CPC and CCR&R Service Delivery System Assessment Executive Summary MA Department of Early Education and Care December 6, 2005 1
I. Executive Summary Project Overview Public Consulting Group was contracted from September 15, 2005 until November 15, 2005 to gather information and report to the Department of Early Education and Care in part to respond to a Legislative reporting requirement in the FY06 budget and also to consider broader operational issues. This report provides an assessment of the current operations, business capacity and services offered by the Child Care Resource and Referral Agencies (CCR&Rs) and the Community Partnerships for Children (CPCs) in order to inform the development of an efficient and coordinated regional and local infrastructure for the administration of early education and care services in the Commonwealth. Methodology PCG used several methods to collect information Collection of data and information already maintained by EEC Survey of the CCR&Rs and CPCs o Response rate: 14 of 14 CCR&Rs; 123 of 164 CPCs Site visits to all CCR&Rs and to a sample of CPCs Creation of a project email address where CCR&Rs and CPCs could send additional information Statewide meeting for CPCs o 109 attendees representing 101 CPCs Summary of Findings CPCs and CCR&Rs conduct a large volume of business transactions and parent/provider interactions. Much of the eligibility, waitlist and payment process system is paper driven, with limited technological efficiencies. CPCs, CCR&Rs, and the state perform similar activities resulting in a duplication of activities across the system. Eligibility inconsistency and limited coordination make the system confusing for parents. 2
CPCs provide comprehensive services based on local decision-making and available funding. Provider payments differ, further fragmenting the system. A large amount of professional development is offered; however, it is not coordinated toward meeting statewide goals. State data collection methods and information gathered does not allow for ready analysis for state decision making. Volume of Business: CPCs and CCR&Rs conduct a large volume of business transactions and parent/provider interactions. Volume of Business Payments CPCs (97 responding) reported processing over 19,000 invoices in FY05. CCR&Rs managed a total 80,549 vouchers in FY05 for children in 205,050 placements, resulting in 51,282 invoices being processed in FY05. (Each individual child may have more than one voucher or placement during the year). CPC Payment Invoices Processed In FY 05: # of Invoices Processed # of CPC Respondents 0 23 1-100 29 101-200 37 201-500 27 501-1000 3 Over 1000 1 3
Volume of Business Payments and Processing CCR&Rs provided the following information regarding the level of effort required to manage each function. Statewide CCR&R Program Expenditures and FTEs Program Area FTE Expenditures Number of CCR&Rs Reporting Other Expenditures 3.62 $ 363,501 13 Professional Development 29.29 $ 1,607,642 13 Technology and Data Expenditures 1.18 $ 316,049 13 Voucher Management 107.43 $ 5,227,098 13 Waitlist Management 7.66 $ 416,094 13 Information and Referral 26.07 $ 1,200,436 13 Administration - $ 965,166 14 Total 175.25 $ 10,095,985 Voucher management, eligibility and payment processing requires the largest portion of staff effort under the current system design. On the FY06 Attachment B CPCs reported $7.7M in Administrative costs and $1.3M in in-kind administrative support. These amounts do not include some CPC staff costs. In addition, CPCs reported $8.2M in other in-kind support. Volume of Business Provider Outreach (Vacancies) CCR&Rs reported making over 90,000 contacts with providers annually to gather vacancy information. All CCR&Rs reported collecting this information at least every 8 weeks. CPCs also contact providers for vacancy information, at varying intervals as illustrated in the following chart. 4
How Frequently Does Your CPC Receive Updates From Providers Regarding Open Placements? Number of Respondents 50 45 40 35 30 25 20 15 10 5 0 Weekly 1 Once a month 48 Every 3 months 14 Quarterly 5 Once a year 22 7 1 2 1 Twice a Year When they have vacancy Do Not Collect Use CCR&R Database Randomly/Upon Request 6 Frequency Volume of Business Information Distribution CPC o CPCs distribute information to families through various means. (Respondents were asked to select all that apply) In What Format is Information Provided to Families? Number of CPCs 120 100 80 60 40 20 0 Mailed 98 55 E-mailed In person at CPC office 86 In person in home/other 42 By telephone 90 By fax 61 Other 40 5
Volume of Business Information Distribution CCR&R o 20,650 packets of information are sent to families each year. o Over 50% of packets are sent via the mail. Consider the following: Method of Distributing Information # of Packets of Information Mailed 10,294 E-Mailed 6,953 In-Person 1,405 Other 1,998 Total 20,650 Paper Driven Process: Much of the eligibility, waitlist and payment process system is paper driven, with limited technological efficiencies. Data Management and Invoicing is Paper Driven 100% of CCR&Rs receive attendance information from providers on paper (Boston is conducting a limited pilot to use IT systems for data sharing). 93 CPCs reported that providers submit child-specific data to the CPC on paper or by fax. (93 of 102 respondents to this question. Not every CPC elected to respond). Format of Child Specific Data Submitted by Providers 100% 80% 60% 40% 20% 0% CCRR CPC Paper based E-mailed electronically By Fax Other Not applicable 6
