Blog City Budget

Data Before Dollars

Are Child Welfare Preventive Services Worth the Investment?

August 22, 2017

The New York City Fiscal Year 2018 Adopted Budget for the Administration for Children’s Services (ACS) projects $313 million in spending on “preventive services” intended to prevent maltreatment of children and foster care entry. This is a 42 percent increase in spending from Mayor Bill de Blasio’s first year in office and is intended to increase service capacity by 28 percent, from 12,500 to 16,000 preventive slots in fiscal year 2019. Given the planned expansion, greater scrutiny is needed to determine to whether preventive services are effective in preventing repeated abuse and reducing the need for foster care placement.

This blog finds ACS’s current reporting is insufficient to determine whether or not preventive services are meeting their goals and argues further investment should be contingent upon a more thorough public reporting on outcomes.

Preventive Services: The Basics

The creation of ACS as its own agency in 1996 coincided with a growing consensus that foster care had negative effects on children.1 Long-term studies of former foster children find they are more likely to have contact with the criminal justice system, have higher teen birthrates, and have lesser earning power than those who remain at home.2 One of ACS’s central goals has been to reduce foster care placements by offering preventive services to families while the child remains in the home.  Preventive services include an array of interventions to address the underlying causes of family crisis. (See text box.)

Referrals to preventive services are typically made following an ACS investigation into whether child abuse, neglect, and/or maltreatment have occurred. Services are provided by contracted social service agencies, over which ACS provides oversight.  A family is referred to a specific preventive service model depending on its needs. Of the roughly 9,600 new cases between April 2016 and March 2017:

  • 56 percent were referred to “general preventive” services including general case management, counseling, vocational programs, and housing assistance.
  • 31 percent were referred to Evidence-Based Models (EBMs), which target specific populations. For example, the Child Parent Psychotherapy model works with families with children, ages 0 to 5, who have experienced acute trauma and are exhibiting parental attachment issues.
  • 11 percent were referred to Family Treatment and Rehabilitation, geared toward families facing serious substance abuse or mental health issues.  They see licensed therapists and psychiatrists and receive enhanced substance abuse treatment.
  • 2 percent, with medical and/or developmental disabilities, were referred to the Special Medical Prevention Program.

Source: Administration for Children’s Services, Flash Report (May 2017), p.11.

ACS now serves more children through preventive services than through foster care, and these services are less costly as well. ACS served 46,207 children in 16,913 preventive cases opened in fiscal year 2016 in comparison to 10,000 children served through foster care that year.3 In fiscal year 2015 the average daily cost per child in foster care was $125 per day compared to $24 per child per day in preventive services.4

Social service agencies are contracted by the City to provide a certain number of preventive service slots each year. Each slot can provide services to one or more families over the course of the year depending on the length of services, and a single slot typically serves more than one family in a given year.5 The number of slots increased to 11,000 in fiscal year 2001 from just more than 9,000 in the prior year.6 The number of slots has been fairly stable since then, averaging 12,000 in fiscal year 2016, while the number of children served has fluctuated.7 (See Figure 1.)

Figure 1: Preventive Service Spending and Average Daily Caseloads, FY2000-FY2016

City Expansion of Preventive Services

City spending on preventive services increased from $123 million in fiscal year 2000 to $235 million in fiscal year 2016, with the State reimbursing the City for 62 percent of the cost.8 Spending grew by an additional 9 percent in fiscal year 2017 and 18 percent in fiscal year 2018 to reach $313 million.9

The Adopted Budget for Fiscal Year 2017 added 3,000 additional slots (a 23 percent increase), increased per slot funding, enhanced provider training programs, and increased the number of ACS staff who work directly with preventive providers to facilitate casework.10 ACS preventive services for children being discharged from foster care were expanded and are expected to reach the roughly 1,500 families who are reunifying in fiscal year 2018.11 Table 1 details the projected increase in funding for this expansion of services, which will total $41.2 million in fiscal year 2018 and increase to $53 million thereafter.

Table 1: NYC Administration for Children's Services, AdditionalChild Welfare Spending for Fiscal Years 2017 to 2020

Additional funding has been added for preventive services in the last year to pay for staff training and for more facilitators at the social service agencies to implement new case conferencing protocols.  ACS has also set aside greater resources to increase provider budgets once it completes a planned review of contract provider funding. By fiscal year 2019 the City expects to have 16,000 available preventive slots.12

Are Preventive Services Effective?

