IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA: one family, one plan, one case manager. casey family programs. one family, one plan

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1 casey family programs December 2012 casey.org

2 Michael Nutter mayor of Philadelphia We have a chance as public servants and local government to change, to transform or save people s lives. For me in public service, it just doesn t get any better than that.

3 Table of Contents The Smith Family Story... 1 Introduction... 1 Crisis and the Origins of Cultural Change... 1 The Promise: Transforming Child Welfare Practice in Philadelphia... 1 Getting to IOC... 1 Adding the Details to Make It Work... 1 The Power of the Union... 1 The IOC Model: New Roles and a Focus on the Community... 1 Tracking Progress: Data-Driven Decision Making... 1 Support From the State... 1 Financing IOC and a Waiver From the Federal Government... 1 A Closer Look at Congregate Care... 1 The Anderson Family Story... 1 Family Team Conferences: The Heart of IOC... 1 Strengthening Families: Parents Helping Parents... 1 Role of the Courts... 1 The First Two CUAs and their Community-Based Philosophy... 1 Rolling It Out: Technical Assistance and Training... 1 Lessons Learned... 1 Challenges and Concerns... 1 A Family Story With a Promise for the Future... 1 Conclusion Which Is Really a New Beginning... 1

4 Introduction I think too many hands in a pot makes things confusing for our families. And I think we do a disservice to our families when we are reinventing the wheel and families have to explain their situation to various people over and over again. Shontay Taylor, adoption worker, DHS The Smith family is unique, as are all families. Unfortunately, the missed opportunities to help this struggling mother are not at all unique. In Philadelphia, and in many child welfare systems across the country, it is commonplace for families to be involved with multiple systems and numerous workers child welfare, juvenile justice, special education, public health, substance abuse, mental health, domestic violence all at the same time. Parents get multiple, sometimes conflicting, instructions from multiple providers; often they do not know who is in charge. Workers do not talk regularly or coordinate services. If children have been removed from the home, court requirements for reunification sometimes add to the complications. These systems are failing the children and families who need help the most. Beginning in 2006, leaders in Philadelphia cast a critical eye on DHS and found a dysfunctional system in need of major reform. With support from Casey Family Programs, a national operating foundation that focuses on safe reduction of foster care placements, Philadelphia launched a research effort to study child welfare reform efforts across the country. By early 2011, DHS had a new direction and a tentative new model. It reached out to its partners on the ground in Philadelphia to help it plan the details. Together, they are reinventing child welfare in Philadelphia. DHS calls its package of reforms Improving Outcomes for Children, IOC for short. The name embraces the goal, an obvious one at first glance. After all, who is against improving outcomes for children? But in striving to reach that goal, leaders are moving far beyond restructuring or shaking up their organizational chart. IOC represents a profound transformation in one of the largest child welfare agencies in the country. It is a severe disruption of the status quo, says Mike Vogel, a fan of IOC and head of Turning Points for Children, a community provider in Philadelphia. IOC is also a story of transformation among community providers and other partners that have long worked with DHS, too often without clear lines of authority. In the past, community providers implemented decisions made by DHS. In the future, community providers will be decision makers, along with the families they serve. This report chronicles the history of Improving Outcomes for Children. Why was reform of such scale necessary? What are the core components of IOC, and who are the people at the heart of the reform? Which community organizations are stepping up to the challenge to build a new kind of partnership with DHS? Finally, what have the leaders in Philadelphia and the state learned so far about ramping up large-scale change in their child welfare practice? Glossary Every child welfare agency has its own language, replete with abbreviations that seem to outsiders like alphabet soup. Key terms and phrases that are used in this report include: DHS: Department of Human Services, the child welfare agency in Philadelphia. IOC: Improving Outcomes for Children, the package of reforms that is transforming practice. CUA: Community umbrella agency, the private providers partnering with DHS to change child welfare practice in Philadelphia. OCYF: The state Office of Children, Youth and Families. NET: NorthEast Treatment Centers, the first CUA to come onboard. APM: Asociación Puertorriqueños en Marcha, the second CUA to come onboard. IHPS: In Home Protective Services, services for families and children in their own homes when children are not removed. QSR: Quality Service Review, a methodology that assesses the effectiveness of service delivery in randomly selected cases and helps leaders make recommendations for system reform. Crisis and the Origins of Cultiral Change The death of a child is always tragic. When a child dies from intentional abuse, the tragedy is an outrage against humanity. When a child dies while under the protective supervision of the government, outrage should shake the very foundation of our community. Sadly, that outrage is too often buried in governmental bureaucracy. Protecting Philadelphia s Children: The Call to Action* The path to child welfare reform in Philadelphia began with a tragedy. Danieal Kelly, a 14-yearold with cerebral palsy, died of starvation and infection in her own bed in August She had been left alone, with large, untreated bedsores, to lie in her own waste. She was not taken to a doctor. She was not enrolled in school, although she was capable of educational success and had done well in a special-education class before moving to Philadelphia. When she died, Danieal weighed 42 pounds. She was 3 feet, 6 inches tall. 8 casey family programs casey.org casey.org casey family programs 9

5 The dysfunction at DHS goes deep, down to the bone, the grand jury said. It called on the city of Philadelphia and DHS to institute large-scale reform to improve accountability and transparency and, in essence, to change the culture at DHS and sharpen its focus on its core mission, which is to protect children. The Kelly family was reported to DHS numerous times and accepted for services in the fall of But the private-provider staff assigned to the case rarely visited the home, and when they did, they did not see Danieal. In 2008, a grand jury recommended criminal charges, not only against the mother, who was most directly responsible for the girl s death, but against staff from the provider agency and DHS as well. The dysfunction at DHS goes deep, down to the bone, the grand jury said. It called on the city of Philadelphia and DHS to institute large-scale reform to improve accountability and transparency and, in essence, to change the culture at DHS and sharpen its focus on its core mission, which is to protect children. The grand jury was not alone in its scathing indictment of the system, nor was Danieal s death the first crisis to result in an urgent call to action. Frank Cervone, executive director of the Support Center for Child Advocates, was part of a 1990 federal class-action lawsuit that found DHS had lost children in the system; workers did not know where they were. As part of a settlement of that lawsuit, DHS added data and tracking systems, but they were not adequate or were used inefficiently. Internal dysfunction at DHS led to several high-profile tragedies, despite the fact that most social workers at DHS, as well as their counterparts in community agencies, care deeply about the children and families they serve. Workers believed then, as they still do, in providing support to ensure child safety. These workers were employed by a system that not only failed the children and families, but also failed the workers. The Philadelphia Child Welfare Review Panel In 2006, soon after Danieal Kelly s death, Philadelphia Mayor John Street bore witness to the pain and began the move from outrage to action. Pennsylvania has a county-administered child welfare system, so the mayor was in a position to make a difference. He changed the leadership at DHS. He appointed a highlevel panel of experts and charged them with recommending reforms focused on everything about DHS, from its mission to its policies and practices to accountability. The panel made 37 recommendations for both DHS and the private providers that are its partners in the community. The recommendations were measurable; the panel intended for DHS to be held accountable for improvement. The recommendations, the panel said, were imperative to improving the safety of children in Philadelphia (panel s italics). Several of the recommendations spoke directly to the large-scale reforms that are embedded in IOC. Street was determined that this report would not get a splash of publicity and then sit on a shelf until the next crisis. DHS embraced the reality of its problems and set out to fix them. Little did the agency know at the time how big a fix it would develop. Recommendations of the Philadelphia Child Welfare Review Panel The panel listed its recommendations with a time frame, those that must be addressed within a year and those that would take longer to implement. Before the panel s report was even released, DHS began tackling the problems. The most immediate accomplishment was development of a safety assessment tool for use with intake and investigation and throughout the life of a case. The panel s recommendations, some already implemented and some reflected in IOC, included: Development of a new mission statement and values centered on child safety. Implementation of a safety model of practice. More frequent visits by DHS with all children and families. Development of a comprehensive internal strategy to monitor DHS performance. Improved oversight of contracted provider agencies. Clarification of roles and responsibilities between DHS workers and supervisors and their counterparts at private providers. Alignment of prevention programs and in-home service programs with the mission and values of DHS and with child safety. Expansion of family team decision-making meetings. Development of a process for ongoing community oversight of improvements at DHS. (This recommendation resulted in the formation of a Community Oversight Board appointed by the mayor; this board continues to meet on a regular basis.) A Portrait of Child Welfare in Philadelphia With a population of 1.5 million, Philadelphia is the fifth-largest city in the U.S. But among the 10 largest cities, it has the highest poverty rate, 25 percent, according to a Pew Charitable Trusts report titled Philadelphia 2011: The State of the City. In some neighborhoods, the poverty rate rises to 56 percent. Nearly half of Philadelphia s population, 48 percent, earns less than $35,000 a year. Infant mortality, at more than 10 deaths per 1,000 births, is considerably higher than in other cities of comparable size and is well above the national average of 6.8 per 1,000. This is the context for child welfare in Philadelphia, where one in three families is involved with the child welfare system at some point in their children s lives. As Deputy Mayor Donald Schwarz said, In a city with poverty rates like ours, it s a substantial challenge to families if they have a kid who has physical or behavioral health challenges. It s a real hard thing not to need the support of the child welfare system. DHS has reduced the numbers of children in care substantially since But the agency still struggles with challenges, such as the high proportion of older youth in out-of-home care and a high rate of children in congregate care. DHS hopes that IOC will help it address those problems, while maintaining the safety of children and families in their own neighborhoods. 10 casey family programs casey.org casey.org casey family programs 11

6 Placement Population in Philadelphia, ,467 3,267 5,899 3,046 6,089 2,989 5,742 2,677 Children in Placement 5,289 2,527 4,679 2,259 4,140 2, Source: DHS Division of Performance Management and Accountability. Youth in placement are ages The Promise: Transforming Child Welfare Practice in Philadelphia How many chances does a child welfare agency have to remake an entire system with full support of the city and state government? Brian Clapier, IOC implementation officer, DHS deputy commissioner for performance management and accountability YOUTH in Placement DHS worked through the recommendations of the Child Welfare Review Panel one by one. By the time leaders began detailed planning for IOC, most of the panel s recommendations had been addressed. A big exception was clarification of case management roles between DHS and community providers. Current child welfare practice at DHS a dual case-management system means families have at minimum two main caseworkers, one from DHS and another from a private provider agency under contract with DHS to deliver services. For a family with numerous children, the workers multiply. Lack of communication between DHS and the provider agencies abounds, often with 4,041 1,909 negative consequences on the timing and delivery of services. With IOC, says Philadelphia s current mayor, Michael Nutter, We re going to cut out all this finger-pointing. No more, I thought you had it. No, I thought you had it. Well, didn t you call? I thought you called. DHS Commissioner Anne Marie Ambrose, who arrived in 2008 with a mandate for change, likes to say, When everybody s responsible, nobody s responsible. This one sentence became the mantra at DHS during the planning period for IOC. Dual case management was not working, not for families, for children and not for the line staff at DHS or the providers who dedicate their careers to protecting children. Under IOC, DHS will implement a single case-management system, in which DHS transfers primary responsibility for a family s case to a lead agency in the community where that family lives. These lead agencies are called community umbrella agencies (CUAs). A case manager from the CUA becomes the family s main worker, team leader and coordinator of all services throughout the life of the case. Those services will be delivered in the community whenever possible, eliminating the need for parents without cars to spend hours on public transportation. If children must be removed from their home, they will be placed in the community. DHS staff will facilitate family team decision-making meetings, bringing parents and their chosen support network together with their workers to make decisions about the family s service plan. DHS will also expand its oversight and monitoring roles. With IOC, DHS intends to achieve four outcomes: More children and youth will be maintained safely in their own homes and in their own communities while their families get services. More children and youth will achieve timely reunification or other permanence. Use of congregate care will decrease. Child, youth and family functioning will improve. IOC in Philadelphia is more than an initiative. Some at DHS don t like to call it an initiative at all. Anyone who has logged a few years in child welfare knows that initiatives come and they go. DHS intends for this effort to last. Kimberly Ali, operations director for DHS, likes to call it a movement. Nutter wants to institutionalize IOC so it becomes the new standard operating procedure for DHS and for the city. Implementing change as big as this is risky, of course, and the leaders in Philadelphia including the mayor, the courts, DHS and the providers are under no illusion that the path will be easy. It will affect the lives of all families in the system, not to mention the jobs of those who provide services, both at DHS and in the community. It was clear that huge, transformational change was necessary, Nutter says. We re willing to take on the fight when the fight is worth fighting for. And this one is. 12 casey family programs casey.org casey.org casey family programs 13

