Among necessary preconditions, the data suggest the importance of clear decision-making protocols, triaging strategies, and data systems that can be used for case and program management. Hence, changes in fiscal incentives do not appear to be sufficient causes of major reform in child welfare. Although the flexibility in funding provided the opportunity for agencies to develop creative approaches to service delivery, one might also ask whether such funding changes are necessary for reform, or whether other approaches might achieve the desired benefits. There are current in the field proposals for major change that do not place fiscal reform at the center of concern, most notably the shifting of responsibility for response to child maltreatment to communities. At the moment, there is no dominant approach to change in the child welfare system that has been empirically demonstrated to be superior.
More experimentation is needed, with both managed care and other approaches.