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Comparison of Public and Private Foster Care in Colorado | Social Work Research Center i

October 2012

Comparison of Public

and Private Foster

Care in Colorado

Final Report

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center ii

ACKNOWLEDGEMENTS

Report Authors

Marc Winokur Graig Crawford Keri Batchelder

Applied Research in Child Welfare (ARCH) Project Participants

Adams County

Arapahoe County Boulder County

Broomfield County Denver County Douglas County El Paso County

Jefferson County Larimer County Pueblo County

Colorado Department of Human Services Colorado Administrative Review Division

Touchstone Health Partners

Workgroup Contributors

Lee Oesterle Barb Weinstein

Research Associates

Valerie Ebanks-Thompson

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center iii

TABLE OF CONTENTS

Executive Summary .......................................................................................................................... v

1. Introduction ................................................................................................................................ 1

1.1 Study Rationale ..................................................................................................................... 1

1.2 Study Context ........................................................................................................................ 1

1.3 Research Questions ............................................................................................................... 2

2. Literature Review ........................................................................................................................ 2

2.1 Child Welfare Privatization .................................................................................................... 2

2.2 Foster Care Privatization ....................................................................................................... 3

2.3 Private and Public Foster Care Outcomes ............................................................................. 3

3. Methods ...................................................................................................................................... 4

3.1 Data Collection ...................................................................................................................... 5

3.2 Study Parameters .................................................................................................................. 5

3.3 Variable Definitions ............................................................................................................... 6

3.4 Outcome Measures ............................................................................................................... 7

3.5 Cost Measures ....................................................................................................................... 8

3.6 Sample Selection ................................................................................................................... 8

3.7 Data Analysis ......................................................................................................................... 9

4. Demographic Comparison .......................................................................................................... 9

4.1 0-5 Age Group ..................................................................................................................... 10

4.2 6-12 Age Group ................................................................................................................... 11

4.3 13-18 Age Group ................................................................................................................. 12

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center iv

5. Outcome Comparison ............................................................................................................... 13

5.1 Demographic Characteristics .............................................................................................. 14

5.2 0-5 Age Group ..................................................................................................................... 14

5.3 6-12 Age Group ................................................................................................................... 16

5.4 13-18 Age Group ................................................................................................................. 17

6. Cost Comparison ....................................................................................................................... 19

6.1 0-5 Age Group ..................................................................................................................... 19

6.2 6-12 Age Group ................................................................................................................... 21

6.3 13-18 Age Group ................................................................................................................. 23

7. Discussion .................................................................................................................................. 25

7.1 Conclusions .......................................................................................................................... 25

7.2 Limitations ........................................................................................................................... 26

7.3 Implications ......................................................................................................................... 27

8. References ................................................................................................................................ 29

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center v

Comparison of Public and Private Foster Care in Colorado

Executive Summary

The Applied Research in Child Welfare (ARCH) Project is a partnership between Colorado

State University (CSU), the Colorado Department of Human Services (CDHS), and the

Departments of Human/Social Services in Adams, Arapahoe, Boulder, Broomfield, Denver,

Douglas, El Paso, Jefferson, Larimer, and Pueblo counties. The purpose of the ARCH Project is to

conduct applied research on child welfare interventions that informs social work practice and

policy in Colorado. This report presents results from an outcome study of foster care in

Colorado, which was conducted by the Social Work Research Center in the School of Social

Work at CSU with funding from the ARCH Project.

Introduction

Facing unprecedented budgetary constraints and accountability requirements, child

welfare agencies are hungry for research that analyzes the outcomes and costs of children

placed in foster care. The steady growth in the privatization of foster care services has

magnified this need, as policymakers also are looking to the research for guidance on how

private and public foster care compare on outcomes and costs. However, there are few studies

that have used experimental designs because randomly assigning children who require out-of-

home placement to either private or public foster care has ethical implications for the safety

and well-being of the children. As a result, non-experimental comparative and associational

research designs are more commonly used in foster care research. Overall, there is little

independent, empirical evidence on this topic, and the research that has been conducted

shows mixed findings in both outcome and cost differences between private foster care and

public foster care.

According to child welfare practitioners, outcomes for children in foster care are

multidimensional as they are based on the intersection of provider performance, caregiver

involvement, county practice, and child characteristics. While they are not responsible for the

initial difficulties that precipitate an out-of-home (OOH) placement, child placement agencies

(CPA) and foster parents are expected to provide a safe and nurturing environment that helps

children to mitigate some of these deficits. Therefore, this study is not designed to determine

which placement type is the most appropriate, as that depends on the specific child, family,

caseworker, and provider. The study is intended to supply caseworkers and providers with

information on foster care outcomes and costs to assist them in making data-driven decisions

about how to best serve children. The following three research questions guided the study:

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center vi

1. Are there statistically significant differences between children in CPA and county foster

care on demographic characteristics for the 0-5, 6-12, and 13-18 age groups?


care on permanency, safety, and subsequent involvement outcomes for the 0-5, 6-12,

and 13-18 age groups?


care on average daily rates, administration rates, provider rates, and costs per episode

of care for the 0-5, 6-12, and 13-18 age groups?

