Some thoughts on privatization
....finding the right balance between public and private.
On the tail of a pretty critical report, the Nebraska legislature this week is considering an end to a 10-year experiment with privatized child welfare case management. The release of the report and accompanying legislative recommendations gives me the opportunity to talk a bit about a thorny subject: privatization of child welfare.
First, it’s important to note that much of the child welfare system is already in the hands of the private sector, and for good reason. Child welfare systems began as private efforts, and such organizations as The New York Foundling (established 1869) and our own South Georgia Methodist Children’s Home (established 1872) were caring for abused and abandoned children long before the federal government stepped in. Private providers across the nation handle foster care, treatment and therapy, transportation, and dozens of other services needed to protect and care for vulnerable children and their families.
The Nebraska reports focus in on issues that can arise with a more “fully” privatized system, in which all case management as well as other services are entrusted to the private sector. The state piloted this full privatization in one region, thereby creating the opportunity to compare apples to apples. Nebraska’s review found that in the region piloting case management privatization, the results were (1) a 9% increase in the foster care population vs. a 2.1% decrease in non-pilot areas; (2) longer median lengths of stay vs. non-privatized regions; and (3) lower well-being scores for children in care. Overall, there was no improvement in any area. Significantly, the state also found the organization that won the bid had severely underestimated the cost of the work, resulting in financial trouble and a restructured contract with a significantly higher price.
“Full” privatization has also run into trouble in Florida. Texas has tried a different approach, turning over placement of children to private agencies that are responsible for finding the “right” foster care or group home for the child. Recently, there have been concerns raised over this arrangement, as well.
So is privatization itself bad? Of course not. The key, however, is that the State (or other jurisdiction) has to maintain control over whether children enter the foster care system, the services they receive via family preservation or foster care, and their path to permanency via reunification, guardianship, or adoption. This control can be maintained by keeping a state-employed case manager in charge of each child’s case while working with private foster care agencies, therapists, service providers, and even privatized case managers. After all, it’s government that is legally responsible for making decisions that keep children safe, provide them with the most appropriate placement and services, and get them to permanency as rapidly as possible.
What are your thoughts on privatization? Please sound off!
In other news:
Someone I know has a new website. Check it out!
Fascinating article in the New York Times about children of “disappeared” parents during the Pinochet regime in Chile. They were abducted by the government and adopted internationally.
There’s a crisis in mental health services for children in Rhode Island, according to the State Child Advocate. (Hey, y’all call me — I’ve got a solution!)
We’re all aware that children and youth who have experienced foster care are more prone to become homeless. Liz Owens at WRDW in Augusta, Georgia, introduces us to some homeless former foster youth.
Do you ever yell “that’s what I’ve been saying!” at the newspaper or TV when reading/watching the news? Read this and shout your head off.
Speaking of Mental Health, I highly recommend you read Ben Miller’s substack on mental health.
Here’s a story about another tragic child abuse death in the UK.
Have a great weekend!
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I think framing this question as one over the merits of privatization itself creates a bit of a red herring. In truth, no jurisdiction operates a purely privatized system. At a minimum, government maintains responsibility for the investigatory and judicial functions of the child welfare system. Nor does any jurisdiction operate without any reliance on services from private providers. Instead, all jurisdictions have some degree of a hybridized system.
Rather than focusing on whether or what services should be privatized, I think the more important question is how you contract for services. Does the child welfare agency structure procurement or vendor selection in a way that meaningfully vets providers' ability to deliver high quality services? Does the jurisdiction's procurement system weigh cost and quality with appropriate balance? Is there meaningful competition within the jurisdiction's provider community? Does the jurisdiction structure contracts in a way that incentivizes the right outcomes? And does the child welfare agency exercise effective oversight of the contract?
Unfortunately, I think these more mundane administrative questions of vendor selection and contract management fail to engender the same interest as a debate on the merits of privatization itself even though they may have a more significant impact on driving positive outcomes.