Bill would require DHHS child welfare case management

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 heard Jan. 26 by the Health and Human Services Committee.

Lincoln Sen. Kathy Campbell said LB961 resulted from the committee’s interim study of the recent child welfare reform initiative undertaken by DHHS, which privatized some services for Nebraska foster children and families.

In July 2009, the department selected six private entities as lead agencies to implement the reform initiative. Currently, two lead agencies remain under contract with DHHS to assist with implementing reforms.

Campbell said one of those remaining agencies, KVC Nebraska, informed the department in November 2011 that they lacked the ability to continue funding their portion of the reform efforts. DHHS was able to resolve the situation, she said, but losing another lead agency would have had dire consequences for state wards.

“Children in the southeast [service] area would have been a mere 38 days from losing all case management,” she said.

“Research shows that permanency substantially drops with each [additional] case manager that a child has,” she said. Seventy-four percent of children with one case manager achieve permanency, Campbell said, but that number drops to 17.5 percent for children who have two or three case managers.

Mary Boschult, former assistant director of DHHS, testified in support of the bill.

Case management should be the responsibility of the state, she said. Vesting case management with one private lead agency puts children at risk if the agency can no longer provide services, she said.

“It’s a disaster waiting to happen,” Boschult said.

Lincoln foster parent Lisa Koperski also testified in support of the bill, saying her experience with KVC case management was marked by confusion and a lack of communication. Koperski said her foster son had six different family permanency specialists in 18 months.

“This experience has left us feeling disappointed, frustrated and unappreciated,” she said. “The turnover in our case was unacceptable.”

Sarah Helvey of Nebraska Appleseed testified in support of the bill, saying a return to case management by DHHS would help bring long-term stability to the child welfare system. Reforms have led to a 27 percent increase in costs, she said, but haven’t improved outcomes for Nebraska children.

“[LB961] is critical to creating an accountable and dependable system that is focused on the needs of children and not the bottom line,” Helvey said.

Carol Crumpacker, executive director of Child Guidance Center in Lincoln, also supported the bill.

KVC has failed to provide adequate case management for children who receive treatment services through her organization, Crumpacker said. KVC’s case managers lack training, accountability and oversight, she said.

“This bill is just one of several that, together, will transform the system of care for children in our state,” she said.

But Scot Adams, interim director of DHHS’s division of children and family services, said changing case management duties would result in increased disruption for children in the state’s foster care system.

Testifying in opposition to the bill, Adams said it is too early to judge the success or failure of reform efforts. At least three years are required to make a full transition to a strong public-private system, he said.

“We are changing tires as we’re driving down the road,” Adams said.

KVC employee Linda Gamble opposed the bill, saying her caseload was higher as a DHHS employee. Gamble said she often had as many as 38 cases when employed by the department, while her highest caseload at KVC has been 18 families.

Father Steven Boes of Boys Town also testified in opposition. He said the committee should listen to the stories of families and workers, but urged them also to consider survey and outcome data.

“What we know about anecdotal data is that it tends to skew negative,” he said. “To dismiss an entire system … with one horrible story is easy.”

Boes said reform is showing hopeful signs and should be given ample time to succeed.

Sandra Gasca-Gonzalez, president of KVC Nebraska, agreed. Case management was shifted to the lead agencies to streamline communication and improve service delivery, she said, but final decisions regarding safety and other issues remain with the state under the current system.

“Returning case management to the state would be a step backward because we are seeing positive improvement,” Gasca-Gonzalez said.

Both privatized service areas in the state have seen improvement in five out of six outcome measurements, she said.

“The overarching theme is … children are safer and more stable than they were prior to implementation of the reform efforts,” she said.

The committee took no immediate action on the bill.