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).
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
The TSG Nebraska DCFS Assessment Report and Executive Summary: