The Center for Health Care Strategies (CHCS) has identified promising cross-system collaborations that support integrated prevention planning and implementation, and focus increasingly on upstream approaches. Following a document and literature review, CHCS interviewed 46 stakeholders from four states (California, Kentucky, New Jersey, and Ohio) and one tribe (Salt River Pima-Maricopa Indian Community in Arizona), including representatives from child protection agencies, behavioral health, Medicaid, community-based organizations, youth and families with lived expertise, as well as other experts in child and family well-being. These geographically diverse jurisdictions deliver prevention services through a range of collaborative structures.

This document profiles cross-system collaboration efforts in Ohio.¹ For detailed information on the other jurisdictions, see: California, Kentucky, New Jersey, and Salt River Pima-Maricopa Indian Community. For an overview of lessons learned across all five of these collaboration efforts, see: How can child protection agencies collaborate to prevent foster care and support family well-being?

 

Ohio	2017	2018	2019	2020	2021
Children involved in a substantiated maltreatment report	24,897	25,158	25,470	23,691	24,267
Foster care entry rate (per 1,000)	4.5	4.7	4.8	4.1	4.0
Children in foster care on Sept. 30	14,961	15,730	16,387	16,017	15,449
Children adopted	1,538	1,566	1,665	1,466	1,622
Source: https://cwoutcomes.acf.hhs.gov/cwodatasite/pdf/ohio.html

 

Background and structure

The Office of Families and Children, under the Ohio Department of Job and Family Services, promotes the safety and well-being of children and their families through several initiatives in partnership with other state agencies, the federal government, and county Public Children Services Agencies, which are a key partner as child welfare programs in Ohio are state supervised and county-administered.

Ohio has implemented a range of collaborative policies and programs intended to reduce or prevent child welfare system involvement for children and families across the state. Examples include:

• Protect OHIO, a Title IV-E waiver demonstration project that operated from 1997 to 2019 and supported the implementation of kinship supports and family team meetings in 15 counties.
• Initiatives to improve care for families experiencing substance use, such as Sobriety Treatment and Reducing Trauma (START), that convene children’s services, juvenile courts, and behavioral health providers to support families.
• A Multi-System Youth and Innovation Support Fund to provide financial support for youth to access needed health care services and, in doing so, prevent custody relinquishment. The fund released an action plan in 2020.
• Children’s Services Transformation, an initiative established by the Governor’s Office in 2019 to implement recommendations of a multi-disciplinary advisory council to improve outcomes for children and families, including prevention services.

Ohio also has designed and implemented two key initiatives to advance and expand prevention services for children and families: the state’s Family First prevention plan and a specialized Medicaid managed care plan for youth with complex behavioral health and multisystem needs.

In 2023 Ohio created a new cabinet-level agency, the Department of Children and Youth, to focus solely on child- and youth-focused programs, including children’s services, childcare, education, early childhood, developmental disabilities and early intervention, early childhood mental health, and home visiting. The new department aims to elevate family and youth voice and is convening a group of over 30 organizations focused on this work. While there is still work to be done, the state anticipates that aligning child-serving programs under one agency will help advance these goals.

Key initiatives and collaborations

Title IV-E Family First Prevention Plan

Ohio’s Title IV-E Family First Prevention Plan was approved in December 2021. To develop its plan, Ohio organized a cross-agency Family First Leadership Advisory Committee, which included 30 representatives from state and local agencies, community-based organizations, and people with lived expertise. State agencies involved included: Job and Family Services; Medicaid; Mental Health and Addiction Services; Developmental Disabilities; Youth Services; and the Ohio Children’s Trust Fund. In all, over 200 stakeholders were engaged in the design of the plan.

Ohio selected its Family First Prevention Plan services based on data regarding the needs of children and families, and a review of existing programs in the state. The first phase of the plan calls for incorporating several evidence-based prevention programs into Ohio’s service array: Multisystemic Therapy; Functional Family Therapy; Sobriety Treatment and Reducing Trauma; Healthy Families America; and Parents as Teachers. The plan also leverages Family First funding to support existing initiatives, including Maternal Infant and Early Childhood Home Visiting programs. Looking forward, three priorities for Ohio’s future prevention planning are: 1) moving upstream toward primary and secondary prevention; 2) ensuring that family voice is at the forefront; and 3) continuing to identify gaps in prevention service eligibility.

Specialized Medicaid managed care plan

In July 2022, Ohio launched OhioRISE (Ohio Resilience through Integrated Systems and Excellence), a new specialized Medicaid managed care plan for youth with complex behavioral health needs. OhioRISE was designed and implemented by a cross-agency collaboration, led by the Department of Medicaid, the Governor’s Office of Children’s Initiatives and the state’s Family and Children First Cabinet Council, and involves multiple agencies that oversee health, education, developmental disabilities, and juvenile justice.

The plan aims to prevent children from being separated from their homes due to behavioral health challenges by offering specialized services, such as moderate and intensive care coordination, enhanced intensive home-based treatment, flex funds, and behavioral health respite services. The state also contracted with 20 regional care management entities to provide care coordination to youth enrolled in OhioRISE.

Aligning across initiatives

The Department of Job and Family Services and the Department of Medicaid have made it a priority to work in close coordination, which has allowed the state to align services, policies, and regulations across its various prevention-based initiatives. This work is bolstered by a cabinet-level cross-agency leadership team that meets regularly to discuss intersections across OhioRISE, Family First, and other child-serving systems and initiatives.

Staff from both agencies communicate regularly — even daily — to ensure alignment, avoid duplication, and ensure that everyone who needs to be at the table is included. The strong communication between the departments helps staff working on Family First and OhioRISE to think holistically and incorporate long-term considerations into planning and implementation. Additionally, a cabinet-level cross-agency leadership team meets regularly to discuss intersections across Family First, OhioRISE, and other child-serving systems and initiatives. For example, the state uses the Child and Adolescent Needs and Strengths (CANS) assessment to determine eligibility for OhioRISE, and also as its level of care assessment for Qualified Residential Treatment Programs or QRTPs.

As Ohio is a county-administered child welfare system, state agencies communicate regularly with their local and regional partners, including county Public Children Services Agencies. The state hosts educational events and shares resources related to Family First and OhioRISE, and supports local peer-to-peer learning and capacity building. The state also has set up a Child and Adolescent Behavioral Health Center of Excellence, which is a centralized source for information, technical assistance and training, and fidelity monitoring. Additional implementation support is provided by the association of Public Children Services Agencies, which has a role dedicated to supporting counties in their work at the intersection of these initiatives.

Ohio Family and Children First — a partnership of state and local government, communities, and families that is governed by the Governor’s Children’s Cabinet — is another structure that strengthens collaboration on prevention services in Ohio. The partnership pulls together 88 county-based Family and Children First Councils to build capacity, engage families, and coordinate across child-serving systems. The county-based councils also provide opportunities for collaboration by connecting schools, early childhood organizations, children’s services, crisis response services, local officials, courts, mental health services, health departments, and other community partners to organize and align on programs and initiatives that serve children with behavioral health needs, such as High Fidelity Wraparound, trauma-informed care, and early childhood services.

1 Agencies/Organizations interviewed: Cadence Care Network for Children, a regional Care Management Entity serving Trumbull County; Office of Families and Children; Ohio Department of Job and Family Services; Ohio Department of Medicaid; Ohio Family Care Association; Public Children Services Association of Ohio; Trumbull County Children’s Services; and Trumbull County Family and Children First Council.

2 2021 Kids Count. The Annie E. Casey Foundation.