Methods

This study employed a between-county comparative research design to analyze the

outcomes and costs for children with a closed foster care placement in the 10 ARCH counties

during the 2008-2010 fiscal years. The outcome data were aggregated across the three fiscal

years while the cost data were collected from fiscal year 2008 and fiscal year 2009. The

demographic, placement, outcome, and cost data for this study were collected from individual

case records entered into Colorado Trails, which is Colorado’s Statewide Automated Child

Welfare Information System (SACWIS). The main inclusion criteria for the outcome study were

children with a closed service authorization at any time between 7/1/07 and 6/30/10 from

these placement types: CPA Foster Care (Private Foster Care) and County Foster Care (Public

Foster Care). If a foster care authorization had a governing body at any time during the

placement, it was considered to be CPA foster rather than county foster. The unit of analysis for

the outcome study was “episode of care” rather than service authorization. An episode of care

was created by merging Colorado Trails service authorizations into a continuous span of care

for a child with a given placement provider.

The study employed a non-probability sampling design that was both purposive and

convenient. The selected sample included children ages 0-18 that were in the child welfare

system under delinquency and/or dependency and neglect court actions in the ARCH counties.

Children residing within the Division of Youth Corrections (DYC), children from out-of-state, and

children with privately paid placements were not eligible for selection. The overall sample size

was 11,661 with 6,740 episodes of care for CPA foster and 4,921 for county foster. The

outcomes for this study were as follows: permanency at discharge, reentry, institutional abuse,

subsequent placements of any type, subsequent community placements, subsequent

residential placements, subsequent placements days of any type, subsequent community

placement days, subsequent residential placement days, subsequent DYC involvement days,

and subsequent DYC commitment days. The cost measures for this study were average daily

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center vii

rate, average provider rate, average administration rate, and average cost per episode. The

foster care groups were separated into three age groups (0-5, 6-12, and 13-18) because of the

diverse needs and services for children in the different age ranges. The comparison of

demographic characteristics was intended to examine the equivalence between the two foster

care groups. The demographics were chosen based on their accessibility and demonstrated

relationships with case outcomes.

Findings

Similar to the studies cited in the literature, the results for the outcome and cost

comparisons for public and private foster care were mixed and varied by age group. Overall, the

outcomes for county foster care were greater than or comparable to the outcomes for CPA

foster care, but CPA foster care had lower costs per episode of care than did county foster care.

Furthermore, there were differences in client acuity but no definitive sense of which placement

type was serving higher risk cases. For the 0-5 age group, there were statistically significant

differences between the foster care groups on permanency at discharge, institutional abuse,

subsequent any placements, and subsequent any placement days, with county foster care

having an advantage for these outcomes. However, there was no difference between the foster

care groups on reentry. The cost per episode of care was more expensive for county foster care,

with county foster care having higher administration costs and CPA foster care having higher

provider costs. The higher provider costs suggest that children in the 0-5 age range have higher

needs as measured by the Needs Based Care (NBC) instrument which sets CPA foster parent

rates. Furthermore, the CPA foster group was comprised of a higher percentage of non-

Caucasian children. However, the county foster group was comprised of a higher percentage of

children in Program Area 6 (special needs are barrier to adoption). As a result, the difference in

client acuity between the foster care groups for this age range is unclear.

For the 6-12 age group, there were statistically significant differences between the

foster care groups on subsequent any placements, subsequent any placement days, subsequent

community placements, and subsequent community placement days, with county foster care

having an advantage for these outcomes. There were no differences between the groups on

permanency at discharge, reentry, institutional abuse, subsequent residential placements and

placement days, and subsequent DYC involvement days and DYC commitment days. The cost

per episode of care was more expensive for county foster care, with county foster care having

higher administration costs and CPA foster care having higher provider rates. The two foster

care groups appeared to be equivalent for the 6-12 age group, as there were no demographic

differences.

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center viii


foster care groups on permanency at discharge, subsequent any placement days, and

subsequent community placements, with county foster care having an advantage for these

outcomes. There also was a statistically significant difference for institutional abuse with CPA

foster care having an advantage for this outcome. There were no differences between the

groups on reentry, subsequent any placements, subsequent community placement days,

subsequent residential placements and residential placement days, and subsequent DYC

involvement days and DYC commitment days. The cost per episode of care was more expensive

for county foster care, with CPA foster care having higher administration costs and county

foster care having higher provider costs. However, CPA foster care appeared to serve higher

risk cases based on ethnicity and prior placement.

