• By Dartington SRU
  • Posted on Tuesday 11th January, 2011

What you get is what you pay for

When, five years ago, 9494 young people in Florida were locked up in one year alone it dawned on the state that it had a problem. It turned to a solution called Project Redirection, which provides an array of evidence-based programs that effectively redirect at-risk youth from out-of-home placement to treatment at home and in the community. In its short life, Redirection has achieved a 35 per cent reduction in felony convictions and adjudications one year after youth complete the course. The $16 million invested has saved the taxpayer over $51 million, according to figures from the Florida Department of Juvenile Justice.Pivotal to this success is small virtual company called Evidence-Based Associates. EBA guarantees outcomes and cost savings by ensuring that model programs are implemented with fidelity and quality. One of its consultants, Clay Yeager, visited the UK before Christmas in 2010, and during his visit he spoke to an audience of senior policy makers in Birmingham.He explained that Redirection uses Functional Family Therapy, brief strategic family therapy and Multi-Systemic Therapy, all of which are listed in the Blueprints database of effective interventions to prevent and address violence.The services are delivered in the home and are capable of engaging resistant or reluctant families. Intensive treatments are accompanied by extensive quality assurance protocols. Clinical outcomes are proven and specifically, and include reduced recidivism. Supported by the Florida Legislature and the Department of Juvenile Justice, Redirection has expanded significantly since it started in 2004-05, when it served 154 young people. By the middle of 2010, 5142 youth and their families had received one of the three programs.Critically, payment is tied directly to results, through a method known as performance-based accountability (PBA). “Performance-based accounting has been around for a long time and used for civil engineering projects, like building bridges, but this is really the first time it has been applied to social services”, says Yeager.“Until five years ago we would say to providers of services for abused or drug-abusing children, ‘We’ll give you so many dollars to serve this number of children’” he adds. “At the end of the year all we knew was how many children had been served. With PBA you guarantee payment to providers if they deliver the outcomes. Before there was no incentive for doing good work: if you save this year you get less money next year.” In the case of Redirection, all of the risk is transferred to EBA, who agree specific performance measures – ideally no more than three or four – over a clearly defined period. Apart from notional management costs, EBA only gets paid if outcomes are achieved.To do this, EBA negotiates with potential providers to provide the three programs, and invests in training and certifying staff according to national standards. Teams are monitored closely for how well they are implementing services, and whether they are achieving targets – 75 per cent of young people not offending during services, 60 per cent not re-offending one year after discharge, and so on.EBA reviews the data monthly with providers and program representatives and also holds quarterly review meetings with stakeholders. A bonus plan helps to retain effective staff.“We [EBA] are successful because we are a single entity holding providers’ feet to the fire on a daily basis to ensure that they follow program protocols”, Yeager comments. “Real-time data is reviewed to trouble shoot, and there is no cutting corners. Fidelity to the model is essential. If providers aren’t meeting targets we sit down with them and agree a plan of correction. We have let providers go.”The savings thus far to Florida taxpayers of over $51 million are based on the reduced use of residential placement places. These cost $34,774 for each young person, whereas Redirection costs just $7,715 – a saving of $27,059.But Yeager recognizes that unless budgets are closed off, savings won’t be realized. This is because the system will adjust and catch other children for residential provision. “There is a fear that organizations will have to re-spend money saved on previously unmet need. You don’t save hard dollars until you close institutions down. The state of Florida is still paying for institutions – electric bills, bricks and mortar.”He also acknowledges anxieties about private involvement in public services. “When you talk about the private sector in public sector circles there is immediate distrust. Although EBA is a private for-profit organization, its function could be fulfilled by another sector. However, government agencies can’t do this. They say they can but they have too many other balls in the air.”

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