Moving Toward Performance-Based, Managed Care Contracting in Child Welfare: Perspectives on Staffing, Financial Management, and Information Technology

Abstract

Social service managers in performance-based and managed care contracting environments may be required to alter their agencies' personnel, financial management, and information technology practices to deal with the heightened financial risk present in these environments. This study describes the barriers that nonprofit child welfare managers faced, as well as the changes their agencies made, in these three areas of organizational functioning while adapting to a performance-based, managed care contracting environment. It reports on the results of analyses of in-depth interviews with administrators and foster care supervisors from nine nonprofit agencies either operating under or in the process of transitioning to a performance-based, managed care contract with the state of Michigan's public child welfare agency.

Keywords:

• child welfare
• performance-based contracting
• managed care
• staffing
• financial management
• information technology
• service provision

Acknowledgments

Support from the Aspen Institute Nonprofit Sector Research Fund, the Michigan Department of Human Services, the Nonprofit Academic Centers Council, the Global Program for Youth of the W.K. Kellogg Foundation at the University of Michigan School of Social Work, and the Horace H. Rackham Graduate School at the University of Michigan is gratefully acknowledged.

Notes

1. While the pilot did not contain some common managed care characteristics such as capitation or uniform case management services, it was considered by both FIA and the nonprofit agencies to be a managed care initiative. Official FIA documents described the pilot as a managed care system (Family Independence Agency, 2000), and administrators from agencies with pilot contracts made public presentations in which they referred to the pilot as a managed care system. Additionally, during the telephone interviews conducted as part of the process evaluation of the pilot, agency respondents noted repeatedly that they believed the pilot to be a managed care system.

2. For a full description of the life cycle of the pilot initiative, see Meezan and McBeath (2006).

3. Parts of this section are based on previously published works, including Meezan and McBeath, (2003), McBeath and Meezan (2006), and Meezan and McBeath (2008b).

4. The nine participating agencies were (alphabetically): Catholic Social Services of Wayne County (pilot); Evergreen Children's Services (non-pilot); Homes for Black Children (pilot); Judson Center (pilot); Lutheran Child and Family Services of Michigan (pilot); Lutheran Social Services of Michigan (non-pilot); Orchards Children's Services (pilot); St. Francis Children's Services (non-pilot); and Spectrum Human Services (pilot).

5. No foster care workers or case managers were interviewed regarding the questions addressed in this paper, (although interviews did take place with 20 line workers on other topics), for two reasons: it was determined that few workers had been employed at the pilot agencies prior to the inception of this initiative, and therefore they would not be able to address issues concerning changes that occurred due to its implementation; and line workers were unlikely to have been aware of changes that occurred in most of the areas addressed in this manuscript.

6. The Adoption and Safe Family Act of 1997 dictates that the goals of any child welfare system should be child safety, permanency, and well-being.

Adoption and Safe Families Act of 1997, Pub. L. No. 105-89, 111 Stat. 2115 (1997).