Revisiting California’s “Continuum of Care Reform” Initiative

Jim Roberts, CEO/Founder
September, 25, 2019 -

Three+ years ago I wrote an article published by The Chronicle for Social Change, entitled “California’s Continuum of Care Reform – Will It Produce as Promised?” Fast forward to today--has CCR produced as promised? Remember that the goal of CCR was to reduce group home placements by shifting foster youth to family-based services. There have been some modest accomplishments, but from my perspective, there is a long way to go to really achieve success!

CCR, as it is commonly referred to, has had some positive outcomes. First, California has seen a reduction in group home placements by about one third since 2011. Second, all private providers (but not county providers) are now required to be Nationally Accredited, creating a consistent, high bar for program evaluation, fidelity and monitoring. However, this accreditation requirement should also apply to counties providing direct services. And finally, CCR implemented a standardized Child Family Team process for assessment, case planning and monitoring activities, basically eliminating unilateral decision making. This process is definitely a Best Practices for foster children, youth and their families.

Unfortunately, CCR has also spent hundreds of millions of dollars creating a huge, unwieldy state bureaucracy which is far from efficient or effective. For example, millions of dollars have been wasted to determine whether to require “CANS” or TOPS” as a required assessment instrument, when in fact the CANS had already been pushed by the state for years. Millions more were spent developing the “Level Of Care” (LOC) rate system for assessing and placing foster children. Today, the LOC system has not been fully implemented, it is not a scientifically validated instrument, and nobody working in the field likes it, counties and providers alike.

Probably one of the most egregious misuses of CCR funding--nearly $200 million--has been for the Foster Parent Recruitment, Retention, and Support (FPRRS) program. It was a great idea, but went solely to the counties and not to the private providers (such as FCNI). FPRRS should have been used to help create more Intensive Services Foster Care (ISFC) families to step down kids from group homes or serve as an alternative to group home placement. ISFC is almost exclusively provided by private Foster Family Agencies with very few counties delivering the service, and basic county level foster parents are not equipped, or properly supported to work with very challenging behaviors. Consequently, we have a serious shortage of ISFC approved families, and no evidence that FPRRS funding had any impact on meeting this critical need!

Here is where CCR has really fallen short. Yes, there are fewer kids in group homes, because there are fewer group homes and counties have inappropriately been pushing challenging youth into lower levels of care such as the Transitional Housing Placement Program (THPP), or basic level foster care. Reality check--we still do not have a “reformed” statewide, foster care system which is effectively and uniformly serving foster children and youth; we still do not have critical services in place for the youth who need it most!

Consequently, we have a substantial population of foster youth being under-served, creating real challenges at the county level. FCNI’s THPP program is bursting at the seams, but the failure rate is higher than ever without the financial ability to provide the services required. More salient, in the past year, FCNI has had over 160 incidents of putting children and youth with very difficult behaviors in motel rooms or to the ER with full-time awake staff because the county had no other place for them; no out-of-state placement and no foster home! 

Another glaring gap in CCR is that there was no accommodation for very high needs, behaviorally challenging youth who need to be in “secure” psychiatric facilities; foster youth Short-Term Residential Therapeutic Program’s (STRTP) are not accepting or are discharging. This past week at the California Alliance conference, provider after provider gave testimony to state officials about youth who were unmanageable, assaultive, and a risk to themselves or others. One very large STRTP in the LA area is closing its doors because local law enforcement does not have the capacity to respond to the number of incidents which regularly occur. Where will these foster youth go?

Remember why CCR was initiated in the first place--to reduce foster care expenditures, not to serve the best interests of foster youth! For CCR to really succeed, and I believe it can, there needs to be a far greater investment. Allocate the funds to really develop ISFC as a viable alternative to group care. Pay provider rates that cover their costs. Develop a rate structure for “Professional” foster parents which will allow a person to be a full-time, therapeutic foster parent. Create a statewide system to serve severely emotionally disturbed youth in a secure setting. And most importantly, begin investing in early intervention and prevention services to prevent the need for children and youth to go into foster care.