate funding model to improve outcomes for children and families -- makes initial progress through its Enhanced Foster Care programming.

The first of April marked six months since we began overseeing the placement and care of more than 850 children in foster care in Kent County through a contract with the Michigan Department of Health and Human Services (MDHHS). The flexibility of the performance-based funding model has allowed us to increase availability of trauma-informed, family-like placements in our continuum of care, which we hope will lead us to improved permanency outcomes.

Under the new funding model, MDHHS pays WMPC a semi-annual case rate allowing us to be innovative in creating services that meet the needs of children and families. The case rate amount decreases the longer a child remains in care, thus incentivizing safety, permanency and placement stability. This differs from more traditional child welfare funding models which pay contracted agencies on a per-diem basis – in other words, for how many days the agency provides services to children and families.

This funding model reinforces positive outcomes including finding children a permanent home more quickly through reunification with their families or adoption if it’s not safe for them to return home, higher levels of family reunification, better child functioning in all domains, and stronger family connections. It also allows us to reinvest savings for continued improvements in the community. For example, as more children safely return home from foster care more quickly, the savings that result from returning/keeping children in their homes can be reinvested in developing services that will fortify and support the community to prevent other children from entering foster care in the first place.

A key component of the model is a strong continuous quality improvement plan that holds WMPC and its subcontracted providers publicly accountable for achieving defined child welfare outcomes for children and families. Using cutting-edge technology, WMPC provides dashboards of its outcomes at monthly meetings with its advisory committee to allow for dialogue and brainstorming around areas of success and areas where improvements are necessary. WMPC also implemented quarterly review meetings at each of its partner agencies to review performance measures and facilitate quality improvement planning.

WMPC leads and empowers a collaborative coalition of five private licensed child placing agencies that provide foster care in Kent County, Michigan: Bethany Christian Services, Catholic Charities West Michigan, D.A. Blodgett-St. Johns, Samaritas, and Wellspring Lutheran Services.

Valuing reunification and family preservation as a priority, WMPC and its partner agencies aim to strengthen and empower families, increasing reunifications, decreasing the time children are in the child welfare system, and mitigating future re-entry.

Addressing the Needs within the System

After our October 2017 launch, we knew immediate action was necessary to improve outcomes for children and families experiencing foster care in Kent County within the five year scope of the pilot.

There are an estimated 13,00 children in foster care in Michigan according to the Michigan Department of Health and Human Services.

In Kent County, approximately 30 children and youth are placed in foster care each month--more than 800 children at any given time.

Seven years of reflective data collected by the Public Consulting Group and Lewis and Ellis, commissioned by MDHHS, indicates that the average length of stay for a child in foster care in Kent County is 2.4 years, or almost 29 months.

This number is more than double the nationwide median length of stay for children in the foster care system of 13.9 months, according to statistics from the Child Welfare Gateway System.

When we examined the reasons behind the length of stay, we identified that there were a significant number of children placed in residential settings, simply because they offered the clinical supports youth need to heal from traumatic experiences. Knowing that it is in the best interest of the child to be placed in the least-restrictive, most family-like setting that meets their needs, and that placement in a residential setting can prolong a child’s path to permanency, we needed to develop a solution that increased community-based, trauma-informed placement options.

Recruiting and retaining a healthy pool of foster parents is a challenge nationally, with the average turnover rate of 30 to 50-percent, according to a study by the Foster Care Institute.

The study identified the following reasons for the high turnover rate of foster care parents across the nation:

• Lack of support and training from caseworkers and/or agencies, leading them to feel like inadequate foster parents

• Lack of communication from caseworkers and/or agencies on the amount of care required to take care of the children being placed in their home

As we spoke to our five partner foster care agencies, these reasons were reflected in the anecdotes they shared about the challenges to placement of children in foster homes.

