Testimony Before the New York State Assembly Standing Committee on Children and Families, Subcommittee on Foster Care

November 12, 2008

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Good Morning. My name is Jane Golden and I am the Director of the Foster Care Division at The Children’s Aid Society. On behalf of our CEO, C. Warren Moses, and our Board of Trustees, I want to thank the Assembly Committee on Children and Families for holding these hearings. The healthy development of disadvantaged children has been central to our mission for 156 years. Children’s Aid provides services to over 150,000 children and families in New York City each year through neighborhood community centers, camps, community school programs, medical and mental health clinics, foster care, adoption and preventive services, day care, Head Start and early childhood programs, housing for homeless families, juvenile justice, and legal advocacy programs.

The Children’s Aid Society is one of 33 agencies that contract with the New York City Administration for Children’s Services (ACS) to provide foster care services to children and families in New York City. We are currently providing foster care and direct primary medical care to 635 foster children – and many of these are medically and developmentally challenged – 164 are in our special medical foster care program, and 67 are in our therapeutic foster care program. We will address two areas with regard to the topics that have been selected for these hearings: 1) how is ACS ensuring that high quality services are being delivered by contracted agencies under the Improved Outcomes for Children Model and 2) how does the local social service district, (ACS) provide appropriate oversight of foster care services?

Ensuring High Quality Foster Care Services Under IOC
The Children’s Aid Society is one of nine foster care programs that ACS selected to participate in the Improved Outcomes for Children (IOC) initiative. We are pleased to be a part of the Phase 1 IOC Foster Care initiative, which represents a dramatic shift in child welfare service delivery. There are two key elements of IOC that are new: the first is the new model of Family Team Conferences, and the second is the delegation of case management authority from ACS to the contract agencies. Family Team Conferences present an opportunity for all the stakeholders involved in a foster care case to come together to assess the status of the case, and to talk about what is needed to move the children toward permanency - whether through adoption or reunification. The stakeholders that attend Family Team Conferences include birth parents and other family members, foster parents, youth, the agency caseworker and supervisor, other service providers, and members of the community who step forward to support the family. Family Team Conferences are held frequently – at minimum on a quarterly basis. This is a major shift in practice which has implications for funding and staffing – since the prior standard was a minimum of two annual Family Service Plan Meetings. A Family Team Conference is also held each time there is a critical incident on a case; such as when and if a child is to be moved from one foster home to another; if the goal of the case is to be changed from return to parent to adoption; or if a decision is made to discharge a child to their parent.

ACS is represented at the Family Team Conference by staff that serve as Conference Facilitators and/or Permanency Specialists. These ACS staff are responsible for actively listening to all the stakeholders at the conference, and for asking questions to assure that safety and risk are being assessed, and that there is sufficient progress toward permanency. The goal of the Family Team Conference is to reach consensus among all the parties. If consensus cannot be reached, the voluntary agency is the final decision maker. However, the ACS Facilitator or Permanency Specialist has the right to object to any decision for safety reasons. An ACS objection for safety reasons automatically raises the decision to a higher level of decision-making authority, both at the agency and at ACS.

The second key element of IOC is the delegation of case management authority from ACS to the contract agencies. After a year of practice in implementing the IOC model, it is clear that the delegation of case management authority has improved our practice. Before IOC, there were serious deficiencies in the child welfare system’s case management practices, which often ended up being just a paper review, done by people far removed from the daily realities of the children and families served. The case management oversight done by ACS often duplicated good work already being done by the voluntary case planning agency - and it took too long. Many have agreed that this process was cumbersome and generally unhelpful.

One of the purposes of today’s hearing is to examine the question of ACS oversight of the voluntary agencies under IOC. We understand and appreciate the need to ensure sufficient ACS oversight when case management authority is delegated to the contract agencies. Our experience with the IOC model so far has demonstrated that IOC has the potential to build in a new level of ACS oversight that in the long run will be more effective than the traditional practice of keeping case management decision making solely with ACS. Under IOC, ACS oversight is twofold - ACS maintains an active role in the regular and frequent Family Team Conferences, and ACS applies an intensive level of monitoring and evaluation of contract agency practice through both the ACS Offices of Research and Evaluation and Agency Program Assistance.

