Investment Measures used in other cities and states across the country have demonstrated the success of similar community-based models. As Philadelphia begins to roll out CUAs under the IOC model, it is important to understand the social value of the investment that is being made in them. A Need for Change The CUAs are changing the very structure of the child welfare system in Philadelphia. In doing so, they continue to be boldly disruptive. By contributing to the broad restructuring of DHS, the CUAs serve are reforming the hierarchy of a child welfare system that had struggled for decades. There is a pressing need for the CUAs. As Regan Kelly notes, “We cannot go back to what used to be.” The CUAs are meant to be family- and community-centered organizations that are meant to support both greater well-being and greater permanency among children and youth in the child welfare system. Yet will that be the case? This form of child welfare system has only recently been rolled out in Philadelphia. However, one can gain a comparable social return on investment by examining data acquired from other states using similar models, in particular, the community-based care center in the state of Florida. The scale of child welfare reform is broad. Under IOC, however, child well-being and permanency are two primary objectives. By focusing on these, it becomes easier to assess and evaluate this field. The CANS assessment offers a measurement of such factors from a strengths-based perspective. In the past, Philadelphia has used the CANS specifically to better understand residential lengths of stays for Treatment Foster Care. The use of this tool has not only helped the city to greatly reduce treatment foster care stays but also saved the city $11 million in just its first year of usage. Additionally, the CANS is used extensively in the state of Florida. It not only informs service delivery and tracks outcomes, it can also help to determine the appropriate level of care for a child. In particular, the CANS for children and adolescents in the child welfare system measures nine categories of information: functional status, caregiver needs and strengths, child safety, substance abuse, mental health, case management, child risk behaviors, criminal and delinquent behaviors and child strengths (Praed Foundation, 2012). IOC Stakeholders Many individuals and groups have a stake in this new child welfare system. Children and families are the primary target group of the CUAs. Families involved in child welfare seek to gain from services that are coordinated around their local communities. With the implementation of the CUAs, families stand to specifically benefit from shorter commutes to required services and a streamlining of case management services through one nearby provider agency. Next, existing agency providers have enormous interest in the new system. More than 250 providers are currently in competition for the remaining CUA regional contracts. With such a limited number of contracts available under this new system, some agencies will lose out. Conversely, those agencies that do receive CUA RFPs will have to also adjust their previous policies and practices. Case managers in particular at these agencies will need to adapt to a more intensive, long-term and localized form of family case management. DHS also has much at stake in the IOC model. Financially, DHS allocated a combined $25 million in the first year of work between APM and NET. While DHS continues to define to how much funding future agencies will receive, the department now must also carry the costs of running the existing child welfare systems simultaneously as well. Organizationally, DHS is taking a risk as well. Though it has been promised that no jobs will be lost during the rollout of the CUAs, this new system marks a fundamental, hierarchical change of power within DHS. Without case management responsibilities, DHS workers will need to adapt to new roles that focus more on intake, investigation and data tracking. Social workers’ and supervisors’ unions connected to DHS thus also have an interest in the success and returned value of this new child welfare system. Needing to protect their members both financially and professionally, these unions are highly invested in a smooth transition between systems. Finally, the mayor’s office is also strongly invested in the success of the CUAs. It has contributed a great amount of money and research to this new approach. Though smaller improvements have been made in the DHS system in recent years, the mayor’s office has fully supported this overhaul. Determining Inputs, Impacts and Social Return on Investment – A Florida Example For the purpose of determining the true social return on investment, data drawn from community-based care centers in Florida in 2005 on out-of-home youth will be used as indicators to define inputs. Inputs reflect the quantified value of the sum of investments made by various stakeholders in a project. In this case, the inputs focus around those connected to the target group of the CUAs, namely, children and families in the child welfare system. In particular, inputs related to child permanency and well-being will be explored both through quantitative data and through data obtained from the CANS. The state of Florida adopted a statewide community-based child welfare system in 1996. However, it was only in October 2006 that Florida obtained an IV-E waiver of the Social Security Act. In doing so, Florida was granted greater flexibility in using federal funding to promote services that supported well-being and permanency for children. In particular, the waiver was intended for three purposes. It was meant to reduce the number of children placed in out-of-home placements, to reduce the lengths of their stays and also to increase the amount of prevention and intervention services available in the state (Armstrong, Swanke, Strozier, Yampolskaya, & Sharrock, 2013). By the end of 2005, it is known that 28,679 children had entered out-of-home care placements in Florida. The yearly cost of keeping one child in foster care at that time was $5,214. Therefore, the state of Florida was investing $149 million dollars each year in placing children out of their homes and away from their families (Armstrong et al., 2013). Several activities and events contributed to this cost. First, before the IV-E waiver, the state of Florida had extensively focused on community prevention, not on local reunification. Additionally, families also contributed to this cost. Many families frequently traveled great distances in order to reunite their families and to comply with the requirements mandated under the previous child welfare system. Attitudes and access changed once the IV-E waiver went into effect, however. After 2005, the state was not only able to focus more intensively on community engagement and prevention but also able to develop community and family