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Private child welfare group making strides after one year



 
 
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Old March 12th 05, 11:48 PM
wexwimpy
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Default Private child welfare group making strides after one year

Private child welfare group making strides after one year

By JONATHAN FOERSTER, March 12, 2005

In many public circles privatization is a dirty word.

Ceding direct governmental control to independent agencies at the best
bid price often seems like the end to social welfare services that
have over the course of the last century become ingrained in American
culture.

At first the February 2004 assumption of near-total authority of
Southwest Florida's child welfare by Camelot Community Care was
treated like a hostile takeover. Concerns ranged from the nonprofit
organization's relationship with its publicly traded management firm
to its attempts at streamlining the foster care system.

Now more than a year removed from the first phase of action in
District 8, made up of Lee, Collier, Charlotte, Hendry and Glades
counties, questions linger over how well privatization will work in
the region. But most of the people asking them say they are optimistic
that the future will be bright.

"Am I a perfectly happy camper? No," local child welfare advocate Stan
Appelbaum said. "Do I think we are making progress? Yes. Only time
will tell if we will get there. But it certainly isn't going to happen
in a year."

'It's a damn hard job'

It isn't their fault they need help.

As many as 80 percent of the children in the foster care system come
from homes where drug or alcohol dependency makes a normal family life
impossible. Often they are pulled out of their homes at a moment's
notice with no real understanding as to why it's happening.

Will they ever see their parents again? Who's going to take care of
them now? Will they need therapy to heal the scars of separation?

Those are a few of the questions Florida pays Camelot, the region's
lead agency, as much $23 million a year to answer.

In the process of protecting the children in its care the organization
is also trying to revamp a system that many believed to be flawed.

"What they are trying to do isn't easy," Appelbaum said. "It's a damn
hard job."

As was the case with other transitions into the privatization of child
welfare services, only Miami-Dade and Monroe counties still use the
state Department of Children and Families for all services.
Expectations were that it would take a year or so for the new system
to make progress toward a better product.

"Change in any organization, whether it's a merger or a change in
management, typically causes what is called a delta dip, where
performance drops," Camelot CEO Harry Propper said. "We didn't have a
dip. We managed to increase the performance in certain areas."

The retention of foster parents increased, the percentage of children
removed from their homes dropped and case workers became responsible
for half as many children. A recent foster parent training program,
which normally sees fewer than 10 people finish, graduated 25 into the
system.

"I think it was the smoothest transition in the state," local DCF
director Mike Murphy said. "It's been a remarkable teamwork process."

Propper and the leadership of the three case management organizations
— Ruth Cooper Center for north Lee County and Charlotte County,
Lutheran Services for the remainder of Lee County and Family
Preservation Services for Collier, Hendry and Glades counties — say
the key was keeping most of the DCF case workers and supervisors on
for continuity. In fact, Propper was a DCF employee until only a few
months after Camelot was awarded its five-year contract.

"For the most part people still work in the same units and sometimes
the same offices they were in before the transition," Propper said.

Smaller subcontracting agencies might not see any changes from the DCF
days.

"We do the same work we always did," said Anne Simon, director of the
Naples-based Youth Haven shelter. "For the most part we deal with the
same people. The only time there is a difference is when we negotiate
contracts, and even then we are getting the same amount of money."

One group that has noticed a big change is the foster parents. Propper
said one of his first big moves was to set up a position with the sole
responsibility of making sure the foster parents' needs are met.

It's definitely made the lives of Eula Thomas and Michelle Spellman
easier. Both women have been foster parents since before Camelot's
designation as the lead agency and both say the response they've
gotten after the switch has been phenomenal.

"When I first started as a foster parent, things were shaky at best,"
Alva resident Spellman said. "Now when I need more clothes for the
kids or have a question, they are there to help."

"They're just taking more interest in the kids," Thomas said.

Growing pains

Despite being praised as a smooth transition by most of the agencies
involved, major snags and flaws surfaced during Camelot's first year
in Southwest Florida. From the outset questions were raised about the
group's relationship with Providence Service Corp., a publicly traded
Tucson-based company that provides management services to Camelot.

