Raising Permanency Rates during Fiscal Crises
from the Winter 2010 issue of Adoptalk
By Gail Johnson Vaughan
From 1985 to 2007, while Gail Johnson Vaughan was executive director of Sierra Adoption Services, she oversaw work to find permanent placements for more than 1,100 children in foster care. In 2007 she founded Mission Focused Solutions, an organization committed to helping nonprofit and governmental agencies improve child welfare outcomes.
In a time of fiscal crisis, the moral imperative to locate permanent families for children in foster care can be eclipsed by the fiscal realities of competing with other critical services for dwindling state dollars. Complex government funding structures can further cloud an obvious truth: It costs less to achieve and sustain child permanency than it does to leave children in foster care. By the same logic, programs that reinvest foster care savings into child and family preparation activities can realize substantial benefits without generating additional cost.
In California, Sacramento County is demonstrating this truth. Better yet, with determination and carefully crafted advocacy efforts, your state or county can replicate Sacramento’s success.
Home to the state capital, Sacramento County has about 4,000 children in foster care. More than 1,000 children between ages 11 and 18 do not have a reunification or adoption plan, and are not living with a relative. Because they are older, the children are harder to place for adoption and cost the foster care system more—in foster care rates, treatment for unresolved loss issues, and expenses associated with frequent placement moves.
To improve the odds of locating permanent families for older children in care, Sacramento County took part in a federal Adoption Opportunities grant that made the Destination Family Youth Permanency Project possible. During the funding period (2003–2008), 84 percent of youth referred to the permanency program found a permanent family.
Though the grant was time limited, the county believed it could sustain the successful Destination Family program without the grant if it were able to reinvest savings generated by the increase in permanent placements (and reduced number of children in foster care). The reinvestment strategy was included in the county’s grant proposal..
Sacramento County's Reinvestment Strategy in Action
The Department of Health and Human Services (DHHS), in partnership with the Departments of Behavioral Health (DBH) and Human Assistance (DHA), and Sierra Forever Families—a private child welfare provider—are involved in the permanency program. DHHS refers youth to the program and oversees other aspects of child welfare, and DBH draws down state and federal Medi-Cal/EPSDT (Medicaid/Early Periodic Screening, Diagnosis, and Treatment or EPSDT) funding. DHA transfers funds to DBH to pay the required county match, and Sierra delivers permanency services under an EPSDT contract.
Diagnostic and treatment services can include preventive care, outpatient psychiatric services, home and community-based services, physician-directed clinical services, in-home personal care attendants, and certain targeted case management activities.
Many youth permanency services are therapeutic, so they naturally fall into the mental health framework of assessment, therapy, rehabilitation, and medication support where needed. Sierra tailors services to help youth and families prepare for and sustain permanency. When an older child’s mental health and developmental needs are addressed prior to adoption and supported in the adoptive family, she stands a much better chance of realizing permanency with a new or known family.
DHA disburses foster care stipends, Kin-Gap payments for relative guardians, and adoption assistance subsidies. When a youth moves from foster care to a permanent adoptive family or guardian, or returns home, DHA has lower costs. By federal law, adoption assistance and kinship stipends cannot exceed foster care rates, and are often markedly lower. Heightened numbers of permanent placements also reduce administrative costs. In California, where counties pay 60 percent of the non-federal share of foster care, but just 25 percent of the non-federal share of adoption assistance, our county savings are even greater.
Annual per child savings range from about $1,000 when a youth leaves a foster family home for a financially supported relative guardianship, to more than $20,000 for youth in Level 14 group homes who move to permanent families. In the past, savings reverted to the county’s General Fund and were lost to child welfare. Under the new program, DHA transfers some of the savings to DBH so DBH can pay the 5 percent match needed to draw down Medi-Cal/ EPSDT funds.The savings and reinvestment occur within the same budget year.
If permanency services were provided to all 1,100 youth aged 11–18 who are not on track for adoption or in a relative placement, the county has the potential to save $9 million a year in foster care costs. Better yet, county children would have more chances to find the lifelong connections they deserve.Key Replication Strategies
To create a program that improves permanency prospects for older youth without costing your state or county any extra money, review the strategies below. California’s, and a few other states’, child welfare systems are state supervised and county run. In most other states, systems are both supervised and run by the state. In these states, advocates must determine their state equivalent for different players in the youth permanency project.