programs to reduce the number of out-of-home placements. Families in the welfare system responded favorably to these new services. The outputs from these expanded local services for families are evident. By the end of 2011, heightened community-based services and engagement had paid off. Out-of-home placements declined to 15,217 youth. The rates of out-of-home care declined because families were investing in family-centered resources in their communities. Meanwhile, the rate of reunification had increased from 50.5% in 2005 to 51.1% in 2011. The outcomes associated with such improvements in community-based care are notable. By 2011, the annual cost of paying for youth in out-of-home care had declined to $84.2 million per year (Armstrong et al., 2013). Not only did the state gain from the expansion of community-based services, but families and children benefitted as well. Families were able to travel increasingly shorter distances for services, particularly regarding reunification procedures. They also had access to a growing amount of community preventative programming and resources. Finally, children were also able to gain from this improved system. Data from the CANS demonstrate improved capabilities among youth and their families. The true impact of the community-based care centers in Florida affects how the final social return on investment is understood. The outcomes from these improvements following the IV-E waiver are striking. However, it is also likely that at least a portion of these outcomes would have been achieved even without the introduction of the waiver and the expansion of community-based services. Community-based care centers have produced generally positive results in Florida since their rollout in 1996. In 2004, 25,615 children were served by out-of-home care, resulting in over $137 million spent by the state. When this amount is subtracted from the over $84.2 million that state spent in 2011, the actual impact amounts to $53.2 million. This reflects how much money the state would have spent on out-of-home youth had it not been for the waiver (Armstrong et al., 2008). The social return on investment for community-based centers in Florida incorporates this analysis of inputs, outputs, outcomes and impacts. The objective of this community-based system is to increase permanency rates and to improve the well-being of children and youth in the system. More specifically, it seeks to reduce costs associated with out-of-home care. Social return on investment here can be calculated by dividing the total impact that this system will have by the total outcomes of the system in 2011. The final return on investment then comes out to be 63.1%. The CUAs in Philadelphia have only recently begun to roll out. Nevertheless, it is important to understand the actual return that such a great investment might have for the city. The example of similar models being used in other states and cities allows for an adequate comparison. Community-based care centers in the state of Florida offer an ideal assessment by allowing the comparison of data before and after it expanded its community-based services. The high rate of social return on investment that is produced in this example offers favorable insight into what may similarly prevail in Philadelphia. Moving Forward Truly, there are no easy answers. Philadelphia’s child welfare system, by its own initiative, is in the process of fully transforming itself. This paradigm shift is leading the city into uncharted territory. However, DHS believes that through the lessons learned from the recent past, Philadelphia is equipped to not only handle but excel in this transition. Enacting cross-sector collaboration, increased accountability through single-case management, rigorous data tracking and intense focus on individual communities, Philadelphia intends to become one of the first successful implementers of this model as a nationwide leader. At this point, there are many questions that have yet to be answered and that will have to remain unanswered until data and outcomes can act as a true compass. We can look to other examples and obtain a glimpse of the promise that this new model can hold. Despite the current ambiguity, in 2006 Philadelphia’s DHS was in dire need of a disruptive innovation in order to survive—it needed a lifesaver. The concept of a community- and family-centered, single-case management system is an innovation for Philadelphia. Its theory and implementation represent a fundamental shift in the belief system landscape. It recognizes that the traditional paradigm was not achieving safe outcomes for at-risk youth and demonstrates the extent to which the city will go to protect the children that live within it. In 2006, during the grand jury trial of Danieal Kelly’s death, that dedication to children was in question. Through IOC and the implementation of the CUA model, DHS’ Children and Youth Division is reinforcing the belief that when families and communities are put at the very center of the decision, then Philadelphia can truly improve outcomes for children. Sarah Evans is the associate director of Development at the Abramson Cancer Center at the University of Pennsylvania Health System and recently received her master of science in nonprofit leadership from the University of Pennsylvania. Jennifer Lydic is a dual-degree graduate school candidate at the University of Pennsylvania, where she is pursuing a master of public administration at the Fels Institute of Government and has recently completed a master of social work from the School of Social Policy and Practice. REFERENCES Armstrong, M. I., Swanke, J. R., Strozier, A., Yampolskaya, S., & Sharrock, P. J. (2013). Recent changes in the child welfare system: One states experience. Children and Youth Services Review, 35(10), 1712–1718. doi: 10.1016/j.childyouth.2013.07.005. Armstrong, M., Vargo, A., Jordan, N., King-Miller, T., Sowell, C., & Yampolskaya, S. (2008). Report to the Legislature: Evaluation of the Department of Children and Families Community-Based Care Initiative, University of South Florida. Retrieved from cfs.cbcs.usf.edu/_docs/news/CBC_LegReport.pdf Casey Family Programs. (2012). Improving outcomes for children in Philadelphia: One family, one plan, one case manager. Philadelphia, PA: Casey Family Programs. Retrieved from dynamicsights/dhs/ioc/files/1330_SC%20IOC%20Philly%20Chronicle_sm.pdf City of Philadelphia Department of Human Services. (2007). Department of Human Services at a glance 2007. Retrieved from phila.gov/districtattorney/pdfs/Grand_Jury_DHS_new.pdf Human Systems and Outcomes, Inc. (2010). Pennsylvania Quality Service Review (QSR) for children, youth and families. Retrieved from pacwrc.pitt.edu/Resources/PA%20QSR%20Protocol%20Version% 201%200.pdf The Praed Foundation. (n.d.). About the CANS. Retrieved from praedfoundation.org/About%20the%20CANS.html#Here
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