Kansans Talk Back

Early Responses to the Move to Privatization of Child Welfare Services

Interested web browsers are strongly encouraged to request all written testimony in order to get a full sense of the Kansas-NASW report and how it was supported by verbal testimony. To do this, call the Kansas Legislative Services at (785) 296-2391 and make a request for the written testimony regarding child welfare for November 4, 1997, to the interim committee, SRS Transition Oversight Committee. Request the testimony of the following individuals: Sky Westerlund, Gary Brunk, T.C. Mosier, Judge Jean Shephard, Earl Robinson, Linus Thuston, Elizabeth Cauble, Judge Graber, Tammi Hawk, and Karen Baker. There will be a charge for this service.

In the last year and a half, from June 1996 to May 1997, the three major Child Welfare Services, Family Preservation, Foster Care, and Adoption have been "privatized" in Kansas. That means that services formerly provided through SRS (Public Welfare in Kansas) are now the responsibility of and provided by private contractors. The Kansas Chapter of the National Association of Social Workers (KNASW) has developed this report, Kansans Talk Back: Early Responses To The Move To Privatization of Child Welfare Services, from the many stories we have been told from social workers and other frontline service providers across the state.

KNASW organized a panel of six service providers to present information about privatization to legislators. The panel consisted of a family advocate, foster parent, a judge, a school social worker, a county attorney, and a social work professor. In addition, there were three written testimonies submitted from a second judge and two social workers. The report and testimony were presented to the Legislative SRS Transition Oversight Committee on Tuesday, November 4, in Topeka. This document contains the report.

If you have any questions about this document, you are invited to contact KNASW at (785) 354-4804.
Sky Westerlund, LMSW, Executive Director, KNASW

The Kansas Chapter of the National Association of Social Workers (KNASW) represents approximately 1700 social workers and social work students, many of whom work in the field of child welfare, both for SRS and private providers. Children and families also represent a primary constituency of the social work profession. As a result, our organization has a high priority of continuing advocacy for children and families, as well as social workers, in the child welfare field. It is for this reason we have prepared this report regarding the privatization of child welfare services in Kansas.

KNASW supports the effort to correct previous problems in the child welfare system. It is recognized that there have been many problems in the past. This report will highlight difficulties in the current system, while not suggesting that we return to the ways of the past. We do believe that positive steps have been taken. Nevertheless, the evidence suggests that there are still both immediate and long-term concerns which require attention. KNASW requests that the legislature continue to monitor closely both the implementation and the outcomes of child welfare privatization in Kansas. Significant work remains to develop a service delivery system, which can best meet the needs of children, families, and citizens of this state.

KNASW also wishes to be a resource to the legislature in this process. As an organization representing social workers in both the public and the private sector, we intend to provide an honest and fair view of the service delivery system. As child and family advocates, we will encourage improvement in services wherever possible. It is our hope that we can honestly and openly present the problems, highlight the successes, and be a part of assisting in the solutions.

We thank you for your interest in developing successful and effective child welfare services and for the opportunity to share our views with you.

Monica Flask, LMSW,
President, KNASW

Public Child Welfare is the service system designed and implemented to assure the safety and protection of children. Successful Child Welfare depends on the cooperation and communication between many social services. These include the public welfare agency (SRS), community mental health centers, numerous community family service agencies, emergency shelters, group homes, foster parents, the court system, law enforcement, the school system, drug/alcohol centers, daycare facilities, and the healthcare system. An organized, coordinated, and comprehensive service system helps families who are in crisis in many ways. Some families need prevention services designed to better equip and educate them so they can meet their children’s needs. Some families need support services to maintain children in the home and work through their problems to solve their family crisis. Some families need intensive services to re-unite children into the family after they have been removed from the home for safety issues. Some families are not able to provide safety and protection for their children. These children deserve a permanent, healthy home through adoption or independent living support.

