Evaluating Private Provider Performance in Wisconsin

In many states, out-of-home care is a responsibility the state child welfare agency shares with the private sector. While a provider’s ability to achieve positive outcomes for children is a function of its own policies and practices and the clinical needs of the children it serves, its performance is also tied to the jurisdiction in which it works. This is especially true in county-administered child welfare systems where counties have unique cultures, policies, practices, and resources.

So that it could target efforts to improve outcomes more effectively, leadership in the Wisconsin Department of Children and Families wanted to learn whether permanency rates differ among its contracted foster care service providers, but wanted to do so in a way that accounted for differences in those providers’ varying ecologies. In a new research brief, Evaluating Provider Performance in Wisconsin, we describe how the Data Center used advanced analytics to level the playing field and examine how permanency outcomes differ inside the state’s private foster care provider network.

An executive summary appears below. Want to learn more?

• Download the brief, Evaluating Provider Performance in Wisconsin.
• For more detail, read the technical report by Chapin Hall Researcher Scott Huhr.

Executive Summary

The context:
In many states, out-of-home care is a responsibility the public child welfare agency shares with the private sector.  Although the nature of that partnership differs from state-to-state, private agencies supervise many of the foster family, group home, and residential care settings needed to protect children whenever families are unable to do so.  In those states then, improving outcomes for children depends on understanding how each partner contributes to children’s well-being.

The question:
So that it could target efforts to improve outcomes more effectively, leadership in the Wisconsin Department of Children and Families asked: Does the rate of permanency differ by the provider supervising the homes in which children are placed? It is an important but complicated question.  Providers not only differ with regard to the children they serve; they also differ with respect to the counties that hold their contract.  Wisconsin is a county administered system where counties can and do adopt their own approaches to working with families. Therefore, it is reasonable to expect that county-level differences also influence a private agency’s permanency rate.

The analysis:
Adopting methods used in health care and education, we leveled the playing field and explored whether the private agencies influence permanency rates over and above the influence of child and county characteristics.

The findings:
We found that private agencies play an important role in shaping permanency outcomes for children. Though the findings show that county factors do matter, notwithstanding their influence some providers had a permanency rate that outperformed the state average. For other providers, the opposite was true.

The implications:
In child welfare systems with a strong private sector, getting better outcomes depends on public/private cooperation.  In Wisconsin, we were able to help the leadership answer an important question: Do permanency rates differ by provider? In a CQI context, the question and answer are both important. CQI generally begins with an observation that core outcomes vary by age of child, gender, race, clinical rating, region of the state (e.g., county) or some other organizational unit such as a provider.  When one finds variation, the next step in the CQI process is to ask whether that variation reflects appropriate care across subpopulations. If not, then reducing the variation by promoting best practices is key to improving outcomes.