Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Outcomes in Foster Care

Service Provision to Foster Children and Families in an Incentive-Based Managed Care Setting: New Findings From the Wayne County Pilot Evaluation

Objective: Managed care mechanisms have recently diffused from the behavioral and physical health sectors to at least 29 state child welfare systems. Because these changes are so recent, little empirical research is available relating to the impact of managed care mechanisms on service provision to foster children and families. This presentation examines the effect these shifts have on service provision to clients over time, as well as on the differential provision of services based on client and caseworker characteristics. It extends the analyses presented at last year‘s conference by more than a year.

Methods: Data were collected on a sample of 243 foster children being served by nine nonprofit agencies in Wayne County, Michigan. These agencies have contracted with Michigan’s public welfare agency to provide foster care services under one of two contractual mechanisms: a per child, per-diem reimbursement system or an incentive-based, managed care reimbursement system that contains performance bonuses for the movement of foster children into permanent placements. Because foster children in Wayne County are randomly assigned to nonprofit agencies, the study design is the equivalent of a true experimental design.

The panel dataset (which will be extended by the time of the conference) currently contains 570 days of information on children’s service histories, individual and familial characteristics, and caseworker characteristics. OLS regression models and other appropriate multivariate techniques are used to examine whether children served by incentive-based, managed care agencies received as many services as did children served by agencies reimbursed under the per-diem model, controlling for child, family, and caseworker characteristics.

Results: Children served by managed care agencies received fewer non-therapeutic and therapeutic services over the length of their duration in foster care, suggesting the existence of a managed care-related disparity in these two measures of service provision. Analyses completed to date suggest that this disparity in service provision decreased over time for the measure of non-therapeutic service provision but not for the measure of therapeutic service provision. The statistical models employed explain roughly 40 percent of the variation in service provision, with the reimbursement model explaining the bulk of the variance; few characteristics of the children, their families, the reasons for their removal, or caseworker characteristics were associated with service delivery at any point in time.

Discussion: This study finds evidence of managed care-related disparities in service provision to foster children, controlling for other variables. These results are consistent with studies concerning the effects of managed care in other service sectors, in which managed care is associated with depressed service utilization to children and families. Implications for practice include the need for greater attention at the agency- and system-level to how and why reimbursement systems are associated with reductions in service provision to disadvantaged clients generally, and child welfare caseloads in particular. Implications for research include the need to examine whether managed care-related service reductions are associated with negative outcomes for foster children and families, including a reduced likelihood of achieving permanency, increased duration in foster care, and increased likelihood of reentry into foster care.

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