7 Getting to IOC IOC is righting the system. We need to make sure our hot line and intake and investigation is bulked up and strengthened. We need to make sure we re accepting cases for services that absolutely need to be accepted. We need to better monitor the system, and in order to do that, we need to let go of case management. Samuel Harrison, human services program administrator, DHS A shift in culture as large as IOC could come only from an in-depth planning process. In this case, the road to reform was paved with intense discussions and debate that began with DHS and city leaders and spread to include more than 150 outside stakeholders. The process took root in 2008 with appointment of a new DHS commissioner. After a 19-month, nationwide search reviewing more than 100 candidates, Nutter hired Ambrose. Schwarz, the deputy mayor, was on the search committee and recalls that Ambrose s interview cohered beautifully with the recommendations of the Child Welfare Review Panel. Clearly, she had thought about it, and she had a really fresh perspective, he says. Moreover, she had worked at DHS in the past and was, at the time she was appointed, the director of Child Welfare and Juvenile Justice Services at the state Department of Public Welfare. She knew the politics of the state and the city, and, of course, she knew the issues. This matters, because in Pennsylvania s state-run, county-administered child welfare system, close coordination between DHS and the state is essential. I did not want this job at first, Ambrose says now. I knew the history of the agency. I knew the good and the bad, the wonderful and the sometimes ugly history of this agency. But she was up to the challenge and she knew that this opportunity could make a difference in the lives of a lot of children and families. Ambrose began work in June 2008, just one month before the grand jury released its report on Danieal Kelly s death. When you read the grand jury report, Ambrose says, it sort of hits you in the gut. I think it s fair to say we were a national disgrace. The report motivated her to push for large-scale change. Facing down skeptics, Ambrose held up a vision that DHS would be a, if not the, leading child welfare agency in the country. Building Blocks of Reform: Using Data to Drive Decisions One of the first things Ambrose did was to establish a new division, Performance Management and Accountability (PMA), to collect and organize data on outcomes for children and families so that the department could use lessons from those data to increase accountability to the families it serves. Susan Kinnevy, former DHS deputy commissioner and currently director of special projects, came onboard in 2009 to oversee PMA. She found multiple databases in various departments across the agency, and most did not speak to the others. Kinnevy and her colleagues addressed that issue and then layered the data within substantive or clinical information, so the quantitative data would have a qualitative context. It was all to improve practice, she says. DHS introduced ChildStat and Quality Service Reviews (QSR), two methodologies for analyzing individual cases in depth and looking at trends over time. Ambrose herself conducted a QSR that put a spotlight on the disconnect among DHS, a provider agency and a family. She reviewed the case of a child in foster care, one of three unrelated children in a foster home. Six workers were in and out of that home. The foster mother did not even know the name of the DHS worker for this child. As far as the foster mother could tell, the DHS worker was doing the same job as the worker from the private provider. The fact that so many strangers were coming into this home really hit home for Ambrose. Not just one or two workers, she says, but six. Are we crazy? What could be more intrusive than something like that? And this foster child was doing fine and the house was fine. Ambrose adds, If our work is all about kids and families, we couldn t have set up a more confusing and inefficient and crazy system to try to help them do the right thing. After that QSR, Ambrose says, planning for IOC kicked into high gear. Learning From Other States and Jurisdictions DHS knew that other large child welfare jurisdictions had taken on major reform efforts, and Ambrose did not want to reinvent the wheel. Casey Family Programs was on the scene in Philadelphia before Ambrose came onboard, working with DHS leaders to implement various reforms. When Ambrose arrived in 2008, she welcomed and expanded this relationship with Casey leaders, who had firsthand knowledge of reform initiatives across the country. Ambrose and a team of stakeholders from inside and outside the agency hit the road to find the best practices in the field. Casey helped fund these visits to New York City, Florida and Illinois, and also supported peer technical-assistance exchanges in which leaders from other systems came to Philadelphia. Each site was different from Philadelphia, with different assets, problems and lessons. But each offered some key ingredient that found its way into the Philadelphia IOC package. Early visits to New York City were critical turning points. DHS looked at New York s transfer of case management to providers in the community. And Philadelphia leaders liked New York s emphasis on family team decision-making meetings held at key points during the life of a case, in which families involve their own support systems and help develop their own service plans. From Florida, DHS took notice of lead agencies based in the community and focused on work with families and children in the neighborhoods where families live. DHS added conference calls and Internet searches to its research list and invited leaders from other systems to visit Philadelphia and share their experiences around implementing major Casey Family Programs was on the scene in Philadelphia before Ambrose came onboard, working with DHS leaders to implement various reforms. 14 casey family programs casey.org casey.org casey family programs 15

8 reforms. DHS learned from Milwaukee the importance of giving lead agencies enough money to do the work. From KVC, a lead agency in Kansas, it learned a host of lessons, including keeping the vision and values front and center at all times and analyzing data on a daily basis. DHS looked to Illinois for a community-based initiative called Strengthening Families, an approach that helps families improve parental resilience, build social connections and access concrete services in times of need. A New Model Emerges Ambrose led her internal DHS leadership in ongoing discussions of a vision that would transfer case management to community providers. They asked themselves: Were there enough private providers in Philadelphia with the right stuff that, with the right training, could take over case management responsibilities? There was some understandable skepticism at first. Paul Bottalla, director of policy and planning at DHS, recalls a retreat of DHS leadership in which they outlined the key components of IOC and tried to build consensus around whether to move forward or not. The question was whether providers would become single case managers. On my Post-it, Bottalla says, I drew a little fence, and I put myself sitting on the fence. I was saying, I m not real sure about how this is going to work, but I m not certain as to why we can t do it. He says now, I ve come a long way from that retreat. The vision was gaining traction. IOC was ready for specifics. Adding thr Details to Make it Work There are a hundred ways to address the Child Welfare Review Panel s recommendation to streamline the roles between foster care agencies and DHS. IOC is a very dramatic way to do it. There is tremendous promise in the entire restructuring, but it is all in the details. Katherine Gomez, managing attorney, Family Advocacy Unit, Community Legal Services The vision and concept were on the table. Single case management in the community was the goal. The next step was to get a map. Ambrose and her leadership team moved quickly, appointing a steering committee and a variety of work groups to define every aspect of IOC. The steering committee included the social workers and supervisors union, individual providers and the association of providers, advocates, community leaders, academics, the mayor s office, the state and other critical stakeholders who work with children and families in Philadelphia. Ambrose herself met one-on-one with key leaders in the city, explaining the vision and where they hoped to take it. The steering committee was launched in December Wanda Mial, a consultant supported by Casey Family Programs, came onboard as project manager and facilitator and worked with Samuel Harrison of DHS, who served as the internal project manager. The pace was intense. It was like a campaign, Mial recalls, describing the rapid evolution of the work. The intensity was by design. Child welfare systems across the country have a reputation for starting reforms and not always delivering on the details. Ambrose intended to deliver. And she did not want to waste time. Six Work Groups Add Depth The steering committee identified six interlocking work groups to define the work. Each would be co-chaired by a DHS staff person and an outside stakeholder. In all, around 150 different community stakeholders were engaged over the course of a year. Work group members had permission, even a mandate, to hold deep and lively debates. They knew a lot was at stake, and all wanted this effort to succeed. It took a lot of trust. The work groups, created to cover all aspects of IOC, were: Practice Model Community and Systems Engagement Data and Performance Management Policy and Legislation Financing and Contracts Staff Development and Capacity Building The first three work groups began meeting in April 2011; the others got under way in June of that year. In all the meetings, facilitators made sure everyone s voice was heard, but also kept the focus on the goals of IOC. Harrison pointed out that work group members are folks at the top of their field, and to get them on the same page is a tremendous challenge. If you can keep them focused on the purpose of what this is all about, they can put the egos and the personal stuff aside and work more collaboratively. Ali, the DHS operations director, and Raheemah Shamsid-Deen from the state Office of Children, Youth and Families (OCYF) co-chaired the Practice Model work group, a team of 30 vocal, engaged stakeholders. Ali called the process grueling, adding, There was never a dull moment. Shamsid-Deen agreed. Meetings were so lively and full of healthy debate, she recalls, that some days we walked out with headaches. Their goal was to air the debates and differences of opinion early on, and they did just that. They knew that sweeping disagreements under the rug for the sake of a shallow consensus would do no one a favor in the long run. The end product was a safety practice model that put family team conferencing front and center. Teaming meetings will be held at key points throughout every case. DHS will retain responsibility for the hot line, investigations and intake, and will participate with the CUA in the initial safety plan, but at that point will hand over the case to the CUA. (See section on family team conferencing.) 16 casey family programs casey.org casey.org casey family programs 17

