In cases where a provider may have difficulty changing focus, the New Mexico Children, Youth, and Families Department has worked with them to identify other funding sources or help them to change their work. Like New Mexico, many other states are using CFSR outcomes and indicators in contract requirements and requiring monthly or quarterly performance reports from contractors.
These reports, not unlike CFSR data profiles, allow contract monitors and contractors to continually examine aggregate data to identify trends and possible problems. Case record reviews, often modeled after the onsite portion of the CFSR, allow the contractor and contract monitor to gather qualitative information that is not evident from reported data.
Both sources of information help to drive continuous quality improvement efforts. Other initiatives to improve quality assurance of contracted services include the three projects funded under the QIC PCW.
Three states Florida, Illinois and Missouri have designed and implemented contracted services that integrate performance based contracts with expanded quality assurance systems. The pilot programs are aimed at using data to identify quality practice techniques and improve both practice and client outcomes. These outcomes and indicators are incentivized in the performance based contracts and data on performance is monitored through expanded quality assurance systems.
Service goals and objectives, and reporting requirements, should be clarified at the outset and incorporated into contracts. Decisions about what is to be monitored, how monitoring is done, and how the information will be used, should be part of the initial contract discussions. This section outlines issues that agencies should address in building their contract monitoring infrastructure. It also examines how the public agency can design and implement its monitoring activities in partnership with service providers, and how the responsibilities for quality assurance and monitoring can be shared by public and private agencies and other oversight bodies.
How public agencies monitor contractors is as varied as the types of contracts that public agencies have with private agencies. For each contract, the public agency must have a monitoring plan, which lays out the steps for monitoring, as well as the methods and techniques to be used. Ideally, the plans also clearly define the roles of public agency staff and private contractors in ensuring accountability. The public agencys monitoring plan defines precisely what a government must do to guarantee that the contractors performance is in accordance with contract performance standards Eggers, , Eggers lays out steps that are important to designing a monitoring plan.
The monitoring plan should be quantifiable and specific, meaning that it includes information about the reporting requirements, the frequency and number of meetings to be held, complaint procedures, and a way to access the providers records if needed. A monitoring plan should also include information about the number of individuals who are required to monitor the contract, who those individuals are, and what their responsibilities should be.
Different services and outcomes require different types and levels of monitoring, which must be taken into account in the plan. Similarly, different providers may need different monitoring structures. For example, Florida bases the frequency of its on-site visits on the risk assessment of the contractor. Those contractors that do not receive an on-site visit receive annual desk reviews see preceding text box.
In many states, the key elements in monitoring plans are prescribed by statute or administrative rule. In Florida, for example, the Department of Children and Families DCF is required to adopt written policies and procedures for monitoring the contract for the delivery of services by lead community-based providers[that] at a minimum, address the evaluation of fiscal accountability and program operations, including provider achievement of performance standards, provider monitoring of subcontractors, and timely follow-up of corrective actions for significant monitoring findings related to providers and subcontractors.
Florida Statute As Eggers points out, monitoring should be viewed as a preventive rather than an adversarial function. The contractor should be considered a strategic partner and be given incentives to innovate, improve, and deliver better service. For this to happen, a relationship of trust must be built between the public agency and the contractor, and performance terms must be mutually understood.
Ideally, this begins in the planning stage with developing a monitoring system that is clearly understood and accepted by both public and private agencies. The process should include designating individuals from the public agency and from the contractor staff who will communicate on a regular basis, such as through monthly meetings or conference calls. In practice, state procurement regulations and practices vary with respect to the timing and extent of communication between agency officials and contractors prior to the award of a contract.
If not prohibited, some agencies involve contracted providers and other community stakeholders in the process of determining which outcomes to measure and in defining a collaborative approach to quality assurance and contract monitoring. There are several examples of states that have used a collaborative decision making process to develop performance measures, penalty and reward mechanisms, and feedback loops.
One example is Missouri. Prior to initiation of performance based contracting in Missouri, the state undertook a two-year developmental process to involve community stakeholders in framing the content for service contracts. Key stakeholders included executives of private contracting agencies, judges and other juvenile court personnel, and representatives of advocacy groups.
The resulting contracting model provides for strong partnership communication and routine feedback via interactions between contracting agencies and the administrators in the Missouri Childrens Division Watt et al. Contractors can provide helpful advice in developing the performance indicators that they are meant to achieve. An advantage to this approach is that it lessens the likelihood of misunderstandings over the nature of the performance measures during the contract period Eggers, Furthermore, successful collaborative planning often carries through to implementation.