Nearly everyone would agree, in the recent past, Child Welfare in Kansas had some major problems and was in need of various system changes. Problems with the old system included, but were not limited to, a crisis-oriented service delivery system that lacked coordination; children and families underwent multiple assessments and were assigned multiple staff. The seriousness of the problems in Child Welfare was made apparent by the 1989 filing of a lawsuit. The civil suit was amended and joined by the American Civil Liberties Union in 1990. An out of court settlement was reached between SRS and ACLU/Children’s Rights in June 1993. Compliance with the settlement has not been met and monitoring of SRS compliance continues.

By mid 1997, the three major Child Welfare Services -- Family Preservation, Foster Care, and Adoption, were transferred from SRS to private providers through contract agreements. The model implemented for service delivery is a modified form of managed care. Child Welfare Managed Care (privatization) is similar to the more commonly known model of managed healthcare in that there is a case rate at a capitated level for each family or child, depending on whether Family Preservation, Foster Care, or Adoption services are used. The case rate is expected to meet all of the crisis situation needs of the family and/or children for the duration stated for each of the services through the contracts. Child Welfare Managed Care (privatization) is unlike the healthcare field in that contractors do not control who comes into their system--they must accept all children and families who SRS refers.

The changes in the way Child Welfare Services are delivered and the shifting roles of SRS and private providers are still at the beginning stages. Adjustment, modification, re-negotiations, and clarification are to be expected as problems emerge and solutions are sought. The complicating issue with this process of transition is that these changes are occurring simultaneously with the crisis needs of families and children who are depending on Child Welfare Services to help them.

As a result, many children and their families have found themselves in a confusing maze of different answers, different procedures, different people, different services, and different responsibilities. The transition difficulties further complicate their own particular family crisis.

For about a year, the Kansas Chapter of the National Association of Social Workers has asked social workers and other frontline service providers to tell us what they see happening in their day to day work with families and children as a result of the Child Welfare Managed Care (privatization) changes taking place. They were asked to speak about what was working and what was not working. It took nearly six months to gain feedback and start receiving anecdotal stories. The feedback ranged from generally positive regarding the Adoption contract, somewhat negative regarding Family Preservation and generally negative regarding Foster Care contracts. Most of the anecdotes involved comments on the Foster Care contracts. In reviewing the anecdotes, several systemic themes began to emerge. These include:

• Community-based services networks are severely compromised.
• Mental health services are not being delivered.
• Confusion about who is responsible for the welfare of the children.
• Lack of consistent use of standards for effective child welfare services.
• Staffing issues causing problems for workers and others.
• The interplay between the ACLU settlement and Contractors.

These themes grow from the anecdotal information received and are meant to point out preliminary experiences of frontline providers and call attention to possible larger system issues needing to be addressed.

Community-Based Services Networks Are Severely Compromised

The use of community-based services have, at best, become uneven across the state and across contractors. At worst, some community agencies and service providers have closed their doors or stopped aspects of services as a direct result of Child Welfare Managed Care (privatization) contracts. In some areas, communication has been eroded and little cooperation exists between contractors and community-based providers.

Family Preservation

• Some agencies that formerly provided family services to SRS closed as a result of the Family Preservation contract as all families are now referred from SRS to the private contractor for services.
• Little planning occurred between Foster Care Lead Contractors and community-based providers resulting in less cooperation and less communication between them.
• There has been a drop in foster care beds in some areas as community-based agencies shut their doors.
• Some long time, highly qualified and experienced foster parents quit fostering children due to the treatment they received and distrust they felt from their region’s Lead Contractor.

Adoption

• There was an increase of community-based agencies developing adoption programs because the Adoption contractor designed their services to include community-based agencies.

Anecdote Information

A long time community agency serving juvenile offender, child in need of care mothers, and pregnant teens found they could no longer accept referrals from one Foster Care Lead Contractor for their Mother/Infant program because the contractor would not re-imburse enough to meet the costs of the program.

A group home open for twenty nine years decided to close their doors. Staff felt the new privatized Foster Care system would not allow facilities to make decisions about the children who would benefit within the program, thus jeopardizing the integrity of their long time service.

Solution Thinking

• Lead Contractors should use local, community-based services in addition to their own internal services.
• Increase communication and cooperation between Lead Contractors and community-based agencies.

Mental Health Services Are Not Being Delivered

The state medical card, which is issued for all children in state custody, cannot be used to pay for mental health services for the children in Foster care and Adoption.

Family Preservation

Lack of a medical card to pay for mental health services may not be as large an issue for families receiving Family Preservation services, as the services themselves are usually mental health and/or crisis intervention for the family. Children are not usually in SRS custody at this point and would not necessarily have a state medical card.

Foster Care

• The ramifications of not being able to use the medical card for mental health services is of great concern for children in the Foster Care contract. These children have an enormous need for mental health services to assist in providing emotional stability during an acute time of family crisis.
• Under the current Child Welfare Managed Care model (privatization), it is up to the Lead Contractors to arrange and pay for mental health services and this is not always carried out.
• The capitated case rate of payment per child may or may not adequately cover mental health costs.
• There may be a disincentive for providing comprehensive mental health services as costs of these services are expensive and results are not necessarily predictable.
• Mental health centers may or may not be getting properly reimbursed for services.

Adoption

• Children who are referred to the adoption contract have already been in the Foster Care system for a minimum of one year. With comprehensive mental health services early, through Foster Care and a stable foster family environment, these children have somewhat less of a need for mental health services. However, preparation for adoption and adjustment to a new family often creates a crisis situation so services are still necessary.
• The Adoption contract utilizes an independent partner agency to determine and authorize mental health services. This cooperative arrangement increases the availability and continued mental health services for children in the adoption contract.
• When an adoptive family signs the intention to adopt the child (adoption placement agreement) the state medical card can then be used to pay for mental health services as necessary.

Anecdote Information

A family had been working with a therapist in a community health center for a period of time. A crisis situation occurred and the family was brought to SRS attention and referred to the Family Preservation contract. They were informed that they could not continue the work with their original therapist and had to use services provided by students instead because the Contractor would not pay for the therapy sessions.

Another child was assessed to have a behavioral problem instead of the previously documented and diagnosed severe mental illness. Mental health services were reduced causing acute emotional disturbance and suicidal behaviors.

Other reports indicated that foster parents were told mental health services would be provided through the contractor and outside services would not be re-imbursed. However, the mental health services were not forthcoming and children went without needed support.

A Judge in a rural county ordered a birth family and their child who is in foster care to continue with their therapist of four months. When the Lead Contractor refused to pay for these mental health services, the Judge ordered that either the Contractor or SRS are responsible for the payments.

Solution Thinking

• The state medical card should be used to pay for mental health services for every child in SRS custody if the child needs such services.
• Mental Health Centers and Lead Contractors should develop a working relationship to work out their re-imbursement and services issues.

Confusion About Who Is Responsible For The Welfare Of The Children

Confusion exists about who is legally and financially responsible for children who are in state custody as well as who has the authority to make decisions on behalf of the children.

Family Preservation

This is not a source of problem for the Family Preservation as children are not in the custody of SRS. Parents are the ones responsible for the children when they are receiving Family Preservation services.

Foster Care

• Numerous situations have arisen between contractors, service providers, foster parents, SRS, and others in which it is not clear who has the responsibility for the children. Specifically, foster parents report getting conflicting information regarding clothing vouchers or transportation expenses. One thing is said one day and another thing is said another day. Foster families do not know who the main decision-maker is for the children in their care.
• School officials report they are receiving requests for information on foster children from the private contractors without proper documentation from SRS which compromises confidentiality for children and their family.
• Mental health centers are experiencing a great deal of confusion as to who is responsible for the payment of mental health services for children in state custody. As a result, the centers themselves become "responsible" because they end up not getting re-imbursed for services rendered.
• Courts report, in an effort to secure services for some children in state custody, they find it necessary to issue court orders for services.

Adoption

Little confusion exists in the adoption contract as to who is responsible for the foster child’s needs as the child awaits an adoption placement.

Anecdote Information

Several foster families reported spending a great deal of time on the telephone trying to get answers about who is responsible for additional expenses for the children in their care, including clothing and transportation expenses.

One SRS office indicated that it was no longer an SRS job to remove children from the home. The service provider requesting assistance was referred to the Foster Care contractor.