Limitations

The outcome study faced numerous methodological challenges common to most

research on child welfare interventions using comparative research designs and secondary

data. The most notable limitation is the differences in populations served by the private and

public foster care agencies due to client acuity. However, these differences were not consistent

within and across age groups. Nonetheless, these observed differences in child characteristics

along with other unobserved differences (e.g., behavioral functioning) likely explain some of

the differences in outcomes between the foster care groups.

The integration of cost data into a child welfare outcome study brings its share of

complications. It is important to note the context behind county foster care cost data, as

counties have different practices that lead to different cost accounting. The major issue is the

difficulty in capturing the administration costs to provide county foster care. These cost data

are not available in Colorado Trails and it is up to the counties and the State to calculate and

report this information. Thus, counties provided cost data from their own data systems for

administration costs associated with county foster care placements. Furthermore, the cost

comparisons have limitations because they are so heavily based on per episode length of stay.

This study should be interpreted in light of the reality that foster care providers are only

partially responsible for child outcomes, particularly length of stay, permanency at discharge,

reentry, and subsequent placements. For example, child placement agencies typically do not

provide services to biological parents who are directly responsible for whether and how quickly

a child returns and/or stays home. Furthermore, caseworkers and courts often have the most

influence in regard to where and when a child is placed. The generalizability of the findings to

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center ix

the larger child welfare population in Colorado is somewhat problematic because of the lack of

random sampling and the criteria used to select the sample. In addition, the findings are most

applicable to larger child placement agencies and larger counties, as smaller agencies and

counties have a lower percentage of the overall sample size. Even with these limitations, this

study has important implications for child welfare practice, policy, and research in Colorado.

Implications

Based on the overall comparability in outcomes and costs between public and private

foster care, the main implication of this study is that caseworkers can be confident in placing

children in the most appropriate foster home setting regardless of the placement type. Meezan

and McBeath (2008) believe this suggests the need for child welfare decisions to be driven by

the needs of children and families, not by financial decisions. However, the variability in

outcomes and costs by age group should also be considered in out-of-home placement

decisions.

This study added to the research on foster care by comparing administration costs for

county and child placement agencies. Critics of private foster care claim that there is an

increased administration cost due to greater demand for government oversight and increased

labor cost per case in private agencies (Kamerman & Kahn 1998; Poole, 1999; Meezan &

McBeath, 2008). The results from the cost comparison did not support this claim, as the daily

administration rate was actually lower for private foster care placement in all age groups.

Furthermore, the average cost per episode of care was lower for CPA foster care in all age

groups. There is a need for more sophisticated outcome and cost analyses, so that comparisons

among foster care placements can be made more precise.

Another recommendation is for child placement agencies to have a more collaborative

role in conducting child welfare research in Colorado. Specifically, CPAs should provide input on

the measures used and the outcomes evaluated while providing data from their own systems to

complement the administrative data collected in Colorado Trails. Lastly, child placement

agencies are encouraged to conduct their own outcome and cost studies to contribute to the

research-informed discussion about how best to design and implement a child welfare system

that is responsive to the needs of children and families.

Comparison of Public and Private Foster Care in Colorado | Social Work Research Center 1

1. INTRODUCTION

The Applied Research in Child Welfare (ARCH) Project is a partnership between Colorado

State University (CSU), the Colorado Department of Human Services (CDHS), and the

Departments of Human/Social Services in Adams, Arapahoe, Boulder, Broomfield, Denver,

Douglas, El Paso, Jefferson, Larimer, and Pueblo counties. The purpose of the ARCH Project is to

conduct applied research on child welfare interventions that informs social work practice and

policy in Colorado. This report presents results from an outcome study of foster care in

Colorado, which was conducted by the Social Work Research Center in the School of Social

Work at CSU with funding from the ARCH Project.

1.1. Study Rationale

Facing unprecedented budgetary constraints and accountability requirements, child

welfare agencies are hungry for research that analyzes the outcomes and costs of children

placed in foster care. The steady growth in the privatization of foster care services has

magnified this need, as policymakers also are looking to the research for guidance on how

private and public foster care compare on outcomes and costs. However, there are few studies

that have used experimental designs because randomly assigning children who require out-of-

home placement to either private or public foster care has ethical implications for the safety

and well-being of the children. As a result, non-experimental comparative and associational

research designs are more commonly used in foster care research.

1.2. Study Context

According to child welfare practitioners, outcomes for children in foster care are

multidimensional as they are based on the intersection of provider performance, caregiver

involvement, county practice, and child characteristics. While they are not responsible for the

initial difficulties that precipitate an out-of-home (OOH) placement, child placement agencies

(CPA) and foster parents are expected to provide a safe and nurturing environment that helps

children to mitigate some of these deficits. Therefore, this study is not designed to determine

which placement type is the most appropriate, as that depends on the specific child, family,

caseworker, and provider. The study is intended to supply caseworkers and providers with

information on foster care outcomes and costs to assist them in making data-driven decisions

about how to best serve children.


