Partners for Philadelphia Families
Philadelphia City Council
Committee on Public Health and Human Services
David R. Fair, Deputy Chief Executive Officer
Turning Points for Children
June 14, 2016
Good afternoon. My name is David Fair, Deputy Chief Executive Officer at Turning Points for Children. I testify today on behalf of a new coalition, Partners for Philadelphia Families, which has been formed by the seven community organizations operating Community Umbrella Agencies (CUAs) throughout Philadelphia’s neighborhoods. The other organizations that are part of this partnership are APM, Bethanna, Catholic Community Services, NET Community Care, Tabor Community Partners, and Wordsworth.
I am joined today by Noelis Zavala, CUA Director at APM, and Staci Boyd, CUA Director at Tabor Community Partners, to help should you have any questions.
We are meeting this afternoon to discuss the reasons for, and the impact of, the decision by Pennsylvania DHS to issue a provisional license to Philadelphia DHS for the delivery of child welfare services.
This decision was based on the results of an audit conducted by PA DHS into the operations of Philadelphia DHS, and a review of investigations, intake, and cases managed by Philadelphia DHS as well as Community Umbrella Agencies in partnership with community foster care agencies. This audit highlighted a number of critical areas where the lack of financial and human resources, and the pressure of a rapidly increasing number of families in care, has had a harmful effect on the quality of care provided by the child welfare system – which includes DHS, the CUAs, and foster care agencies subcontracting with the CUAs.
Three years ago, Philadelphia DHS began implementing Improving Outcomes for Children (IOC), which was designed to revolutionize the delivery of child welfare services in Philadelphia. In fact, much of the promise of IOC has yet to be implemented, let alone realized. Unfortunately, this has led to a rush to judgment in some quarters to question IOC’s effectiveness.
But it’s important to remember that IOC was adopted in order to fix a broken system. There was and is a consensus that the old ways were not, in fact, adequately protecting the safety of Philadelphia’s children; that they were not, in fact, adequately assuring their well-being; that they were not, in fact, doing a good job of helping children find safety and permanency in their own communities, with their own families or in an adoptive home. And that was all when we had a system serving only 4,000 children in foster care; today, that number is over 6,100.
It should also be noted that IOC is not a “pilot program” or an “experiment.” The unprecedented changes in policies, procedures, roles, priorities, methods, personnel, and yes, financing, that have taken place over the past three years have fundamentally transformed our child welfare system and moved it into the 21st Century, and we should not turn back the clock on the profound and positive changes that have already been made. To do so would be unnecessarily disruptive to the care we provide and put at risk the 13,000+ children and their families who have been entrusted to us.
Today’s problems with IOC implementation are largely budgetary, not problems with the approach. A child welfare system that had a $750 million budget ten years ago (with about 3,500 children in care) is now one with $100 million less and almost twice as many children to care for.
Only by solving the financial challenges can we truly relieve the many stresses that impact our support of children and families, and only with smarter investment of available funds can we say we are addressing the issues raised by the state audit.
While there have been many implementation challenges in the first three years of IOC, largely having to do with a 46% increase in the number of children in foster care and largely static funding from the Commonwealth, it is also true that the IOC initiative is achieving results that are as good, or better, than what was being achieved under the old model. These results include:
• A continuously increasing rate of reunifications and adoptions; overall, permanencies have increased by 25% over a year ago, adoptions are up 15%, and reunifications have increased by 30% over last year;
• Improved rates of placing children with relative caregivers rather than strangers, which today is happening at a higher rate than ever before;
• Keeping children in their own neighborhoods and schools, and close to friends and families;
• Keeping siblings together;
• Reducing the use of group homes and institutions;
• Improving safety visitation rates, which are consistently higher than when this service was performed by DHS;
• Through our neighborhood-engagement efforts, organizing coalitions of neighborhood organizations to support children in care and advance the protective factors that keep children safe in healthy families and communities; and
• Implementing highly successful parent education services through Parent Cafes consistently offered in every neighborhood throughout the city.