9 Role of the Provider Community in the Planning Process Except for DHS itself, no other organizations will be more affected by IOC than private providers. In the current dual case-management system, DHS partners with hundreds of providers in the community. With IOC, it will focus on 10 community umbrella agencies, with 10 major contracts. The CUAs will subcontract with other providers for services the CUA does not provide. Provider representatives sat on all the work groups. It was not always easy. Margaret Zukoski, associate director of the Pennsylvania Council of Children, Youth and Family Services (PCCYFS), a consortium of provider agencies, is a member of the IOC steering committee and participated in work groups as well. Everyone agreed that there are too many people going into a family s home, Zukoski says in discussing the CUAs new roles, but you still need to have other professionals in the community involved with oversight and direct care of children. Zukoski says PCCYFS members support getting more services directly to the community, but when it comes to the methodology for doing that, she says, there is a wide range of opinion among its membership. The work groups aired those opinions. The consensus they reached in the end was all the more valuable because of the presence of private providers. Parent and Child Advocates in the Planning Process In developing the practice model, advocates who stressed the importance of child safety sometimes sparred with those whose primary goal was family reunification. These positions are not mutually exclusive, of course, and all agree that safety should be at the center of all decision making. That said, the practice model got into the weeds on this issue. Ali remembers a very tough conversation about reunification. DHS wants reunification to be paramount, the first line of permanency, she says, emphasizing that safety is a critical component of permanency. Some of the discussion was theoretical. Child advocate Cervone wonders if reducing foster care is the right goal, or if it is just trendy. Rather than focusing on foster care reduction, he is more interested in whether the incidence of abuse is going up or down. We think it will go down, he says, because we re not just sending kids home, we re sending kids home with support and we re helping families, rather than cutting them loose. No one wants to reduce foster care numbers by sending kids into unsafe conditions. So we have the roots of it; we have the stuff of the soup. Both child and parent advocates can agree on this point, and it is the heart of IOC. Parent advocate Gomez is passionate about supporting parents caught in the system. Part of my job as a parent attorney, she says, is to make sure that when a parent is in a deep hole, we re not throwing over dental floss, that we re really throwing over a ladder. If we are serious about helping children reunite safely with their families without unneeded delay, we must provide their parents with very significant, individualized help upfront. She is adamant that framing child welfare in a parents versus children debate does a horrible disservice to everybody, especially children. In the end, the work groups became a place of trust for both child and parent advocates. They felt free to air their strong opinions, to listen to each other and to find resolution. The Power of the Union Once we got an iron-clad agreement in writing that there would be no layoffs, we could talk about what the DHS jobs would be. Rita Urwitz, vice president, AFSCME Local 2187 The union at DHS has the power to make or break an initiative, especially one as large as IOC, in which many social workers responsibilities will be transferred to CUA case managers. Ambrose knew from the start that getting the union to support this would make all the difference in the world. Rita Urwitz, who passed away in December 2012, was vice president of the union and wielded the power of labor at DHS. She was initially skeptical of IOC. Her concern focused on two key issues: Could the community agencies carry the weight and the responsibility? These agencies traditionally have tremendous staff turnover and young, inexperienced staff, she says. If CUA workers took over case management, what jobs would DHS workers have? This was a bread-and-butter issue to us, she explains. Ambrose and her leadership team met regularly with Urwitz, asking her to sit on the steering committee and ensuring that union representatives had seats on all the work groups. Early on, DHS agreed that there would be no staff layoffs, even though ongoing casework would be transferred out. Urwitz was fully aware that when New York City privatized its casework, extensive layoffs followed. This was not her idea of successful reform. There were some tense moments. The union wanted DHS to sign off on the family service plan every six months. DHS leaders thought that if they agreed to that, it would simply be a continuation of the current dual case-management system. This was where we started drawing a line in the sand, Ambrose says. Having DHS facilitate family team meetings helped address this impasse, as did the promise of targeted training for CUA workers and expanded oversight and monitoring on the part of DHS. In the end, Urwitz says, We got together as union and management to just negotiate, and I think the nuts and bolts were worked out at that time. What DHS leaders could tell the staff and when they could tell them became a problem for both the union and management. The staff knew that change was under way. They knew the basic framework of IOC, that community providers would be taking over ongoing casework. The commissioner had promised no layoffs, but it was clear that jobs would not remain the same, and the DHS staff did not know how they would be affected. This caused understandable anxiety. At the point when the commissioner was ready to present the details to the staff, the union was still insisting that DHS sign off on the family service plans and held up any announcement. As Urwitz herself acknowledges, When people don t know what s going on, they hear rumors. In this case, the rumors grew to fill a muddled void. When the Philadelphia Inquirer heard about 18 casey family programs casey.org casey.org casey family programs 19

10 IOC and called the commissioner, she went on the record and IOC became public. This meant some workers learned about DHS job changes from the newspaper, not an ideal form of internal communication for staff members who were already nervous. Both DHS leaders and Urwitz agree now that their negotiations over IOC were successful. Urwitz says of Ambrose: She had a vision, and she moved that vision. I have a lot of respect for her for that. Ambrose says of Urwitz: It made a huge difference for her to support this, because she could have held it up. At the end of the day, she stood by our side, and I admire and appreciate that, because I think it has been hard for her. It helped that the union shares with DHS the common goal of doing what is best for children and families. Urwitz began her career as a social worker at DHS and worked in family preservation services, so she knows the value of supporting families and children in their own homes and communities. Schwarz, the deputy mayor, gives Urwitz credit for also believing that doing right by children promoted the best interest of her workforce. You have to have people who believe that to make meaningful change. The bottom line here is that DHS made sure the union was at the table during the planning process. It was a lesson it had learned from other states that did not engage their union and paid for it. If DHS had not reached out to the union and held fast to the dialogue, IOC might have been over before it started. The IOC Model: New Roles and a Focus on the Community Our big DHS building is in the middle of Center City, where none of our families live. If we want to make this family-focused, shouldn t we be in the communities to make it easier for families to access services? And shouldn t we be putting work in the hands of providers who actually have some credibility and where families might actually go for help? Anne Marie Ambrose, commissioner, DHS IOC grew out of the effort to address role confusion between DHS and its private providers. As the vision expanded and DHS and its partners began to develop a map, it became obvious that the work itself needed to be planted securely in the community. DHS has horrible credibility in the community, Ambrose says. But more important than addressing their reputation, she adds, IOC is a chance to really support families where they live and, at the same time, to support those communities. You can t have gray areas in this work, Nutter says. There are real consequences to dropping a ball. With IOC on the ground, active, engaged community partners who know these neighborhoods like the back of their hands, who deal with cultural issues and language issues all the time, will work with families. The responsibility of DHS is to monitor them, to stay on top of what s going on. The CUAs are expected to ensure that families get services in the community. If children need to be removed, they will be placed in the community. No more public transportation nightmares for parents trying to get to visit their children in foster care or to get to therapy or parenting classes on the other side of the city. Ali, the DHS operations director, explains what this will mean to a family: The CUAs will be able to contract with the grassroots agencies in the community who will come knock on the door and take you to an appointment. And you can walk out your door, walk five blocks and you re at your mental health provider. That s who the families trust. They don t trust big, old DHS and our I-can t-get-through-toanybody bureaucracy. The community piece is why IOC is so much more than privatization. In fact, DHS does not use the term privatization. Ambrose explains that DHS officially privatized 20 years ago when it first contracted with private providers to deliver services. But we never got rid of the role confusion, she says. Privatization is a buzzword in the child welfare field. Harrison, the former DHS project manager for IOC, explains, We wanted to focus our language on improved outcomes for children and families instead of privatization. Each CUA will have a community advisory board selected by the community and will develop and implement a community engagement plan. The first two CUAs have long been deeply engaged in their communities. The expectation is that the other eight will be as well. The community, not the government, should inform what the service delivery continuum looks like for the people who live there, Ambrose says. Joanna Otero-Cruz of Concilio, the Council of Spanish-Speaking Organizations, adds that it will take a lot of collaboration and partnership with local groups to make it work. New resources will have to be pulled into the continuum of care. It s a different level of ownership, she says. It s like going back to the proverb of It takes a village to raise a child. It is our plural responsibility to ensure this child is safe, ensure that this child has access to adequate services, including education and health care, to ensure that this child has a better outcome. One Go-To Case Manager in the Community With IOC, each family will have their own case manager from the CUA in their community. This case manager will be the family s main link to all services, their go-to person throughout their You can t have gray areas in this work, Nutter says. There are real consequences to dropping a ball. With IOC on the ground, active, engaged community partners who know these neighborhoods like the back of their hands, who deal with cultural issues and language issues all the time, will work with families. The responsibility of DHS is to monitor them, to stay on top of what s going on. 20 casey family programs casey.org casey.org casey family programs 21

11 time in the system, the person who ensures that the children are safe and that the parents get the services they need. This is the essence of a single case-management model. To Otero-Cruz, the IOC case-management system is like a primary health-care model. You have one primary care doctor who is your overall, head doctor. And as he sees the need for specialists, he gives you the referrals. The case manager will take the lead in locating the right services for each family. No more one-size-fits-all service plans. The CUA will supervise any necessary subcontracted services that it does not have in-house. The CUA will also oversee visitations. Foster parents will mentor biological parents. The CUA case manager will be present at all court hearings and will present to judges. When families are reunified, the CUA will provide aftercare. Having one CUA in charge can make a big difference not only for families, but also for workers from different provider agencies who provide different services to the same family. The current system does not encourage workers from one agency to reach out to those from another. Kimberly Walker, an IHPS worker at Turning Points for Children, explains: We don t know the other workers, and we don t communicate. They wouldn t feel comfortable with me calling them and asking them about the services they are providing. With IOC and within a CUA, this kind of collaboration and communication will be more natural, which will help the workers do their jobs better and, of course, help the family. Who Does What at DHS Within the IOC Continuum of Care? DHS and the union agreed there would be no layoffs among the DHS staff. But as the core of ongoing casework is transferred to the CUAs, job titles and functions at DHS will change. The new framework at DHS looks like this: Hot line, investigation and intake responsibilities remain with DHS and will be strengthened. These units will change very little under IOC, although some workers and supervisors will be stationed in offices in the community. DHS will strengthen its investigations of repeat abuse or neglect cases, a critical safeguard for children. DHS intake workers will partner with the CUAs on development of the initial family service plan. Using family team conferencing, DHS and CUA workers will meet with families and the families own support systems to develop the initial plan. DHS will then hand the case over to the CUA case manager, who will lead the work until the case is closed. DHS staff will facilitate ongoing family team conferences at critical decision points. Team coordinators, a new position for DHS social workers, will organize these family meetings, engage the families in the process, identify extended family members and other key people to attend and support the family, and track the progress of all meetings. At the supervisory level, DHS practice specialists will facilitate the team meetings and help identify strengths and barriers to reunification and permanence. (See section on family team conferencing.) Oversight and monitoring are enhanced under IOC and remain a DHS responsibility. Based in the Division of Performance Management and Accountability, DHS quality visitation reviewers and practice monitors will evaluate the CUAs provision of services to families. Program analysts and supervisors will assess the CUAs in terms of contract compliance related to safety, permanency and well-being. All CUA case managers and supervisors will take the required Pennsylvania Charting the Course training for child welfare social workers. In addition, DHS learning specialists will develop and evaluate training for both DHS and CUA staff in their respective new roles. DHS social workers will also be available to provide onsite and ongoing support for CUA staff on such topics as safety assessments, service plans, permanency, navigating court processes and data entry. Roles and Responsibilities of DHS and CUAs Source: DHS DHS Hotline, investigations & intake Financing/contract mgmt Data, perfomance mgmt & accountability Professional development, training & system capacity Support Centers 10 CUAs, 10 Jurisdictions Family Team Conferencing Community partnerships & engagement Case transition Community Umbrella Agency Full case mgmt responsibility -Safety assessment -Service plans Court Participation Coordination of all services With IOC, DHS will go from more than 250 contracts with provider agencies to just 10, one for each lead agency in 10 jurisdictions, each representing approximately 10 percent of the city s child welfare population. The CUAs will subcontract to get additional services for families. The 10 jurisdictions are geographically based on police precincts. The first two CUAs cover three police precincts, which have the highest reports of abuse and neglect in the city. These are the toughest communities, the areas of greatest need, which is why DHS is starting there. Child advocate Cervone suggested an additional reason for starting there: There s a time clock on governments. You have to be able to deliver within the life of one executive administration. If DHS held off doing the hardest communities until the end, I believe they wouldn t have time. 22 casey family programs casey.org casey.org casey family programs 23