1.3. Research Questions

The following three research questions guided the study:

1. Are there statistically significant differences between children in CPA foster care and

county foster care on demographic characteristics for the 0-5, 6-12, and 13-18 age

groups?


county foster care on permanency, safety, and subsequent involvement outcomes

for the 0-5, 6-12, and 13-18 age groups?


county foster care on average daily rates, administration rates, provider rates, and

costs per episode of care for the 0-5, 6-12, and 13-18 age groups?

2. Literature Review

This literature review explores the recent research on privatization in child welfare and

provides a foundation for the study’s comparison of public and private foster care.

2.1. Child Welfare Privatization

In the United States, the rise in child welfare privatization has been a reaction to both

public outcries regarding the safety and well-being of children in care, and mounting concern

about governmental agency accountability (Else, Groze, Hornby, Mirr, & Wheelock, 1992). The

1997 Adoption and Safe Families Act (P.L.105-89) helped to fuel privatization as it mandated

improvement in child welfare outcomes, with particular focus on improving permanency

outcomes for children in foster care without compromising their safety and well being. Child

welfare reform has led to new initiatives including varied types of purchase-of-service

arrangements and community-based partnerships (Sellick, 2007; Yampolskaya, Paulson,

Armstrong, Jordan, & Vargo, 2004), which entail diverse contractual arrangements (Kamerman

& Kahn, 1998). Researchers estimate that at least half of child welfare services are being

satisfied by private entities in the United States (McBeath & Meezan, 2009). However,

Rosenthal (2000) points out that the level of dependence on privatization of child welfare

services varies across the country with less reliance in the Western states.


2.2. Foster Care Privatization

Advocates of foster care privatization argue that purchasing foster care services will

improve outcomes with regard to efficiency, safety, and services including cost savings, more

timely attainment of permanency outcomes, a reduction in foster care placements, less reentry

into care, and the offering of a more diverse range of services (Meezan & McBeath, 2008).

Opposing voices contend that the privatization of foster care services is associated with

negative consequences and/or inconsequential effects that include cost ineffectiveness, as

exhibited by exorbitant fees charged to governmental authorities (Sellick & Connolly, 2002).

Additionally, it is posited that it is often more difficult for states to devise new policies and

respond to changing needs under the auspices of privatization (Center for Public Policy

Priorities, 2008). The vacillating debate between the pros and cons of purchasing foster care

services from non-governmental organizations appears to be an ideological argument more

than one based on evidence substantiated with empirical data (Kamerman & Kahn, 1998). For

example, Unruh and Hodgkin (2004) indicate that both public and private foster care have

realized varied degrees of improvement regarding specific child welfare outcomes.

2.3. Private and Public Foster Care Outcomes

There are limited studies comparing the outcomes between children in private and

public foster care. In one study, Zullo (2002) examined reunification rates across six types of

foster care placements that included a comparison between private and public foster care

placements. Similar to an earlier study by George (1990), private foster care placement was

associated with a reduction in the rate of children moving to permanency. Further analysis

demonstrated no difference between the groups on rates of reentry to foster care placement

for those children who transitioned to a permanent placement during the study time frame.

Using the Smith and Lipsky (1993) typology of private foster care agencies, Zullo (2002) found

that cases managed by newer and smaller community-based agencies realized permanency

rates similar to public foster care agencies, while the older agencies were associated with

significantly lower rates of permanency.

In another study, Zullo (1998) collected ethnographic and case file data to compare

private and public foster care outcomes in Milwaukee County, Wisconsin. The findings indicated

lower permanency rates among children placed in older, private foster care agencies. However,

children served by newer, private foster care agencies attained similar permanency rates as

public foster care agencies. Public foster care agencies, as compared to older private foster care

agencies, performed more consistently with regard to reunification of children and/or


placement of children in adoptive homes. Rates of reentry were not different between the two

types of foster care agencies. For cost, Zullo (1998) found that the direct per case cost was

greater in private foster care agencies because private contracting demanded greater

administrative overhead expenses associated with public agency oversight.

Following the 1996 implementation of a pilot project to privatize child welfare services

in Florida, statewide privatization was mandated in 1998 after the model produced notable

results (Freundlich & Gerstenzang, 2003). Florida’s Community-Based Care (CBC) model

combines the outsourcing of foster care and related services to private agencies utilizing a lead

agency design (Paulson et al., 2003). Paulson et al. (2003) used a quasi-experimental cohort

design to conduct a comparative evaluation between CBC counties and the remainder of the

state. The results indicated that counties with earlier implementation dates performed better

on permanency outcomes as compared to the remainder of the state. These counties also

performed better than, or the same as, the remainder of the state on finalized adoption and

reentry rates. However, Paulson et al. (2003) note that there is insufficient evidence to make

any definitive conclusions regarding the effectiveness of the CBC model due to a few key factors

during the study. First, the counties were at differing stages of implementation with regard to

the privatized model. Second, there was a change in the administrative database system that

impacted the outcome comparison.

