ANN ARBOR—A new foster care program that reimburses agencies based on performance was designed to improve the lives of children and their families in Michigan.

But a new University of Michigan study shows that the outcomes were no better than the traditional method that pays on a per-child, per-diem system during the first 300 days a child spends in foster care.

In the first study of its kind to explore the impact of new service arrangements on child welfare agencies and the children and family in their care, U-M researchers William Meezan and Bowen McBeath learned that foster children in six Wayne County (Michigan) agencies that participated in a pilot program—which takes a performance-based, managed care approach—were no more likely to be placed in stable environments than agencies using the traditional reimbursement structure within their first 300 days of care.

"The fact that the same proportion of families in the pilot agencies reached an appropriate outcome having received less service leads to numerous additional questions regarding how stable their placements will remain and the long-term impacts of these financial arrangements on child and family well-being. Our continued work will shed further light on the impact of managed care approaches that are relatively new but spreading quickly within the child welfare arena," said Meezan, the Marion Elizabeth Blue Professor of Children and Families in the School of Social Work. McBeath is a doctoral research associate in the school.

The study, "Moving to Managed Care in Child Welfare: First Results from the Evaluation of the Wayne County Foster Care Pilot Initiative," will be discussed by officials from state foster care agencies during a conference at 9 a.m. Oct. 27 in the School of Social Work, 1080 S. University Ave. (Central Campus map: http://www.umich.edu/news/ccamp.html). The study’s results will be submitted to the state as it considers whether to expand the managed care approach to other parts of Michigan.

In 1997, the state Family Independence Agency, a public child welfare agency, adopted this performance-based, managed care approach to its contracting for foster care with four private nonprofit agencies in Wayne County; the number increased to six in 2000 when the study began.

Currently at the end of its second year of data collection, the three-year study tracks 244 foster children and their families in both pilot and non-pilot agencies. The achievement of timely outcomes is being studied at various critical points in a child’s history in the foster care system: return to a parent, family member or guardian within 290 days; termination of parental rights with 515 days; adoption within seven months of parental rights termination; and the ability to sustain such an appropriate placement for six and 12 months.

The findings from interviews with agency personnel, which were part of the research effort, support other researchers’ conclusions suggesting that managed care contracting requires service providers to quickly diagnose clients’ needs, focus additional resources on collecting client and service information in databases and pool funds to address the multiple needs of clients systematically and simultaneously.

While the empirical understanding of managed care contracting in child welfare is limited to what was learned in Wayne County, Meezan and McBeath offered insights based on these interviews:

• Contract incentives directly influence the work environment, employee behavior, job satisfaction and employee retention.

• Performance deadlines must allow ample time for employees to conduct thorough assessments and place children in living situations that promote safety, permanency and positive well-being.

• Joint agency education and training programs at all levels might lead to efficiencies in the transition to managed care.

• Interdepartmental meetings should be implemented in such a way that staff can gain a holistic sense of how departments must balance pressures and responsibilities.

The cooperating agency partners include Catholic Social Services of Wayne County, Evergreen Children’s Services, Homes for Black Children, Judson Center, Lutheran Child and Family Services, Lutheran Social Services of Michigan, Orchards Children’s Services, St. Francis Family Services, Spectrum Human Services and the Michigan Family Independence Agency. The research support received from the Aspen Institute—Michigan Nonprofit Research Program, W.K. Kellogg Foundation through the Global Program on Youth (U-M School of Social Work), the Michigan Family Independence Agency, U-M Office of the Vice Provost for Research, Rackham Graduate School and the Skillman Foundation.

Related Links:

Meezan’s faculty web site

Meezan’s experts bio

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