Maryland’s Proposed
Title IV-E Waiver Demonstration
Application
A presentation by DHR to the
Social Services Administration's Child and Family
Advisory Board and
Members of the IV-E Waiver Committee &
Provider Advisory Board
October 31, 2013, 9:30 - 12:00
Baltimore, MD
Title IV-E Demonstration Waiver
BACKGROUND ON THE TITLE IV-E
DEMONSTRATION WAIVER
Title IV-E Demonstration Waiver
Child and Family Services Improvement and Innovation Act
HR 2883 (PL 112-34) Bill Signing
Provided HHS with
authority to grant
up to 10 waivers in
each of FFY 2012,
2013 and 2014.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
New Demonstration Authority
• HHS can authorize up to 10
new demonstrations in each
of federal fiscal years 2012,
2013, 2014.
• 9 States were approved for
waivers in FFY 2012.
• 8 States were approved for
waivers in FFY 2013
Title IV-E Demonstration Waiver
Waiver States as of October 2013
Title IV-E Demonstration Waiver
Key Requirements
• States/Tribes must demonstrate readiness.
• Required to implement Child Welfare Program
improvement policies.
• States/Tribes must submit proposal covering 22
required items. (ACYF-CB-IM-12-05 of May 14,
2012).
• Demonstrations must be cost neutral to the
federal government.
• Requires rigorous, independent evaluation.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Cost Neutrality
• Cost comparison method
• Capped allocation method
– What would the State/Tribe have received in IV-E
Foster Care payments in the absence of the
waiver?
– Capped allocation can include almost any foster
care costs, but most state capped allocation
waivers have included maintenance payments
and administration.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Child Welfare Demonstrations
Implementation Time Frames
State
FL
CA
OH
IN
OR
O-12
N-12
D-12
J-13
F-13
M-13
A-13
M-13
J-13
J-13
A-13
S-13
O-13
N-13
D-13
Dec. 2013
June 2014 ->
9/30/2015
6/30/2017
6/30/2016
AR
CO
IL
MA
MI
PA
UT
WA
WI
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Where States Are
Steps in the Process
Explore application
Develop and Submit Application
Negotiations with ACF
Execute Terms and Conditions
Developmental Cost Plan
Initial Design & Implementation Rpt.
2012
2013










Evaluation Plan
~
Schedule of Payments
Implement
~
~
2014
~
Casey Family Programs, 2013
Key: Completed
~Underway
Title IV-E Demonstration Waiver
2012 States
State
Focus
Target Population
Scope
AR
Comprehensive practice model.
Expand EB and EI practices.
All children referred
to CWS
Statewide with 8
counties in Year 1
CO
Systemic reforms and innovative
practices to increase family
engagement
All children with
screened in reports
Up to 64 counties
IL
Address impact of early
maltreatment and trauma
Children age 0-3
who enter care.
Cook County
(Chicago)
MA
Performance-based contracts of
residential services
Children in
residential
placement and can
return to family
Statewide – 3,400
youth
Casey Family Programs, 2013
10
Title IV-E Demonstration Waiver
2012 States (continued)
State
Focus
Target Population
Scope
MI
Expand secondary and tertiary
All children in
prevention to families with young specified
children at risk
communities
3 sites, 1,500
families over 5 years
PA
New case practice model focused All children in
on family engagement,
placement or
assessment and expanded use of receiving services
EBPs.
5 counties initially
WA
Family Assessment Response (a
differential response pathway as
alternative to CPS)
Families screened in
representing low or
moderate risk
Statewide over five
years.
WI
Post-reunification case
management and support
services for 12 months post
discharge
All children who
have reunited
Milwaukee County
year 1, remainder of
state years 2 to 5.
Casey Family Programs, 2013
11
Title IV-E Demonstration Waiver
Summary of New Demonstrations
Scope
State
Funding/ Cost
Evaluation
AR
Statewide
Capped Allocation. Payments and
Admin
Outcome changes over time
CO
Phased – up to 64 counties
Capped Allocation – Payments and
Selected Admin Categories
Matched case comparison and time
series analysis
IL
Age 0-3, Cook County
Treatment/Control Comparison
Quasi-experimental comparison
MA
Statewide
Capped Allocation – Payments and
Admin (compare to Congregate care
history)
Pre-post outcome comparison
MI
3 sites
Treatment/Control Comparison
Experimental design
PA
5 counties to start – can be
expanded
Capped Allocation – Payments and
Admin.
Interrupted time-series design using
propensity score matching, and metaanalysis of common interventions.
UT
Statewide
Capped Allocation – Payments and
Admin.
Outcome & cost changes over time
WA
Statewide – low to
moderate risk families
Capped Allocation – Payments and
Admin.
Matched case comparison design
WI
Milwaukee – may expand
statewide
Capped Allocation – Payments and
Admin
Matched care comparison –
longitudinal outcomes
Casey Family Programs, 2013
12
Title IV-E Demonstration Waiver
Common Strategies
• Many states have identified expanded use of in-home services as a
strategy.
• Many states have identified trauma-informed assessments and care as
strategies.
• Several states have identified implementation or expansion of
differential or alternative response initiatives.
• Several states have identified use of Family Finding as a tool.
• A number of states have identified family/youth engagement and
involvement as strategies.
• Several states focus on kinship care (supporting effective placements
and moving those placements to permanency).
• Several states are focusing on reducing reliance on congregate care or
residential treatment.
• Several states are collaborating with their Medicaid and/or Behavioral
Health systems.
Casey Family Programs, 2013
Title IV-E Demonstration Waiver
Increased Federal Emphasis
•
•
•
•
•
•
•
What are your target populations?
