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The Key Ingredient for Highly Targeted Pay for Success Initiatives: Integrated Data

June 23, 2014 | David Crampton, PhD, Associate Professor, Case Western Reserve University

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The growing complexity and intensity of social problems alongside shrinking government resources for human services require more creativity and flexibility in how we, as holistic communities, address the needs of vulnerable children and their families. Pay for Success (PFS) provides both governments and local communities with an innovative approach in funding effective delivery of family services.

The growing complexity and intensity of social problems alongside shrinking government resources for human services require more creativity and flexibility in how we, as holistic communities, address the needs of vulnerable children and their families. Pay for Success (PFS) provides both governments and local communities with an innovative approach in funding effective delivery of family services.

PFS includes third-party funders and performance-based contracting through which the government pays for services only if predetermined outcomes are achieved. This contracting method can be used to scale the delivery of primary prevention efforts, such as home visiting or universal prekindergarten, yielding short-term and long-term benefits for a large number of people. PFS can also be utilized to deliver highly specialized services to smaller population segments that are associated with high treatment costs but, unfortunately, experience suboptimal outcomes as a result of insufficient service coordination.

For example, an Illinois study examined 502,165 families that received child welfare and/or food stamp services to see whether any of their family members were involved with adult incarceration; juvenile incarceration; or mental health, substance abuse, or foster care services. The study found that 43% of families received none of these five services, 34% received one, and 23% received more than one. However, the multiservice-use families accounted for 86% of the costs of those five services. The underpinning integrated data analysis, which overlaid costs across multiple service systems to highlight the costs associated with the same families, exposes the potential to serve multiple-need families in a more comprehensive way, saving money for governments and producing better outcomes for local communities. The Illinois study also highlights how integrated data is key to exploring whether PFS is even a viable funding mechanism for a particular government program. Integrated data helps governments pinpoint families for which money is being spent inefficiently and, as a result, for which a weaker impact is produced.

In Cuyahoga County, Ohio, we are launching a PFS project that will serve homeless families that also receive child welfare services. Integrated Data Systems (IDS) at the Center on Urban Poverty and Community Development are critical to the program’s intervention design and long-term evaluation. IDS integrates individual-level data from multiple administrative agencies on an ongoing basis. Our child welfare colleagues know that families do not become involved with child welfare due to homelessness alone, and our IDS analysis confirmed their thinking.

To test their hypothesis on the overlapping homeless and child welfare needs of these families, we examined 6,061 women who entered homeless services in 2010, 2011, and 2012. We found that nearly 30% of these women had an open case with the county child welfare agency. Only 7% of these women, representing 411 households, had children placed in foster care. However, the 739 children placed in foster care from these households represented 18% of all the children in foster care over this three-year period. We also found that the cost of care for this subset of child welfare-involved children exceeded $18 million dollars for the county, amounting to a government expenditure of nearly $25,000 per child.

This care is expensive partly because children placed in foster care from homeless families spend far more days in foster care than their counterparts from housing-secure families. These extensive foster care experiences are not only related to the families’ homelessness but also to high rates of mental health, substance abuse, and trauma challenges prevalent among this population.

In addition to our analyses on the overlapping needs of these families, we also know that Cuyahoga County has made tremendous progress from both its child welfare and homelessness prevention systems. The county’s Division of Children and Family Services has led America’s foster care reform at the county level while the county’s Office of Homeless Services has made successful headway in diminishing chronic homeless for single adults. However, despite these successes, and as our analyses have indicated, an integrated and coordinated approach is needed to better serve the needs of multisystem-involved families across the county’s child welfare, homeless, justice, domestic violence, and mental health systems.

With this in mind, we are working closely with FrontLine Service, Inc. to develop a program that first provides stable housing to our targeted families, supplements housing with an evidence-based service called Critical Time Intervention, and then addresses the families’ multiple trauma needs and the mothers’ substance abuse and parenting concerns. By meeting their needs comprehensively, we believe that we can reduce the number of foster care days for a child, increase parent reunification rates, and/or accelerate a child’s path to an adoptive family. We can use those savings to fund this innovative intervention and a rigorous evaluation of FrontLine’s impact.

In this way, PFS benefits families by meeting their unique, complicated needs in a more comprehensive way and benefits taxpayers by ensuring that government pays for successful programs. Through a rigorous evaluation, we plan to demonstrate that we can do more with less and respond to the dual challenges of growing social problems and shrinking government resources.

David Crampton, PhD, is as an associate professor of social work and associate director of the Center on Urban Poverty and Community Development at the Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University in Cleveland, Ohio. His scholarship focuses on the evaluation of family-centered and community-based child welfare practices with the ultimate goal of protecting vulnerable children through the engagement of families, communities, and public-private partnerships.