Solution Thinking

• SRS should issue a report explaining and clarifying the responsibilities and authority of SRS and Lead Contractors for children in state custody and make it available to communities, foster parents, advocates, and anyone else interested in having the information.
• Lead Contractors must develop ways to accurately inform foster parents and other service providers the scope of their responsibilities, including the day to day need requirements of children within the contract.

Lack of Consistent Use of Practice Standards For Child Welfare Services

Complicated family situations and how children are reacting require sound judgments and timely actions to promote stability and safety. Practice standards for Child Welfare Services takes into account what procedures and guidelines need to be followed to assure the best care for children and families in crisis.

Family Preservation

In some areas, students are being utilized to provide Family Preservation services to families. Procedures must be in place to assure that the students are receiving appropriate supervision in their work.

Foster Care

• Children were reportedly moved from stable, sometimes long-term (more than six months) foster families to contract foster families with little to no preparation or sound rationale for the move. Children have become traumatized, some to the extent of needing psychiatric hospitalization.
• Some children who were moved from stable foster homes to contract foster homes were told they could not take personal belongings as there was no room for them. This traumatized children due to the loss of their possessions.
• Some children were transported to a different foster home by drivers who did not know the child’s name.
• Children who have been diagnosed with severe mental disorders have been re-assessed and determined to suffer from less profound conditions with less need for services resulting in potentially dangerous acting out behaviors from the child.
• Placement decisions of children seem to have been made by bed availability rather than by what the needs of the child are.
• Significant others, professionals involved, and family members have not been consulted regarding the behaviors and patterns of children, thus losing important information and understanding of the child’s needs.
• Mental health services that have been on-going in a child’s life have been abruptly severed with the shift to the "internal" provision of mental health services.
• Children may be placed anywhere in their regions' boundaries, but this can mean they are placed at a significant distance from their biological family. This is disrupting other relationships the child has and impedes the ability to visit family, including siblings, and the work toward re-unification.

Adoption

Some concern that older children may be placed in adoptive homes without adequate preparation.

Anecdote Information

A sixteen year old child had been removed from the home and placed in custody as the mother has intensive mental health problems and is a drug addict unable to keep the child safe. The child was making significant progress in her foster home. The Foster Care Lead Contractor returned the child to the mother’s home with no services or support, thus endangering the child’s emotional and physical well-being.

A fifteen year old child was placed in Foster Care for two years with 3 different moves. Within three months of being transferred to the Lead Contractor, the child had been moved nine times. The child became severely traumatized and is now requiring intensive intervention such as hospitalization.

Several social workers report that they are unable to address family issues in early phases. Rather, they must wait until families reach an acute, potentially child endangerment situation, before they are able to refer the family for Family Preservation services.

Solution Thinking

• Contractors and SRS must be adequately trained in best practices for child welfare services.
• Staff must have proper supervision and support in actions and decisions made on behalf of children.
• Support staff and volunteers must be adequately trained to work with the children in their care.
• Children in Foster Care must be placed in closer proximity to their family.

Staffing Issues

The rapid transfer of child welfare services to private contractors has created some concerns regarding staff issues.

• There has been a high turnover of staff causing children to have 3 to 5 case managers in a six month period of time.
• Some staff are in charge of large geographic areas that effect the ability to respond to the needs of families and children in a timely manner.
• Some contract social workers have caseloads of 20 to 40, exceeding the maximum numbers in the contract agreements.
• Some staff are working 10 to 12 hour days on a regular basis.

Anecdote Information

Some social workers report that they have large geographic areas to cover which can entail two to four hours drive to see one child or family. The large areas often include several judicial districts as well.

Solution Thinking

• Lower staff/client ratio.
• Limit geographic areas to be covered by one person.
• Identify causes of high turnover and address those issues to prevent further turnover.

The Interplay of the ACLU Foster Care Lawsuit Settlement Agreement

In 1989, a Topeka attorney, (later joined by the American Civil Liberties Union) filed a lawsuit seeking additional foster care beds for Shawnee County children. The Children’s Rights Project of the ACLU filed an amended petition in February 1990. The class action lawsuit contended SRS did not comply with state and federal law, and was violating the constitutional rights of Kansas children. In May, 1993, SRS and ACLU reached an out-of-court settlement. As part of the settlement, an independent entity was to act as a monitor of SRS compliance with the terms of the settlement. Legislative Post Audit has been monitoring the compliance and producing a report every six months since 1993.