83% of CPCs reported that they were either comfortable or very comfortable with web based reporting. CPC Comfort Levels 100% 90% 80% 70% 83% 82% 72% 60% 50% 40% 30% 26% 43% 40% 39% 33% 27% VERY COMFORTABLE COMFORTABLE NOT COMFORTABLE 20% 17% 18% 17% 10% 0% General Computer Use 0% 0% 2% Email Use Using Web Web Based Reporting Database Program Duplication: CPCs, CCR&Rs, and the state perform similar activities resulting in a duplication of activities across the system. Duplication Contracts outside Catchment area Over 92% of CCR&Rs and 79% of CPCs have contract and payment relationships with providers outside their catchment area. Percent with contracts outside catchment area 100% 80% Percentage 60% 40% 20% 0% CCR&R CPC 7
Duplication Waitlist Management Over 77% of CPCs maintain a waitlist on paper or an Excel Spreadsheet. 100% of CCR&Rs use CCIMS to manage the waitlist. Most CPCs reported that they maintain the CPC and state waitlists separately: How is the CPC Waitlist Maintained? Number of CPCs 80 70 60 50 40 30 20 10 0 70 CPC and State waitlists are maintained separately Method 33 CPC and State waitlists are combined Duplication Waitlist Management CCR&Rs contact each family once every six months, via USMAIL, to maintain waitlist information. If a family does not respond to this contact, the family is removed from the waitlist. CPCs reported the following number of contacts before removing children from the waitlist: Number of CPCs 50 45 40 35 30 25 20 15 10 5 0 How many Attempts are made to Contact the Family Before a Child is Removed from the Waitlist? 11 0 - Children are not removed from list 7 44 1 2-3 4-5 More than 5 Attempts 25 9 8
PCG estimates that waitlist management costs for CCR&Rs and CPCs exceeds $500,000 annually Comprehensive Services: CPCs provide comprehensive services based on local decision-making and available funding. Comprehensive Services A Vast Array 123 CPCs reported offering a total of 695 Comprehensive Service opportunities for almost 50,000 children. o 61 CPCs noted offering various literacy and language development programming and supports to providers. Some examples of provider support include speech consultation, language mentoring, professional development, materials and supplies, and curriculum development. o 40 CPCs highlighted parent support activities which included play groups, parenting classes, literacy training, and other parent-child activities o 42 CPCs listed mental health services which could include teacher workshops, classroom observations, family support, behavioral consultation, therapeutic intervention, individual and group therapy, and developmental screenings. o 35 CPCs reported resource libraries for providers and families. o 20 CPCs reported home visiting services to assist families in a variety of activities o 14 CPCs reported providing health and dental screenings o 4 CPCs reported providing speech and language support/consultation to programs. o 3 CPCs noted that they provide/sponsor science enrichment activities. o 1 CPC listed occupational therapy support/consultation. Parent Access: Eligibility inconsistency and limited coordination make the system confusing for parents. Parent Access -- Geographical Location Through the site visits we learned, there is no standardized referral process from CCR&Rs to CPCs, from CPCs to CCR&Rs, or to contracted slots. o Families may need to contact 3 agencies to access subsidized care. 9
CCRRs and CPCs were asked to report on the number of children served within specific geographical areas relative to intake location. They did not report significant disparities in how far families served live from intake locations. Number of Families Served by CPC's who Live within a Specified Radius of the CPC 7% 5% 0% 17% 5 Mile Radius 6-10 Mile Radius 11-20 Mile Radius 21-60 Mile Radius Over 60 Mile Radius 71% Number of Families Served by CCR&R's who Live within a Specified Radius of the CCR&R Intake Location 2% 8% 0% 30% 60% 5 Mile Radius 6-10 Mile Radius 11-20 Mile Radius 21-60 Mile Radius Over 60 Mile Radius 10
Parent Access - How is Eligibility Determined While CPCs predominantly reported that eligibility assessments occur at the CPC office they also reported a multitude of other venues for eligibility determinations. (Respondents were asked to select all that applied). Parent Access - Eligibility Paper Work for Vouchers The current voucher eligibility process used by CCR&Rs requires clients to submit a great deal of paperwork and information, much of which is also captured by other state agencies and systems. The Guide To Community Partnerships for Children has some similar documentation requirements, as noted in the table below. CPC Councils may set additional documentation requirements. CCRR Required Document Required by CPC Guide? Verified by DTA in BEACON Verified by MassHealth in MMIS or MA21 Verified by DOR Positive Identification including Photo ID Additional form of identification Birth Certificate or other documentation of relationship for each child Documentation of residence including utility bill or rental agreement dated within 45 days of application Yes, if earning wages, but Four of most recent six week's pay stubs or letter from company on letterhead with Most recent 4 Within 6 reported one federal tax ID weeks months Within 1 year quarter behind Documentation of hours worked to verify service need # of hours only # of hours only # of hours only # of hours only Documentation of social security benefits Documentation of other income including rental income, pension income, annuities Public Assistance documentation Documentation of Unemployment Compensation Retirement Income verification Documentation of Child Support Documentation of training program or education program on school's letterhead Verification of parental incapacity Verification of child's Special Needs Eligibility Workload Each of the 54,000 voucher clients must be reassessed every 6 months for continued eligibility for a voucher. In addition, if any changes in eligibility occur at any time during the year, such as change in work status or work hours, CCR&Rs must rewrite the voucher when they become aware of the new information. Changes include: o Availability of transportation o Mode of transportation and transportation time to work o Hours of employment o Change or addition of employer 11