How Does ACS Provide Appropriate Oversight of Foster Care Services?
The ACS Offices of Research and Evaluation and Agency Program Assistance engage in continuous and ongoing monitoring of contracted agency practice through regular case reviews, and through numerous other quality improvement initiatives that keep agencies engaged in a seemingly endless discussion with ACS about agency performance. The following is a summary of the many ways that ACS monitors agency practice.

Provider Agency Measurement System (PAMS): One way that ACS monitors agency practice is through the Provider Agency Measurement System. PAMS is an annual case record review of 50 cases from each foster care program. ACS staff read the electronic record for each child and then they come out and visit each agency - to read the child’s entire paper record including the health, dental and mental health record. ACS evaluates the case record against a 68-page instrument that assesses every aspect of agency practice, including the number and quality of foster home contacts, family and sibling visits, and contacts with birth parents. The PAMS review process also involves in-home interviews with 25 foster parents. The questionnaire used for the foster home interviews includes an assessment of both the physical space of the home and of the quality of the relationship between the foster parents and the children they are caring for.

Outcome Measures: On an annual basis, ACS also evaluates agency data to monitor practice outcomes such as: 1) the time it takes agencies to provide permanency for children in foster care (either through reunification with their families, or through adoption); 2) the number of children that go AWOL (Absent Without Leave) from foster care; 3) the number of times that children move from one foster home to another; and 4) step-ups of children from family based foster care to residential foster care.

ACS Office of Special Investigations: The ACS Office of Special Investigations maintains responsibility for investigating allegations of abuse or maltreatment of children in foster care. Every report of abuse or neglect in a New York City foster home made to the State Child Abuse Hotline is sent to the Office of Special Investigations. When ACS completes the investigation and makes its determination, it also makes recommendations about services to be provided to the child in order to improve child well-being. The voluntary agencies are obligated to respond to the OSI report within 15 days.

Compliance Measures: Each year ACS also tracks and grades agency performance on numerous compliance measures including: 1) the timeliness of Family Assessment and Service Plans that are sent to the state; 2) the timeliness of initial kinship home studies; 3) the timeliness of foster home recertifications; 4) the sufficiency and timeliness of foster parent training; 5) the timeliness of Permanency Hearing reports; and 6) the timeliness of responses to OSI investigations.

Preparing Youth for Adulthood: Each year ACS also evaluates agency practice working with adolescents in the foster care system. We are evaluated on the services that we provide to help youth develop the life skills they will need to function as adults. ACS monitoring staff review the quality and quantity of life skills workshops provided to youth, they review the written information we are required to send twice a year to foster parents and to the teens themselves on the availability of family planning services, and they evaluate the sufficiency of educational or vocational support that we provide to teens in foster care.

All of the above criteria are organized and released to agencies each year in the form of a Scorecard. The Scorecard ratings are then scaled as Excellent, Very Good, Good, Satisfactory or Needs Improvement - creating public pressure to do well. In addition, the rate we are paid for providing Family Foster Care Services is dependent on our ACS evaluation in that we are paid a performance based rate. This process of monitoring and evaluation, along with the active role that ACS takes in frequent and regular Family Team Conferences, provides sufficient oversight of the New York City Foster Care system.

Recommendations and Note of Caution Going Forward - IOC
While our agency supports the innovations which the Improved Outcomes for Children model promises for the system as a whole, we do so with a strong note of caution – the program will not work if it is underfunded. Unless voluntary agencies are provided with sufficient funds to do the innovative work required by IOC, then IOC will not be sustainable. In order to do IOC well, foster care caseloads must be smaller. In order to work meaningfully with all the families on their caseload, and to be able to attend all the additional Family Team Conferences that IOC requires, caseworkers must not have more than 10-15 children on their caseload. Under IOC, funding must also be available to hire scheduling staff. Quarterly Family Team Conferences attended by numerous stakeholders must be scheduled and then often need to be rescheduled – this in itself is a full time job.
We urge this Committee to ensure that foster care services are fully funded at the level necessary to ensure that IOC can be taken to scale – so that New York State will be able to assure that high quality services are provided to all of the families and children in our care. We look forward to hearing about the recommendations you make as a result of these hearings and to the changes in policy and practice that you help initiate in the coming months. Thank you for extending an invitation to the foster care provider community for input.