12 Each CUA, whether concentrated in one or two police precincts or more, will represent an area with a more or less equal number of families in the system. DHS is rolling out IOC one community at a time, from 2013 to Beginning with the first two CUAs, cases will roll out in a managed way, first with in-home cases, then in three months adding families with children in foster care, and finally adding families whose children are in treatment foster care or congregate care. In addition to taking new referrals, each CUA will receive 10 to 20 percent of the existing cases in its jurisdiction; the rest will remain in the old dual case-management system until they naturally close. Training and hands-on support for CUA staff will be a key part of the picture throughout. Geographic Boundaries of Community Umbrella Agencies in Philadelphia Department of Human Services Improving Outcomes for Children Community Umbrella Agency Zones Spreading the Word About IOC With changes so big that affected so many individuals and organizations, communication took on a star role in the planning process. You can never have enough, Ambrose says. DHS Deputy Commissioner Vanessa Garrett Harley notes: It s a fine line you walk. You have to be as transparent as possible, but also have to be able to filter that transparency so that you don t scare people. DHS mobilized a communication team that included Communications Director Alicia Taylor and outside consultants. Casey Family Programs supported the work of John Beilenson, president of the firm Strategic Communications and Planning, to help DHS prepare a package of materials about IOC for use in speeches and presentations. He also organized listening sessions with staff and stakeholders, provided support for the Community Engagement work group and helped that group develop a communication plan for the CUAs to take the message to their constituents. His current work with IOC includes development of regular newsletters for the IOC website, as well as support for the internal DHS communication team. Internal Communication: It makes sense for large systems such as DHS to engage the people most affected by major changes early on. DHS knew that, but it lost some time during union negotiations. (See section on The Power of the Union above.) When it was able to go public with the details, the rumor mill was already activated. The commissioner set up a series of large staff meetings to reach everyone who worked at DHS. This was a logistical challenge in itself, since DHS has no single space large enough for all 1,700 staff members at one time, and it took several days of meetings to make sure every staff person could attend. The IOC website and newsletters were, and remain, helpful tools in answering the questions of nervous workers. Getting DHS workers and supervisors who were still enmeshed in the day-to-day issues of their current caseload to focus on the future was, of course, a challenge. As more case management is transferred to CUAs and jobs begin to change around them, their attention will no doubt grow. Department of Performance Management & Accountability January 14, 2013 In the meantime, DHS leaders continue to spread the word to the staff. If you take the time to explain to people what we re doing, more times than not, they will get it, Taylor says. When Garrett Harley talks with anxious workers, she uses stories to describe the importance of IOC. She cites a typical case, a mother of numerous children, with numerous workers telling her what to do, carrying her kids on buses all over the city to meet the requirements of her service plan. Garrett Harley asks the workers, Do we or do we not set this mother up for failure? For staff, this is often a eureka moment, she says. Prepared by The Data Integration Management Unit Miles External Communication: DHS reached out to providers from the beginning. In addition to selecting providers to sit on the work groups and steering committee, DHS organized a series of provider round tables to explain IOC to the many nonprofits in the community whose work will be affected. Some of them will become CUAs. Most will not. But the round tables give providers particularly some of the smaller, more focused nonprofits an opportunity to explain their work to the larger community. CUAs will need to subcontract for services that they don t have within their own network. The round tables were a three-way information exchange among DHS, potential CUAs and other nonprofits. 24 casey family programs casey.org casey.org casey family programs 25

13 The Community Engagement work group focused on outreach to the community and was pumping out the elements of a local communications plan when the city s legal department intervened and shut down all the work groups. Since some providers on the work groups might apply to become CUAs, the lawyers reasoned, it was a potential conflict of interest for them to serve on the work groups as the RFP was developed. The early demise of the work groups was a particular blow to communication efforts. We were developing a lot of nice momentum, says Beilenson, who worked with the community engagement group. Providers were stepping up generously to use their standing in the community to get the word out. He says he understands the legal rationale, however, adding, No energy is ever wasted. Otero-Cruz of Concilio, who co-chaired that work group, shares both the frustration and the faith in its work. When we had a lot of our ducks lined up, that s when we had to dissolve, she says. But it developed a communication plan and, in the first two CUA districts, had already begun to collect names of faith-based organizations, block captains, owners of corner grocery stores and more. They gave that information to the first two CUAs. Taylor points out, The work we did set the groundwork for all the future CUAs. They have a communications framework that all CUAs will be able to use. Tracking Progress; Data-Driven Decision Making In this field and as a CUA, you need to have real-time data, and you need to make informed decisions based on data. If you err on one side, it can be financially disastrous. If you err on the other side, a child s life could hang in the balance. Mike Vogel, chief executive officer, Turning Points for Children The success of IOC will depend on using data to make decisions. Social workers deal with life-and-death issues every day. Without good use of data, the IOC reform will have no teeth, no way of knowing what s working or not. One of the first IOC work groups focused on using data for performance management. This work group wanted to make sure both the CUAs and DHS use advanced technology to track the progress of families in the system. The work group created a grid that includes all the elements it wants to be able to measure. This tells it what kind of IT work will be required. A lot of the elements are around timing and deadlines, says Kinnevy, the DHS special projects director. If we really want to shorten the time the kids are with us, she says, we have to shorten every increment. We have to make sure that things are not bottlenecked and that we have a way of finding out if they are. Electronic case management is embedded in the CUA contracts, which means CUA staff must be able to use the DHS data system. DHS has already conquered some of the crucial confidentiality hurdles around sharing data with the CUAs. This is a major leap forward. The CUAs will be acting as our representatives, Kinnevy says. It s an issue of what they need to see in order to do their job. DHS social workers will be on hand to help the CUAs with data entry. In the fall of 2012, a lead community agency in Kansas City, KVC Health Systems, came to Philadelphia to share its lessons in putting together a package of reforms. The key to its success, it says, has been monitoring its data every day at 8:10 a.m. DHS got the message. It is lining up the measures for its own data dashboard, with a goal of using it daily. Child advocate Cervone says, IOC built in the solution to the 20-year problem of being overwhelmed by information and failing to use it in a way to not only know where the kids are, but to have a sense of how well they are doing. This is praise indeed from an advocate who 20 years ago advanced a class-action lawsuit against the department. Support from the State It s important for the state to have an open collaboration with DHS and open conversations and for us to be as supportive as we can be to DHS throughout IOC implementation. Raheemah Shamsid-Deen, southeast regional director, State Office of Children, Youth and Families Because Pennsylvania has a state-supervised, county-administered child welfare system, the state is an essential partner in everything DHS wants to do. The state can, and has in the past, cracked down on DHS if it is not performing up to required state standards. When Ambrose became commissioner in 2008, for example, DHS was on a provisional license for failing to comply with certain regulations. This was lifted as DHS began to improve outcomes steadily. There are layers and layers of detail in this reform once you dig beneath the surface, and many of them touch on state-mandated policy and regulations. Could Philadelphia make such sweeping changes without policy changes at the state level? Would it need legislative approval? Bottalla, the DHS policy and planning director, who also served on the Policy and Legislation work group, went through every state regulation on the books to see which would be affected by IOC. The main question concerned the issue of turning over case management to the CUAs. As it played out, Bottalla recalls, the state did not see any regulatory reason why we could not have providers acting on our behalf. The only regulation DHS could not touch concerned investigations, which by law had to remain at the department. But DHS wanted to keep that part of the continuum anyway, and to strengthen it. IOC did require, however, a signed protocol and constant communication between DHS and the state. Beverly Mackereth, secretary of the state s Department of Public Welfare, came onboard well into IOC s planning period and had to play catch-up, as she says. Sometimes the state 26 casey family programs casey.org casey.org casey family programs 27

14 wasn t on the same page as DHS, she recalls. We weren t always sure what Philadelphia was asking for. What regulations did they really need us to waive? We had to focus on a lot of definitional things. Constant communication and shared goals saved the day. Along with DHS, Mackereth keeps her eyes on outcomes: The bottom line for us is family engagement, drilling down to the real needs of the families and using evidence-based intervention strategies to solve problems. It s as simple as that. She is a realist, however, and knows that it s not going to be simple to implement. Shamsid-Deen, of the state Office of Children, Youth and Families, is based in Philadelphia and worked closely with DHS throughout the IOC planning process. To her, this work was like another full-time job beyond her current responsibilities for the state. She says the move from dual case management to 10 community umbrella agencies will be interesting, a rather large understatement. But to her, and to so many of the leaders in Philadelphia, this work is a ministry. Either you do this work because it s mandated and is the mission of the agency, she says, or you do it because it s a ministry. This work is a ministry for me, and the moment that stops I need to look for something else to do. Financing IOC and a Waiver from the Federal Government There were a lot of providers on the Finance work group, and that was helpful because we got a lot of provider feedback. Their feedback made us think of things differently. Jennifer Bieter, former senior analyst, Public Financial Management, currently strategy analyst, Philadelphia School District PFM built the model to project costs on a quarterly basis and let it look all the way out to the year 2019 so that DHS could use it as a decision-making tool. We have a lot of dynamic parts in IOC; everything is moving, says Finance Chief of Staff Chanell Hanns. The model itself does not build in cost neutrality, but it can project costs quarterly and allows officials to change the assumptions and see the financial changes instantly. Thus a decision maker at DHS is able to determine which mix of assumptions will result in cost neutrality. Some providers from the beginning raised questions about whether, given the need for cost neutrality and no DHS layoffs, there will be adequate funding for IOC. The cost neutrality requirement, however, does not mean lack of flexibility in how money will be spent. And in this case, DHS is getting big-time help from the federal government and the state with a Title IV-E waiver (see below). In addition, DHS is determined to reduce the number of youth in congregate care, a cost-savings measure that is also better for families. Both Casey Family Programs and the Annie E. Casey Foundation are providing technical assistance to help DHS work through the financial puzzles of IOC. For the CUAs, at least at first, DHS will continue to bear the financial risk, paying the actual cost of services delivered. The goal in the future is to share the cost with the CUAs. DHS is looking at various scenarios that would transfer sums to the CUAs to use for all services. If a CUA is able to maintain more children in their own homes safely, close more cases, decrease re-entry or decrease placements in expensive levels of congregate care, the money that is saved can be reinvested in other community-based support services for families and children. Regan Kelly, vice president of NorthEast Treatment Centers (NET), the first CUA to go online, in January 2013, talks about what this funding arrangement will mean to its work. Successful reunification is one of her prime goals, which means supporting families with ongoing services after the children are returned home. This helps families and makes sense financially, too, she says. If that reunification fails, the child comes back to you with no additional funding. The funding arrangement incentivizes two things: not sending kids home too early, but also really making sure the family is stable for a period of time after reunification. Transferring case management to the community requires a new way of paying for child welfare services. The overall DHS budget is $650 million, a combination of federal, state and local dollars. This total will not change under IOC. Cost neutrality was a requirement of IOC from the beginning. What will change is how DHS spends its money, since large amounts will be shifted to the CUAs. Configuring the funds for something as complex as IOC is a herculean task, involving a complicated financial model developed by Public Financial Management, a consulting group that works with governments. This financial model had to take into account such things as staffing needs at the CUAs, training for both CUA and DHS staff for new positions, costs of services per family and per child, and even the cost of office space. It is a dynamic model that is used to test assumptions, such as the difference in costs based on caseloads of varying sizes. Philly has a very large budget, and there are a lot of pieces to their budget, says Lori Partin, who is now an IT project manager at DHS but who was an analyst with PFM when it was developing the model. The model put decisions into real dollars, she says. What Is a Title IV-E Waiver and Why Did Pennsylvania Want One? Child welfare services are funded by a complicated amalgam of federal, state and local funds. With IOC, DHS will be helped by a five-year, Title IV-E waiver from the federal government that gives the state and five of its counties, including Philadelphia, flexibility in how they spend foster care funds. Without this federal waiver or capped child-welfare demonstration project, as it is called in Philadelphia DHS would be allowed to spend foster care funds only on placement, after children are removed from the home. The waiver allows the state to use this money for prevention, reunification or other interventions that will benefit children and families. The caveat is that the funds are capped, so if for some reason DHS needs to place more children in care, no additional money would be available. Over the past six years, as DHS reduced the number of children in out-of-home care and increased permanency, it could not access the money that was targeted for placement only. Now, as Garrett Harley, the deputy commissioner, points out, The waiver will allow us to invest 28 casey family programs casey.org casey.org casey family programs 29