o Loss of job o Additions to household o Change of selected provider CPC subsidy clients are given eligibility for a full fiscal year, even if a family experiences a change that would make them no longer eligible for the subsidy. Therefore, there is no CPC workload related to re-assessment of eligibility during the year. Rates: Provider payments differ further fragmenting the system. Rates a nd Rate Setting Differ Vastly CPC program rates are set by each CPC. 77 CPCs reported that the CPC Council is involved in rate-setting, and there can be a variety of other contributors, as indicated in the table below. 72% of CPC Councils pay providers based on Published Private Rates. CCR&Rs are required to use the state rate established by EEC, which is lower than most published private rates. Who is Involved Determining CPC Rates? Cs P of C 90 80 70 60 50 40 30 20 10 0 11 15 6 14 77 11 CP Coordi School district st Outsid consulta Supervis of CPC coordinat Bookkeep Other Le Agency Staff CCR& staf ber CP Coun Oth Num 47 1 2 C nator aff e nt or or er ad f R C cil er Person Involved 12
Professional Development: A large amount of professional development is offered, however it is not coordinated toward meeting statewide goals. Professional Development/Training CPCs and CCR&Rs reported a high volume of provider staff trainings, with a total of 1,709 offerings statewide. o These trainings focus on a wide range of topics and are generally uncoordinated between the regional and local level, unless a contract between a CPC and CCR&R for training exists. o Training assessments and goals are not uniform or comprehensive. Trainings with a reported high need such as behavioral and mental health trainings are not coordinated at the state level. CCRR Number of Courses CPC Number of Courses Type of Training Offered 2 hour workshops Reported 456 Reported 319 Total Courses 775 Workshops/trainings/prof development 140 198 338 Other 98 36 134 First Aid CPR 85 36 121 Training in other languages 73 2 75 Training for CEUs 24 28 52 College Course Work 16 113 129 Training for college credit 11 13 24 Conference 7 36 43 College Prep Courses 2 4 6 Career Counseling 2 7 9 Adult Literacy 1 2 3 Total 915 794 1,709 State Data Collection: State data collection methods and information gathered does not allow for ready analysis for state decision making. State Data Collection Efforts PCG performed a review of data collected by EEC with the following findings: o EEC collects thousands of data elements from CCR&Rs and CPCs annually. The data is not collected uniformly There is no consolidated database 13
Much of the data must be manually data entered o Budget data collection is different between CCR&Rs and CPCs. CCR&Rs invoice based on UFR line items such as salaries, taxes, occupancy costs, etc. CPCs report based on programmatic objective such as quality and affordability and accessibility. These formats make it impossible to compare data between the types of programs. EEC does not currently collect data to allow comparisons of CCR&R budgeted amounts to actual expenditures. The current data collected does not support analysis of cost by function or activity. Stakeholde r Identified Strengths and Weaknesses Stakeholder Identified System Strengths CPCs CCR&RS Local Control/Local Service Collaboration: The CCR&R Delivery: The ability to operate at Network helps the agencies a local level helps meet specific collaborate. needs of the community. Investment of Funds: Investment Collaboration and In Kind of both state and federal funds Support: Relationships with other benefits the current system. agencies are a strength, including Mixed System of Care = Parent the lead agency which often Choice: The mixed system of care provides in-kind services. Rates: Child Care subsidies paid by helps with stability of programs and greater parent choice. CPCs are paid closer to the actual Quality: Participation with cost of care than vouchers. (NACCRRA) and the current Quality: The Standards of licensing system contributes to Programs and Curriculum program quality. Guidelines developed by DOE contributes to program quality. 14
Stakeholder Identified System Weaknesses CPCs and CCR&Rs agreed on several system weaknesses o Inadequate and Inconsistent Funding: the state rate is too low to support quality and does not meet the actual cost of care. The system is not adequately funded to meet state early ed and care needs. o Confusing and Fragmented System: the current fragmented system is confusing for parents. Parents must first understand the system, and then they must fill out multiple applications for care. CPCs also identified the following weaknesses: o Paperwork and reporting procedures are overwhelming. o Families in rural communities may have to drive long distances to receive services. CCR&Rs also identified quality weaknesses in the system: o Provider training requirements are too low however child care staff can not afford higher education opportunities. In addition, CCR&Rs noted that there is not a consistent measure of quality. While funding is spent on supporting quality, there is no benchmark to rate quality. 15