Overall, there is little independent, empirical evidence on this topic, and the research

that has been conducted shows mixed findings in both outcome and cost differences between

private foster care and public foster care.

3. Methods

This study employed a between-county comparative research design to analyze the

outcomes and costs for children with a closed foster care placement in the 10 ARCH counties

during the 2008-2010 fiscal years. Colorado state fiscal years run from July 1 through June 30 of

the following year. The outcome data were aggregated across the three fiscal years while the

cost data were collected from fiscal year 2008 (FY08) and fiscal year 2009 (FY09). The data

collection techniques, study parameters, sample selection, variable definitions, and data

analysis procedures are described in the methods section.


3.1. Data Collection

The demographic, placement, outcome, and cost data for this study were collected from

individual case records entered into Colorado Trails, which is Colorado’s Statewide Automated

Child Welfare Information System (SACWIS). Colorado Trails is an online data management and

analysis system used for child welfare case management documentation. To obtain the sample,

the appropriate search terms, logic, and filters were used. A template to record and calculate

the administration costs for county foster care was designed for this study. To collect the

county-specific cost data, an Excel file with the template was emailed to each county. However,

only 7 of the 10 counties were able to provide the required data.

3.2. Study Parameters

The main inclusion criteria were children with a closed service authorization at any time

between 7/1/07 and 6/30/10 from these placement types: CPA Foster Care (Private Foster

Care) and County Foster Care (Public Foster Care). If a foster care authorization had a governing

body at any time during the placement, it was considered to be CPA foster care rather than

county foster care. This timeframe was selected to generate a sufficient number of

authorizations and to allow outcomes to be collected 12 months out for each episode of care.

There were secondary exclusion criteria which further narrowed the sample. Service

authorizations with the following placement leave reasons were excluded from the study: (1)

opened in error, (2) payee wrong code, and (3) runaways and business office corrections when

the authorization was opened and closed on the same day. If the placement leave reason was

(a) same provider/change in service type and the new authorization was still open or closed

after the study end date; (b) transfer to another county and the new authorization was still

open or closed after the study end date; or (c) client left county/state and the new service

authorization was still open or closed after the study end date or was open less than 30 days,

the authorizations were removed from the sample.

The unit of analysis for the outcome study was “episode of care” rather than service

authorization. An episode of care was created by merging Colorado Trails service authorizations

into a continuous span of care for a child with a given placement provider. Episodes of care

were used in lieu of service authorizations for two primary reasons: (1) to account for nuances

in data entry practices that lead to multiple service authorizations for a single, uninterrupted

span of care; and (2) to account for short-term disruptions in placements spans caused by

runaways or hospitalizations. Episodes of care were created according to the following criteria:


a. Service authorizations with the same provider without a 30 day absence (for running away, hospitalization, or detention) were merged into a single episode of care.

b. Service authorizations with a leave reason of same provider/same service or same provider/change in service type were merged with the subsequent service authorization into a single episode of care. The begin date on the subsequent service authorization was updated to the begin date of the first service authorization.

c. Service authorizations with a leave reason of transfer to another county with the same provider were merged into a single episode of care for the county in which the authorization was transferred.

d. Service authorizations closed and re-opened the same day with the same provider were merged into a single episode of care.

3.3. Variable Definitions

The variables included in the outcome study were defined as follows:

1. Age at Placement – age of child when service authorization was opened.

2. Age Group at Placement – age group of child when service authorization was opened (0-5, 6-12, or 13-18).

3. Gender – gender of child with service authorization (female or male).

4. Ethnicity Group – primary ethnicity of child with service authorization. For this study,

the ethnicities were grouped into Caucasian or non-Caucasian (Hispanic, African American, Asian, and Native American).

5. Program Area – current program area as of 6/30/10 for child with service

authorization including Program Area 4 (juvenile delinquency and beyond control of parents), Program Area 5 (child abuse and neglect), and Program Area 6 (special needs are barrier to adoption). Because historical tracking of program area is not available in Colorado Trails, an authorization could have been opened under one program area but recorded under a different program area for this study.

6. Placement Type – placement setting for which service authorization was opened

(CPA foster care or county foster care).


7. Prior Any Placement – any community or residential placement prior to episode of care.

8. Per Episode Length of Stay – per episode length of stay without episodes of care with

a discharge setting of runaway for each placement type.