Individuals responsible for monitoring have different titles from one state to another. While several different people with similar titles might be responsible for different aspects of monitoring within a state, it is not uncommon for their roles to blur in actual practice. Some jurisdictions rely upon a single individual to be the primary monitor; others have a team approach. While there is no evidence that one public agency staffing approach is preferable to another, it is important for staff operating across divisions to communicate and collaborate in the timing and frequency of their quality assurance or monitoring activities, share findings, and strive to reduce the duplicative and overlapping auditing and program monitoring functions that have proven problematic in some privatization initiatives.
In addition to the need for strong communication and collaboration across public agency divisions, it is critical to have the support and direction of upper management in the design and implementation of monitoring efforts. Strong leadership promotes consistent messages throughout the public agency and to providers, and facilitates allocation of sufficient resources for monitoring and support efforts. From discussions with several states, contract monitoring and quality assurance models are still a work in progress.
States are working to establish the best structure for their programs. As described below, Florida provides a good example of a state working to improve its system based on lessons learned from its prior efforts. To this point, the discussion has focused primarily on the public agency as the entity monitoring its contract with the private provider.
Private agencies with performance-based contracts often rely upon methods that are similar to those used by their public agency counterparts namely ongoing review of performance data, chart reviews, focus groups, problem-solving mechanisms at the practice and systems level, and satisfaction surveys to tell them what is working and what needs improvement. Floridas monitoring system involved three tiers:. This tiered approach to monitoring was designed to give the CBC lead agencies the flexibility to monitor their contracts, but also to provide a structure in which DCF could oversee how the system was working.
In practice, the tiered monitoring system was not as effective in tracking lead agencies and subcontractors performance as planned OPPAGA, June For instance, lead agencies were not completing their Tier 1 quality assurance reviews in a timely manner and often not reviewing the required number of cases.
This resulted in significant delays between Tier 1 and Tier 2 reviews, which made it difficult for state staff to validate earlier findings that is, match the quality assurance data collected by the lead agency with what was currently being reported in case records. In consultation with Chapin Hall Center for Children, Florida restructured its oversight procedures to improve its ability to track contractual compliance and agency performance; some of the major changes include OPPAGA, June :.
While state officials report it is too early to determine the impact of these changes on agency oversight and performance, the states Office of Program Policy Analysis and Government Accountability conducts ongoing assessments of the states child welfare system and will continue to produce reports on its findings.
Some states supplement their staff-driven and private agency quality assurance and contract monitoring activities with oversight by independent community-based stakeholder bodies. These groups are charged with reviewing overall agency performance and helping to identify and remedy barriers to success.
Some of these bodies are created by the public agency, while others are appointed by the Governor. Many states have legislatively mandated bodies charged with helping to continually review performance of both the public agency and its contract providers. For example, when the County of Milwaukee Child Welfare system was taken over by the state, the state legislature created the Partnership Council by statute. The Partnership Council is an independent advisory body comprised of state legislators, county board members and gubernatorial appointees.
Among those appointees are the Childrens Court Presiding Judge, medical leaders, public school leaders, child advocates, public policy advocates, and guardian ad litem representatives. All meetings include public and private partners. Having an independent body assist in bringing public and private partners to the table to create improvements has been very effective in Milwaukee.
For example, one committee may be responsible for operational issues, and one for technical issues, while a senior executive committee addresses strategic issues. Illinois uses such a strategy. This includes any issues related to contracts and contract monitoring. Moreover, these meetings keep the vehicle open for [the] private agencies to raise any issues or concerns McEwen, a. The CWACs meetings provide an important avenue for private providers and the public agency to come together to discuss Illinois child welfare system.
In other states, there are ongoing, less formal, public-private communication mechanisms such as monthly meetings between the public agency and its contract providers to share data, communicate new information on policies or procedures, and discuss strategies for improvement. A spokesperson for Cornerstone, a child welfare service provider that has a performance based contract with Tennessee DCS, indicates that the monthly reviews and the relationship with DCS are a critical part of the success of their contract because it has helped them to be able to meet their targets.
Similarly, in Missouri, the state agency meets regularly with private partners, alternating between the program directors who manage the contract daily and the CEOs who bring big-picture issues to the table. Public agencies monitor a private providers compliance with various state and federal regulations, and with the terms of the contract.
As noted, until a decade ago compliance monitoring was the primary focus of contract monitoring. Monitoring compliance is often tied with monitoring a providers processes. For instance, the Texas child welfare agency requires a contractor to maintain sufficient records that adequately account for the use of awarded funds and to provide reasonable evidence that the service delivery complies with contract provisions Texas Department of Family and Protective Services, Compliance is included as part of its programmatic monitoring, and involves the following activities:.
