2010 Highlight - Child Care

Building Stronger Systems

The 11-year-old girl lived with her mother in a small apartment near downtown Charlotte. “Julie” did well in school, where her favorite subjects were science and math, and she helped with chores at home. When her mother had to work at night, she made sure her little brother got to bed on time.

But a few months after her mother’s new boyfriend moved in, Julie’s perfect attendance ended. She stopped doing her homework. Her grades slipped. Teachers saw their once-cheerful student become withdrawn. Authorities intervened after they discovered the boyfriend had been abusive.

A social worker had to determine the next steps. Would it be best for Julie to move in with a relative or a foster family? Maybe group care would be the best option? If there are mental health issues, could a private provider offer appropriate services?

Working toward answers

For the past two years, a unique workgroup in North Carolina grappled with those kinds of questions.

“We asked each other, ‘How can we build a stronger system where we can make the best choices for children?’ ” says Sherry Bradsher, director of the Division of Social Services for North Carolina in Raleigh.

The participants – from public agencies, private providers and The Duke Endowment – came together to learn from each other, identify common values and work toward improved outcomes for the thousands of children who enter the foster care system each year.

The group formed in 2008 with the Endowment, the Division of Social Services (DSS), and Benchmarks, a statewide alliance of private providers. It later grew to include several private providers and county DSS representatives. As participants discussed federal policies, fiscal challenges and the many other issues impacting quality care, they began to see where enhanced public-private cooperation could improve child well-being.

“In the beginning, I think we each had things in our own mind that we wanted,” says Keith Henry, an executive vice president at Baptist Children’s Homes of North Carolina. “DSS was probably thinking, ‘These private providers don’t understand what we are going through.’ And the private providers were thinking, ‘We wish Raleigh would quit doing this or that.’ In the initial meetings, we just explained our perspectives. Then eventually, all of us around the table moved from promoting our own agendas to asking ‘How can we do better by the children?’ ”

The DSS/Private Provider Quality Workgroup, as it called itself, focused on developing a tool to help county DSS departments define “quality” among private providers. North Carolina has a county-administered child welfare system, and many county agencies have longstanding relationships with their private providers. But a standard tool would help all county agencies decide which provider to use, help match children’s needs with their placement and increase referrals to quality agencies.

The new pool would include fewer providers, but each one would be considered “high quality.” And with more children going to the top providers, that smaller number of agencies would experience higher volume – generating sufficient resources to re-invest in quality programs and sustain them. As Bradsher explains, it’s hard to have a robust program with a broad array of services if you don’t have the numbers to support the infrastructure.

“While the state has a licensure process … it doesn’t necessarily equate to quality in terms of service provision,” Bradsher says. “You meet some sort of bare minimal criteria and you are eligible to be licensed, but it doesn’t help social workers who are choosing placements to evaluate one agency against another in terms of quality – or even one agency against another in terms of who would best serve a particular child.”

The group also worked to create a standard tool to help identify the best placement level for children needing care. With the right information, providers can determine if they can meet a child’s needs. The assessment tool would help prevent a child from starting in one place, and then being moved to another if the first fails.

“The worst thing you can do is keep bouncing a child around,” Henry says. “We all agree on that. So we decided to try to come up with a way to assess the child for unresolved mental health issues and put them in the right spot to begin with.”

With recommendations in place, the group decided at the end of 2010 to move forward through county pilots.

Seizing an opportunity

At the same time, with many state child welfare systems struggling to provide high quality services with limited resources, a national effort was underway to study efforts to increase public-private collaboration.

Using a $5 million federal grant, the National Quality Improvement Center on the Privatization of Child Welfare Services was created in 2006. The center would gather information about public-private partnerships and, through three pilot sites, test the effectiveness of certain models.

As the effort continued, project leaders shared what they were learning through national summits; by late 2010, they invited states to apply for in-depth training focused on local efforts.

With the DSS/Private Provider Quality Workgroup in place, North Carolina was one of five states selected to participate.

“If our group had not been meeting for those two years,” says Karen McLeod, president of Benchmarks, “we wouldn’t have been ready to apply for this valuable resource.”

South Carolina effort

In South Carolina, where some 4,500 children are in foster care, The Duke Endowment participated in a similar effort. With representatives from the South Carolina Department of Social Services and select private providers, the group worked to increase understanding about the way they operate within the system. Discussions looked at placement stability, assessment tools, funding issues and foster parent recruitment.

“It was intense, but we got a tremendous amount of work done around relationship-building,” says Paula Fendley, chief operating officer of the South Carolina Association of Children’s Homes and Family Services.

From the beginning, the group faced challenges. The state was in the middle of drastic budget cuts – and leadership at the Department of Social Services would likely change after a gubernatorial election.

During meetings, participants reviewed other states’ approaches to learn from their successes and failures. They also analyzed service gaps across South Carolina to pinpoint areas of critical need.

A significant point of agreement emerged. State DSS officials, responding to national mandates, seek to place more children in family settings – ranging from family foster care to in-home support for biological, kinship or adoptive families. Private providers, meanwhile, were willing to expand their services beyond traditional group care by recruiting new foster care families, offering in-home support and participating in family group conferencing.

With a concurrent feasibility study on outsourcing child welfare services, the conversations led South Carolina DSS to examine whether private providers should be contracted to offer non-traditional services in specific areas of the state.

Katie Morgan, former chief of staff for the state DSS, says the process was like brainstorming.

“When you come at things from different perspectives,” she says, “it helps you identify different options to solve a variety of problems.”

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