9. Discharge Setting – setting upon exit from placement including return home, APR/guardianship/other relatives, Division of Youth Corrections (DYC) commitment and detention, kinship foster care, kinship care, county foster care, CPA foster care, receiving homes, group home/group center, Therapeutic Residential Child Care Facility (TRCCF), Residential Child Care Facility (RCCF), emancipation, adoption, runaway, hospitalization/psychiatric hospitalization, Psychiatric Residential Treatment Facility (PRTF), and transfer to another county/state.

3.4. Outcome Measures

The outcomes for this study were defined as follows:

1. Permanency at discharge – return home, permanent placement with relatives

(guardianship), or finalized adoption at discharge from placement.

2. Reentry – subsequent placement in OOH care within 12 months after returning home or having permanency placement with relatives (guardianship).

3. Institutional Abuse – founded incident of abuse or neglect during placement by foster care provider. Only abuse or neglect assessments reported during the study timeframe were included.

4. Number of placements – subsequent placements in any setting (community or

residential), community setting (CPA foster, county foster, group home, or kinship foster), and residential setting (TRCCF or RCCF) within 12 months after discharge.

5. Number of placement days – subsequent days in any setting, community setting,

residential setting, DYC involvement (detention or commitment), and DYC commitment within 12 months after discharge.


3.5. Cost Measures

The cost measures for this study were defined as follows:

1. Average Daily Rate – total gross expenditures for placement type divided by total number of placement days based on cost data from FY08.

2. Average Cost Per Episode of Care – average daily costs multiplied by per episode

length of stay.

3. Average Provider Rate – total gross expenditures paid to CPA providers and county foster care providers divided by total number of placement days based on cost data from FY08.

4. Average Administration Rate (CPA foster care) – total gross expenditures paid to

child placement agencies for administration costs divided by total number of placement days based on cost data from FY08.

5. Average Administration Rate (County foster care) – estimate of administration costs

associated with placing children in county foster care based on cost data from FY09.

3.6. Sample Selection

The study employed a non-probability sampling design that was both purposive and

convenient. The theoretical population is all children in Colorado removed from the home for

delinquency or maltreatment and placed in foster care. The accessible sample is children in

Colorado representing the service authorizations that met the aforementioned criteria. The

selected sample included children and adolescents ages 0-18 that were in the child welfare

system under delinquency and/or dependency and neglect court actions in the ARCH counties

(subsequently referred to as “children”). Children residing within the Division of Youth

Corrections, children from out-of-state, and children with privately paid placements were not

eligible for selection. Children with a Children's Habilitation Residential Program (CHRP)

designation were eligible for selection in this study.

The actual sample was comprised of duplicated cases, in that children who had multiple

closed service authorizations during the study timeframe were counted for each placement

type. Children who were placed in the same OOH setting but with different providers were

counted multiple times, as were children who were placed with the same provider but at

different times during the study timeframe. As displayed in Table 1, the overall sample size was


11,661 with 6,740 episodes of care for CPA foster and 4,921 for county foster. Denver County

had the highest percentage of episodes of care for both county foster and CPA foster at 25.3%

and 28.6%, respectively.

Table 1

Episodes of Care from FY08-FY10 by County for Foster Care Placement Types

County

County Foster Frequency Percent

CPA Foster Frequency Percent

Adams 581 11.8 1,041 15.4 Arapahoe 819 16.6 620 9.2 Boulder 427 8.7 31 0.5 Broomfield 45 0.9 18 0.3 Denver 1,247 25.3 1,946 28.9 Douglas 57 1.2 15 0.2 El Paso 41 0.8 1,928 28.6 Jefferson 651 13.2 433 6.4 Larimer 577 11.7 107 1.6 Pueblo 476 9.7 601 8.9 Total 4,921 100.0 6,740 100.0

3.7. Data Analysis

The data were transmitted in Excel spreadsheets to the Social Work Research Center

with the unique child and case identifiers removed. The demographic, placement, outcome,

and cost data were entered into the IBM Statistical Package for Social Sciences (SPSS), checked

for missing and incorrect data, and recoded into the appropriate variables. Descriptive and

inferential statistics were generated from the data to answer the research questions posed in

the study. Specifically, chi-square tests and t-tests were used to analyze the results for the

foster care outcome comparisons.

4. Demographic Characteristics Comparison

The foster care groups were separated into three age groups (0-5, 6-12, and 13-18) and

were compared on demographic characteristics including ethnicity, gender, program area, prior

placement history, age at placement, and per episode length of stay for a duplicated count of

children. The sample was divided by age group because of the diverse needs and services for

children in the different age ranges. The comparison of demographic characteristics was

intended to examine the equivalence between the two foster care groups. The demographics


were chosen based on their accessibility and demonstrated relationships with case outcomes

(see Section 5.1).

4.1. 0-5 Age Group

As displayed in Table 2, the CPA foster group had 53.4% of the episodes of care for the

0-5 sample, while the county foster group had 46.6% of the episodes.