The increasingly central role preventive services play in New York City’s child welfare system and the planned expansion of these services demand that their effectiveness be measured. Are these services achieving their goals to reduce foster care placements and reduce repeated maltreatment? Publicly available data are insufficient to answer the question because the data are not disaggregated to demonstrate outcomes for families receiving preventive services.

Two trends, however, are worth noting. First, foster care entries have declined substantially, 63.5 percent, between fiscal years 2000 and 2016, while the number of children receiving preventive services has grown; evidence the reduction is due to preventive services is not definitive.13 Second, between fiscal years 2000 and 2011, repeat substantiated maltreatment rates doubled, rising from 8.6 percent to 17.1 percent. More recently, the rate has declined to 15 percent in fiscal year 2016, but continues to significantly exceed the New York State target of 7 percent14 In both instances, public data is unavailable to examine incidents of foster care placement for children receiving preventive services and incidents of mistreatment for families receiving preventive services specifically.

A May 2017 report by Casey Family Programs, commissioned by ACS, included data not regularly released to the public regarding outcomes for families engaged in preventive services. These findings suggest families receiving preventive services may have better outcomes for repeat maltreatment and foster care placement than the overall child welfare-involved population; however, some indicators were stable for the study period rather than showing further improvement among those receiving preventive services.15

Better Data for Better Outcomes

The lack of public data has been an issue for some time. In 2001 a Child Welfare Advisory Panel called for the creation of a system to evaluate preventive services after concerns about their effectiveness were raised in the Marisol v. Giuliani case.16 No action was taken until ACS created a Scorecard in 2008 to monitor providers and shift slots away from underperforming ones. ACS recently published the fiscal year 2016 provider Scorecard, but has not done so consistently in past years, and audits by the Office of the New York City Comptroller and Department of Investigation have found ACS’s oversight lacking.17 The Mayor’s Management Report includes only four indicators for preventive services, all of which measure caseloads rather than quality or outcomes.18 Similarly, the information contained in ACS’s Monthly Flash Reports and annual Child Welfare Indicators Report is limited to caseload and referral volumes.

Some changes may be on the horizon. ACS reports it is planning to unveil a new public data dashboard to track engagement and outcomes in preventive services.19 In addition, City Council Members Mark Levine, Elizabeth Crowley, and Margaret Chin introduced a bill (Intro 1374-2016) to enhance the reporting requirements for preventive services in December 2016.20 The bill, currently in Committee, is a step in the right direction and would require monthly reporting on preventive caseloads; families who enter foster care during the month who previously received preventive services; the number of families receiving preventive services after reunification; and other measures.

As many of the metrics measure outputs rather than outcomes, a limitation also identified by the Citizens’ Committee for Children and the Council of Family and Child Caring Agencies, the City Council should work with ACS to expand the required indicators.21 For example, reporting should differentiate between the different service models and case severity so that there is a better understanding of what works best for which populations.

Conclusion

New York City has more than doubled its investment in preventive services from $123 million in fiscal year 2000 to $256 million in fiscal year 2017, and an additional increase of $57 million (22 percent) is projected for fiscal year 2018 to bring total spending to $313 million.22 These investments are meant to improve outcomes for families and prevent foster care and child maltreatment–critically important policy goals. Additional investments in these services should be contingent on a more thorough understanding of whether these services are achieving the desired outcomes. ACS’s performance should be evaluated consistently, using data and metrics, rather than in response to headlines of tragic cases that focus the public’s attention.