Implementing Programs to Address the Needs of Foster Children and Families

WMPC knew we needed to increase our continuum of care and that increasing support and training to foster parents was key to our efforts. We researched treatment foster care models nationwide to identify a solution to implement in Kent County. We hosted listening sessions with our community to elicit feedback on the benefits and challenges of different models. Our newly launched Enhanced Foster Care draws from best practices from these models while tailoring the approach for the needs of our community.

We heard from our partners that any model we implement must build the capacity of the current caregiver, if the child is already in a placement, to respond to a child’s needs resulting from their trauma. Models that had been implemented in the past allowed certain homes to be designated as treatment homes, therefore contributing to placement instability in situations where a child needed support in their current placement that was not a designated treatment home. Furthermore, our partners shared that previous criteria for being designated a treatment home often served as a barrier to recruitment of treatment homes.

Therefore, WMPC designed Enhanced Foster Care to follow the child and grow the capacity of caregivers by increasing their knowledge and skills to effectively nurture a child with trauma-induced behavioral and emotional needs. Children in foster care and caregivers receive Enhanced Foster Care services in their current foster care placement. Services are tailored to the child and based on a three-level system. Children with the highest intensity of needs are provided with level three services, while children stepping down from Enhanced Foster Care services are deemed a level one.

The program is designed to provide an intensive community-based approach by stabilizing current youth in foster care, diverting youth from being placed out of the community, and deliberately returning youth from residential care back to the community.

Through Enhanced Foster Care, foster parents and other caregivers are provided the right level of training and support by clinical case managers and behavioral specialists at the moment it’s needed. This could include individualized training for the caregiver, development and implementation of behavior plans, and regular support from both a clinical case manager and a behavioral specialist.

“Our goal with Enhanced Foster Care is to reduce the placement of children in residential settings four percent by September of 2019,” said Beth Caldwell, WMPC director of care coordination.

There are no specific requirements for foster families to be able to provide Enhanced Foster Care services. An Individual Service Agreement, outlining the specific needs of the child and interventions required by the foster parent, is developed between the foster care agency and the foster parent that identifies what the foster parents will do as part of the Enhanced Foster Care treatment team.

“Using this program, we have already seen an increase in children transitioning from residential settings to foster and relative homes that best fit their individual needs. We believe all children deserve safety, belonging, and the opportunity for a better future, and our Enhanced Foster Care programming is helping us achieve this,” said Caldwell.

The expansion of Enhanced Foster Care has the potential to generate significant savings on two fronts. First, level three services for children cost far less than the per diem rates for housing a child in a residential facility. Second, by providing the needed services immediately, we are able to achieve faster stability and permanency resulting in greater cost savings by discharging the child from the system sooner. These savings can then be reinvested into other prevention services to assist families.

WMPC has enrolled 34 children in Enhanced Foster Care since the program launched in January, served at each of WMPC’s partner agencies. Of the 34 children enrolled, WMPC was able to divert 21 children from placement breaks in their foster home and discharge six children from residential settings. Many of the children receiving Enhanced Foster Care services have already experienced multiple disruptions in placement since their time in care. Enhanced Foster Care aims to stabilize and equip the current caregivers to prevent this from occurring again.

The creation of WMPC is the result of a long-time public-private partnership between local foster care and other social service agencies, county government, and MDHHS that has been cultivated by the Michigan Child Welfare Partnership Council and the legislature.

These state-wide and community leaders studied child welfare models nationwide to identify program design elements that led to successful outcomes. The key ingredients they identified were privatized administration of foster care, performance-based contracting, creative and flexible funding that incentivizes permanency, and the use of data to inform continuous quality improvement. These elements were woven into the WMPC program design.

WMPC operates as a consortium, overseeing a continuum of care. This structure coordinates placement and care of children removed from MDHHS, placing youth in the least restrictive setting available that meets their needs, and providing the most appropriate services. The continuum of care is offered by WMPC’s network of private child placement agencies.

For more information on WMPC’s Enhanced Foster Care programming, visit: wmpc.care.