Nebraska Department of Health and Human Services

 

In 2019, The Stephen Group completed a review of the evidence base for Family Centered Treatment (FCT) in accordance with the standards articulated in the Title IV-E Prevention Services Clearinghouse Handbook of Standards and Procedures (“the Handbook”).  This evaluation was conducted by TSG as part of the requirements of the newly enacted Federal Family First Preventions Services Act (FFPSA).   In collaboration with our subcontracted partner, MEF Associates, a systematic review of three published studies was completed and the TSG team  arrived at a rating of WELL-SUPPORTED for FCT. According to the Handbook, a well-supported program: “Has at least two contrasts with non-overlapping samples in studies carried out in usual care or practice settings that achieve a rating of moderate or high on design and execution and demonstrate favorable effects in a target outcome domain. At least one of the contrasts must demonstrate a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome (p. 43).”   TSG found that these standards were met.   TSG completed a detailed memo summarizing its review of the three FCT studies examined, providing supporting evidence for the well-supported rating.  

For a copy of this Report, please contact the Nebraska Department of Health and Human Services, Division of Children and Family Services. 

 

 

In 2018, TSG performed a targeted assessment of the use of the Structured Decision Making (SDM) Assessments in Nebraska by the DCFS front line case managers, including concerns, impact, and field experience with the SDM instruments.    In addition, DCFS requested that TSG examine related topics including the needs of a child/youth removed from their homes that are in need of behavioral health or substance use disorder services and access to these services through linkages with the Division of Developmental Disabilities, Division of Medicaid and MCOs serving child welfare-eligible children and youth in Nebraska through Nebraska’s Heritage Health Medicaid managed care plans.  Finally, TSG was asked to review whether the SDM tools were sufficient to assess the risk of suicide, as well any suggested improvements to the process used by the Hotline related to reports received pursuant to the Comprehensive Addiction and Recovery Act (CARA).  

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In October of 2018, the Nebraska Department of Health and Human Services (DHHS), Division of Children and Family Services (DCFS) contracted with The Stephen Group to perform an assessment of whether the Department should continue to outsource case management for in- and out-of-home cases in the Eastern Service Area (ESA), which is located in and around Omaha. In addition to the insource vs. outsource feasibility study, TSG was also tasked with evaluating the existing service delivery system for services in the ESA and recommend a future state model, define the outsourced service delivery vision, conduct an impact analysis and provide recommendations for the path forward for the state.

TSG designed a comprehensive review to collect information using the following approaches:

  • Review of prior audits, studies, and reports on the Nebraska child welfare system and the outsource in the ESA.
  • Review of the existing contract, extensions, and amendments in Nebraska.
  • Review of other state best practices in child welfare contracting.
  • Review of financial, operational, and performance data from DHHS and existing outsourced Vender.
  • Extensive interviews with DHHS, and the existing outsourced vendor leadership staff.
  • Interviews with DHHS: Leadership, State office contract management and continuous quality improvement staff.
  • Meetings with the DHHS Division of Behavioral Health.
  • Focus groups, process mapping, and analysis of the case transition process with DHHS and the outsourced vendor’s administrative, supervisory, and frontline caseworker staff from Douglas and Sarpy Counties.
  • Interviews with key stakeholders, including the State’s Inspector General, judges, county attorneys, state and county CASA officials, guardian ad litems, the Foster Care Review Board, the Nebraska Family Support Network, Project Harmony. 
  • Meetings with child welfare providers including facilitating a group call with providers operating in state-run and outsourced regions and individual provider interviews with the Nebraska Children’s Home Society, Capstone BH Services, and Cedars.

After completing the review, TSG produced a comprehensive report for DCFS that included detailed findings and recommendations with specific actions steps to follow moving forward on a new design of the ESA outsource model.    Some of the recommendations included:

  • Enhancements to the contract to include performance-based elements including financial incentives and remedies that drive progress. 
  • A new process of contract oversight and management 
  • A new form of collaboration between DCFS and the next ESA contractor 
  • The engagement of other DHHS divisions in the ESA model to ensure that the state and contractor maximizes existing resources and also a vision for a different community engagement model

Simultaneous to the above review and analysis, the Nebraska DCFS contract also required TSG to provide technical assistance to DCFS in drafting the new and improved ESA outsource RFP, designing and developing a new quality management oversight process, where CQI, Contract Monitoring and Finance would regularly meet and follow a new protocol.   TSG also developed a new contract monitoring tool that will be used by DCFS’s contract manager and monitors in the future in monitoring the next ESA contract.  TSG also designed a negotiations document that would be used by DCFS when negotiating the final contract with the next ESA contractor and TSG also developed a readiness tool that is to be used to ensure the next contractor is ready to take on case management under the new model at the time the contract requires go live.    

This contract with DCFS also involved TSG providing technical assistance to the DCFS Federal Families First Prevention Services Act Advisory Team.   DCFS has created an FFPSA internal workgroup that has been very engaged with stakeholders and providers in the state.     

A final scope area under this contract is for TSG to provide technical assistance to the DCFS leadership in the entire Transition process with the next ESA vendor.  TSG was tasked by DCFS leadership in preparing a draft of a transition plan with a number of scenarios and timelines and deliverables to ensure a smooth and seamless transition in the ESA.  On June 4, 2019, DCFS announced the new vendor selected for the ESA and the transition plan has been executed and TSG is currently providing technical assistance to the DCFS Transition Plan Manager and the various transition team leads.  

The TSG Nebraska DCFS Assessment Report and Executive Summary:

http://dhhs.ne.gov/Documents/StephenGroupReport-Final.pdf

http://dhhs.ne.gov/Documents/StephenGroupReport-ExecutiveSummary.pdf