cpc and ccr&r service delivery system assessment and ccr&r service delivery system...

PublicConsultingGroup.com

CPC and CCR&R Service Delivery CPC and CCR&R Service Delivery System AssessmentSystem Assessment

MA Department of Early Education and CareMA Department of Early Education and Care

December 6, 2005

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 informationCollection of data and information already maintained by EECSurvey of the CCR&Rs and CPCs

Response rate: 14 of 14 CCR&Rs; 123 of 164 CPCs

Site visits to all CCR&Rs and to a sample of CPCsCreation of a project email address where CCR&Rs and CPCs could send additional informationStatewide meeting for CPCs

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.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.

HMS NEWS

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 205,050placements, 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

0 231-100 29

101-200 37201-500 27

501-1000 3Over 1000 1

Volume of Business – Payments and Processing

CCR&Rs provided the following information regarding the level of effort required to manage each function.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.

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$

Statewide CCR&R Program Expenditures and FTEs

Volume of Business – Provider Outreach (vacancies)

CCR&Rs reported making over 90,000 contacts with providers annually togather vacancy information. All CCR&Rs reported collecting this information at least every 8 weeks. CPCs also contact providers for vacancy information, at varying intervals.

How Frequently Does Your CPC Receive Updates From Providers Regarding Open Placements?

1

48

14

51

22

71

62

05

101520253035404550

Weekly

Once a

mon

thEve

ry 3 m

onths

Quarte

rlyOnc

e a ye

arTwice

a Yea

r

When th

ey ha

ve va

canc

yDo N

ot Coll

ect

Use C

CR&R Data

base

Rando

mly/Upo

n Req

uest

Frequency

Num

ber o

f Res

pond

ents

Volume of Business – Information Distribution

CPCCPCs distribute information to families through various means. (Respondents were asked to select all that apply)

In What Format is Information Provided to Families?

98

55

86

42

90

6140

020406080

100120

Mailed

E-mail

ed

In pe

rson a

t CPC of

fice

In pe

rson i

n hom

e/othe

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elepho

ne

By fax

Other

Num

ber o

f CPC

s

Volume of Business – Information Distribution

CCRR20,650 packets of information are sent to families each year.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

HMS NEWS

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

0%20%40%60%80%

100%

Pap

er b

ased

E-m

aile

del

ectro

nica

lly

By

Fax

Oth

er

Not

appl

icab

le

CCRR

CPC

However…

83% of CPCs reported that they were either comfortable or very comfortable with web based reporting.

CPC Comfort Levels

83% 82%

72%

43%

33%

17% 18%

26%

40% 39%

0% 0% 2%

17%

27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

General ComputerUse

Email Use Using Web Web BasedReporting

Database Program

VERY COMFORTABLE

COMFORTABLE

NOT COMFORTABLE

HMS NEWS

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

0%

20%

40%

60%

80%

100%

CCR&R CPC

Perc

enta

ge

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?

33

70

0

10

20

30

40

50

60

70

80

CPC and State waitlists aremaintained separately

CPC and State waitlists arecombined

Method

Num

ber o

f CP

Cs

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:

PCG estimates that waitlist management costs for CCR&Rs and CPCs exceeds $500,000 annually.

How many Attempts are made to Contact the Family Before a Child is Removed from the

Waitlist?

117

44

25

9

05

101520253035404550

0 - Childrenare not

removed fromlist

1 2 - 3 4 - 5 More than 5

Attempts

Num

ber

of C

PC

s

HMS NEWS

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.

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. 40 CPCs highlighted parent support activities which included play groups, parenting classes, literacy training, and other parent-child activities42 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.35 CPCs reported resource libraries for providers and families.20 CPCs reported home visiting services to assist families in a variety of activities14 CPCs reported providing health and dental screenings4 CPCs reported providing speech and language support/consultation to programs.3 CPCs noted that they provide/sponsor science enrichment activities.1 CPC listed occupational therapy support/consultation.

HMS NEWS

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.Families may need to contact 3 agencies to access subsidized care.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%

71%

17%5 Mile Radius6 - 10 Mile Radius11 - 20 Mile Radius21-60 Mile RadiusOver 60 Mile Radius

Number of Families Served by CCR&R's who Live within a Specified Radius of the CCR&R Intake Location

60%

30%

8%

2%

0%

5 Mile Radius6 - 10 Mile Radius11 - 20 Mile Radius21-60 Mile RadiusOver 60 Mile Radius

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).

CCR&R – Most family meetings are conducted in the agency office or the DTA office.Nearly all families must come in person to submit documentation when a subsidy is available.

