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    In September, 2002, the Massachusetts Commissioner of the Department of Social Services (DSS) launched a system wide reform effort focused on safety, permanency and well being with several key initiatives.

    One of the initiatives involved working closely with the provider community to examine and improve how DSS was managing $300 million of purchased services in the area of residential treatment, group homes, short term shelters, specialized foster care, family based and community based services

    Services were splintered for example Commonworks services for residential/group care were managed by lead agencies; family based services were managed by other lead agencies. A workgroup was charged with looking at how to integrate services.

    A procurement review workgroup made up of DSS managers, provider leaders and family representatives worked together and recommended that the agency continue to use lead agencies but to charge them with managing the whole array of services. The group recommended 29 lead agencies to work with 29 area offices and 6 regional resource centers to work with the 6 regional offices.

    Other collaborative workgroups (again with DSS representatives, provider representatives and families) were formed one worked on roles and responsibilities under the new system; another worked on residential services (re engineering those services; addressing state barriers).

    The agency developed a request for information (RFI) and then a request for responses (RFR) for lead agencies and regional resource centers. Bidders were selected and contracts started July 1, 2005. DSS issued an RFI for network services that closed in Sept., 2005 and will issue an RFR soon.

    The collaborative groups and DSS have done a lot of work to build consensus around principles. They talked a lot about developing a performance framework focused on permanency, stability, supporting kids in families without removing them, etc. DSS is committed to building consensus and commitment around these principles and realizes that you cant make people do things in the long run unless they believe in what they are doing.

    A critical thing that has spurred creativity is an act of the legislature in 2002 that allowed DSS to move $ between budget lines of residential/group care and community/family based services. This flexibility has led to a lot of creative work on reengineering residential systems.

    DSS has been committed to making this process translucent/transparent and making everyone a stakeholder. This has helped overcome suspicion. Neither DSS nor providers know everything about the system. Other benefits of this open collaboration have been

o      Bringing everyone together leads to a multiplicity of ideas and of creativity

o      Everyone understands better the pressures on the system for example, the federal reporting requirements, the role of the legislature

o      Participants in these workgroups got to understand the roles and responsibilities of others in the system. The provider described listening to union representatives talk about their deep commitment to their mission of protecting workers and jobs and having a much better understanding of this perspective

o      In the past there was almost no dialogue or contact between the Commonworks providers (residential services) and the family based services networks. The provider serving as a lead agency described beginning to hold integrated service provider meetings and how powerful these have been to build relationships and encourage partnerships across these systems.


    Having area based leads in smaller areas allows more diversity in participation and networks that are more tailored to respond to the needs of local communities

    Lead agencies are charged with integrating services both on the case level and on the system level. They convene family team meetings and work with providers to develop integrated networks of services

    There was much discussion about the experience of reducing the census in residential beds. Some comments from MA included:

o      It helped that other states in the region were also trying to reduce residential placements as a lot of providers work across state lines and children are placed across state lines

o      MA talked about how they have worked to change the culture to be more family centered (with family group conferencing, teams, etc). But also they now have a wider array of tools available to support in home and community based placements more supports and services

o      Many residential providers are interested in getting into working with families at home and DSS is working with them to support and help them with this transition process.

o      DSS is working hard to use performance tools to provide an objective way to focus on performance

o      Talking broadly about the philosophy and building consensus on that really helps. Providers may have experienced difficulty with declining enrollments but understand and agree with the philosophy.

o      To combat the argument from residential providers that it could not be done (transitioning kids and services to family/community based services) DSS brought in representatives from 3 states that had been through this process successfully to meet with leaders in the provider community. This helped build believability.