State changing how troubled families are served
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By NANCY HICKS / Lincoln Journal Star
The state is changing the way services are provided to troubled families by dramatically reducing the number of contracts it has with agencies to provide services and making a few private agencies responsible for keeping families together.
Instead of more than 100 contracts — with many agencies providing a single service — the state will contract with six, large private agencies.
Beginning July 1, those six agencies will provide all the services required to work to keep children safe and living with their families.
The following example, which shows how the state investigates and handles reports involving troubled families, is fictional:
A Health and Human Services case manager investigates a report that young children in a family have been seen outside playing at midnight several times in the last few weeks.
The case manager finds the young, single mother is overwhelmed. Her own mother recently died. Her boyfriend left. She admits she has been drinking too much and has not heard the children leave the house, which is filthy and has little food.
The case manager decides the children are in danger of neglect, but the family might be able to stay together with help: counseling for the mother and a few months of family support, where a worker comes into the home to teach her how to discipline her children, manage her money, and plan and prepare meals.
The case manager decides to put the children into an emergency shelter while things are being sorted out. So the HHS worker starts making arrangements for services, contacting several local agencies.
How it will change
Under the new consolidated system that begins July 1, the HHS case manager will still do the initial investigation. But then the manager will call just one number, and the family will be assigned to an agency that offers, through its network, all the necessary services.
If it is a crisis situation, that private agency must have a worker at the family home within two hours.
If there is no crisis but some serious issues, the agency should contact the family within a day.
If there are no serious safety concerns, the HHS case manager will set up a meeting with the agency worker and the family to discuss services.
The private agency will provide all services, and both HHS and the agency will monitor progress.
Agencies to provide services
These agencies have signed contracts to provide services in a specific region under the new system.
Southeast Service Area: OMNI Behavioral Health, $2,846,347; Cedars Youth Services, $3,580,925; and Visinet Inc., $2,730,983.
Western Service Area: Boys and Girls Home of Nebraska Inc., $5,096,562.
Central Service Area: Visinet, $1,899,229; and Boys and Girls Home of Nebraska, $2,488,125.
Northern Service Area: Boys and Girls Home of Nebraska, $7,674,062.
Eastern Service Area: Boys Town, $1,953,930; OMNI Behavioral Health, $3,931,574; and Child Saving Institute, $957,967.
Each agency’s success rate will be evaluated and the results posted on the Health and Human Services Department Web site.
It is a major reform intended to improve the services and the outcomes, said Todd Landry, director of the HHS Division of Children and Family Services.
Landry anticipates the new system will improve services to children, as well as oversight of those services, and help the state determine what works best.
Last year, the state worked with more than 8,500 families providing in-home services and safety-related services through 116 contracts, at a cost of about $20 million, Landry said.
The goal of the new system is not to save money but “to change the way we deliver services to get better outcomes,” he said.
The winning bidders had to commit to serving the entire region, not just one county. And the agency had to commit to providing all the services, Landry said.
One result should be that families in western Nebraska have access to all services, something that currently isn’t the case, he said.
The contract agency generally will have subcontracts with other agencies in order to provide the full array of services.
For example, the Lincoln-based Cedars Youth Services has subcontracts with Lutheran Family Services and Epworth Village, said Katie McLeese Stephenson, Cedars chief operating officer.
HHS case managers will do the initial investigation, then turn over cases to the contracting private agency, which will provide all services.
Under the new system, HHS case workers will not have to make a number of calls trying to arrange for services.
“They will make one phone call, one referral to a provider,” Landry said. “It makes for a much more efficient and timely response.”
The new system also creates a partnership role between case worker and provider, he said.
The private agency will indicate what services the family needs, and, if documented, the case worker will authorize the services.
The private agency and HHS will monitor the progress, Landry said. HHS also will track how successful each network is and post outcomes on its Web site, he said.
The agencies will be rated on issues such as their timely response to a crisis call and the reduction in substantiated reports of maltreatment for the families they serve.
In regions with several contract agencies, families will be assigned to agencies on a rotating basis. That assures a fair distribution of the work, risk and reward. It also allows the state to better compare results, Landry said.
Carol Stitt, director of the state’s Foster Care Review Board, sees both benefits and potential problems with the new contracts.
Stitt says it’s unclear how the state will maintain oversight of providers. She also has concerns about the short timeline for agencies setting up new services, a two-week period between contracts being signed and the beginning of the new system.
In addition, her agency and others have questioned the quality of services by some of the agencies with state contracts.
“Why wasn’t past performance considered?” she asked.
But Stitt praised the requirements that many of an agency’s employees have college degrees and the agency provide training.
When the new system begins, some disruptions may occur as some families transfer to new providers, Landry said.
“We believe that is going to be minimal,” he said.
Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.
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