Return of child welfare case management to DHHS advances

The state Department of Health and Human Services (DHHS) would be required to provide case management for Nebraska’s child welfare system under a bill advanced from general file Feb. 29.

In July 2009, the department selected six private entities as lead agencies to implement a child welfare reform initiative. All but one lead agency – Nebraska Families Collaborative (NFC) in Omaha – have left the reform process, citing an inability to fund their portion of the reform effort under the terms of their individual contracts with DHHS.

Lincoln Sen. Kathy Campbell said LB961, introduced by the Health and Human Services Committee, reflects the committee’s belief that privatization resulted in too much reliance on lead agencies and that case management should reside with DHHS.

A report by the state auditor of public accounts affirmed that belief, Campbell said, and indicated that allowing providers to oversee management of their own cases can give rise to potential conflicts of interest and an incentive to prioritize costs over the best interests of children in the system.

“The state can never contract away its responsibility for these children,” she said.

During debate Feb. 28, Norfolk Sen. Mike Flood expressed concern that moving all case management back to DHHS could result in the loss of NFC as the sole remaining lead agency, requiring yet another costly and disruptive transition within the child welfare system.

He said moving families back to DHHS following the most recent loss of lead agency KVC-Nebraska will cost the state an additional $20 million.

Flood suggested the possibility of exempting from LB961 the area of the state served by NFC and using the remainder of the agency’s contract period as a pilot project to study how best to provide case management services – through the state or through a private contractor.

“This is a question that we have to be very careful answering as a Legislature,” Flood said.

Omaha Sen. Bob Krist said a pilot project in one service area should have been done before DHHS began the reform initiative statewide in 2009. He agreed that allowing NFC to continue case management in the short-term would be the least disruptive course of action.

“I think it’s the smart thing to do,” Krist said. “I think it’s the compromise that we need.”

Campbell said an amendment would be offered on select file that would include parameters and time lines for a pilot project that would allow NFC to continue providing case management in the eastern service area, with legislative oversight.

Lincoln Sen. Colby Coash said focusing on whether case management is provided by the state or the private sector will not solve the root problem with the state’s child welfare system. Nebraska has one of the highest rates in the country for removing children from the home, he said.

“The problem is that we’ve got more kids coming into the system than we can handle,” he said.

Sen. Gwen Howard of Omaha said removing a child from the home is not done by DHHS, and is not a decision that is taken lightly.

“Only police remove children from their biological homes,” she said. “And nobody – nobody – wants a dead child on their conscience.”

LB961 also seeks to address the issue of caseload size. Campbell said smaller caseloads would reduce turnover and increase workforce stability in the child welfare system.

As introduced, the bill would reduce the average caseload by 10 percent per year until each caseworker’s caseload is within standards established by the Child Welfare League of America (CWLA).

A Health and Human Services Committee amendment, adopted 40-0, changed the proposed reduction to 25 percent each year beginning Sept. 1, 2012 until CWLA standards are reached. The amendment also would require DHHS to include caseload data in its annual report and would define a caseload.

Under the amendment, if children in a family receive services in the home, all children would be considered one case. If any child is placed out of the home, each child would be considered one case.

Lincoln Sen. Amanda McGill said the distinction is important because there are a variety of ways to construct caseloads.

Best practices indicate that 16 children is the optimal caseload, she said. However, some lead agencies have been using families as the unit of measurement, McGill said, which could mean that a caseworker is serving double the recommended number of children while appearing to be within CWLA guidelines.

Sen. Tony Fulton of Lincoln acknowledged that there have been “missteps” in DHHS’s reform effort, but said that reform was instigated to solve existing problems within the child welfare system. He expressed concern that the Legislature might be engaging in “overreach” with LB961.

“Are we stepping into an area of government that is reserved for the executive branch? That is a question that I have with this bill,” he said.

Krist disagreed, saying the bill is a reflection of senators’ constitutional role. DHHS has failed in its reform effort, he said, and the Legislature needs to step in and provide the agency with direction.

“The Legislature’s responsibility is to legislate – to set policy, to appropriate funds and to provide oversight. We are not micromanaging the executive branch.”

Lawmakers advanced the bill to select file 42-0.