1. Meticulously track savings realized through improved youth permanency outcomes—including the difference between the state’s/county’s adoption assistance and foster care payments, lower administrative costs for foster care, and the potential of drawing down state or federal funds due to the increased ability to provide matching funds. Documented savings demonstrate that your state or county can reinvest foster care savings into child permanency work.
Find spreadsheets for tracking costs at www.cpyp.org/assessment.html.
2. Establish positive relationships with your county’s Board of Supervisors/ Commissioners or state legislators.
- Involve these leaders at the outset of the youth permanency service delivery process so they can feel ownership.
At regular intervals, give presentations to the board/legislators that highlight favorable results, stories of youth finding families, savings achieved, and your appreciation for the board’s/legislators’ support. All interactions with these individuals should involve an expression of appreciation for their role in making the project a success.
3. Weave together a network of stakeholders who will advocate with individual policy makers. Child advocates, current and former foster youth, caregivers, adoption workers, community leaders, court-appointed special advocates, guardians ad litem, family and juvenile court judges, etc. are good candidates. Try to identify one person to coordinate reinvestment advocacy efforts and inform the network about appointment times and hearing dates. Prepare talking points and encourage stakeholders to offer public testimony.
4. Engage leaders from your public child welfare, public assistance, and mental health service providers.
- Regularly brief leaders of your county or state child welfare division, as well as the department under which the division operates. Counteract any prevailing negative belief about finding families for older youth by sharing personal success stories and funding benefits.
- Point out that increased youth permanency rates can lead to more favorable federal and state Child and Family Services Reviews.
- Identify someone who is a natural champion and will find a way to partner with other county departments to further child permanency goals.
- Make certain your youth permanency steering committee includes local mental health leaders.
- Educate them about the clinical nature of most youth permanency activities, and the need for permanency-competent clinicians to address adoptive, relative, guardianship, and other permanent families’ unique needs.
- Ask them to partner with child welfare services to achieve improved mental health (and permanency) outcomes for youth in and adopted from care.
- If a public welfare department makes foster care and subsidy payments but does no adoption work, seek their help.
- Tell leaders how successful youth permanency practices can lower their costs, and keep them in the loop with updates about reinvestment efforts.
- Work together to develop a methodology for tracking the savings.
- Ask them to partner with child welfare and mental health services to achieve same year savings.
5. Engage leaders at the county or state executive level. Net savings from youth permanency reinvestment involve multiple departmental budgets. County executives need to understand that the program is truly budget-neutral within the same fiscal year. In times of budget deficits and drastic cuts to county programs, budget neutral projects—particularly when program savings can be used to leverage additional state and federal funds—can free up funds for other key priorities.
6. Initiate dialogue with the county board-appointed human services advisory boards, if applicable. Net county or state savings from the reinvestment can be used for services that matter to the appointed boards.
7. Publicize program successes in human and financial terms. Local media follow budget cuts and will be interested in the fundamental budget reform represented by youth permanency reinvestment. The program is unique in its ability to help youth, draw down funds, and maintain fiscal neutrality within the same year.
8. Actively participate in the county budgeting process. Proactively present reinvestment position papers to county budget staff, county administrative officers, and members of the board. Attend and testify at all budget workshops and hearings to drive home the point that the program achieves positive outcomes for youth and net savings for the county.
9. Publicly praise county staff and leadership for their hard work. For youth permanency efforts to succeed, leaders and staff must shift their belief systems and practice protocols. Those who do should be praised for their work in front of county, departmental, and board leadership. Youth permanency work, by nature, is collaborative. Keep the collaboration strong by pointedly recognizing everyone who invests his or her time, money, talents, or services in giving more youth a chance to find their forever families.
10. Persevere. The practice of reinvesting foster care savings in permanency work for waiting youth is both a moral and fiscal imperative.
In the wake of our deep recession, some states have repeatedly trimmed funding for a variety of child and family welfare services. If we are to weather this daunting fiscal climate, child welfare agencies and other county departments must work together to ensure that children in care achieve permanence in a timely manner.
It can be done; counties and states can increase permanency without additional money and realize long-term savings as fewer emancipated youth become incarcerated or homeless. For youth who find a permanent family before aging out of care, the cycle of abuse can be broken, and the productivity of our once-systemed children can blossom.
If you have questions or would like more information about the reinvestment model, please contact Gail at email@example.com.