Where CPC's Perform Eligibility Determinations

0102030405060708090

100

Meet withparents inperson at

agency office

Meet withparents at

family home

Parent mayapply over

thetelephone

Parent mayapply via amailed oremailed

application

Other

Method of Collecting Information for Determinations

Num

ber o

f CPC

's

Where CCR&R's Perform Eligibility Determinations

0246

8101214

Mee

t with

pare

nts

inpe

rson

at

agen

cy o

ffice

Mee

t with

pare

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at th

est

ate

agen

cy(D

TA)

Mee

t with

pare

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mily

hom

e

Par

ent m

ayap

ply

over

the

tele

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e

Par

ent m

ayap

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ail

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icat

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et

Out

sour

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igib

ility

dete

rmin

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ns

Oth

er (p

leas

ede

scrib

e)

Method of Collecting Information for Determination

Num

ber o

f CC

R&

R's

Parent Access - The Voucher Eligibility Process

CPC Subsidy Eligibility Process

CPC eligibility and intake occurs at a variety of locations and by a number of different individuals, depending on how the CPC is structured, and a single CPC may utilize more than one method. While there is some variability, the vast majority of the determinations reported in the survey are performed in house by the Lead Agency or CPC Coordinator.

Who Conducts Eligibility Determinations?

0102030405060708090

Leadagency/CPCCoordinator

Individualproviders

Intake iscontracted out

to CCR&R


to anotheragency


to anindividual

Num

ber

of C

PC

s

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 DocumentRequired by CPC Guide?

Verified by DTA in

BEACON

Verified by MassHealth in MMIS or MA21

Verified by DOR

Positive Identification including Photo IDAdditional form of identificationBirth Certificate or other documentation of relationship for each childDocumentation of residence including utility bill or rental agreement dated within 45 days of application

Four of most recent six week's pay stubs or letter from company on letterhead with federal tax ID

Most recent 4 weeks

Within 6 months Within 1 year

Yes, if earning wages, but reported one quarter behind

Documentation of hours worked to verify service need # of hours only # of hours only # of hours onlyDocumentation of social security benefits

Documentation of other income including rental income, pension income, annuitiesPublic Assistance documentationDocumentation of Unemployment CompensationRetirement Income verificationDocumentation of Child SupportDocumentation of training program or education program on school's letterheadVerification 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&Rsmust rewrite the voucher when they become aware of the new information. Changes include:

Availability of transportationMode of transportation and transportation time to workHours of employmentChange or addition of employerLoss of job Additions to householdChange of selected provider

CPC subsidy clients are given eligibility for a full school 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.

HMS NEWS

Rates: Provider payments differ further fragmenting the system.

Rates and 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?

47

111

152 6

14

77

11

0102030405060708090

CP

CC

oord

inat

or

Sch

ool

dist

rict s

taff

Out

side

cons

ulta

nt

Sup

ervi

sor

of C

PC

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dina

tor

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kkee

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er L

ead

Age

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Sta

ff

CC

R&

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aff

CP

CC

ounc

il

Oth

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Person Involved

Num

ber o

f CPC

s

HMS NEWS

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.

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. 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.

Type of Training Offered

CCRR Number of Courses Reported

CPC Number of Courses Reported Total Courses

2 hour workshops 456 319 775Workshops/trainings/prof development 140 198 338Other 98 36 134First Aid CPR 85 36 121Training in other languages 73 2 75Training for CEUs 24 28 52College Course Work 16 113 129Training for college credit 11 13 24Conference 7 36 43College Prep Courses 2 4 6Career Counseling 2 7 9Adult Literacy 1 2 3Total 915 794 1,709

HMS NEWS

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:EEC collects thousands of data elements from CCR&Rs and CPCs annually.

The data is not collected uniformlyThere is no consolidated databaseMuch of the data must be manually data entered

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.

HMS NEWS

Stakeholder Identified Strengths and Weaknesses

Stakeholder Identified System Strengths

CPCsLocal Control/Local Service Delivery: The ability to operate at a local level helps meet specific needs of the community.Collaboration and In Kind Support: Relationships with other agencies are a strength, including the lead agency which often provides in-kind services.Rates: Child Care subsidies paid by CPCs are paid closer to the actual cost of care than vouchers.Quality: The Standards of Programsand Curriculum Guidelinesdeveloped by DOE contributes to program quality.

CCR&RSCollaboration: The CCR&R Network helps the agencies collaborate.Investment of Funds: Investment of both state and federal funds benefits the current system.Mixed System of Care = Parent Choice: The mixed system of care helps with stability of programs and greater parent choice.Quality: Participation with (NACCRRA) and the current licensing system contributes to program quality.

Stakeholder Identified System Weaknesses

CPCs and CCR&Rs agreed on several system weaknessesInadequate 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.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:Paperwork and reporting procedures are overwhelming.Families in rural communities may have to drive long distances to receive services.

CCR&Rs also identified quality weaknesses in the system: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.

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