Wayne County Foster Care
Investigator
Project Information
In 2001, the research team began an evaluation of the Wayne County foster
care pilot initiative that involved all six nonprofit agencies contracting
under the pilot initiative, as well as a control group of three non-pilot
agencies, in order to examine the effects of the initiative on service
providers as well as the foster children and families served by these
nonprofit agencies.
This report addresses four research questions from this process evaluation:
- What organizational accommodations did private nonprofits make when they shifted to a specific managed care contracting environment in the delivery of child welfare services?
- What organizational accommodations did private nonprofits expect to make as they anticipated shifting to a specific managed care contracting environment in the delivery of child welfare services?
- What was the effect of the shift to a specific managed care contracting environment on the services that private nonprofits provide to children and families in the first 120 days of care?
- Should differences exist, which variables explain differential service patterns between nonprofit foster care providers operating in a specific managed care contracting environment and those operating in a traditional, per diem reimbursement, environment?
The study examines the effects of managed care on private nonprofit foster care agencies through an open-ended, structured telephone survey of 84 agency employees. These qualitative survey data allowed the authors to assess managed care-related changes across various types of pilot employees and on a range of topics, including service delivery, interdepartmental and interorganizational relations, staffing patterns and staff training, staff roles and responsibilities, and financial management and technology use. Additionally, staff from foster care agencies that were not operating under managed care at the time (but that expected to have to operate under the managed care system in the near future) were interviewed. These interviews with non-pilot agency staff provided a comparative perspective of the changes that agencies expected to make in implementing the managed care system.
The study also assesses the effects of managed care on the type and amount of services agencies provided to foster children and families by tracking the in-agency and out-of-agency services that pilot and non-pilot agencies provided to a sample of 244 foster children. Methodologically, this phase of the study took advantage of the conditions for a natural experiment in order to isolate the independent effect of this managed care model on service utilization.
Background
During the last four years, the Michigan Family Independence Agency (FIA) has adopted, on a pilot basis, a new way of providing foster care services which uses an incentive based, managed care approach in its contracting with private agencies in Wayne County. This method of an incentive-based system of managed care has now been taken county wide, making this research even more important. This approach is being tested to see if it reduces the youth's length of stay in out-of-home care by offering providers fiscal flexibility and resources to shorten the time to achieve permanent placements for children (return home, placement with relatives, attainment of guardianship, entry into independent living, or adoption) and reduce recidivism in the system.
Six private nonprofit agencies (the pilot agencies) of a total of 19 Wayne County providers have contracted with FIA to provide services under this new system. Rather than being reimbursed for services solely on a flat, per-child, per-diem basis, these pilot agencies have contracted to provide services on a reduced administrative per-diem basis, supplemented by an up-front initial payment and additional payments if performance indicators are met. Thus, if performance indicators are met the nonprofits benefit financially; if performance indicators are not met, the nonprofits incur a monetary loss.
The Goal
The need for two interrelated studies has emerged from this new relationship between the state and the private nonprofit child welfare sector. The first, a process evaluation, is needed to track how these changes impact organizational functioning and the delivery of services to clients. The second study, an output evaluation, is needed to answer questions related to whether movement to an incentive-based, managed care system impacts the status of children in care and their families (time in foster care, time to reunification, recidivism in the foster care system, time to termination of parental rights, etc).
The project is now in the process of formal data collection for the process and outcome studies. Partners communicate with each other via a Community Zero website.
Next steps
Due to the current economic environment and its reduced priority in the
eyes of the participating agencies, the next step to review the logic
model and ensure that the program is ready for an outcome evaluation has
shifted. Instead, the collaboratory will continue to extend and develop
its output study.
Last updated: 11/3/03
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University of Michigan
Global Program on Youth, School of
Social Work Building, Room 3743
1080 South University, Ann Arbor, MI 48109-1106 ssw.global@umich.edu