CONTRACT OVERSIGHT DESK REVIEW - Centerforchildwelfare.cbcs.usf.edu

In FY 15/16, ECA P/P received back of the bill funding and in FY17/18, ECA P/P applied for and receivedRisk Pool Funding. In FY18/19, ECA P/P began the fiscal year with a carry forward deficit of 508,998even after receiving risk pool and back of the bill funding in FY17/18. According to the FY17/18 Risk PoolCommittee Report, the primary factors contributing to the need for risk pool funding were an increase inremovals, an increase in case management positions to reduce caseloads, licensed group home rateincreases, and a transition in available diversion services. Recommendations made by the committeeincluded reviewing high cost placements, re-evaluation of alternative ways to reduce caseloads, resolveissues with placement timeframes, re-educate CPIs on the use of the new diversion programs, beginusing conditions for return staffings, analyze administrative costs, evaluate possible “step down“placements, and refresher training for staff on the Practice Model.ECA P/P also applied for and were awarded 2.9 million in risk pool funding for FY 18/19. According tothe Risk Pool Committee Report, the recommendations for the ECA P/P were:1. Continue to execute the recommendations from the FY 2017-2018 Risk Pool Report.2. Place a stronger emphasis on the reduction in the number of children in residential group care,particularly ages 6-12.3. Develop an action plan in conjunction with the sheriff’s offices to improve the utilization ofdiversion services as a safe alternative to removals.4. Until ECA-P/P is able to operate without a deficit, a more appropriate caseload is a ratio of 1:20with a goal of 1:17 long term.5. Consistent with the findings during the most recent on-site monitoring, ECA-P/P should continueto focus on addressing case manager turnover.6. ECA-P/P would benefit by expanding the availability of the Family Reunification Team to all casemanagement organizations.The full Risk Pool Peer Review Committee Report is available here: ECA P/P FY18/19 Risk Pool Report.SECTION 4: PERFORMANCE INDICATORS AND QUALITY ASSURANCE DATAThis section provides a picture of ECA P/P’s performance as captured by data indicators that are used toassess how well ECA P/P is performing on contract measures and within the larger program areas ofsafety, permanency and well-being. The information in the following graphs and tables representsperformance as measured through information entered into the Florida Safe Families Network (FSFN)and performance ratings based on the Department’s CQI case reviews. The performance measuresoutlined in this report are accessible through the Child Welfare Dashboard and include both federal andstate measures used to evaluate the lead agencies on 12 key measures to determine how well they aremeeting the most critical needs of at-risk children and families.Federal regulations require Title IV-E agencies to monitor and conduct periodic evaluations of activitiesconducted under the Title IV-E program to ensure that children in foster care are provided qualityservices that protect the safety and health of such children (sections 471(a)(7) and 471(a) (22) of theSocial Security Act). The Department of Children and Families has developed additional methods toevaluate the quality of the services provided by the lead agency using Rapid Safety Feedback (RSF) andContinuous Quality Improvement (CQI) reviews.FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 20197 P a g e

Rapid Safety Feedback (RSF) assesses open in-home service cases. The RSF Tool focuses onsafety and is used to review active cases that have specified high risk factors.CQI reviews are conducted on a random sample of cases that are both in home and out ofhome. The reviews are conducted by CBC staff and use the same review instrument as the Childand Family Services Review (CFSR).In addition to the state developed quality assurance reviews, section 1123A of the Social Security Actrequires the federal Department of Health and Human Services to periodically review state child andfamily services programs to ensure substantial conformity with the state plan requirements in Titles IV-Band IV-E of the Act. This review is known as the CFSR. After receiving the results of the CFSR review,States must enter a Program Improvement Plan (PIP) to address areas that the Children’s Bureaudetermines require improvement (45 CFR 1355.34 and 1355.35). CFSR reviews are completed by CBC and DCF staff and consist of a case file review, interviewingcase participants, and completing the on-line review instrument. In addition, these casesreceive 2nd level reviews by the Office of Child Welfare and at times, 3rd level reviews by theAdministration for Children and Families to ensure each case was accurately rated.The results of the CFSR are considered baseline performance and the PIP goal is the level ofimprovement needed to avoid financial penalties. Therefore, the PIP goal may be lower than the overallfederal and state expectation of 95%. The Department expects CBC agencies to strive toward 95%performance expectation on all CQI measures with focused activity around the federal PIP goals.The quality ratings used throughout this report are based on the Department’s CQI case reviews,including CQI/CFSR reviews and Rapid Safety Feedback reviews. The CFSR On Site Review Instrumentand Instructions and the Rapid Safety Feedback Case Review Instrument are both available on theCenter for Child Welfare website and provide details on how ratings are determined.CONTRACT AND CBC SCORECARD MEASURESDuring FY 2017/2018, ECA P/P has met or exceeded their established contract target, federal standardsand statewide performance in nine of the 13 measures including: M01: Rate of abuse per 100,000 days in foster careM02: % of children who are not neglected or abused during in-home servicesM03: % of children who are not neglected or abused after receiving servicesM04: % of children under supervision who are seen every 30 daysM06: % of children exiting to a permanent home within 12 months for those in care 12 to 23monthsM09: % of children in out-of-home care who received medical service in the last 12 monthsM10: % of children in out-of-home care who received dental services within the last sevenmonthsFY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 20198 P a g e

M11: % of young adults in foster care at age 18 that have completed or are enrolled insecondary educationAdoption Measure: Number of children with finalized adoptionsThese measures were successfully met in FY 16/17. (See Table 5) M02: % of children who are not neglected or abused during in-home servicesM04: % of children under supervision who are seen every 30 daysM05: % of children exiting to a permanent home within 12 months of entering careM06: % of children exiting to a permanent home within 12 months for those in care 12 to 23monthsM09: % of children in out-of-home care who received medical service in the last 12 monthsM10: % of children in out-of-home care who received dental services within the last sevenmonthsM11: % of young adults in foster care at age 18 that have completed or are enrolled insecondary educationM12: % of sibling groups where all siblings are placed togetherAdoption Measure: Number of children with finalized adoptionsIn the remaining four measures, ECA P/P did not meet the established targets for FY 17/18. Thesemeasures are: M05: % of children exiting to a permanent home within 12 months of entering careM07: % of children who do not re-enter care w/in 12 months of moving to a permanent homeM08: Placement moves per 1,000 days in foster careM12: % of sibling groups where all siblings are placed togetherFY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 20199 P a g e

Performance MeasuresContract Targets Compared to Federal Standards and Statewide PerformanceFY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201910 P a g e

CHILD SAFETYThe figures and tables on the follow pages depict ECA P/P’s performance related to safety in thefollowing areas:1.2.3.4.5.6.Rate of Abuse in Foster CareNo maltreatment after Family Support ServicesNo maltreatment during in-home servicesNo maltreatment after receiving servicesChildren seen every 30 daysQualitative Case ReviewOverall, ECA P/P is performing well or trending positively on both scorecard and quality safety relatedmeasures.RATE OF ABUSE IN FOSTER CARERate of abuse or neglect per day while in foster care (Scorecard Measure M01): The graph belowdepicts the rate at which children are the victims of abuse or neglect while in foster care (per 100,000bed days). This national data indicator measures whether the state child welfare agency ensures thatchildren do not experience abuse or neglect while in the state’s foster care system. It should be notedthat this measure includes both licensed foster care and relative/non-relative placements.ECA P/P’s performance on thismeasure has improved overall in thepast eight quarters, despite a slightdecline in performance in midFY17/18. In seven of the past eightquarters, ECA P/P exceeded theperformance target and in all of thepast eight quarters ECA P/P’sperformance on this measureexceeded the statewideperformance. (See Fig. 2)Additionally, quality reviews showthat ECA P/P is consistently makingconcerted efforts to assess andaddress risk and safety concerns related to children in their own home or while in foster care. (See Table7)FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201911 P a g e

NO MALTREATMENT AFTER FAMILY SUPPORT SERVICESPercent of children not abused or neglected within six months of termination of family supportservices. This graph depicts the percentage of children who did not have a verified maltreatmentduring the report period. This is aFlorida indicator that measures theCBC’s success in enhancing theprotective factors in a family toensure the children remain safe afterfamily support services have ended.Since FY 16/17 ECA P/P’s performancehas improved overall on this measureand in the most recent two reportingquarters, ECA P/P’s performanceexceeded the statewide performance.Rapid Safety Feedback (RSF) reviewsshow that quality visits areconsistently being made between thecase manager and children andbetween the case manager andparents. (See Tables 6 and 7)NO MALTREATMENT DURING IN-HOME SERVICESPercent of children not abused or neglected while receiving in-home services (Scorecard MeasureM02): This graph depicts thepercentage of children who did nothave a verified abuse or neglectmaltreatment while receiving in-homeservices. This indicator measureswhether the CBC was successful inpreventing subsequent maltreatmentof a child while a case is open and theCBC is providing in-home services tothe family.In the past eight quarters, ECA P/P hasexceeded the performance target forthis measure. Further, quality reviewsshow that ECA P/P is consistentlycompleting sufficient familyFY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201912 P a g e

assessments and safety plans which control danger threats and reduce episodes of maltreatment duringin-home services. (See Table 6)NO MALTREATMENT AFTER RECEIVING SERVICESPercent of children with no verified maltreatment within six months of termination of supervision(Scorecard Measure M03): This graph depicts the percent of children who were not the victims ofabuse or neglect in the six monthsimmediately following termination ofsupervision.With the exception of FY16/17 Q4 andFY17/18 Q1, ECA P/P exceeded theperformance target in the past eightquarters.Quality reviews show that ECA P/P casemanagers are promoting long term childsafety by consistently conducting visitswith children that are of sufficientfrequency and quality to ensure childsafety and evaluate progress towardscase plan goals. (See Table 10)CHILDREN SEEN EVERY 30 DAYSChildren under supervision who are seen every thirty days (Scorecard Measure M04): This graphdepicts the rate at which children areseen every 30 days while in foster careor receiving in-home services duringthe report period.ECA P/P has shown strong andconsistent performance in ensuringchildren are seen every 30 days. In thepast eight quarters, ECA P/P exceededboth the performance target andstatewide performance in this measure.Quality reviews further support ECAP/P’s focus on ensuring quality andfrequent visits between case managersand children. (See Table 10)FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201913 P a g e

QA CASE REVIEW DATATables 6 and 7 provide the current performance in items related to child safety that are based onqualitative case reviews. Rapid Safety Feedback (RSF) reviews show that from the period of July 1, 2017through June 30, 2018, ECA P/P casemanagers were frequentlycompleting sufficient assessments,completing quality visits to addressissues pertaining to safety andevaluate progress towards case planoutcomes, and ensuring a sufficientsafety plan is in place to controldanger threats. However, duringFY17/18, performance declined inRSF Items 1.1 and 2.1, with the mostsignificant drop related to thesufficiency of the assessment. (SeeTable 6)Conversely, Florida CQI reviewsshow improvement during FY17/18which shows that ECA P/P has madeconcerted efforts to provideservices to families geared toward preventing children’s entry into foster care or re-entry afterreunification. With the exception of CQI Item 3 (concerted efforts to assess and address risk and safetyconcerns related to children in their own homes or while in foster care), ECA P/P’s FY17/18 performanceexceeds the statewide performance on safety related quality review items. (See Table 7)FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201914 P a g e

PERMANENCYThe graphs and tables on the follow pages depict ECA P/P’s performance related to permanency in thefollowing areas:1.2.3.4.5.6.7.Permanency in 12 monthsPermanency in 12-23 monthsPermanency after 24 monthsPlacement stabilityPercent not re-entering careSiblings placed togetherQualitative case review resultsOverall, several permanency related measures represent areas where focus and attention would yieldimproved performance. Achieving permanency within 12 months, ensuring children do not re-entercare and reducing placement moves and increasing shared sibling placements are areas needing focusand attention.PERMANENCY IN 12 MONTHSPercent of children exiting foster care to a permanent home within 12 months of entering care(Scorecard Measure M05): This graph depicts the percentage of children who entered foster careduring the report period where thechild achieved permanency within 12months of entering foster care.ECA P/P’s performance in thismeasure trended negatively overall inthe past eight quarters, however inthe first quarter of FY18/19, ECA P/Pexceeded both the performancetarget and the statewideperformance.Quality reviews indicate that thefrequency and quality of case workervisits with mothers and fathers werefrequently insufficient to ensuresafety, permanency and well-being ofthe children and promote achievement of case goals. (See Table 10)FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201915 P a g e

PERMANENCY IN 12 – 23 MONTHSPercent of children exiting foster care to a permanent home in 12 months for children in foster care12 to 23 months (Scorecard Measure M06): This graph provides the percentage of children in fostercare whose length of stay is between12 and 23 months as of the beginningof the report period who achievedpermanency within 12 months of thebeginning of the report period.ECA P/P exceeded the performancetarget in all of the past eight quarters,however performance is trendingnegatively and is below the statewideperformance.As mentioned above, quality reviewsindicate a need to strengthen thequality and frequency of visitsbetween case workers and parents topromote case goal attainment. (SeeTable 10)PERMANENCY AFTER 24 MONTHSPercent of children in foster care for 24 or more months exiting to a permanent home: This graphdepicts the percentage of childrenwho were in foster care for 24 ormore months and achievedpermanency upon exiting foster care.ECA P/P has shown an overall positivetrend in performance on this measureshowing a focus on achievingpermanency for children who havebeen in care more than 24 months.ECA P/P has exceeded the statewideperformance in all the past fivemeasured quarters.FY 18/19 Desk ReviewEckerd Community Alternatives – Pasco/Pinellas, Contract QJ511January, 201916 P a g e

PERCENT NOT RE-ENTERING INTO CAREPercent of children who do not re-enter foster care within 12 months of moving to a permanenthome (Scorecard Measure M07): This graph depicts the percentage of exits from foster care topermanency for a cohort of childrenwho entered foster care during thereport period and exited within 12months of entering and subsequentlydo not re-enter foster care within 12months of their permanency date.ECA P/P has struggled to meet theperformance target on this measure,meeting it only once in the past eightquarters. Also, quality reviewsindicate that ECA P/P did not meetthe FY17/18 State or Federalperformance expectation in makingconcerted efforts to provide servicesthat prevent children’s reentry intocare or after reunification. (See Table9)PLACEMENT STABILITYPlacement moves per one-thousand days in foster care (Scorecard Measure M08): This graph depictsthe rate at which children changeplacements while in foster careduring the report period.ECA P/P’s performance on thismeasure has trended negatively inthe past several quarters and has notmet the performance target since FY16/17 Q2. However, of the qualityreviews conducted in FY 17/18,scoring indicates that placementmoves made by ECA P/P were in thebest interest of the child(ren) and

The desk review period was for the period of July 1, 2017 - September 30, 2017. The review identified four areas with four findings and eight areas of observation. ECA P/P corrected the errors. For further details, please see the complete fiscal report - 2017-18 CBC Desk Review Financial