Georgia Association of Homes and Services for Children

Community of Care Proposal to the State of Georgia

November 21, 2004

With the implementation of Level of Care, few can say that it has fulfilled all of what we had hoped for in this initiative. We envisioned a full and seamless continuum of care for children who are at risk of entering the child welfare system. We imagined it would be fully supported. We envisioned it would be community based, family focused and that assessments would drive the services. Accountability for outcomes would be expected as a part of every service provided.

We understand the State also had many expectations with Level of Care. Costs would be controlled and budgeted and predictability would be enhanced. Positive outcomes for children would be purchased and there would be a tracking of results. The number of children entering care would be reduced. Children would benefit from treatment and the length of time children remained in care would be reduced. The number of “failed placements” and moves would be reduced. Children would find permanency in care through reunification, adoption or emancipation. Most importantly, children would leave the system in better shape than they arrived.

Certain accomplishments within Level of Care were realized. Improvements have occurred. The needs of children are better assessed. Foster family home capacity has been expanded. Georgia is better prepared to measure its services needs. All providers are on a level playing field in regard to rates. Federal revenue is better maximized and utilization reviews are more comprehensive.

However, Level of Care can and should do more for children. It can be more than just a placement system. It can be a full continuum of care that we all have envisioned implementing since 1995. It can produce the outcomes that the state and the community want for its children.

Community of Care – A Conceptual Model Proposal

It is believed that the Level of Care program can be enhanced if it would move toward the “Community of Care” model that was envisioned years ago. The Community of Care model will help the Level of Care program accomplish all of its objectives and potential. The state’s child welfare system’s efficiency and effectiveness would be enhanced as well as positive outcomes for children.

The new model is based upon the following:

· Public/Private Partnership – The Public sector and the community must share in common goals for the continuum that we want. Over the last decade, the partnership and collaboration have been strong between public and private providers. We need to continue this partnership and enhance its effectiveness.

· Common Goals – We need to agree on common goals that we want for children and for the system.

· Performance Outcomes – As partners, we need to hold each accountable for certain results. Moving toward an effective system of performance based contracting can be helpful if handled properly. Providers are prepared to share responsibility with the state in meeting the outcomes that we all want for children.

· Networks of Care – Providers will develop continuums of care that are single entry, seamless, integrated and community based.

· Family Centered Care – Family centered practice is considered best practice and must be integrated into care. Ultimately families are Georgia’s greatest resource for children. Families are important and need to be strengthened and preserved when possible. The outcomes for children are often tied to the involvement of their families.

· Budget Predictability and Controlled Costs – This is a must for the state contractor and the private provider. Knowing the costs and the expected outcomes are required if predictable outcomes are expected.

Features of the Community of Care Model:

· Continuous Quality Improvement Accountability for outcomes

· Full Continuum of Services

o Accurate assessments

o Most appropriate first placement

o Family Preservation and Support

o Intake

o Assessment and Evaluation

o Case Management

o Crisis Intervention / Counseling

o Family focused services

o Family Foster Care

o Structured Congregate Care

o Therapeutic Foster Care and Residential Services

o Hospitalization

· Seamless transitions

· Aftercare

· Outcome and data management

A Pilot Project Initiative

Community of Care is the cooperative and collaborative effort of the state, private providers and the community seeking to meet the needs of at-risk children and strengthening their families, where possible. A pilot project is being proposed to establish a network of providers to provide a full continuum of services. Cooperative and respectful relationships with all parties in partnership are necessary to achieve common goals and outcomes.

Flow Chart of Pilot Project

· At risk child is identified by DFCS or DJJ

· DFCS or DJJ contacts Community of Care continuum in pilot project area

· Initial Assessment made by Community of Care

· Services identified and implemented by continuum

· Coordination of services provided by continuum

· Family supports provided by continuum

· Case management provided by continuum

· Placement services provided by continuum

· No Eject/Reject*

· Aftercare provided by continuum

· Guarantee Post Discharge Outcome for six months

Next Steps

Enter into negotiations with the State to pilot this Community of Care in several areas of the state.

*A method will be developed to manage for proper case mix adjustment either through a gate keeping function and/or a rate of adjustment based upon case outcomes reviewed and adjusted at regularly scheduled intervals. This provides for maintenance of the continuum integrity for all concerned. This is essential to achieve desired outcomes.

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