Integrated Data Systems are Key to “Pay for Success” in Cuyahoga County (Cleveland) (Harvard - Ash)

BY PATRICIA AUSPOS 

Families who receive social services frequently need help from more than one public system. Typically, they struggle with an array of problems requiring simultaneous assistance from multiple agencies. But the help they receive from government often is fragmented and reactive rather than coordinated and preventative. Information about each family is split across the separate agencies that provide food assistance, workforce training, child welfare services and schooling. Agencies cannot see – and are not responsible for – how their support of a family affects what happens in these other closely-related systems.

And so while it’s generally true in human services that “an ounce of prevention now is worth a pound of cure later,” usually the price of this prevention and the cost of the cure are being paid by different agencies. This misalignment of incentives, commonly known as the “wrong pocket problem,” is a huge obstacle to directing public dollars where they can do the most good. It’s an obstacle that an initiative called Partnering for Family Success in Cuyahoga County is trying to overcome with a combination of innovative financing and coordinated data. 

Partnering for Family Success (Family Success, for short) is the first county-level program in the United States to use a funding mechanism known as pay for success. Introduced in the United Kingdom in 2010, pay for success has attracted widespread interest as a way for governments to get upfront private and philanthropic dollars to run evidence-based programs. Unlike traditional philanthropic grants, the funding that supports pay for success programs is treated like an investment: funders are paid back out of tax dollars if — and only if — the program is shown to be effective and generates savings for government.

At root, Cuyahoga County’s Family Success initiative provides a particularly vulnerable population – homeless mothers who have children in the child welfare system – with housing and other supports to more quickly reunite these families or to allow the child to enter alternative permanent placement. The investors are funding comprehensive services for homeless mothers and will be paid back from the savings generated by shortening the time the children of these homeless mothers spend in out-of-home care. And the glue holding together this complex arrangement is an integrated data system (IDS) developed by the Center on Urban Poverty and Community Development at Case Western Reserve University (CWRU) that holds data from 18 separate administrative systems in Cuyahoga County. 

For a more detailed version of this case study, related case studies,  and resources on how to build integrated data systems to improve child and family services, see the Annie E. Casey Foundation resource page at: http://www.aecf.org/blog/improving-child-and-family-services-through-integrated-data-systems/

The challenge. Spurred by interest and financial support from The George Gund Foundation, Cuyahoga County officials issued an RFP in October 2012, asking for project ideas from organizations interested in partnering with the county on a pay for success initiative. Though they received several proposals, it wasn’t until CWRU researchers used the county-level IDS to examine linked data from the homeless administration and the child welfare system that county officials were able to identify a target group and service strategy that made programmatic and financial sense.

IDS data was critical to designing, and financing this initiative. To get started, the Cuyahoga County consortium needed an accurate picture of a high-need, high-cost population of families who receive services from the homeless and the child welfare systems. To develop this picture, CWRU researchers connected administrative data collected by two separate agencies but linked through the ChildHood Integrated Longitudinal Data System (CHILD), the IDS launched by CWRU in 1999. The Office of Homeless Services collected information about the mothers, but not about their children if the women entered the system without children. A separate department, the Division of Children and Family Services, had information about children receiving child welfare services and some information about their mothers, but did not necessarily know when mothers became homeless. Getting a more precise picture of these vulnerable families required CWRU to look across both systems to understand the interplay between what happened to the mothers and what happened to their children.

Using IDS data, CWRU researchers discovered that the overlap population was smaller than expected but large enough to be a significant concern.  In addition to being homeless, the mothers struggle with an array of problems — substance abuse, mental illness and the effects of domestic violence — that make it difficult to provide a safe and stable home environment for their families. The researchers were able to plan an intervention that addressed these families’ multiple needs and then design a rigorous evaluation that could test the effectiveness of a program providing a more targeted set of services and supports than the current, highly fragmented mix. And they could estimate potential savings for the county government if the new program were to succeed in reducing the time children of homeless mothers spend in child welfare custody.

The agreement. After sharing  information from the IDS on homeless mothers with children in child welfare custody, the consortium of county leaders, nonprofit agencies and private and philanthropic funders sponsoring the pay for success initiative crafted a service program, an evaluation and a financing model. The consortium chose a promising, evidence-based intervention developed by a long-term service provider in Cuyahoga County, FrontLine Service. Family Success provides a mix of housing assistance and housing resources, behavioral health services, an innovative trauma support intervention and intensive case management to homeless caregivers with children in foster care. Staff continue to work with the family, including the children, once the family reunites.

The program, launched in 2015, will serve a total of 135 homeless mothers with an estimated 270 children in foster care. Planners expect the program to reduce the time children spend in foster care by helping to stabilize families and enabling caseworkers to make better, faster decisions about family reunification or an alternative permanent placement for children. Based on a calculation of how much this will save the public, the county will pay back the investors $75 for every day of reduced care, up to a maximum of $5 million. Any additional savings will be retained by the county. And CWRU researchers are using the IDS in a randomized controlled trial — the gold standard in program evaluation — to determine whether Family Success shortens time in child welfare and whether the investors can be paid back.  

Value added by the IDS? Faster, better, cheaper. Researchers, county administrators, service providers and funders all attest to the central role the IDS has played in designing, implementing and testing Cuyahoga County’s Family Success program, allowing a broad team of actors to coalesce around an innovative service model for homeless mothers who have children in foster care. “If not for the IDS, Partnering for Family Success wouldn’t have happened,” said David Merriman, administrator for Cuyahoga Job and Family Services. “We needed the data on homeless mothers and children in child welfare to develop the Family Success program, and we wouldn’t have had the data if it weren’t for the IDS.” 

David Crampton, an associate director of the Center on Urban Poverty and Community Development at CWRU, agreed: “Without the IDS, nobody knew how big this population was, or how long the children were in foster care. Analyzing the overlap through the IDS showed that it was sizable. The data also made it clear that we weren’t getting the results we wanted from our current programs.”

Family Success partners agree that having an IDS already in place — with data available, cleaned and linked, and use agreements and privacy protocols worked out — saved months of work during the project’s development phase. CWRU’s reputation as an experienced and trusted data source, and its long history of working with county staff, nonprofit providers and philanthropic funders also facilitated the development process.

Assessing the Cuyahoga County experience, Third Sector Capital Partners, a technical assistance provider that works with state and local governments to design pay for success initiatives, draws this lesson for other jurisdictions: “Invest in integrated data systems now.”

ABOUT THE AUTHOR

PATRICIA AUSPOS

Patricia Auspos, an independent consultant, writes about social policy issues and programs.  She was a Senior Fellow at the Aspen Institute Roundtable on Community Change and a Senior Associate at MDRC. This case study is one of a series she wrote for the Annie E. Casey Foundation to show how states and localities use integrated data systems to improve policy, programs and practice.