Testing What Works

3/1/2013

State Legislatures Magazine | March 2013

Federal waivers give states the flexibility to discover what’s best for children in foster care.

By Nina Williams-Mbengue

Child on playgroundWant to build a strong child welfare system, try programs that will save money and improve foster care? Seeking a child welfare waiver—allowed under the Child Welfare and Family Services Innovation Act of 2011, might be your answer. The federal act authorized the U.S. Department of Health and Human Services to issue 10 waiver demonstration projects for 2012, and 10 more in both 2013 and in 2014.

The waivers allow states to use money usually reserved for specific foster care expenses to test new ways of providing and financing child welfare services. Ideas submitted for approval must aim to safely shorten children’s stays in care, increase children’s safety and well-being, prevent child abuse or keep children from going back into care.

Priority is given to projects that will improve the lives of children who have experienced trauma, contribute to the body of evidence about what works, and  include other programs, such as mental and behavioral health services.

A History of Success

State experiments with waivers as far back as 1995 have shown success in saving states money while keeping children safe. According to evaluators from the U.S. Health and Human Services Department, children in waiver demonstration programs in Illinois, Minnesota, Oregon, Tennessee and Wisconsin spent significantly less time in foster care than children in control groups. The programs focused on helping children get adopted, find permanent homes with relatives, or return home to their families.

The waiver demonstration programs that tested flexible funding schemes also showed positive results. For example, Florida’s waiver allowed it to pay community-based agencies that serve children and families to provide substance abuse, mental health and crisis intervention services and help with rent, utilities and child care in order to keep children safely at home. This led to a 37 percent decline in the numbers of children in care between 2006 and 2011. As a result of fewer children entering foster care, especially expensive institutional care, the state’s foster care costs dropped significantly.

Evaluators also noted that programs in Indiana and Ohio reduced the time children spent in foster care. In Indiana, children receiving services under the waiver averaged 113 fewer days in care compared with a control group. In Ohio, children spent 1.77 fewer months in foster care before being adopted than they would have without the waiver program.

The waiver program was initially authorized in 1994, but had expired in 2006. Previous successes, along with three years of hard work by state legislators and NCSL staff advocating for the program, led the federal government to reauthorize it in 2011. Last year, nine states received waivers: Arkansas, Colorado, Illinois, Massachusetts, Michigan, Pennsylvania, Utah, Washington and Wisconsin.

Interested in Appyling?

If your state is interested in applying for a waiver, here’s what you need to know.

 

Child Welfare Demonstration Waivers 2012

Arkansas: The state is shifting from out-of-home care to in-home services, including supporting children and their families after they are reunited.
Colorado: The state is working on improving its ability to identify and treat the effects of trauma in abused children and to engage families in making the decisions needed to keep their children safe.
Illinois: Focusing on babies and toddlers in Cook County, the state hopes to reduce the effects of trauma, find permanent homes sooner and lower the rates of repeat foster care due to abuse.
Massachusetts: The state is focusing its efforts on families after children return home, older kids leaving foster care to live independently, and at-risk families so that children may remain at home.
Michigan: The state is focusing on at-risk families by contracting with private agencies in three sites to coordinate services and work with families in their homes to prevent the need for foster care.
Pennsylvania: Focusing on five counties, the state plans to reduce group home care, re-entry into foster care, and the number of days spent in foster care.
Utah: The state is hoping to improve its in-home services, the assessment of the trauma experienced by abused kids, and the coordination of local and regional services.
Washington: The state is developing its Family Assessment Response program, which allows the use of more than one approach when handling reports of child abuse or neglect.
Wisconsin: To reduce re-entries into the system, the state is working to improve its services to families after children return from foster care, beginning with Milwaukee County.                         


1. THERE’S STILL TIME
U.S. Health and Human Services will continue to accept waiver proposals even though the deadline for 2013 was Jan. 15, but they may not be reviewed by the end of the federal fiscal year on Sept. 30. Proposals not reviewed, however, will be carried over for consideration in 2014. States can submit letters of intent before submitting an application. The federal government provides states free assistance in preparing their applications as well as help after they are approved.

2. EXISTING PROGRAMS MAY QUALIFY
States can seek waivers for existing programs. For example, Colorado will use its 2012 waiver to develop four major initiatives that were already in the planning or early implementation stages. Arkansas will expand programs it has been testing, such as “permanency roundtables” in which child welfare officials focus on finding loving families for the children who have been in care for a long time because they have no home to return to, no relative to live with or almost no chance at adoption.

3. FOCUS ON TRAUMA
Many of these child welfare demonstration projects provide services that address the consequences of trauma caused by physical and sexual abuse, domestic violence or homelessness. Children and adults who suffer this kind of trauma often experience high rates of chronic health conditions, substance abuse, mental health disorders and criminal activity, according to the U.S. Substance Abuse and Mental Health Services Administration. Having a good understanding of what children and families who have suffered trauma may be experiencing helps to provide services that don’t re-traumatize them.

4. FEDERAL FUNDING CONTINUES
Waivers allow states to continue receiving the same amount of federal money, even if they reduce the number of kids in foster care. Any savings achieved by demonstration projects may be used for other child welfare purposes. For example, they can offer families additional services when out-of-home placements aren’t needed or when children return home after placements.

5. THERE ARE RULES TO FOLLOW

State officials have to demonstrate within three years that they have accomplished (or plan to) at least two of the following:

  •  Adopted a foster child bill of rights.
  •  Established a plan for meeting the health and mental health needs of children in foster care.
  •  Provided Title IV-E assistance to relatives who choose to be guardians.
  •  Extended foster care beyond age 18.
  •  Reduced the use of group homes.
  •  Kept siblings together in foster care when possible.
  •  Made efforts at recruiting and retaining foster families.
  •  Helped older kids reconnect with their biological families.
  •  Established programs to prevent foster care placements.


6. LEGISLATORS ARE KEY PARTNERS
Legislative leadership is key to examining and promoting any promising approaches. Legislative support can help child welfare agencies make better use of state funding sources and develop effective partnerships with other state agencies focused on improving the lives of children and families.

Washington Representative Ruth Kagi (D), for example, served on an advisory committee to make recommendations to the state’s children’s administration about the Title IV-E waiver application.


“The legislature strongly supported the waiver,” says Kagi. She’s pleased the state now has “the flexibility and tools to transform our child welfare system and keep many more children safely at home.” Lawmakers already passed four major bills last session to reform Washington’s child welfare system, including one to reinvest state funds from foster care caseload savings back into child welfare, a first of its kind in the nation.

Last year in Nebraska, lawmakers created a committee to review, report and provide recommendations regarding the state’s application for a waiver demonstration project. The committee developed a plan and timeline for the application, and decided the focus of the project. “The Nebraska Department of Health and Human Services worked with a committee of stakeholders and the newly created Children's Commission to develop our application,” says Senator Kathy Campbell (NP), who sits on the committee. She says she is confident the demonstration project “will assist Nebraska in its commitment to strengthening families and serving children in their homes."

Kagi and Campbell echo the goals proposed across states in their various waiver demonstration programs—to strengthen families, to ensure children are safe and to place them in permanent homes with loving families. Waivers give state officials the flexibility to work toward these goals while addressing their state’s specific challenges, strengths and resources.

Nina Williams-Mbengue is NCSL’s expert on state child welfare issues.