What interventions do you plan to use?
What outcomes do you expect?
What is your theory of change?
How will you evaluate these outcomes?
How realistic are your plans?
What are the costs and savings (goes beyond
cost neutrality)?
Casey Family Programs, 2013
MARYLAND’S APPLICATION
PLACE MATTERS
Building on the
Foundation of
Place Matters
•Engaging Families: Developed
a family centered child focus
practice model.
•Finding Permanence for
Children: Keeping children in
their home when safe;
reducing the length of stay in
care; finding permanent
homes for children.
•Using Data: DHR set goals for
key measures and used data to
analyze the caseload and make
better decisions for at risk
children
PLACE MATTERS
Using Data to Measure Success
Children in Out-of-Home Care
12,000
10,000
8,000
6,000
4,000
2,000
0
Out-of-home
placements have
decreased 43% since
2007.
PLACE MATTERS
Using Data to Measure Success
Group home placements have decreased 47%.
72% of youth in care are placed with families.
# in GH
2,500 20%
2,000
20%
17%
15%
13%
1,500
1,000
% in GH
Children in Group Homes
14%
15%
12%
11%
11%
10%
11%
10%
10%
10%
10%
10%
500
5%
0
0%
PLACE MATTERS
Using Data to Measure Success
Average # of Families Served in In-Home Services
4,500
4,000
3,500
4,130
3,775
3,479
3,190
3,207
3,235
3,000
2,500
Average FY
2,000
1,500
1,000
500
FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013
PLACE MATTERS
Using Data to Measure Success
More children are
finding permanent
families through
adoption,
reunification and
guardianships.
Our goal is for children to have no more than two
placement changes a year and to reduce the length
of stay in foster care.
Children who grow up
with permanent
families are more
likely to succeed later
in life.
Title IV-E Demonstration Waivers
Federal Priority Areas
• Produce positive well-being outcomes for children, youth and their
families, with particular attention to addressing the trauma experienced
by children who have been abused and/or neglected;
• Enhance the social and emotional well-being of children and youth who
are available for adoption, as well as those who have been adopted, with a
particular emphasis on those children who have been waiting the longest
or are hardest to place in order to achieve and sustain successful
adoptions;
• Yield more than modest improvements in the lives of children and
families and contribute to the evidence base; and/or
• Leverage the involvement of other resources and partners to make
improvements concurrently through child welfare and related program
areas, including proposals to establish financial incentives based on the
achievement of positive child outcomes.
Title IV-E Demonstration Waivers
Federal Goals Required to be Addressed
by the
Waiver Application
(at least one must be addressed)
• Increase permanency for all infants, children, and youth by
reducing the time in foster placements when possible and
promoting a successful transition to adulthood for older
youth.
• Increase positive outcomes for infants, children, youth, and
families in their homes and communities, including tribal
communities, and improve the safety and well-being of
infants, children, and youth.
• Prevent child abuse and neglect and the re-entry of infants,
children, and youth into foster care.
Title IV-E Demonstration Waivers
Maryland’s Goals
• Build on successes in improving safety & permanency
by promoting child well-being
• Leverage and build upon home- and communitybased service array, including evidence-based and
promising practices, to enhance availability of
services in the community
• Establish a trauma-informed child welfare system
• Support full implementation of Alternative Response
Title IV-E Demonstration Waivers
Ages of Children & Youth Served through In-Home
Services in Maryland
Children in In-Home Services, June 2013, by Age
450
400
350
300
250
200
150
100
50
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18
Title IV-E Demonstration Waivers
Ages of Children & Youth Served through Out-ofHome Care in Maryland
Children in OOH Care, June 2013, by Age
600
500
400
300
200
100
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Title IV-E Demonstration Waivers
Potential EBPs & Promising Practices for Children and their Families with
Child Welfare Involvement
(Non-Exhaustive List—For Discussion Purposes)
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Brief Strategic Family Therapy
(BFST)*
Early Childhood Mental Health
Consultation (ECMHC)*
Family Connections*
Family Group Decision Making*
Functional Family Therapy (FFT)*
Functional Family Therapy—Child
Welfare
Grandparent Family Connections*
Homebuilders*
Home Visiting*
Motivational Interviewing*
Multidimensional Treatment Foster
Care (MTFC)*
•
•
•
•
•
•
•
•
•
•
•
Multi-Systemic Therapy (MST)*
Multi-Systemic Therapy-Child Abuse
and Neglect (MST-CAN)
Oregon Model, Parent
Management Training
Parent Child Interaction Therapy
(PCIT)*
Peer Support*
Safe Care
Social and Emotional Foundations
of Early Learning (SEFEL)*
The Incredible Years
Triple P
Trauma-Focused Cognitive
Behavioral Therapy (TF-CBT)*
Wraparound*
*Currently available or being implemented in at least 1 jurisdiction in Maryland
Title IV-E Demonstration Waivers
Partnerships & Collaboration
• Key partners include the LDSS, Children’s Cabinet
Agencies, providers, families and youth,
universities and community organizations.
• DHR will connect with and leverage other
initiatives, including
–
–
–
–
–
–
–
Children’s Cabinet EBP Implementation
Upcoming 1915(i) State Plan Amendment
System of Care Grants: MD CARES, Rural CARES, LIFT
Project Launch
C-West & Promise Heights
Thrive@25
Local activities and partnerships
Title IV-E Demonstration Waivers
Timeline & Next Steps
• Winter 2014: Application submitted
• Spring 2014: Negotiation with HHS
• September 30, 2014: Final day for
HHS to approve the application
• Fall 2014: Implementation activities
begin
• September 30, 2019: Final day of
Demonstration Waiver authority