To date, there are 138 items required for SRS compliance. (Performance Audit Report #6) SRS must be in compliance with the requirements for one full year before monitoring in those areas stops. When this criteria is met, it is expected that SRS will continue to comply in all 138 areas even though they are no longer specifically monitored.

SRS has a poor track record of compliance over the last four years. One of the problems of compliance is that the two parties have not yet agreed on definitions or how to measure some of the requirements.

With the advent of Child Welfare Managed Care (privatization) of Child Welfare Services, the difficulties SRS has had in complying with the ACLU settlement may be compounded. Some areas that SRS had been in compliance with, and are expected to stay in compliance, appear to have been altered through the Child Welfare Managed Care (privatization) change of service delivery. One example is maintaining the maximum payment to foster parents caring for children requiring extraordinary care. Lead contractors in Foster Care have abandoned the multiple levels of foster care re-imbursement, thus reducing payments to foster parents caring for children with extraordinary needs. A related area that SRS has been in compliance with is the requirement to maintain at least 146 therapeutic foster home beds. Lead contractors have reduced the Foster Care level of care from four to two categories, eliminating the therapeutic foster care.

Solution Thinking

• SRS and Children’s Rights must reach agreement on definitions and how to measure the requirement of the settlement.
• SRS must assure that compliance with the settlement continues in the areas in which compliance has been achieved.

OVERALL RECOMMENDATIONS

Community-based services networks are severely compromised.

Develop community advisory boards that cross over the three contracts. Require these boards to develop plans to build community capacity. Include foster parents on the board.

Mental health services are not being delivered.

Require the Children and Family Services and the Mental Health Commissions to develop a collaborative plan to insure the delivery of mental health services to the child welfare population. The plan must share resources, i.e. neither Commission can be allowed to refuse to provide service delivery dollars.

Confusion about who is responsible for the welfare of the children.

Immediate clarification of SRS and Contractor roles and responsibilities must occur, especially in areas of financial obligation. SRS should inform courts, schools, and other community providers. Private contractors should inform adoptive and foster parents. All clients should receive written notice of what they can expect from whom.

Lack of consistent use of standards for effective child welfare services.

Adopt a set of best practice standard to insure child safety. These must address the issues of assuring children have adequate food, shelter, and supervision. Further, in situations where there is the potential of abuse, a safety plan must be in place. These standards are not proposed to prescribe how services are delivered, but rather to create a solid foundation upon which providers may build community based, creative service delivery.

Staffing issues causing problems for workers and others.

Both SRS and private contractors must move quickly to provide necessary training for new case managers. Those workers involved in assuring child safety must be the first priority for training. SRS must insure that the terms of the contracts with regard to case-loads are met.

ADDITIONAL RECOMMENDATIONS

An easy to understand, easy to use grievance procedure/process should be instituted.

An ombudsman/advocate should be created as an independent resource to guide clients through grievance procedures.

REFERENCES

Kansas Action For Children, Inc., Welfare Reform and Child Welfare Services: Changes in Public Policy and the Implications for Children and Families, October 1997

Legislative Post Audit, Performance Audit Report #6, Verifying Information Provided by the Department of Social and Rehabilitation Services On Its Compliance With the Terms of the Foster Care Lawsuit Settlement Agreement, June 1997

Drissel, Anne B. and Cindy Brach, Editor, Managed Care and Children and Family Services: A Guide for State and Local Officials, Annie E. Casey Foundation

National Association of Social Workers, Social Work Speaks, Fourth Edition, 1997

Kansas Chapter
National Association of Social Workers
700 S.W. Jackson St., Suite 801
Topeka, KS 66603
(785) 354-4804
FAX: (785) 354-1456

email: naswks@mail.cjnetworks.com

For a copy of this document from Kansas-NASW, send an 9 x 12 SASE with $3.00 postage to K-NASW.