Each of these is a critical measure of a successful child welfare system.
IOC has not worked perfectly by any means. But we are moving forward, showing that by almost every system measure, child welfare services based in neighborhoods rather than in downtown offices make the most sense for children and families.
But to truly implement the model as originally designed will require courageous leadership and more financial resources to meet the need. These are needed to help us return to the original goals of IOC and the original program design on which IOC was based. Unfortunately, we have strayed from that original design in important ways.
The most important area where implementation has not been consistent with the original model is in the design of case management services.
It should be noted that prior to IOC, child and family case management was provided by a DHS case manager overseeing the case and a foster care agency case manager who did much of the day-to-day work. IOC is instead based on the model of a single case manager responsible for both functions, because having two case managers was seen as confusing for families and resulted in muddled case planning.
This means that, under IOC, one CUA case manager is now solely responsible for the work formerly performed by two people. And they are working in a system that has not only lost the work of DHS caseworkers, but has forty percent fewer case managers on the provider side than the previous system. Today, we have 392 case managers doing the work formerly handled by 660.
Unfortunately, eliminating the system of “dual” case management did not eliminate the need for services and functions critical to the achievement of safety, well-being and permanency.
Caseloads for these beleaguered and low-paid social workers that according to national experts should be at seven families (or about 16 children) per case manager are more likely now at 14 and 15 families (with 32 to 35 children).
For each one of these 32 to 35 children, the case manager must every day assure the child’s physical and emotional safety, support academic and other education-related progress, assure medical, dental and behavioral health needs are met, transport the child when necessary to and from school and appointments, supervise visits with family members, make sure foster parents have what they need to care for the child when in placement, help birth parents and other family members obtain the often wide range of health, social service and other practical services they need to be able to reunify with their child, identify other family members and community supports, and handle extensive paperwork requirements and assure that all court-mandated duties are fulfilled. Not to mention acting as a counselor and trusted friend, committed to bringing the family back together.
Every day. For each and every one of 32 to 35 children. And while I sit here today to speak for the children and families who desperately need our system to work, we would be remiss if we didn’t also speak for these very staff who are being vilified in many arenas for not being able to produce a quality product, when in fact few of us could do so day in and day out on a consistent basis given the workload they are asked to bear.
To paraphrase a comment made by DHS Community Oversight Board chairperson David Sanders last month, if this was the typical workload of an airplane pilot, none of us would ever get on a plane.
These caseloads are unacceptable, untenable, and risky, and they are the primary reason why the true promise of IOC has not yet been realized, and that the failings identified in the state audit have occurred. It is critical that the Commonwealth and the City work out the financing issues so that the caseloads can be reduced to a level that makes appropriate care possible.
It is also urgent that the Commonwealth and the City recognize that in a crisis of many parts amidst demands of many types, it is the direct services to children and families that should be funded first. These services – the services that keep our children safe and move them towards healthy futures – need to be our highest priority, not just one of many.
Lower caseloads means caseworkers will no longer have to routinely put in 55- and 60-hour workweeks (an expectation that cannot be sustained), just to keep up with the basics of the work they are asked to do. It means less time on burdensome paperwork and more time assuring the safety of children, supporting their physical, mental and educational well-being, and assisting birth parents in addressing the issues necessary to achieve reunification.
Lower caseloads will also result in increased permanency, finally reducing the number of children in care.
Meanwhile, the impossible workload facing our case managers and ancillary staff has led to higher than normal turnover rates among CUA workers. Replacing such workers and on-boarding new ones can be a 6 month process before a case manager can carry a full caseload, primarily because of regulatory training requirements that can cost up to $18,000 per worker. We estimate that the system has lost over $2 million in training costs alone in training workers that ultimately left the system.