As its case management organization for Collier, Hendry and Glades
counties Camelot chose Family Preservation Services of Florida, a
wholly owned subsidiary of Providence. While FPS did a significant
amount of Medicaid work in the region, it had a relatively small piece
of the DCF pie. Camelot increased the company's child welfare budget
100 times.

At the same time, Camelot was accused of preventing Lutheran Services
from seeking it's Medicaid certification. Just two months before
Lutheran Services, the charity arm of the Lutheran Church, was to
start as a management organization, the group was told even if it had
it's Medicaid certification it wouldn't be allowed to provide mental
health services to children under its watch.

Dr. Peter Ledecky, a vice president at Lutheran Services' state
headquarters and formerly the local branch's executive director, said
then-CEO of Providence William Boyd Dover said the children would be
sent to either the Ruth Cooper Center or FPS. Providing mental health
services can cause a big jump in income for the agencies.

"These kids have been in traumatic situations," Appelbaum said. "The
majority of them will need some sort of psychological or behavioral
treatment."

Propper eventually reversed the decision. Dover resigned as
Providence's chief executive and Camelot's board of directors, of
which a majority of the members were Providence executives, added
extra community members and elected a new chair.

A few months later, Camelot announced that all comprehensive
assessments, the intense psychological profiles used to determine
treatment needs for hundreds of troubled children, would be conducted
by Suncoast Psychometrics. The move was intended to streamline the
assessment process in order to move children through the system and
into a treatment program more quickly.

But when local agencies brought forward Suncoast's rather spotty
record of turning in assessments on time, of five of 53 assessments
turned in on time in a two-year period, Camelot changed it's mind.

"We learned we need to talk to our community partners earlier in the
process," Propper said. "We need to work with them in hatching the
plan instead of when we are ready to implement it."

Both the Suncoast situation and the confusion with Lutheran Services
were the result of poor communication, the parties involved said.

"We were all just trying to find the right formula," Ledecky said.
"Everybody was feeling each other out."

The year's most grave problems came from an individual case worker's
falsifying child welfare documents.

According to a DCF investigation, Scott Fultz reported making required
monthly visits to at least two children under his watch when he had
not seen them in several months. Lutheran Services fired Fultz after
he admitted making a mistake.

In the wake of the investigation, Propper said Camelot started a new
oversight program in which foster parents and the children in the
system are called to make sure visits are being made.

"These visits are pivotal to what we do here," he said. "If you are
not having consistent contact with the children and the foster
parents, then you can't assume the safety and well being of either."

Moving with momentum

Despite some very public misjudgments, Camelot seems to have found a
comfort zone heading into its second year. Propper said funding levels
have proved adequate, which is good because little in the way of extra
money is scheduled to come in.

By July, all three case management organizations will have completed
their first year and any staffing issues left to resolve should be
finished. The case workers should be close to Camelot's goal of 20 or
fewer cases at a time. The system should be comfortable with new
additions, such as on-staff nurses for medical problems and case
worker supervised parental visits.

"We are really moving forward with a lot of momentum," local Lutheran
Services director Tom Desio said.

Propper said once the original efforts to streamline the system and
meet goals for adoptions and foster parent retention are complete,
Camelot can begin focusing more on the work DCF was most excited about
to start with: preventing child abuse and neglect.

"Prevention is where we hope they can have the biggest success,"
Murphy said.

Prevention also might be where Camelot makes its legacy in Southwest
Florida. At the moment the group rates as the second best in the state
in terms of meeting performance goals. But the first year has not
given anyone an idea if the group will be able to keep going forward.

Other privatization organizations have stumbled to the point of losing
the confidence of DCF and being replaced. Both Pinellas and Pasco
counties have changed hands from one private provider to another in
the past year. Other regions are struggling because of poor budgeting.

There are no provisions in Camelot's contract to add money for a
sudden growth in the number of cases the company handles each year.
About 1,700 kids are presently in the system. But say that number
jumped to 2,000 or 2,200, then money would in short supply.

Spending on prevention programs to keep kids from entering the system
would keep back-end costs down but goes against the grain of the
typical business model in the state.

"Florida doesn't spend money on prevention," Appelbaum said. "The
state reacts to emergencies."

"But prevention would make sense. We'll just have to take a few years
and see where we are then."
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