Table 2

Placement Type Frequencies between FY08-FY10 for 0-5 Age Group

Placement Type Sample Size Percent

CPA Foster 3,002 53.4 County Foster 2,617 46.6 Total 5,619 100.0

The foster care groups for the 0-5 sample were compared on demographic

characteristics. As displayed in Table 3, the foster care groups had statistically significant

differences in ethnicity and current program area. Specifically, the CPA foster group had a

higher percentage of non-Caucasian children (65.6%) than did the county foster group (61.9%),

and a higher percentage of PA5 children (54.5%) than did the county foster group (48.1%).

There were no statistically significant differences between the groups on gender and prior

placement.

The groups had a statistically significant difference (p < .05) in age at placement, as

children in the CPA foster group (2.0 years) were older at placement than were children in the

county foster group (1.7 years). Although not statistically significant, the county foster group

(209 days) had a longer per episode length of stay than did the CPA foster group (200 days).


Table 3

Demographic Characteristics by Foster Care Placement Type for 0-5 Age Group

Characteristic



Ethnicity* Caucasian 998 38.1 1,003 34.4 Non-Caucasian 1,619 61.9 1,969 65.6

Gender Female 1,237 47.3 1,400 46.6 Male 1,380 52.7 1,602 53.4

Program Area* PA5 1,260 48.1 1,637 54.5 PA6 1,357 51.9 1,365 45.5

Prior Any Placement Yes 1,349 51.5 1,512 50.4 No 1,268 48.5 1,490 49.6

* Statistically significant difference (p < .05)

4.2. 6-12 Age Group



Table 4

Foster Care Frequencies between FY08-FY10 for 6-12 Age Group

Placement Type Sample Size Percent

CPA Foster 1,988 59.2 County Foster 1,371 40.8 Total 3,359 100.0


characteristics. As displayed in Table 5, there were no statistically significant differences

between the groups on ethnicity, gender, program area, and prior placement history.

The groups had a statistically significant difference (p < .05) in per episode length of

care, as the county foster group (262 days) had a longer mean per episode length of stay than

did the CPA foster group (228 days). Although not statistically significant, children in the CPA

foster group (8.9 years) were older at placement than were children in the county foster group

(8.7 years).


Table 5


Characteristic



Ethnicity Caucasian 514 37.5 777 39.1 Non-Caucasian 857 62.5 1,211 60.9

Gender Female 639 46.6 905 45.5 Male 732 53.4 1,083 54.5

Program Area PA5 716 52.2 1,034 52.0 Non-PA5 655 47.8 954 48.0

Prior Any Placement Yes 888 64.8 1,311 65.9 No 483 35.2 677 34.1

4.3. 13-18 Age Group



Table 6

Foster Care Frequencies between FY08-FY10 for 13-18 Age Group

Service Type Sample Size Percent

CPA Foster 1,750 65.2 County Foster 933 34.8 Total 2,683 100.0


characteristics. As displayed in Table 7, the foster care groups had statistically significant

differences in ethnicity and prior placement history. Specifically, the CPA foster group had a

higher percentage of non-Caucasian children (60.1%) than did the county foster group (55.3%),

and a higher percentage of episodes of care with any prior placement (83.0%) than did the

county foster group (76.8%). There were no statistically significant differences on gender or

current program area.


The groups had a statistically significant difference (p < .05) in age at placement, as

children in the CPA foster group (15.2 years) were older at placement than were children in the

county foster group (15.0 years). Although not statistically significant, the CPA foster group (239

days) had a longer per episode length of stay than did the county foster group (230 days).

Table 7


Characteristic



Ethnicity* Caucasian 417 44.7 699 39.9 Non-Caucasian 516 55.3 1,051 60.1

Gender Female 491 52.6 965 55.1 Male 442 47.4 785 44.9

Program Area PA4 448 48.0 879 50.2 Non-PA4 485 52.0 871 49.8

Prior Any Placement* Yes 717 76.8 1,452 83.0 No 216 23.2 298 17.0


5. Outcome Comparison

The demographic groups were compared overall and within each age range on

outcomes including permanency at discharge, reentry, institutional abuse, subsequent any

placements, any placement days, community placements, community placement days,

residential placements, residential placement days, DYC involvement days, and DYC

commitment days. This outcome comparison was intended to identify demographic

characteristics associated with these outcomes so the equivalence of the foster care groups

could be explored. The foster care groups within each age range then were compared on the

study outcomes.


