Senators assess youth services reform

A joint hearing of the Health and Human Services Committee and the Children’s Behavioral Health Oversight Committee heard testimony Aug. 25 on LR568, a resolution passed during the 2010 regular session authorizing an interim study of recent reforms within Nebraska’s child welfare and juvenile services system.

LR568 calls for an examination of the state Department of Health and Human Services’ implementation of changes to juvenile services intended to reduce out-of-home care, the effectiveness of public-private partnerships and the impact of recent reforms on the state’s ability to meet various federal guidelines regarding the safety and well-being of juveniles receiving state services.

Kerry Winterer, chief executive officer of DHHS, said the department is committed to reform in spite of setbacks since implementation began statewide April 1. Since that time, two of the five lead agencies the department contracted with to coordinate service provision are no longer involved in the process due to financial difficulties, he said.

“Reform is about fundamentally changing the system,” Winterer said, adding that the goal is providing care while keeping juveniles in the home whenever possible. “Some things are going well but we also know that we continue to have challenges.”

Todd Reckling, director of the division of children and family services, said the remaining lead agencies – KVC Behavioral HealthCare Nebraska, the Nebraska Families Collaborative and Boys and Girls Home – are collaborating with the department to find efficiencies and to ensure continuity of services to youth and families during the reform process. DHHS also is working with a national organization to learn from the experience of other states, Reckling said.

“But each state is unique,” he said. “It takes time to reform the system.”

Judy Dierkhising of the Nebraska Families Collaborative said the organization was “surprised” by the cost of foster care services, non-court cases and extended treatment. The cost of those services is averaging approximately $350,000 a month over what the organization budgeted, she said, adding that they likely will spend $5 million over the next two years to cover the gap.

That requires continually seeking outside funding sources, Dierkhising said.

Jeff Hackett of the Boys and Girls Home said he remains hopeful about reform in spite of the “traumatizing” effect of losing two agencies early in the process due to the cost of providing service coordination.

“That raises a lot of fear and justifiably so,” he said, adding that subcontractors who provide direct services and are paid by the lead agencies are understandably concerned.

Hackett said Boys and Girls Home has relied on over $3 million from its donor foundation to cover budget gaps, but said donors may be reluctant to continue to underwrite the organization’s contract with the state. Regardless of the challenges, however, the organization is committed to the reform process, he said.

“Our intent is to sustain ourselves and make this work.”

KVC Behavioral HealthCare Nebraska president Sandra Gasca-Gonzalez said her agency has benefitted from involvement in similar reform initiatives in Kansas and other states.

“The reality is that we have been through this before,” she said. “We know that there will be significant challenges.”

KVC had to build relationships quickly when it became the sole contractor in southeast Nebraska after the state’s contracts with Visinet and Cedars were terminated, she said. KVC has faced the same financial challenges as the other remaining lead agencies, including unreimbursed service provision, she said, adding that they expect to operate at a loss of approximately $6 million annually for the next two years.

“We show ourselves breaking even by year three,” Gasca-Gonzalez said.

Over time, she said, KVC plans to find appropriate funding sources to pay for services that currently are unreimbursed and to implement other efficiencies.

“Luckily, we are in a field where what is good for children is also good for our bottom line,” she said.

A follow-up hearing of the Children’s Behavioral Health Oversight Committee, which will include public testimony, is scheduled for Sept. 22.