Footnotes

  1. Vera Institute of Justice, Innovations in NYC Health and Human Services Policy: Child Welfare Policy (January 2014), www.nyc.gov/html/ceo/downloads/pdf/policybriefs/child-welfare-brief.pdf.
  2. Stephanie Clifford and Jessica Silver-Greenberg, “Foster Care as Punishment: The New Reality of ‘Jane Crow’” The New York Times (July 21, 2017), www.nytimes.com/2017/07/21/nyregion/foster-care-nyc-jane-crow.html?mcubz=3. 
  3. New York City Mayor's Office of Operations, Mayor's Management Report (September 2016), www1.nyc.gov/assets/operations/downloads/pdf/mmr2016/2016_mmr.pdf.
  4. CBC staff analysis of data from the New York City Office of Management and Budget, Adopted Budget: Fiscal Year 2018, Budget Function Analysis (June 8, 2017), p. 47, www1.nyc.gov/assets/omb/downloads/pdf/adopt17-bfa.pdf; and New York City Mayor's Office of Operations, Mayor's Management Report (September 2016), www1.nyc.gov/assets/operations/downloads/pdf/mmr2016/2016_mmr.pdf.
  5. New York City Independent Budget Office, Fiscal Brief: A Changed Emphasis in City’s Child Welfare System: How Has Shift Away From Foster Care Affected Funding, Spending, Caseloads? (October 2011), www.ibo.nyc.ny.us/iboreports/childwelfare101211.pdf.
  6. New York City Office of Management and Budget, Executive Budget Fiscal Year 2003: Message of the Mayor (April 2002), p. 140, www1.nyc.gov/assets/omb/downloads/pdf/mm4_02.pdf.  
  7. Usage of preventive services grew following a highly publicized death in January 2006 and then declined by 25 percent between fiscal years 2009 and 2011. According to analysis by the NYC Independent Budget Office, this decline was due to contracting and anticipated budget cuts. The January 2010 Preliminary Budget proposed a reduction in the number of funded preventive slots, on top of a reduction of slots announced as part of a May 2009 Request for Proposals. While almost all of the slots were ultimately restored in the Adopted Fiscal Year 2011 Budget, the instability and late notice led to fewer families being served.  See: New York City Independent Budget Office, Fiscal Brief: A Changed Emphasis in City’s Child Welfare System: How Has Shift Away From Foster Care Affected Funding, Spending, Caseloads? (October 2011), www.ibo.nyc.ny.us/iboreports/childwelfare101211.pdf.  
  8. In October 2002 New York State started to reimburse the city for 65 percent of the cost of preventive services with no cap; the rate was decreased to 62 percent in 2008. In contrast, the State caps its foster care reimbursements according to the prior year’s foster care census. See: Citizens’ Committee for Children of New York, The Wisest Investment: New York City’s Preventive Service System (April 2010), www.cccnewyork.org/wp-content/publications/CCCReport.WisestInvestment.PreventiveServices.April2010.pdf.
  9. New York City Office of Management and Budget, Adopted Budget: Fiscal Year 2018, Budget Function Analysis (June 8, 2017), p. 47, www1.nyc.gov/assets/omb/downloads/pdf/adopt17-bfa.pdf; and New York City Mayor's Office of Operations, Mayor's Management Report (September 2016), www1.nyc.gov/assets/operations/downloads/pdf/mmr2016/2016_mmr.pdf.
  10. Testimony of David A. Hansell, Commissioner, New York City Administration for Children’s Services, before the New York City Council Committee on General Welfare, Int. 1590-2017, Ind. 1598-2017, Int.1601-2017; Int. 1607-2017, & 1609-2017 (June 14, 2017), www1.nyc.gov/assets/acs/pdf/testimony/2017/ACSTestimonyCWBills61417.pdf.
  11. New York City Independent Budget Office, More Funding for Child Welfare: Mayor Aims to Expand & Enhance Preventive Services, Reducing Foster Care Placements (June 2016), www.ibo.nyc.ny.us/iboreports/more-funding-for-child-welfare-mayor-aims-to-expand-enhance-preventive-services-reducing-foster-care-palcements.pdf.  
  12. Testimony of David A. Hansell, Commissioner, New York City Administration for Children’s Services, before the New York City Council Committee on General Welfare, Int. 1590-2017, Ind. 1598-2017, Int.1601-2017; Int. 1607-2017, & 1609-2017 (June 14, 2017), www1.nyc.gov/assets/acs/pdf/testimony/2017/ACSTestimonyCWBills61417.pdf; and Testimony of Dr. Jacqueline Martin, Deputy Commissioner, Division of Preventive Services, New York City Administration for Children’s Services, before the New York City Council Committee on General Welfare, Oversight – Preventive Services at the Administration for Children’s Services (December 14, 2016), www1.nyc.gov/assets/acs/pdf/testimony/2016/121416PreventiveServicesTestimonyFinal.pdf.   
