The following article was written as a guest contribution by Thomas D. Pristow, MSW, ACSW and Nathan S. Busch, JD of Nebraska’s Division of Children and Family Services.
Altering service delivery behavior and changing the culture of an organization which has been based on years of incremental sameness is not a task to be taken lightly. This is a story of an organization that, as a result of years of such behavior, was weighed down by the chains of mistrust, negativity and unilateral actions.
Over the last two years, nine major steps have been put into place to facilitate a change in system wide service delivery behavior. What follows is a description about how those nine steps have helped to initiate a change in that system.
- A commitment from the Director and Senior Leadership supporting Results Based Accountability (RBA) implementation to positively impact Division accountability and culture change.
- System-wide introduction of RBA principles by Mark Friedman.
- Specific training for Division of Children and Family Services (DCFS) staff and Service Providers regarding RBA principles, common language and development of Performance Measures.
- Prioritizing Performance Measures for eight contracted children and family services.
- Developing a system-wide RBA Manual to ensure common application.
- Developing specific Clear Impact Scorecards to track Performance Measure data.
- Performance Measure data collection via the Clear Impact Scorecard.
- Facilitating the “Turn-the-Curve” process to continually improve the quality of services and the customers’ results.
- Unrelenting focus on making sure our customers are “better off.”
The Nebraska Results Based Accountability (NeRBA) Initiative officially began with the arrival of Thomas Pristow as Director of the Division of Children and Family Services (DCFS). Director Pristow had already utilized the principles of RBA in Vermont. Seeing success in Vermont, he was excited for the opportunity to use RBA as one of the vehicles for significant culture change in Children and Family Services in Nebraska.
A structure was developed which addressed an environment traumatized by an attempt to privatize case management statewide. Service Providers and DCFS were struggling in many areas, including service rates, contracting, and system effectiveness. The arena was ripe for the principles of RBA.
In August 2012, a statewide RBA summit was held in Lincoln, Nebraska. Over 400 system stakeholders were in attendance which included Service Providers and DCFS staff and administration. The highlight of the event was the opportunity to learn the principles of RBA directly from Mark Friedman. This opportunity planted the RBA seed in the heads of those system partners who attended. Soon after, a contracting process with Clear Impact for the statewide implementation of RBA began.
A small DCFS workgroup was established to consider the best way to develop Performance Measures, report Performance Measure data and operationalize the Turn-the-Curve process with Service Providers. We believed that by developing Results, Indicators and Performance Measures, the effectiveness of services to the children and families of Nebraska would increase. However, for that to happen, Service Providers and DCFS had to come to the table together. RBA training helped to facilitate a common language and approach to these discussions.
The first step was to train all Child and Adult Protection and Safety staff on the principles of RBA. Karen Finn, Clear Impact consultant, and Nathan Busch, initiative manager, traveled across Nebraska for two weeks offering training opportunities in multiple locations. At the conclusion of the two-week trip, they had trained 930 DCFS staff in the principles of RBA and Performance Measure development. The initial phase of RBA implementation was to use Performance Measures for eight key service contracts:
- Agency-Supported Foster Care
- Agency-Supported Respite Care
- Family Support
- Drug Testing and Lab Confirmation
- Emergency Shelter Care
- In-Home Safety Services
- Intensive Family Preservation
- Group Home Care
A key component of the DCFS RBA training was the opportunity for DCFS staff to develop Performance Measures for each of the key service contracts. At the conclusion of the training, 73 percent of DCFS staff reported they “gained knowledge and skills that will help in my work.”
The next step was to replicate the same process, but with Service Providers. Over a two-week period, Karen and Nathan again traveled around Nebraska conducting RBA training at multiple locations for Service Providers. This gave Service Providers the opportunity to learn the principles of RBA, Performance Measure development and to participate in Performance Measure development for the key eight service contracts. At the conclusion of the Service Provider training, 200 Service Provider staff were trained and 97 percent said they “gained knowledge and skills that will help in my work.”
At the conclusion of the DCFS staff and Service Provider training, the workgroup had Performance Measures developed by DCFS staff and Service Providers for all key eight services.