15 and utilize that money in a different way, such as more prevention efforts in the community to keep kids from coming into the child welfare system in the first place. DHS leaders have a wish list for how to spend their waiver funds, which almost always includes more aftercare services to support families after reunification. Operations Director Ali s list includes investments in recruitment of foster families, support for visitation coaches, and Parent Child Interaction Therapy, an evidence-based program that works with biological parents. Pennsylvania s waiver goals include: A 30 percent reduction in congregate care over five years A 30 percent reduction in re-entry over five years A 30 percent reduction in days spent in care over five years Casey Family Programs provided technical assistance to the state and to DHS during the waiver application process and continues to serve on the state s waiver executive team that oversees implementation. Fran Gutterman, senior director at Casey, says: We know families need a wide range of services, and the goal is to keep families safe and together whenever possible. With the waiver, the state will no longer be penalized by losing money when they decrease placements. The money will follow the needs of the child and the family, whether that is prevention, aftercare or other services. IOC was already in the planning stages when the state applied for the waiver, but the application built on Philadelphia s reform and includes it as one of the demonstration projects. Mackereth believes the waiver s flexibility will be extremely helpful to DHS in implementing IOC. The waiver is not about new money, she reiterates, but about using the monies we have in a better way. The waiver alone will not bring about cost neutrality for IOC, but it will help if the number of children in care in Philadelphia continues to decrease. A Closer Look At Congregate Care We believe very few children should have to be in congregate living or institutional care. IOC will assess family needs and identify the appropriate interventions that we hope will keep children safe in their own homes. Beverly Mackereth, secretary, Pennsylvania Department of Public Welfare It is a concern at all levels, and the mayor s Community Oversight Board established an olderyouth work group, charging it with making recommendations to reduce the levels of youth in congregate care. Congregate care costs more than other placements, an average of $165 a day for group home and institutional care in Philadelphia. IOC is premised on finding support and services for families in their own communities, which DHS hopes will result in fewer institutional placements, which are often in the Philadelphia suburbs or as far afield as Pittsburgh. If a child needs treatment in a group home, the stay should be as short as possible and as close to home as possible. This will not only serve children and families better, but it will also save money and buttress IOC s commitment to cost neutrality. The department is already raising the level of approval needed to place a child in congregate care: The commissioner herself now has to sign off on anyone placed in congregate care. The Annie E. Casey Foundation is helping DHS assess its overreliance on congregate care in order to uncover what drives the problem and find solutions. Chris Behan of the foundation is hopeful that DHS and the CUAs will add more in-home family preservation services, especially for teens who are truant. There has to be a better solution for these kids than putting them in an institution just because it has a school on-site, Behan says. Even the supposedly good will that drives workers to send youth to safer suburbs is, in fact, the antithesis of IOC, which is all about the neighborhood, Behan says. Furthermore, when teenagers are placed far from home, they lose the connection with family members who cannot travel to see them regularly. There has to be a better solution for these kids than putting them in an institution just because it has a school on-site, Behan says. Even the supposedly good will that drives workers to send youth to safer suburbs is, in fact, the antithesis of IOC, which is all about the neighborhood, Behan says. The courts, too, are concerned about the high level of congregate care. Administrative Judge Kevin Dougherty of the Family Court describes a study the court conducted to test the common assumption that older youth remain in care because they have no other options. This study looked at a randomly chosen selection of 52 youth in the system, age 18 and over, the hardest group, Dougherty says. The researchers searched for possible permanency options for these 52 youth and, to their surprise, found numerous possibilities. Some youth found new family members, others got jobs, and one was adopted. If, as will be the case with IOC, the work is neighborhood-focused, he adds, You ll find that maybe this neighbor knows that neighbor and they might know who the father is. In court, when the case says father unknown, Dougherty often asks children if they are in touch with their father. If they say yes, he asks, Do you have his cell phone number? Many reply, Yeah, you want it? This information was not in the file, and no one had asked the child. The state, DHS and the CUAs intend to take a hard look at congregate care placements. Almost half of the DHS population in congregate care is older youth, and Philadelphia s rate of congregate care placement is 22.5 percent, nearly twice the national rate. As the family stories in this report illustrate, teenagers often advance to group homes from truancy charges. 30 casey family programs casey.org casey.org casey family programs 31

16 Family Team Conferences: A Focus on Strengths and Opportunitues Any discussion around IOC has to be around the practice. Our practice is going to be the teaming model. If we were in the private sector, we would say this is our new business model. Khalid Asad, senior adviser to the commissioner, DHS For years, child welfare focused on what was wrong with families in the system. If children were removed, social workers told parents what they had to do get them back. As Gwen Bailey, executive director of Youth Service Inc. in Philadelphia, says, So often we look at the problem and not at strengths, solutions and opportunities. She applauds the fact that IOC is shifting that pattern and requiring a series of family team conferences to be held throughout the life of a case. These conferences are central to the way we make decisions, says Jan Flory, consultant to the Annie E. Casey Foundation, who is providing advice on training for family team conferencing. There are several models of family team conferences used across the country, all with a common approach and philosophy: Family members participate in a facilitated meeting that includes a discussion of their strengths, needs and goals. Parents are invited to bring relatives or other people from their support network. Older youth attend to speak for themselves. The product is a safety plan for the children that addresses services needed for family stabilization. DHS is no stranger to the concept of family team meetings. It has been using a model called Family Group Decision Making; outside agencies facilitate these meetings, and they are not available for every family that could benefit. In many cases, DHS still hands the family a service plan that tells the parents what they need to do. But service delivery is not like pizza delivery, says Behan, of the Annie E. Casey Foundation. You can t just give it to people. When a family is helped to articulate their strengths and problems and when this information is wrapped into their plan, parents will have more motivation to do the hard work. DHS set the foundation for regular use of these conferences when it added a new safety assessment tool, one of the recommendations of the Child Welfare Review Panel after Danieal Kelly s death. Casey Family Programs supported DHS with the introduction of this safetyfocused method of decision-making. Under IOC, whenever the assessment raises a red flag about safety, a family team conference will be held. The Annie E. Casey Foundation is supporting introduction of regular, ongoing family team conferences. Under IOC, family team conferences will be required, rigorously defined, participatory and held at given points throughout the history of a case: 1. Child Safety Conferences: Held before or within 72 hours of a child s placement, usually before the case is handed over to the CUA. DHS intake workers are part of this conference. Goal: to make quality safety decisions, and if the child needs to be placed, to determine where. 2. Family Support Conferences: For families with safety issues, but where DHS concludes that children can remain at home and that the family will receive services. Held after case opening and then regularly until case closure. Goal: to identify the family s hopes and service needs. This level of conference will be held regularly to assess progress on elimination of safety threats and enhancement of parental capacity. (Families that do not have a safety issue but still need services will not have a facilitated conference.) 3. Permanency Conferences: To be held every three months prior to the court hearing for families with children in placement. Goal: to keep the focus on services and needs for a family in preparation for reunification or other permanency decisions for children and youth. 4. Placement Disruption Conferences: Before a child is moved from one placement to another. Goal: to stabilize placement and provide appropriate level of care for each child and youth. Once the case is turned over to the CUA, the CUA case managers and the families themselves will make the decisions about service plans and needs. DHS staff will stay involved by facilitating and coordinating the team conferences. The shift in the mindset for DHS will be huge, consultant Flory says. A bonus is that facilitators will be assigned to specific CUAs, which means they will know that community well and the resources that are available in the community. The family team conferences are possibly the most significant and promising cultural shift brought about by IOC. Because the meetings are required, there s no way to avoid consulting the family about what they want, their needs and preferences, Behan says. Standardized service plans, where families are assigned one program from Column A, another from Column B, will become a thing of the past. Judges should have more confidence that families will buy into their own plans, which means parents will be more likely to do the hard work that is required to stabilize their families. Behan adds, Eventually, people see that the decisions made this way are actually better, and true involvement of families becomes part of the culture. Judges should have more confidence that families will buy into their own plans, which means parents will be more likely to do the hard work that is required to stabilize their families. 34 casey family programs casey.org casey.org casey family programs 35

17 Strengthening Families: Parents Helping Parents Once parents experience parent cafés and all the things that come with it, I think they will see it as an opportunity to get information and also to make some new friends and develop healthy relationships. Brenda Kinsler, administrator of the Family and Youth Engagement Center, DHS IOC is dedicated to helping parents raise healthy children in safe and stable families. If family team conferences are the heart of IOC practice, the Strengthening Families framework is the heart of community engagement. Strengthening Families defines what it really means for children to be safe in their own neighborhoods and communities, says Clapier, the DHS deputy commissioner. Developed by the Center for the Study of Social Policy (CSSP), the Strengthening Families approach works with parents both in and outside the child welfare system and embodies peer support, with parents helping other parents. The goal is to generate and reinforce five specific protective factors among parents and to integrate these protective factors into policy and practice. CSSP research shows that the following protective factors lead to families in which parents are nurturing and in which children thrive and are safe: Parental resilience These protective factors are what make families function and provide a good home for their children, says Brenda Kinsler Availability of social connections to provide emotional support and assistance Access to concrete support in times of need Knowledge of parenting and child development Parental support for the social and emotional competence of their children These protective factors are what make families function and provide a good home for their children, says Brenda Kinsler, administrator of the Family and Youth Engagement Center at DHS, which will oversee the Strengthening Families activities in Philadelphia. Under IOC, most everything for parents takes place in their own community. Adding additional, informal support to shore up parental skills and capacity will be a welcome ingredient. And it s not just for bio families, Kinsler says. It s building up the extended family as well. Casey Family Programs helped DHS develop its Strengthening Families program by supporting research, site visits and peer technical assistance. A team from Philadelphia visited Illinois, which has one of the strongest Strengthening Families programs in the country. There they participated in a parent café, where parents meet other parents for informal discussions about issues of importance to them, such as child discipline or relationships. And yes, there is also food, an obvious ingredient for a comfortable conversation. The cafés are led by parents trained as facilitators. Parents in the child welfare system are often isolated and have few people to go to for help beyond their own family. Parent cafés are an opportunity for these parents to meet other parents who possibly have been where they are now and who can share advice and information. The cafés are voluntary. This is not another required activity on the DHS to-do list for parents. Philadelphia is no stranger to peer parent education, integrating aspects of it in the Parent Action Network and Achieving Reunification Center. With IOC, the goal is to bring parent education into the CUAs in more depth and to expand it across the city. The first two CUAs are enthusiastic. APM wants to make sure the food is as healthful as the conversations. Kelly at NET says: Parent cafés are right up our alley. We had parent peersupport specialists, parents who had been through treatment who then engaged other parents coming into treatment. When she heard about Strengthening Families and the parent cafés, she said, Yes, that s NET. We ll do that. Gutterman of Casey Family Programs notes: The Strengthening Families framework is an important vehicle for supporting parents as decision makers and building a network of parent partners and leaders. It has been wonderful to see the excitement and enthusiasm of both DHS and CUA staff that has grown from exploring this work. Role of the Courts At the end of the day, isn t it about seeing the world through the eyes of the child? Kevin Dougherty, administrative judge, Family Court Division The courts and DHS share a history of miscommunication and distrust, which means that children and families were sometimes caught in the middle. Both the courts and DHS have worked hard to improve communication and have had considerable success in recent years. Beginning in 2005, mental health workers were assigned to Family Court to provide information and advice for judges and DHS alike. When Dougherty became head of Family Court, he recruited a diverse group of new judges who better reflected the diversity of families in the child welfare system. As improvements were implemented, the court and DHS sharpened a joint focus on doing the right thing for families and children, and the number of children in placement decreased. 36 casey family programs casey.org casey.org casey family programs 37

