In the end…

While we wrestled with those questions, a natural progression in the conversation was to staff. More than ever, we needed to support front line staff and supervisors to help them realize the results we will achieve together.

How did we do this? Again – we focused on practice. Keeping front line staff and supervisors from both public and private agencies in mind, we discussed what they would need to be successful together. Success was defined as the outcome of the case, and this success can not be achieved without both agencies problem solving together.

In the end this team, whose charge was to recommend changes for a payment structure, created a recommendation that contained more language about practice improvement than payment.

Not a perfect fit

To define our route, we first asked the question, “How are we doing today?” (Notice “we”). We pulled some data and looked at some individual cases. Focusing on practice alone, we said, “Our goal is to do better. Let’s do it.”

Reality was that we were doing well. But the goal is to do better, so we identified cases that just don’t “fit” typical case progression. Then we asked the question, “How do we deal with the cases that don’t “fit?”

“When a case doesn’t “fit,” what is the practice that supports the safety of the child and the family – that can keep the agency involved?” We looked at practice and practicality – if disincentives are used to manage outcomes, at what level can agencies sustain providing services?

The first concern is the safety of the child and family, so how do we define a manageable approach to these cases? Most important – what is a manageable approach that both private and public agencies can successfully work together on?