The next major stage of implementation was consolidation of the DCFS Performance Measures and the Service Provider Performance Measures. Remarkably, 85 percent of the DCFS and the Service Provider Measures were the same. This became the common foundation for Performance Measure development. Through a series of webinars facilitated by Karen, final Performance Measures were developed.
While working with Service Providers, the RBA Workgroup developed a Nebraska Results Based Accountability Initiative Program Manual. The Manual was organized into chapters including Performance Measure development, Scorecard usage and Turn-the-Curve process. A link to the Program Manual is available on the homepage of the Division Scorecard. This helped to ensure that everyone was informed about the same information and processes. In addition, the RBA Workgroup developed a Definitions document. This document contained definitions of terms used throughout the RBA process and the Scorecard. This document is also available on the homepage of the Division Scorecard. This helped to fulfill the key principle of RBA, to ensure everyone spoke with a common understanding of the terms used.
As the implementation process unfolded, a Service Provider was added to the RBA Workgroup. This was a significant step which demonstrated a level of trust both on the part of DCFS and the Service Providers. The RBA Workgroup meets quarterly to discuss issues with implementation, and needed correction of the Program Manual or Definitions. The addition of the Service Provider representative has led to better communication and perspective different than that of DCFS.
A web-based data collection system, the Clear Impact Scorecard, was utilized to act as a central hub for data collection. Scorecards were developed for each Service Provider and contained Performance Measures for each service offered. All the collected data aggregates to a Director’s Scorecard which shows statewide progress on each of the eight services. Scorecard licenses were provided to DCFS staff and Service Providers, at no cost to the Service Provider, to allow access to the Scorecard. Data is reported on a monthly basis and tracked by the Service Provider and DCFS.
The foundation of RBA implementation has been the development and strengthening of a partnership between DCFS and Service Providers. One key component of this relationship is the stipulation of a two-year “hold harmless” period. This is a two-year period of implementation and development of a data baseline. Service Providers, while required to participate in the Turn-the-Curve process, will not be penalized based on data reported. This strengthened the willingness of Service Providers to be more comfortable and open with the RBA process. Over time the Turn-the-Curve process will be used to identify gaps and to work with Service Providers to strengthen the service delivery they are struggling with.
During the development of Performance Measures, Nebraska made application for the Federal Title IV-E Waiver. Nebraska hypothesized that by measuring Service Providers’ Performance Measures, the quality of services for children and families would increase. Nebraska was granted the Title IV-E Waiver and implementation of the Nebraska Results Based Accountability Initiative began. This is significant because it creates an environment in Nebraska where RBA and the Clear Impact Scorecard can be tested to measure potential impact on Child Welfare best practice nationwide.
In order to deliver the most personalized support possible to Service Providers, DCFS developed a system where localized contract managers will work with Service Provider agencies to report data and turn the curve of that data in a positive direction of service effectiveness for Nebraska’s children and families.
Performance Measures were included in Service Provider contracts with a requirement to report data using the Clear Impact Scorecard on a monthly calendar basis. Nebraska is currently in its fifth month of data reporting. While working with 72 Service Providers to report data on a monthly basis has been a challenge, the amount of data reporting has increased month by month. Currently, only nine Service Providers have not reported any data.
In the upcoming months, Nebraska will begin the Turn-the-Curve discussions with Service Providers. This will be accomplished by localized contract managers working directly with Service Provider contract managers walking through the Turn-the-Curve tutorial on the Scorecard. Every month managers and Service Providers will focus on one service. This will allow for each provider to have all services discussed on a semi-annual basis. All of which is done with an unrelenting focus on making sure our common customers, the children and families of Nebraska, are “better off” because of the services we offer.
What does the future hold for RBA in Nebraska? We have only outlined the implementation process thus far with Child Protection and Safety service contracts. The next phase of the implementation will involve utilizing RBA and the Clear Impact Scorecard to measure the effectiveness of DCFS sub-grants. In addition, DCFS will be implementing RBA with our Economic Support section. In short, you haven’t seen anything yet!
For more information, contact:
Nathan S. Busch, JD
Special Projects Administrator
Division of Children and Family Services
301 Centennial Mall South
Lincoln, Nebraska 68509