Public agencies are responsible for ensuring that contract dollars are spent appropriately. Agencies vary with regard to whether fiscal monitoring is conducted by a separate unit in state government, by the child welfare contracting agency itself, or by an independent audit paid for by the private agency , and agencies differ in the level of detailed oversight required. At a minimum, fiscal monitoring focuses on whether program cost information, including administrative costs, are reasonable and necessary to achieve program objectives.
It involves:. Public agencies can also monitor the case decision-making process through collaborative reviews with providers. In some states, the public agency works very closely with private providers to make decisions about cases on an ongoing basis. This dual case management approach is used in places like Philadelphia , Pennsylvania.
Increasingly, with the expansion of performance based contracts, performance monitoring has become a central focus of most public agencies monitoring efforts. The U. GAO, , 6. Typically, performance targets in child welfare are stated as increases or decreases in a specified factor, such as a reduction in the average length of time a child stays in foster care or other measures that are directly linked to CFSR measures.
Which methods a public agency uses to monitor its contracts depends on the outcomes being measured, as well as other factors, such as the level of monitoring required to ensure accountability and the funds available to support monitoring activities. Examples from three jurisdictions are provided below:.
A critical part of contract monitoring is determining what information is needed to monitor services, costs, and outcomes. The information needed is based on answers to a few key questions:. Child welfare administrators need to examine the mission and goals for the child welfare agency and the role of the private agencies, in light of Federal outcomes of safety, permanency and well-being.
What is the problem the agency is trying to solve through contracted efforts? What results are needed? What program components and actions will lead to the desired results? There are 19 contract groups who are currently involved with the PBC implementation process. The remaining six contract groups will start the process in July Because the approach is staggered for contracts groups to begin the PBC implementation process, groups vary within the project by phases.
As of FY21, the 19 contract groups account for 1, contracts within the implementation process of PBC. Phase 1: Service and Quality metrics that already exist within their contracts to align with PBC process. Phase 2 : Quality and Outcome metrics to enhance the current contract with the assistance of data analytics.
Listed below are the current Service, Quality and Outcome metrics and summaries for the program areas. These metrics represent the PBC aspects of contracts, not the overall success of programs. The goal of the Independent Living IL program is to prepare foster and former foster youth 15 — 21 years old to live independently by increasing their skills, knowledge and competency in key areas.
The IL program is voluntary and is open to all youth that meet eligibility. Data will be available in FY The goal of the Responsible Living Skills Program is to prepare foster youth years old to live independently by increasing their skills, knowledge, and competency in key areas. The program does this by providing child-centered, individualized preschool education and health coordination services built on a foundation of strengths-based family support for the specialized populations we serve.
ECEAP prefers not to use numbers of children to avoid confusion between the number of children served and the number of slots due to turnover. The goal of these community-based family support contracts funded by the Community-Based Child Abuse Prevention CBCAP program is to work collaboratively with Washington State organizations to fund and support capacity-building of the organizations.
The goal is to implement high quality family support programming to increase the Strengthening Families Protective Factors for families and reduce the likelihood of child abuse and neglect. CBCAP, a federally funded grant program, is explicitly capacity-building for primary and secondary child abuse and neglect prevention. In addition to funding programming for families, these contracts also focus on building the capacity of community providers to evaluate their services and use the results to make improvements.
Because of this unique focus, CBCAP is identifying tools and measurement approaches for their FY22 contracts that measure the impact of the capacity-building efforts.
They are doing this to assess the agency's capacity to evaluate and assess program impact. This will require new data collection in FY22 with initial assessment of this approach in FY Early Childhood Intervention and Prevention Services ECLIPSE serves children years old who are at risk of child abuse and neglect and may be experiencing behavioral health issues due to exposure to complex trauma. The goal of Early Support for Infants and Toddlers ESIT is to enable children ages birth to 3 with developmental delays or disabilities to be successful during early childhood years and beyond in a variety of settings.
They are currently implementing a new data collection system to collect service data and will resume PBC implementation in September after the legislative exception for PBC expires. The goal of Home Visiting HV is to provide regular home visits from a trained professional to pregnant mothers or families to improve parent-child relationships, school readiness, and child health.
Participants are defined as actively enrolled if they received at least one home visit during the 90 days prior to the last day of the measurement period. During Q4 of SFY20, this definition was expanded to having received at least one home visit or one encounter during the 90 days.
When Western counties seek to reform welfare so that recipients have to work in return for aid, this poses implementation as well as policy problems. This study of work requirements in Wisconsin … Expand. View 1 excerpt, cites background. State Political Culture and Welfare Reform.
I investigate the link between the general features of state governments and their ability to reform welfare. I … Expand. The growing demand for welfare reform represented a devolution of authority from federal administration and enabled state governments to seek ways to improve efficiency and enhance coordination in … Expand.
This paper examines the choices made by states in the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act of Of existing studies based on time series or state panel data, some tend to underplay the role of welfare reform. The Wisconsin Works W-2 program changed the administrative structure for social welfare services delivery from county government administration to one that includes performance-based contracting … Expand.
Research and Welfare Reform. We see government contracts as defraying costs, not covering [all of] them. The contracts provide no incentive for long-term investment, and for the subcontractors who must relinquish overhead to the prime contractors, current payment schedules may pay only a fraction of the true costs of serving a disadvantaged client.
But accepting these subcontracts allows for financial piggybacking and economies of scale for multiple program cost-sharing. For small nonprofits, whose financial solvency depends upon their performance, reasonable numbers, quality referrals, and timely payment for performance—the last of which depends upon the administrative performance of both the county or city and the prime contractor—the financial risks are clearly high.
The current strategy of the four municipalities studied has been to find a few experienced contractors with good track records and sufficient technological and managerial expertise to provide the services and information systems necessary to ensure full participation and job placement of all eligible clients. Federal mandates and the terms of performance-based contracts require information systems to track and verify the progress of all clients in the system, and these demands often require sophisticated technology and management systems.
For-profit providers have considerable advantages in providing these systems. In New York and Milwaukee, many nonprofit providers have had a long history and good record of providing employment and training services, yet lack the necessary technological and managerial systems to oversee performance-based contracts. Further, because the timing of payments depends on performance in Milwaukee, New York, and San Diego, which in turn requires systems to verify placements, considerable initial capital is necessary to undertake these contracts.
The for-profits can sustain operations in anticipation of future payment streams, since they have access to investment capital. Only a fraction of the nonprofits historically operating in the employment and training business have the working capital to stay the course while they wait for payment.
Smaller, more community-based nonprofits that have historically provided employment and training services to low-income populations represent a large and diverse group nationwide. Thousands of nonprofit and for-profit organizations have received contracts and grants under these titles. In New York City alone, more than individual providers had one or more employment and training contracts under federal titles prior to the newly awarded TANF contracts and the commencement of the WIA programs.
Their capacity and ability to succeed in a more competitive and performance-based environment varies enormously. Most of the organizations interviewed believed they would survive in the short run. Few small organizations had the ability to bid on TANF contracts, given the scale and organizational capacity requirements. In New York, where the bidding process was known as negotiated acquisition, organizations were invited to bid, and many small, historic nonprofit contractors were closed out.
In this process, many historic providers will continue to serve portions of the caseload, albeit in limited roles. Contracting with CBOs has a number of valuable practical and political payoffs as for-profits and nonprofits enter new markets. CBOs may have a better understanding of particular client needs and connections to the resources in the community that can provide prime contractors with needed local expertise as well as protection against political backlash in the communities where they have won contracts.
Moreover, the for-profits may ultimately need less of the political protection they now enjoy through their connection with popular CBOs serving as their subcontractors. This winnowing out will have a mixed impact on the quality and range of available services. Many small providers serve special populations with particular needs. Whether current contracting and referral arrangements can preserve the services that may be critical to special needs populations, like ex-offenders, immigrants, and drug-addicted clients, is questionable.
There is concern that these special-needs groups will fall through the cracks of the system. Some observers also fear the civic and economic consequences of the loss of critical social capital in low-income communities when CBOs are forced to close their doors.
Others view the possible thinning of the provider ranks as healthy because it eliminates weaker and less able providers. While many nonprofits, especially community-based providers, face serious threats to their missions, the large for-profits are thriving see figure 2. The current welfare-to-work contracts have been an increasing profit center to large corporate entities with a foothold in serving state and local governments in technology-related human service areas.
Using large contracts, such as the management of child support enforcement systems, as an opening to branch out to other areas, companies such as Lockheed Martin IMS and MAXIMUS have been increasing the size and numbers of their contracts with state and local governments.
Their strategies have been to concentrate on large welfare reform markets in jurisdictions with large caseloads. The increasing dominance of the for-profits in this business signals potential problems, however. Dramatic declines in welfare caseloads in recent years leave them little growth potential in these markets. Indeed, for-profit corporations gain their comparative advantage from achieving economies of scale and standardization of the product they deliver across markets.
With smaller caseloads and an increasing preponderance of the harder and more expensive clients to place, large, private companies may simply leave the market, moving to areas where their virtues earn larger profits.
A swift exit of these providers would wreak havoc on many local systems.
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