Another crisis facing our system today is the lack of qualified foster parents and other placement options for the increasing number of children in care. As the number of children in care has risen rapidly, our capacity of foster homes has not kept pace, and specialized options such as treatment foster care and congregate care have decreased.
Fortunately, we have improved our success in finding relative caregivers, called kinship caregivers, for many of the children in care. In fact, it was recently determined that for the first time in memory, there are more relative caregivers caring for children in placement than non-relatives. But nonetheless, there are simply not enough foster homes to meet the demand, especially for children with specialized needs.
One reason for this is that payments to foster parents for their foster children’s care in Philadelphia are the lowest of any county in Pennsylvania, and haven’t been increased in over a decade. This payment, currently at $21.25 per day for general foster care, is wholly inadequate to support all of the needs of the children we ask foster parents to care for.
But even more important is the lack of practical and emotional support for foster parents that implementation of IOC has meant. Under the old system, a caseworker with the foster care agency was responsible for working closely with the foster caregivers to help them address the needs of the children in their care. Under IOC as it is presently being implemented, these supports have largely been removed.
Fortunately, a new task force comprised of state, City and CUA representatives has proposed solutions to these challenges, but there is no indication that the state or City will make available the financial resources to enable them.
These are just a few of the major challenges that have undermined the implementation of the Improving Outcomes for Children initiative. There are others.
For example, IOC was also originally designed to be heavily dependent on data – that is, to use a 21st Century system to track our effectiveness broadly as well as down to the individual child, so that we would at all times know where children were, whether those children were being appropriately served, and where those children were on the path to permanency. Using data to assure quality was an essential component of the IOC design – but unfortunately, we are still operating with technology from the last century, and virtually no ability to quickly access data to measure our progress.
DHS is to be commended for its hard work in addressing this problem. But what was originally thought to be a fix that would take six months has gone on for over a year and a half, and we are still at least a year or two away from implementation.
Also, IOC was also originally designed to emphasize innovative and creative ways to address the needs of children and families, so that we would break the stranglehold of old habits and hidebound policies and procedures. We were promised a reasonable and fiscally viable “case rate” that would allow us the ability to be flexible and innovative in the ways we originally proposed in our applications to become CUAs. However, the financial stress of the system’s growth and the unwillingness to be creative with rules and regulations has prevented allowing us the flexibility to be innovative in the ways that IOC requires.
Finally, while the CUA have been asked to manage over $100 million in funds to support the thousands of foster parents at over 40 community foster care agencies, we still receive no administrative fee for managing these funds and few dollars for program, billing and fiscal oversight. It should be noted that these are funds, which comprise about half of the total CUA budgets, are passed through the CUAs and are not available for the direct operating costs of providing case management or other CUA services.
What this means is that each CUA has had to build its own infrastructure at its own cost to track thousands of children every day, process extremely detailed bills for each child’s care on a monthly basis from 40 separate providers, and manage a cash flow of hundreds of thousands of dollars every month – all with a bare minimum of staff. This administrative burden, along with meeting state requirements to share thousands of documents with those 40 providers on a monthly basis, has resulted in an administrative nightmare that has put enormous stress on CUA operations.
Here’s the bottom line: if we’re going to keep our children safe and healthy, we need to catch them before they go over the waterfall, not wait at the bottom to catch the pieces.
Money can’t solve all problems, but in this case, everyone knows that the money we all thought would be there when IOC was rolled out simply is not.
To a large extent, we believe that if the priorities of the existing allocation from the Commonwealth to the City can be re-ordered to fund CUA case management services, IOC outcomes would continue to improve and the CUAs’ workforce would be stabilized.
Rather than engage in blame games so that we can avoid the problem, we all – state, City, CUAs, foster care agencies, foster parents, unions, advocates, judges – need to demand once and for all an adequately funded and creatively led system of care for the children that we, the public, have taken responsibility to protect.
Thank you for your attention.
Partners for Philadelphia Families
David R. Fair, Deputy Chief Executive Officer
Turning Points for Children