Academic journal article Child Welfare

Performance-Based Contracting in Residential Care and Treatment: Driving Policy and Practice Change through Public-Private Partnership in Illinois

Academic journal article Child Welfare

Performance-Based Contracting in Residential Care and Treatment: Driving Policy and Practice Change through Public-Private Partnership in Illinois

Article excerpt

The National Quality Improvement Center on the Privatization of Child Welfare Services selected Illinois as a demonstration site in 2007 to evaluate performance-based contracting in residential treatment services. This article discusses the first two years of project implementation including developing residential treatment performance indicators, adjusting those indicators for risk at the provider level, and setting agency-specific benchmarks, as well as the project's fiscal foundation and related systemic improvements to support policy and practice change resulting from this initiative.

Illinois has an established history of using performance-based contracts to drive system change. Foster care case management contracts have been used since 1997 to incentivize permanency outcomes and are largely credited with reducing the number of children in out-of-home care from more than 51,331 at the contracts' inception to 16,000 presently. Notwithstanding these gains, there was no formal documentation or empirical research done on implementing performance-based contracting for foster care case management. Retrospectively, McEwen (2006) cites three criteria that contributed to successful implementation: (1) private provider input into decision making; (2) reliable and verifiable data on which to base performance; and (3) the state's commitment to reinvest cost savings back into the child welfare system.

Despite Illinois' apparent success in moving children to permanency with performance-based contracting, reviewers in the first round of the Child and Family Service Review were concerned with Illinois' lack of consistency with efforts to ensure placement stability (U.S. Department of Health and Human Services, 2003). Research demonstrates that behavior problems, prior institutionalization, and runaway incidents increase the likelihood of subsequent placement instability (Zinn, DeCoursey, Goerge, &. Courtney, 2006). In Illinois, placement changes within the first year of entry to care have been gradually increasing since the early 1990s.

Children and families involved in the child welfare system today present with more diverse and difficult service needs than previous populations, with a rising need for mental health placements designed to treat more severe clients (McEwen, 2006). Residential care caseloads have changed over time to include more youth experiencing multiple placement failures, longer stays in foster care, and the lack of a permanent home before entering residential care (Budde, Mayer, Zinn, Lippold, Avrushin, Bromberg, Goerge, Courtney, èc Dworsky, 2004). Children leaving residential care are less likely to remain away, 51% of youth discharged from their first residential placement to a less restrictive setting during 1995-2003 were eventually returned to higher levels of care during the same timeframe (Budde et al., 2004). Recent studies of youth being served in residential treatment centers have found significant increases over the past 10 years in the proportion of youth with mental health and juvenile justice histories (Dale, Baker, Anastasio, èc Purcell, 2007). Youth placed in residential treatment centers are more likely to have histories of substance abuse, criminal activity, sexual offending, suicidal ideation, prior psychiatric hospitalizations, and psychotropic medication use when compared with youth in therapeutic foster care, even after controlling for age and gender (Baker, Kurland, Curtis, Alexander, èc Papa-Lentini, 2007).

In Illinois, administrative data indicates the average number of adverse events, such as runaway, psychiatric hospitalization, and juvenile detention prior to admission to residential care has been steadily increasing (Morris èc Bloom-Ellis, 2008). Administrators report the current population is underserved, requiring additional resource development to address behavioral health challenges and concomitant medical complications, chronic mental illness, pregnant and parenting youth with behavioral health challenges, and youth with dual diagnoses for mental illness and developmental disabilities (Illinois Department of Children and Family Services [DCFS], 2009). …

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