California’s Continuum of Care Reform – Will it Produce as Promised?

Over the past four years, California has undertaken a colossal effort to “reform” the state’s foster care system. Much has been written about this initiative, so I won’t dive into the details. In essence, the Continuum of Care Reform (CCR)  will, theoretically at least, accomplish the following:

  • Move thousands of youth from group homes/congregate care to family-based services.
  • Recast group homes as short-term residential treatment programs (STRTP) to prevent kids from being raised in group homes.
  • Make it easier for youth placed with relatives to receive appropriate services.
  • Introduce new levels of provider accountability to ensure a faster, more efficient way to achieve permanency for foster children and youth.

As a concept, it is great. But I think it’s important to remember why CCR was initiated in the first place: to reduce foster care expenditures. California lost a lawsuit which forced the state to dramatically increase group home rates. So, the legislature initiated a process to figure out how to get kids out of group homes to reduce state foster care expenditures. Though this has been presented as a “in the best interest of the children” initiative, that’s disingenuous. The cold, hard fact is that CCR was designed to save the state money.

The success of CCR is contingent on one major element: having a robust statewide infrastructure of qualified families to move foster youth to. Given the fact that the state’s foster home capacity has dropped substantially over recent years, and that it is becoming harder and harder to recruit and retain foster families (now re-branded “resource families”), you would think that the state would start investing heavily in building this infrastructure.

Sadly, this is not the case. And without resource families, CCR is doomed to failure.

The state has established its “new” CCR rates schedule but there is no real, substantial increase in payments to foster parents or to foster family agencies (FFAs) to help them aggressively recruit and train new families. Mind you, FFAs serve the largest percentage of foster youth in California and have been earmarked as significant players in delivering services and supports under CCR.

But basically, these “new” rates allocate the same recruitment amount that was established 20 years ago. That is actually insulting.

For the past couple of years, the state has been doling out more money to the counties to improve resource family retention and recruitment, but I can guarantee you, these are not the families who will be taking the youth coming out of group homes, many of which have significant behavioral, mental and emotional problems. The majority of these kids went into residential treatment because they needed it, not because there was a lack of placement options elsewhere.

Of equal concern is the fact that the state is not willing to appropriately pay foster parents what it takes to serve high-needs, challenging foster youth. The “new” CCR rates include, at best, a paltry rate increase, but actually decrease some rates to foster parents who provide certain levels of care, including those who care for teenagers. We should be doubling or tripling the amount paid to our foster parents who are working with challenging youth 24/7.

My agency, the Family Care Network, has been successful in working with the county to cobble together multiple funding sources in order to pay foster parents one of, if not the, highest rate in the state. But it is still not enough, nor has it helped much in our recruitment efforts.

One ray of hope in the resource family reimbursement debacle is therapeutic foster care (TFC). Yes, TFC will provide additional payment to “therapeutic foster parents” working with an FFA. But they must meet stringent vetting and training requirements, they must participate in the clinical process and complete required daily documentation, and the foster youth must meet “medical necessity” in order to qualify for mental health services. Plus, the FFA must be a qualified specialty mental health services provider with a contract to receive reimbursement. The long and short of this is that it will benefit a handful of foster parents at best, providing that you can find these families.

Another demonstration of the state’s lack of insight concerns probation youth within the juvenile justice system. These kids are one of the higher consumers of group home services and the plan is to move many of them into the community. Again, the “new” rate structure does not provide any accommodation for serving this high-risk, offender population. Most of these youth do not “meet medical necessity” and would not qualify the foster parent to receive the TFC rate augmentation. And I rather doubt there will be many – if any – foster families willing to take in a juvenile offender without substantial reimbursement and the necessary intensive services and supports.

The success of CCR will be very dependent on the health and viability of FFAs. These agencies will not only provide approved, trained families but will be one of the primary providers of services and supports to youth in care. Plus, FFAs will be the providers of therapeutic foster care.

Unfortunately, the state continues to demonstrate complete disdain for FFAs as evidenced by a succinct unwillingness to pay for these services. FFAs have not received a cost of living adjustment for 17 years, and in 2009 the state cut FFA funding by 10 percent. The “new” rate structure does absolutely nothing to restore those years or cuts.

In fact, the rates include the exact same amounts for social worker salaries, administration, recruitment and training. The social work allotment is effectively $16.09 per hour for a master’s level, highly skilled individual tasked with working with the most challenging of foster youth. In the last two years, my agency has lost over 30 social workers to governmental agencies because we just cannot compete with the salaries they pay.

Once again, the Continuum of Care Reform may be a great idea, but until California is willing to put its money where its mouth is, we will only have the status quo with a new name.

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