18 Nevertheless, under the dual case-management system, the lack of clarity around roles for DHS and providers still plays out in the courtroom. As Dougherty says, When things went great, we accepted the praise. But when things went wrong, we pointed the finger. In the current system, both DHS and providers are expected to come to court hearings. If a family has numerous providers in their life, and many do, all the workers are expected to come to court, where they might spend up to a half day at hearings, bench time that is clearly not a good use of workers expertise. Judges are used to relying on the DHS worker as the arbiter of what s going on, says Garret Harley, the DHS deputy commissioner, and are accustomed to giving orders to DHS. IOC will be a change for both the courts and DHS. When Dougherty first heard about IOC, he recalls he had one word for it: radical. Later he called it a tectonic plate shift. With dual case management, he points out, the court could fire a provider if the judge was not pleased with its work. With IOC, the CUAs will be acting as agents of DHS and cannot be replaced. Under IOC, Garrett Harley says, The person who does the casework will be the person testifying. This will be the CUA case manager, who will have the most complete picture of the family s life. Court reps from DHS will be assigned to work with the CUAs, and non-case-carrying DHS staff will remain available at court hearings. When Dougherty first heard about IOC, he recalls he had one word for it: radical. Later he called it a tectonic plate shift. With dual case management, he points out, the court could fire a provider if the judge was not pleased with its work. With IOC, the CUAs will be acting as agents of DHS and cannot be replaced. Dougherty s biggest worry in the beginning was the possible loss of union jobs at DHS, since Philadelphia, as he notes, is a strong union town. He is also concerned about new employees hired by the CUAs and hopes they get the experience and training to take on the responsibilities of supporting families in court. Dougherty likes the addition of more family team conferences and supports the strength-based focus of these meetings. When they were introduced in court-involved cases, he says, I had to convince the judges that the true strength is with the family and not the bench. He adds, If the goal is reunification, then should not the family at least have an opportunity to salvage itself, as opposed to some stranger who s just meeting you? At least give everybody an opportunity. As IOC gets under way, Dougherty has assigned all the cases from the first two CUAs to a single judge. That way, the judges won t have to work with both systems at once. Dougherty is optimistic. He believes the stars are in alignment around this very large set of reforms. At the end of the day, with appropriate training, the right result should occur, he says, because you have an agency in a particular section of Philadelphia that knows all the community-based services, all the schools, all the rec centers, all the rehabs; they know their neighborhood. And if we agree that it s best for children to receive services in their own neighborhood, then who better to do it than an agency operating in that neighborhood? The First Two CUAs and Their Community-Based Philosophy IOC is built on the premise that smaller is better, which is part of local is better. There will be smaller footprints for these providers. They ll be responsible in a more intensive way, but for a smaller region than they are now. Frank Cervone, executive director, Support Center for Child Advocates DHS held a series of provider meetings to introduce IOC to private providers and help them decide if they wanted to apply to be a CUA. Ambrose attended many of these meetings. Some providers asked why they should take the risk. Ambrose answered that they should assess their strengths and weaknesses, their finances and leadership. But for those that have the capacity, she said, the real reason to become a CUA is because it s the right thing to do for kids and families. The first two CUAs were chosen in the summer of Both are large, community-based nonprofits with a long history of service delivery in Philadelphia. They are vested in their community and respected by those who live there. These two pioneers are NorthEast Treatment Centers (NET) and Asociación Puertorriqueños en Marcha (APM). A drive through the neighborhoods of these two CUAs shows areas of poverty and resilience. Philadelphia s famous murals are on display everywhere; tagging and graffiti are rare. People are in and out of small corner grocery stores, a communication hub if ever there was one. Parks, both large and small, are being cleaned up and, more importantly, used. The CUAs know their neighborhoods. Their staff members speak the language of the residents, literally and culturally. They know the local resources, what exists and what needs to be added. NorthEast Treatment Centers NorthEast Treatment Centers, or the NET, as community members call it, has within its organizational network the full continuum of services for children and families in the DHS system. This is an excellent base on which to build a CUA partnership with DHS. NET also has a broad continuum of behavioral health programs, including addiction and treatment facilities. Most of these programs are in the community, including home-based and school-based programs. NET will serve families and children in the 25th Police Precinct, a diverse population of about 70,000 people, nearly half living below the poverty level. More than half of the population is Hispanic, and the majority of those are Puerto Rican. One-third are African-American. We see the diversity of our neighborhood as a great asset, says Kelly, NET s vice president. Kelly explains why NET wanted to become a CUA: This really is just part of what what ve been doing for years, not to this scale, but it fits our values and we felt it was the right thing to do. 38 casey family programs casey.org casey.org casey family programs 39

19 She points out that NET is a good match with DHS because of its focus on quality-driven and cost-effective services. Kelly notes that many of NET s clients need more than child welfare services, citing jobs as an example. NET has done a great deal of work with youth who have behavioral health problems. As Kelly says, We understand the trauma piece and the impact of trauma on the brain. NET has trained its group-home staff to understand that resistance is a reflection of a child s history and Kelly s eyes lit up with the vision of a CUA youth worker. He fit that youth criteria, she says, having had the experience of foster care and really trying hard as a young adult to create a life for himself, college and a job. trauma, and not a reflection of a refusal to obey. Kelly wants to enlist community members as mentors for troubled adolescents. I m very excited about the idea that the community should send the message to these young people that they have value, that they have worth. She adds that the respect can go both ways. The community s respect for youth will increase exponentially if youth then give back to the community. It is a growing circle. Kelly doesn t miss an opportunity to recruit support for children and families. One morning, she met a young man emptying the trash near her office. They started talking. He had recently left foster care and is now in community college and has a job. Kelly s eyes lit up with the vision of a CUA youth worker. He fit that youth criteria, she says, having had the experience of foster care and really trying hard as a young adult to create a life for himself, college and a job. He told Kelly he was struggling with his English class in college. She gave him her card and said she could help. Always a social worker, she says of herself which is a good thing when it comes to CUA opportunities. Asociación Puertorriqueños en Marcha APM will operate as a CUA in the 24th and 26th Police Precincts in Philadelphia, diverse neighborhoods of approximately 116,000 people, nearly 40 percent living below the poverty line. Residents include Latinos, African-Americans, Asians and people from the Middle East. APM was founded in 1970 as a social service organization for Puerto Ricans. It has provided contract-based services for DHS for 27 years and has the full continuum of services, with the exception of In Home Protective Services, which it is adding. APM has behavioral health and drug and alcohol treatment programs within its organization. Cheryl Pope, Ph.D., APM s vice president of human services, is excited about the opportunity to stabilize more families and keep more children safe. APM s philosophy connects the wellbeing of children to that of families; the well-being of families to the stability of their community; and the stability of their community to the success of the city. These supportive connections go in both directions. When people become productive members of the community, the city flourishes, says APM Vice President Jennifer Rodriguez. More dollars come back into the community. Implementing this philosophy with families at the center is what brought APM to DHS as a community umbrella agency. APM also brings added value to IOC from its experience in community engagement and economic development. APM sponsors new housing developments, both rental and ownership, and helps residents replace crime-ridden corner parks with brightly colored playgrounds. It bought land and recruited the firm Cousins to build one of the first inner-city supermarkets in Philadelphia; this 40,000-square-foot food emporium boasts one of the most culturally diverse food selections in the Delaware Valley. APM also successfully wooed and built the TruMark Financial Credit Union building, bringing banking back to the neighborhood after 50 years. In addition, APM developed a mortgage counseling program, and during the recent banking and housing crisis, APM participants had no foreclosures. We are conveners and implementers, Rodriguez says. We bring stakeholders and residents together with resources and programs. In 2013, APM will finish up a major construction project called Paseo Verde, an affordable and market-rate apartment complex that will house its CUA offices, a clinic, a pharmacy and a restaurant. APM also has a financial opportunities center to help families with employment and careers, financial education and access to public benefits. As a CUA, APM will intensify the focus on children and families in its community development work. If we have a family that needs housing, we will put them at the front of the list, Rodriguez says. If they need supportive services, we re there to support them. Nilda Ruiz, APM s president and CEO, knows the child welfare system well, having adopted her children through DHS. With the CUA, she says, we ll have an infrastructure in place where we can move families through social services and behavioral health, and when they re ready for selfsufficiency, we can help with housing and send them to our financial opportunity center and help them become self-sufficient in a way that they can reach the American Dream of owning their own home, having a savings, and retiring, having fulfilled their potential. Community engagement is in the DNA of APM and is how it does all its work. APM surveys the community regularly to identify the problems residents are most concerned about. APM s community outreach teams walk the neighborhoods and knock on doors, handing out information and finding out what s on the minds of residents. We are conveners and implementers, Rodriguez says. We bring stakeholders and residents together with resources and programs. As a CUA, APM will focus community meetings on the needs of children and families and what the community can do to help. Due to societal prejudice, families involved with DHS carry a label, and so at APM, we promote more understanding for everyone in the community, Pope says. APM s community outreach extends totally holistic transformation for people suffering with profound life problems. The agency has the resources to empower people and change their lives for the better. 40 casey family programs casey.org casey.org casey family programs 41

20 Rolling It Out: Technical Assistance and Training We re talking about children s lives, so we are very purposeful and diligent in how we prepare staff to do that. Cheryl Pope, Ph.D., vice president, APM Soon after APM and NET were chosen as the first two CUAs, they began meeting every Monday morning with a DHS implementation team. A true partnership rose from these meetings where NET, APM and DHS raise questions and solve problems. Pope says APM didn t have ready access to DHS in the past. They would talk to us about performance measures, but mainly at quarterly reviews. Now they respond, even to an in the middle of the night. She adds that NET and APM were sometimes competitors for contracts in the past. Now we collaborate. The partnership is there. Bottalla, the DHS director of policy and planning, worked with the CUAs to develop a policy manual and standards for performance, which will be the bible for startup. All the details will be here, including state requirements, how to find community settings for parent visitation meetings and parent cafés. They are writing it all down, but they are also aware of the need to be flexible when operations really begin. More important than creating a structure that can handle every situation, says Clapier, the DHS deputy commissioner, is creating a structure that is firmly focused on outcomes and can then adapt to the individualized situation. Training DHS University coordinates training on the core curricula for all social workers and supervisors. The curricula include understanding state regulations and safety assessment tools. With IOC, all case managers and supervisors from the CUAs will go through the standard social-work training, but it will be customized around the work to be done in the community and will include segments on family team conferencing. DHS is also adding training for the CUAs on data and electronic systems, which the new case managers and supervisors will need to use. DHS is creating a way for CUA case managers to get into the DHS server and enter the information, says Asad, the senior adviser to Ambrose, who is in charge of DHS University. June Cairns, DHS director of staff development, points out the need for capacity building for the CUAs as well as training. Capacity building, she says, is focused on helping the CUA understand their new role and assessing what they need to do to meet the expectations in a different way. DHS is adding training for its own staff as well, to strengthen their front-end investigations work as well as their expanded family team conferencing, monitoring and evaluation roles. DHS staff will need to know and understand IOC as much as the CUAs need to know and understand DHS. Training for NET case managers and supervisors began in November APM s staff began training in January NET is layering on additional training for its case managers and supervisors, modules on motivational interviewing techniques and solution-focused case management. The fact that NET s workers were still carrying their caseloads while training for their new roles posed a challenge. The DHS/CUA implementation team had its first problem-solving assignment. It addressed this dilemma by cutting the caseloads in half and spreading the training sessions over a longer period of time for the first cohort of case managers and supervisors. The next groups of trainees will not be carrying a regular caseload when they begin their training. By the end of the 2013 calendar year, the next eight CUAs should be selected and a schedule for training and transfer of cases should be set for the whole of DHS. IOC will really be on its way. Lessons Learned It s important to get people on your side who are willing to step out in their community. It goes to street cred. If you can get the community to embrace it, you may be able to find some resources that have been hidden for a long time. Vanessa Garrett Harley, deputy commissioner, DHS Child welfare reform initiatives too often start and stop. They get bogged down in details, derailed during implementation. In big systems like DHS, says Chief Deputy City Solicitor Barbara Ash, you get to a certain point and you hit a stalemate, and people get dejected and it goes away. DHS is determined not to let IOC go away. Leaders intend to apply the lessons they are learning every day. Many are sprinkled throughout this report. Leaders cited the following intertwined lessons as particularly noteworthy. The Importance of Child Welfare Leadership With a Vision Ambrose was clear from the beginning about the need for comprehensive reform and a vision of what that reform would look like. Keeping their collective eyes on the prize during planning was the assignment for her team of leaders, many of whom entered the discussion as operational experts and grew to become visionaries. It required continual repetition of beliefs and values and goals. No meeting went by without reminding everyone why they needed this reform: to improve outcomes for children and families. At the same time, no questions or doubts were swept beneath the carpet. DHS leaders, including the commissioner, listened to and engaged in a dialogue with skeptics, internally and among outside stakeholders. This took time, but leaders believe it was time well-spent. 42 casey family programs casey.org casey.org casey family programs 43

