COUNTY OF ALBEMARLE
Charlottesville/Albemarle Commission on Children and Families (CCF) Report on the Comprehensive Services Act – Cost Containment Subcommittee Report
Request approval of Findings and Recommendations presented in CCF’s CSA Cost Containment Report and Recommendations
STAFF CONTACT(S): Ms. White, Ms. Ralston,
AGENDA DATE: ITEM NUMBER:
ACTION: X INFORMATION:
ATTACHMENTS: Yes, Cost Containment Report
The Comprehensive Services
for At-Risk Youth & Families Act (CSA) is a state law that consolidated
funding for legally mandated services to troubled children and families and
required the establishment of local interagency management and service delivery
systems to plan and provide services.
Since the program began in Fiscal Year 1994, CSA caseloads and costs have increased steadily. The average annual increase in children served has been 8% for Charlottesville and 19% for Albemarle. Expenditures of CSA funds for the City have increased an average of 23% per year and for Albemarle, 27% per year. Primarily the growing number of children required to be served and the increasing severity of their service needs has driven CSA cost increases. At the same time, administrative staffing for CSA coordination has remained unchanged at 1.2 FTE positions in the CCF office. State funding for administering this $12 million program (in Fiscal Year 2003) is only $30,456 per year.
Due to growth in the CSA program and its state-mandated administrative requirements, the Charlottesville/Albemarle management and service delivery system has become overloaded. In July 2003, an interagency work group implemented changes to improve the efficiency and effectiveness of the service planning process, however, costs remain a concern. In February 2003, CCF and its CSA Committee established the CSA Cost Containment Subcommittee to study the reasons for cost growth and recommend ways to improve cost control. The subcommittee worked for nine months researching data, examining program operations, and identifying best practices in other localities.
This item relates to Strategic Direction #3, “Enhance the Quality of Life for all Citizens.”
The attached CSA Cost Containment Report presents its findings and recommendations grouped in four categories: Utilization Management, which refers to the activities and processes involved in assessing service needs, selecting providers, delivering, monitoring, evaluating and terminating services; Prevention Services, which refers to the fact that CSA costs are driven by the number of children required to be served, and preventing children from entering foster care and reducing the need for out of school placement is the single best way to control CSA costs; Intervention Services which includes assessment of service needs, service plan development, and provision of services by staff in local CSA agencies; and, Policy Issues, which refers to the need to address several policy areas that could help reduce costs in the CSA program. Below is a select listing of findings and recommendations in each area. The fiscal impact is included in the recommendation, if appropriate.
Primary Findings: 1. There is insufficient personnel capacity and funding within the CSA staff and committee structure to accomplish the work necessary to effectively manage the program and control costs; 2. There is insufficient awareness of and case manager and staff attention to vendor accountability and cost control; 3. CSA agency staff and the CSA Coordinator lack adequate time to conduct thorough case-specific utilization review and system-wide utilization management; and, 4. Limited information is available about outcomes achieved by service providers and the effectiveness of different treatment methods they use.
Recommendations: 1. Establish a full-time Utilization Management Coordinator using appropriated CSA funds (does not require new local funds); 2. Appropriate funds to establish a half-time Family Assessment and Planning Team (FAPT) Coordinator to coordinate clerical functions that would allow CSA coordinator to focus on program management functions that can have an effect on cost control outcomes (requires an additional appropriation of $13,115 in new local funds); and 3. Establish a single FAPT team model to achieve a higher level of expertise and more consistent attention to cost issues (does not require new local funds).
Primary Findings: In recent years older children, ages 12 and up, have become a larger percentage of the foster care CSA caseload. They are typically more difficult and costly to place and serve; the rate of children in foster care in both the City and the County exceeds the state average (36.9 per 1,0000 children in the City; 8.4 in the County; and an average of 4.4 statewide; the national average is 7.5). The number of children in foster care appears to reflect a community philosophy that is especially proactive in preventing children from “falling through the cracks.” And, existing foster care prevention programs have documented success, but lack the capacity to serve all children at high risk of placement.
Recommendations: 1. The City should fund two new Foster Care prevention social worker positions by taking advantage of Title IV-E federal funds; 2. The County should ensure continued funding for foster care prevention services, such as Bright Stars and Family Support Programs; and, 3. City Council and the Board of Supervisors should direct any additional local funding to support other prevention services programs using models with demonstrated success for children ages 11 and older, guided by data on service effectiveness from the CCF and its budget review teams.
Primary Findings: 1. When children must be placed out of home on an emergency basis, there is often no local resource for placement, nor is there an opportunity to conduct a thorough assessment of problems and service needs prior to placement. This can contribute to unnecessarily high cost if children must be placed in more intensive treatment than would be necessary if there was opportunity for better assessment. The subcommittee found that some children are rejected or ejected from multiple treatment facilities on an average of 2.9 facilities that were unable to meet their needs. Some of this is attributable to the inability to conduct a thorough assessment due to the mandatory and emergency need for placement.
Recommendations:: 1. The City and County governments
should support the CSA committee in developing a local program or system to
provide CSA-purchased comprehensive multidisciplinary assessment of any child
who requires it; and, 2. The community should develop and implement local
programs or facilities to accept and stabilize any child in a crisis situation
who needs a CSA funded emergency placement.
There is currently underutilized space at the
Primary Findings: 1. State funding provided for local CSA administrative costs is only $30,380 per year, about 0.2% of total CSA expenditures in FY 2003. There has been only one small increase in nine years, even as mandated administrative requirements have steadily grown; and, 2. Public residential mental health treatment facilities for children have been virtually eliminated by the Commonwealth of Virginia, which has resulted in state-to-local cost shifting. Children with serious mental and emotional impairments who in the past would have been placed in state facilities now must be served by private program with CSA funds.
Recommendations: 1. The City and County should advocate for increased state funding for CSA administrative costs and for relief from cost shifting from the state to the localities through supporting VML and VACO legislative positions on this issue.
The above is a brief summary of the recommendations and strategies that the subcommittee developed. It is not all-inclusive. There are numerous implementation strategies that have not been discussed in this summary, but involve internal structural review and revision to achieve cost containment goals.
The full text of the
report is attached, minus the appendices.
The full report, plus appendices, is available online at www.ccfinfo.org. If Board members would like a hard copy of
the appendices, please inform the Office of the
Staff recommends approval of the report and its recommendations.