  13. Children's Rights, Better Infrastructure, Too Few Results: A Decade of Child Welfare Reform in New York City (July 2007), www.childrensrights.org/wp-content/uploads/2008/06/at_the_crossroads_full_report.pdf.
  14. New York City Mayor's Office of Operations, Mayor's Management Report (September 2016), www1.nyc.gov/assets/operations/downloads/pdf/mmr2016/2016_mmr.pdf; and New York City Department of Investigation, Report on ACS Policy and Practice Violations Identified in Three Child Welfare Cases and Related Analysis of Certain Systemic Data (April 2016), p. 10, www1.nyc.gov/assets/doi/downloads/pdf/May2016/14-ACS%20Report%2005-03-16_FINAL%20w%20Report.pdf. ACS has an updated measure of repeat maltreatment for the last eight years (2008-2015) that is slightly higher than the MMR data presented here.
  15. New York City Administration for Children’s Services, Assessment of New York City Administration for Children's Services Safety Practice and Initiatives (prepared by Casey Family Programs, May 2017) www1.nyc.gov/assets/acs/pdf/testimony/2017/NYCACSAssessmentReportMay2017.pdf.
  16. Children’s Rights, Better Infrastructure, Too Few Results – A Decade of Child Welfare Reform in New York City (July 2007), www.childrensrights.org/wp-content/uploads/2008/06/at_the_crossroads_full_report.pdf; and Schuyler Center for Analysis and Advocacy, Hopeful Future for New York’s Children: Advancing Child Welfare (January 2016), www.scaany.org/wp-content/uploads/2016/01/Hopeful-Futures-for-New-Yorks-Children_January2016.pdf.  
  17. New York City Department of Investigation, Report on ACS Policy and Practice Violations Identified in Three Child Welfare Cases and Related Analysis of Certain Systemic Data, (April 2016), p. 10, http://www1.nyc.gov/assets/doi/downloads/pdf/May2016/14-ACS%20Report%2005-03-16_FINAL%20w%20Report.pdf; City of New York, Office of the Comptroller, Audit Report on the Compliance of the Child Development Support Corporation With Its Administration for Children’s Services Preventive Service Agreements, (March 24, 2008), www.comptroller.nyc.gov/wp-content/uploads/documents/03-26-08_CDSC-audit-report-3-08.pdf; Citizens’ Committee for Children of New York, The Wisest Investment: New York City’s Preventive Service System (April 2010), www.cccnewyork.org/wp-content/publications/CCCReport.WisestInvestment.PreventiveServices.April2010.pdf; and New York City Administration for Children’s Services, FY 2016 Preventive Services Scorecard (August 2017), drive.google.com/file/d/0B6L0Y1E8A6iBbVUxbENzTXl1YWc/view.
  18. New York City Mayor's Office of Operations, Mayor's Management Report (September 2016), www1.nyc.gov/assets/operations/downloads/pdf/mmr2016/2016_mmr.pdf.
  19. New York City Administration for Children’s Services, Assessment of New York City Administration for Children's Services Safety Practice and Initiatives (prepared by Casey Family Programs, May 2017). http://www1.nyc.gov/assets/acs/pdf/testimony/2017/NYCACSAssessmentReportMay2017.pdf.
  20. A Local Law to Amend the Administrative Code of the City of New York, In Relation to the Utilization of Preventive Services, Int. No. 1374, Available at: http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=2895204&GUID=6F134DB2-469B-44AD-8FBF-5B2FBB146983&FullText=1
  21. Testimony of Stephanie Gendell, Associate Executive Director, Citizens’ Committee for Children of New York, before the New York City Council Committee on General Welfare, Oversight: Preventive Services at the Administration for Children’s Services (December 14, 2016), www.cccnewyork.org/wp-content/uploads/2017/01/testimony.preventive.2016.pdf; and Testimony of Jim Purcell, Chief Executive Officer, Council of Family and Child Caring Agencies, before the New York City Council Committee on General Welfare, Oversight: Preventive Services at the Administration for Children’s Services (December 14, 2016).
  22. Fiscal year 2017 projection as of the Fiscal Year 2018 Adopted Budget; final audited spending will not be available until October 2017.  See: New York City Office of Management and Budget, Adopted Budget: Fiscal Year 2018, Budget Function Analysis (June 8, 2017), p. 47, www1.nyc.gov/assets/omb/downloads/pdf/adopt17-bfa.pdf.