21 This early persistence and clarity from the leadership team carried through even during the uncertain times of negotiating with the union, detailing the practice model and refining an RFP for CUA application. With something this big, says Shamsid-Deen, state Office of Children, Youth and Families, you have to step out as a team; you have to step out united. Otherwise, anxieties about job roles, for example, or worries about the future of provider agencies could grow and take over the conversation. Leadership teams jelled on three levels: Internal DHS leaders rallied around the IOC vision and outcomes through weekly Wednesday morning meetings where staff focused on the nuts and bolts of IOC. The result is a team of leaders united in an effort to ensure successful reform and to make child welfare in Philadelphia a national model. These meetings are ongoing. From the beginning, the vision was debated internally, with the state and with local stakeholders. It took, and still takes, courage and sometimes even a leap of faith to believe IOC will work. Once the first two CUAs were selected, leaders from NET and APM began meeting with DHS weekly, every Monday morning. This is where the details of policy and practice in the community were defined and refined and where questions about training and implementation were answered. On the broader leadership front, the IOC steering committee continues to meet monthly, bringing together child welfare leaders from across the city. These experts are there to hold DHS and the CUAs accountable, to make sure they do what is necessary to reach the goals of IOC. From the beginning, the vision was debated internally, with the state and with local stakeholders. It took, and still takes, courage and sometimes even a leap of faith to believe IOC will work. DHS leaders cannot prove cost neutrality in advance, for example, nor can they prove that IOC will succeed. But as Ambrose says: There were a million people who could have shut this down at any point the mayor, the judge, the finance director. There are many, many people who could have undermined our efforts. So part of this is how we as leaders build relationships. It takes a lot of time. The Need for Allies in High Places DHS leaders knew they could not move IOC forward without support from leaders outside the agency. DHS is one government agency, working with families who are involved with many government agencies. In addition, because Pennsylvania is a county-administered child welfare state, no big change can happen in Philadelphia without the mayor. In this case, Nutter has supported Ambrose and her team all along. He knew when he took office in 2008 that DHS needed more than a small fix. He appeared with the commissioner in a press conference to announce the first two CUAs, a clear vote of confidence in the future. The leadership of the courts and other city agencies is also important, and Ambrose nurtures these relationships, staying in close touch with the mayor s office and the presiding judge. Dougherty, the Family Court judge, is onboard, as is Arthur Evans, head of the Department of Behavioral Health and Intellectual disability Services. Evans and court representatives sit on the IOC steering committee. He is also an ex-officio member of the Community Oversight Board. These allies are aware of the unknowns and ready to address problems, move forward and follow progress. David Sanders, chairman of the Community Oversight Board and executive vice president of systems improvement for Casey Family Programs, believes that the support from both mayors Street and Nutter was critical to reform at DHS. The changes over the last five years would not have happened if not for their commitment, he says. Particularly with IOC, Nutter s unequivocal support was there in case opposition bubbled up from the union or from concerned providers. The mayor has been very consistent in communicating that this is a priority for him, Sanders says, adding that Schwarz, the deputy mayor, has successfully translated Nutter s vision to other department heads as well. There is no break in the vision between the mayor, the deputy mayor and the commissioner of DHS, Sanders says. And that s very rare to see. Paying Attention to Timing It takes time to build the political will for change as large as IOC, in a city as large and politically complex as Philadelphia. Zeinab Chahine, a managing director for strategic consulting at Casey Family Programs, was an adviser to DHS in the planning effort. Formerly the executive deputy commissioner of New York City s child welfare agency, she was pivotal in linking DHS to New York s reform, as well as to the efforts of other sites across the country. She points out the need to make sure the timing is right for each phase of the planning process in order to build political will along the way and to anticipate the roadblocks and minimize them. She adds, You also have to build the capacity and readiness for the change, so that when you flip the switch and announce the plan, you re already halfway there. Learning to Trust the Dialogue The seemingly seamless support for IOC among DHS staff leaders and within the city and state did not happen automatically. DHS learned to welcome the tough questions and embrace the intricate planning process, both internally and externally. Asad, the senior adviser to Ambrose, says that early in the process, after the DHS leadership team had agreed on the bottom line single case management and a focus on the community some wanted to get there for different reasons or by different means. Everybody thought we had a good model, he says, but they wanted different things. Some wanted to make sure that IOC was going to be grassroots. Some were focused on the capacity building. Others asked, Why can t we do this internally? They held the tough conversations internally and then made sure they recruited people in the trenches to help them shape the details of the reform. The steering committee and the work groups included people and agencies whose work would be directly affected by this reform. Parent advocate Gomez says, Letting outside advocates provide so much input, I think, improved the model and really sends the message that this is going to be a transparent There is no break in the vision between the mayor, the deputy mayor and the commissioner of DHS, Sanders says. And that s very rare to see. 44 casey family programs casey.org casey.org casey family programs 45

22 process. She adds: At no point have I hit a wall. At no point have I raised an issue and felt like it was disregarded or dismissed. Ideas were discussed very thoroughly, and it was a group process. Lee Tolbert of the West Philadelphia Coalition of Neighborhoods and Businesses agrees: None of the voices on the steering committee went unheard. There was an opportunity for everybody to express their concerns. Sequence and Timing of the Work Groups Work group participants were generally positive about the IOC planning process, but they raised concerns about timing and sequencing of the work groups. For example, several of the groups could not do their work until the practice model work group had done its work. The finance work group had a fiscal model, but it couldn t use it to make decisions until the practice model was fleshed out. The same was true with the staff-development and capacity-building work group. Mike Vogel, who co-chaired that group, says: We found early on that we needed info from another committee that wasn t far enough on to give it to us. There was a lot of sitting around talking, but about what wasn t clear. Better sequencing of work groups was the clear lesson learned. The rather abrupt shutdown of the work groups by the city s legal department was another lesson. This conflict-of-interest issue could have been anticipated and addressed when the groups were formed so that when the RFP was released, the providers would understand the need to step back. The work groups then could have continued in some cases without the providers. In fact, the community engagement work group did continue for a little while, but Ortero-Cruz, the co-chair, was from a provider and had to leave the committee. Support From Foundation Partners Having access to resources to learn from others made a huge difference in the early development of IOC. DHS does not have travel money in its budget to see other child welfare systems in action. It doesn t have money to convene experts and bring them to Philadelphia to share advice and lessons learned. It doesn t have the funds to hire outside consultants to help with the added work required in an initiative as big as IOC. Taylor, the communications director, says, It would be almost impossible for me to do my regular internal and external communication duties and also all the communication work for IOC. She has a staff of one and is grateful for the help of outside communication consultants. DHS and the state are fortunate to have foundation partners that have faith in IOC and are onboard to support leaders in doing the hard work. The William Penn Foundation gave an early grant centered on planning. Casey Family Programs has supported the department throughout the process. This ongoing support from Casey has been critical to the planning and rollout of IOC. With implementation on the front burner, the Annie E. Casey Foundation is also on the scene to provide technical assistance in several key areas. Besides foundation support itself, Ambrose adds, there is another bonus to these philanthropic partnerships. Having foundations involved gives our work credibility, she says. They are not going to support a losing strategy. Communicating IOC Internally and Externally Communication at numerous levels was and remains an essential ingredient of IOC. Among the lessons learned here: Language matters. Child welfare is awash in jargon. That may be acceptable when professionals communicate to other professionals, but it doesn t work when communicating something as complex as IOC to residents in Philadelphia s many neighborhoods. Beilenson of Strategic Communications and Planning particularly appreciated the help of the community engagement work group in translating IOC presentations into lay language. They gave us really strong input about how to more effectively talk to the community about IOC, he says. Identify media willing to have complex discussions. IOC is a complicated package of reforms. Finding media outlets that allow time for in-depth conversation is never easy in child welfare. In this case, Ceisler Communications, a public affairs firm in Philadelphia, helped identify radio and TV talk programs where the commissioner was given the opportunity to explain in some depth the goals and progress of IOC. The Philadelphia Inquirer also published articles and editorials focused on IOC. These efforts are worth noting, given the traditional sea of media distrust of DHS and the press tendency to hammer child welfare agencies in times of crisis, without seeing the whole of what they do. Early engagement of upper and middle management is critical. The DHS top leadership team was onboard and supportive of IOC, but regional directors and middle management did not communicate about it regularly to their staff. It s all about how the information is shared, Taylor says. If directors have the information and feel empowered and included, they are likely to talk about IOC positively. If they are left out, the trickledown effect can be harmful. An important lesson learned for Taylor is the need for a script and talking points to help directors communicate IOC to their staff. Pay attention to the messengers. It matters who speaks about the reform. If you are talking to the legal community, for example, you need a lawyer. It you want to reach the provider community, it helps to have a provider. That s another reason why the diversity of people on the steering committee and in the work groups was so important. They became the champions for IOC among their peers. Creating ambassadors is particularly important in terms of reaching the community. Few child welfare agencies have a very good reputation in the community. Joan Williams, from the West Philadelphia Coalition of Neighborhoods and Businesses, notes that their members had a very negative opinion of DHS, given what had been in the news. Her colleague Tolbert agrees. I really want to increase the visibility of DHS staff so that the community can see the commitment, he says. These communicators will be a huge asset to IOC. The more communication the better. Finally, DHS learned that communication has to stay on the front burner all the time and needs ongoing support from top leadership. When it comes to communicating, Beilenson says, More is more. He points out that as IOC gained momentum, getting DHS approval for communication efforts and materials a bureaucratic requirement that often slows progress got faster over time. The amount of information that has gone out over the last six months has increased and has improved the standing of IOC among key constituencies, he says. 46 casey family programs casey.org casey.org casey family programs 47

23 Challenges and Opportunities This is changing the role of the public work force. This is changing the way business is done with private agencies. This is developing an alternative set of tools to monitor what goes on. This is hard stuff. Donald Schwarz, deputy mayor, Philadelphia From the beginning, DHS aimed for a big reform. Leaders had tried tweaking the system in the past, but that was not enough. As they built out their vision, the work grew in size and scope. The scale is large, not only because Philadelphia is a large city with many families and children in the system. Behan of the Annie E. Casey Foundation believes that IOC is the most complex child welfare reform that has happened in the U.S. in recent memory. The reform is large because it covers a range of complex areas, all rolling out at the same time. They include: Moving responsibility for ongoing case management to private providers and embedding it in the community. Changing practice by including parents and youth in decision making through family team conferencing. Building the protective capacities of families through implementation of the Strengthening Families framework in the community. Changing how child welfare is funded through the Title IV-E waiver. Integrating any one of these reforms into practice would keep a child welfare system busy. Implementing all of them at once might seem daunting, but not to DHS. It did the hard work to get IOC going and is pulling out all the stops to support it. Besides, to DHS, these four areas of reform are not separate at all, but intertwined. Success in one directly affects outcomes in the others. The optimism of the leaders is framed with reality. Leaders at the city and DHS and in the community are mindful of the challenges. They fully expect to face glitches, problems and communication gaps, particularly during the first years of operation. Among their concerns are: The Delicate Dance of Running Two Systems at Once Running two systems at once within DHS is clearly the 800-pound gorilla in the room. Until IOC is fully rolled out in 2016, some part of DHS will still be working under the old, dual casemanagement model, where DHS workers share casework responsibilities with private providers and where family conferencing is optional. Maintaining safety for the children and families in the regions without CUAs will be just as important as for children and families in the jurisdictions where the first CUAs will go live. Ash, the chief deputy city solicitor, says implementing IOC while still running the old system is a bit like trying to get on a plane and off a train at the same time. Ali, the DHS operations director, says, It will be chaotic for the leadership. DHS is protecting regional directors and line staff from dealing with this dual personality crisis. Leadership will manage both systems, but they promised directors and workers that no one would have to work with one leg in the old system and the other in IOC. Line staff will continue to focus on the current system until their region is turned over to IOC. It s too confusing to expect people to flip between the two systems, Garret Harley says. The CUAs, too, as they come online, especially the early ones, will be running two systems at once: ramping up IOC with teams of new case managers and supervisors, but still handling older DHS contracts to provide services to families whose cases are not yet part of IOC. A related challenge for DHS is maintaining a viable workforce during the transition. Some DHS workers and supervisors are already moving into new jobs under IOC. Dougherty, the Family Court judge, is particularly concerned about this, especially if their caseloads are transferred to new or inexperienced caseworkers. DHS acknowledges this as an issue to watch. Dougherty notes: The beauty is that the commissioner and the deputy commissioners have been very open about this concern. They are aware of it and want to look at it collectively to address it before it arises. By the end of 2012, DHS was looking at the possibility of accelerating implementation of IOC, so that the entire system will be working from the same song sheet sooner. As Sanders, chairman of the Community Oversight Board, The length of time to implement IOC makes sense, but it also prolongs the period when there s dual management. The department s increasing sophistication in accessing data, and using it to drive decisionmaking, will help during the transition. With data, Sanders says, we can monitor these issues and deal with the questions that come up. Follow the Bouncing Ball If it sometimes seemed like everything was happening at once, it was. And this reform moved relatively fast, especially for child welfare. The steering committee first met in December 2010, and the work groups began in the first half of By July 2012, the first two CUAs were announced, with plans to start rolling out the new system in January That is almost unheard of in child welfare, where theoretical debate about goals and methodology can go on for years without implementation. The department s increasing sophistication in accessing data, and using it to drive decisionmaking, will help during the transition. With data, Sanders says, we can monitor these issues and deal with the questions that come up. 48 casey family programs casey.org casey.org casey family programs 49

24 The more planning they did, the more questions they asked and had to answer. It s not a natural thing to just go from vision to practice, Asad says. There is a lot that has to be done along the way. But they stuck to it. Staff calendars and inboxes are full. DHS has an system that shuts down if it gets overloaded, a stressful event faced by more than one DHS leader in this effort. Finding time to meet was a major challenge, but every meeting was important and the decisions made in one meeting affected issues discussed in another. Clapier, the DHS deputy commissioner, meets regularly with the DHS leadership team and the CUAs, who in turn organize their troops and it goes on from there. The CUAs, too, are fully aware of the challenges around adequate funding. As Kelly, the NET vice president, says, You only need one or two really high-end, multisystem, complex kids for whom it may be a $500-a-day placement and you go through funds in a hurry. She, too, knows there s no other system money in this pot. Funding Funding during the transition period is on everyone s mind, with cost neutrality always on the agenda. The state is aware of potential budget complications, as Mackereth, secretary of the state s Department of Public Welfare, points out: We want to make sure DHS has enough money, because there is no new money. We want to make sure they are meeting the needs of children and families, while both scaling up and scaling down at the same time. That s a difficult task. The CUAs, too, are fully aware of the challenges around adequate funding. As Kelly, the NET vice president, says, You only need one or two really high-end, multisystem, complex kids for whom it may be a $500-a-day placement and you go through funds in a hurry. She, too, knows there s no other system money in this pot. DHS is committed to supporting IOC as the CUAs and DHS staff adjust to the changes. Cost neutrality is required in the long run. The flexibility of spending with the Title IV-E waiver will make a difference, as can a decrease in the use of unnecessary congregate care, which will save money while supporting children and families better in their own communities. Sticking to the Model Some interviewed for this report are concerned about model drift, a notuncommon byproduct of large-scale reforms. But DHS does not intend for the CUAs to develop their own mini dual case-management system highlighted by role confusion between the CUA case managers and their subcontractors. The training for both DHS and the CUA workers is very specific about roles and responsibilities. The CUA case manager will be the family s main point of contact. The staged rollout of cases at each CUA will help them hold onto the model, as will their daily dashboard to track their data and learn from their practice on an ongoing basis. In addition, both the IOC steering committee and the Community Oversight Board will continue to meet and will be following the rollout with care, ensuring that the model does not get lost in translation. Collaborating With Education and Mental Health Collaboration between child welfare and education is a thorny problem in most systems. In Philadelphia, school systems do not share data with local government, except by court order. Given that one in three Philadelphia families has contact with DHS, what happens to children s schooling when they are in the child welfare system is of critical importance to both DHS and the Department of Education. Schwarz, the deputy mayor, had not anticipated the difficulty of sharing information and resources with education. It s a completely different vocabulary, he says. The partnership between child welfare and mental health is a critical one because so many children and families in contact with DHS are challenged with mental health and developmental issues. This is particularly true of older youth in congregate care, who often need intensive mental health support. The use of common assessment tools, as well as better ways to share information and strategies between departments, is on the agenda. For example, with IOC, staff will be using the Child and Adolescent Needs and Strengths (CANS) assessment tool, which helps identify children and youth who need support around serious emotional health issues. The Department of Behavioral Health does not currently use that tool. However, Arthur Evans, Philadelphia s commissioner of behavioral health, was acting commissioner of DHS before Ambrose was hired, a position that reinforced his understanding of the needs of families in the child welfare system and clearly speaks to the future of collaboration and support between the two departments. In addition, Evans serves on the IOC steering committee and, with Ambrose, is an ex-officio member of the Community Oversight Board. The partnership between child welfare and mental health is a critical one because so many children and families in contact with DHS are challenged with mental health and developmental issues. This is particularly true of older youth in congregate care, who often need intensive mental health support. 50 casey family programs casey.org casey.org casey family programs 51

25 Conclusion Which is Really a New Beginning Any change will be a lot of struggle. And this is a major, major change, so the struggle will be that much longer and harder. But I really do believe at the end of the day, you ll see a better system and kids will be safer. If they stay in their communities, people will look out for them. Families will not be afraid of DHS or of accepting services, because they will know you re not automatically coming in to remove their child. And if you invest dollars in the community, people can find jobs. They will feel important, will have a say in what s going on in their community and will build up the community. Barbara Ash, chief deputy city solicitor, Child Welfare Unit With IOC, DHS is upping the ante. The gates to implementation are open, and the CUAs and DHS are poised to welcome another round of lessons as they enter this new world of child welfare practice together. DHS leaders and staff at the two CUAs may be a bit tired from the intensity of the planning and preparation, but they are finding reserves of resiliency they did not know they had as they bet their careers on a better system of care for children and families in Philadelphia. Leaders know there is no shortcut to child welfare reform. But DHS and its partners built the political will to take the risk, and they are carrying IOC forward with a lot of hope and just a little anxiety. During planning, they may have felt as if they were building something akin to a Rube Goldberg machine, a highly complex mechanism with chains and pulleys and levers all moving sequentially. But in this case, at least all the parts were moving toward the same end. The juggling and planning will continue and will, quite possibly, intensify as the lessons from implementation come in on a daily basis. Leaders learned to listen and communicate in this first stage of the work. The key for us as DHS leadership now, Clapier says, is to be proactive in identifying groups affected by the change and then ensuring that we are truly listening and being transparent with what we know and what we do not know yet. This goes for community providers as well. There is a large group of current DHS providers who will not be CUAs. DHS wants to engage them and find a suitable place for them within the IOC framework. Many will become subcontractors to the CUAs and, as Clapier points out, can become valuable resources for children and families, not to mention the CUAs. He added that subcontractors will have the opportunity to specialize and develop expertise. Holding Each Other Accountable Nothing is more important to success than accountability, and DHS welcomes both scrutiny and support. DHS is held accountable to the mayor, to the courts and, most especially, to the families and children who need help. In addition, DHS will hold the CUAs accountable, and under IOC, the department is strengthening its focus on monitoring and assessment. The IOC steering committee and the mayor s Community Oversight Board will continue to meet. When Nutter took office in 2008, he could have allowed the oversight board to expire. In fact, Sanders, the board s chairman, went to the new mayor, ready to say the board s role was done. Nutter responded with a definitive no. We want our feet kept to the fire, he explains. If we re performing well, then wonderful. We ll pat ourselves on the back for about 10 seconds and move on. If we re not performing well, let me know what we need to fix. Sanders believes that as its role has evolved and strengthened, the board has become a possible alternative to the kind of court oversight that usually comes with lawsuit settlements. He suggests that an outside structure like the board, one that is accountable to the elected official responsible for the system, might be a model to try in other places. To his knowledge, this has not been done elsewhere. High Hopes and Great Expectations Leaders in Philadelphia are clearly not afraid of taking risks. They know they will need to fix some things along the way. DHS leaders are grateful to those who are taking this journey with them, who will not hesitate to speak up when problems arise and, more importantly, who will not hesitate to help strategize. Everyone interviewed for this chronicle has high hopes that IOC will succeed. Most have confidence, too, because they know their hopes are backed up by the hard work of the planning period and the checks and balances built into the new system. Margaret Zukoski, who represents the association of providers, still has some questions about how the providers will roll it out, but she is an IOC supporter. Her wish for IOC is that every outcome we ve spoken about comes true, that children are safer, that s the main thing. I hope that children are not taken out of their home to the degree they are now, that if they are removed, they are reunified more quickly. Child advocate Cervone hopes that DHS will be seen by the community as part of the solution, not the problem. Distrust of DHS, he says, is like not being able to trust the fire department when you call them. It s that seditious. Nutter responded with a definitive no. We want our feet kept to the fire, he explains. If we re performing well, then wonderful. We ll pat ourselves on the back for about 10 seconds and move on. If we re not performing well, let me know what we need to fix. 54 casey family programs casey.org casey.org casey family programs 55

26 Gwen Bailey of Youth Service Inc. hopes that families needing services feel respected, that they feel they are being responded to, that they are not met with criticism and judgment but are really helped to support themselves as best as possible in their own communities. For its part, DHS is determined to give the CUAs the support they need to make IOC work, to make these hopes a reality. Not giving the CUAs the resources to succeed is simply not an option for us, Clapier says. If the CUAs fail, we fail. Social workers always talk about working themselves out of a job in the future. IOC is how they want it to happen in Philadelphia. I would love it if this put me out of business, Ambrose says, because we ve created a safety net at the community level that the community buys into and everyone is part of taking care of the children. The End Ambrose expresses the hopes of her DHS colleagues and the CUAs, too, when she says of IOC: I hope I see improved outcomes for children, that we reduce the number of kids in placement and increase permanence. Those goals can be measured, but there are other hopes that Ambrose also talks about, things that aren t necessarily measured by child welfare data: I hope we see a change at the community level that makes living in Philadelphia a better experience for children and families. I hope that the transformation of this agency results in a transformation of communities for kids and families. The hopes are that clear and that significant. Casey Family Programs engaged Joanne Edgar to chronicle the stories of Improving Outcomes for Children (IOC) in Philadelphia. This report is the first in a series. It includes the voices of those most involved in and affected by change, and it captures their stories, which are at the heart of the IOC innovation. Casey Family Programs wishes to thank DHS, the court, providers and other stakeholders who generously shared their time and wisdom for this report. 56 casey family programs casey.org

27 Anne Marie Ambrose commissioner, DHS I hope we see a change at the community level that makes living in Philadelphia a better experience for children and families.

28 IMPROVING OUTCOMES FOR CHILDREN IN PHILADELPHIA: Casey Family Programs casey.org