5.1. Demographic Characteristics

For the overall sample, there were statistically significant differences (p < .05) between

the ethnicity groups (Caucasian and non-Caucasian) on permanency at discharge, subsequent

any placements, any placement days, community days, residential placements, residential days,

DYC involvement days, and DYC commitment days. However, these differences were mixed as

the non-Caucasian group had greater outcomes for the residential and DYC placement

outcomes. There were statistically significant differences (p < .05) between the prior placement

groups on permanency at discharge, reentry, subsequent any placements, any placement days,

community placements, residential placements, DYC involvement days, and DYC commitment

days. The group with no prior placements had greater outcomes for all of these variables. There

were statistically significant differences (p < .05) between the gender groups on subsequent any

placement days, residential placements, DYC involvement days, and DYC commitment days. The

female group had greater outcomes for all of these variables.

For the 0-5 sample, there were statistically significant differences (p < .05) between the

program area groups (PA5 and PA6) on permanency at discharge, reentry, subsequent any

placements and placement days with the PA5 group having greater outcomes for all of these

variables. For the 6-12 sample, there were statistically significant differences (p < .05) between

the program area groups (PA5 and non-PA5) on permanency at discharge, reentry, institutional

abuse, subsequent any placements, any placement days, community placements, community

placement days, and residential placements with the PA5 group having greater outcomes for all

of these variables. For the 13-18 sample, there were statistically significant differences (p < .05)

between the program area groups (PA4 and non-PA4) on permanency at discharge, reentry,

subsequent any placements, any placement days, community placements, community

placement days residential placements, DYC involvement days, and DYC commitment days.

However, these differences were somewhat mixed as the PA4 group had greater outcomes for

the any placement days and community placement days.

5.2. 0-5 Age Group

As displayed in Table 8, there was a statistically significant difference between the

groups on permanency at discharge with the county foster group (60.0%) having higher rates of

permanency at discharge than did CPA foster group (53.3%). There was no statistically

significant difference between the groups on reentry as the county foster group had a 16.6%

reentry rate and the CPA foster group had a 19.4% reentry rate. There was a statistically


significant difference between the groups on institutional abuse with the county foster group

(0.7%) having lower institutional abuse rates than did the CPA foster group (1.5%).

Table 8

Permanency and Safety Outcomes by Foster Care Placement Type for 0-5 Age Group

Outcome



Permanency at Discharge* Permanency 1,571 60.0 1,600 53.3 No Permanency 1,046 40.0 1,402 46.7

Reentry Reentered 144 16.6 222 19.4 Did not Reenter 721 83.4 920 80.6

Institutional Abuse* Abused 18 0.7 45 1.5 Not Abused 2,559 99.3 2,957 98.5


There were statistically significant differences between the groups on the placement

outcomes for any placements and any placement days within 12 months of exit. As displayed in

Table 9, county foster (.68 placements) had fewer subsequent placements of any type than did

CPA foster (.84 placements). County foster (120 days) also had fewer subsequent any

placement days than did CPA foster (144 days). Because there were so few residential

placements for the 0-5 age group, the foster care groups were not compared on subsequent

community placements and placement days within 12 months of exit because the results were

almost identical to the subsequent any placement number and days results.

Table 9

Subsequent Placements Outcomes by Foster Care Placement Type for 0-5 Age Group

Outcome

County Foster Mean

CPA Foster Mean

Any Placements within 12 Months of Exit* .68 .84 Any Placement Days within 12 Months of Exit* 120 144 * Statistically significant difference (p < .05)


5.3. 6-12 Age Group

As displayed in Table 10, there were no statistically significant differences between the

groups on permanency at discharge, reentry, and institutional abuse. Although not statistically

significant, the county foster group (45.4%) had a higher permanency at discharge rate than did

the CPA foster group (43.6%). Although not statistically significant, the county foster group

(14.1%) had a lower reentry rate than did the CPA foster group (16.7%). Although not

statistically significant, the CPA foster group (0.8%) had a lower institutional rate than did the

county foster group (1.4%).

Table 10

Permanency and Safety Outcomes by Foster Care Placement Type for 6-12 Age Group

Outcome



Permanency at Discharge Permanency 622 45.4 866 43.6 No Permanency 749 54.6 1,122 56.4


Institutional Abuse Abused 19 1.4 16 0.8 Not Abused 1,352 98.6 1,972 99.2


outcomes for any placements, any placement days, community placements, and community

placement days within 12 months of exit. As displayed in Table 11, the county foster group

(1.10 placements) had fewer subsequent placements of any type than did the CPA foster group

(1.19 placements), and fewer subsequent placement days of any type (165 days) than did the

CPA foster group (185 days). The county foster group (.92 placements) also had fewer

subsequent community placements than did the CPA foster group (1.02 placements), and fewer

subsequent community placement days (140 days) than did the CPA foster group (157 days).

There were no statistically significant differences between the groups on the placement

outcomes for residential placements, residential placement days, DYC involvement days, and

DYC commitment days within 12 months of exit. Although not statistically significant, the CPA

foster group (.17 placements) had fewer subsequent residential placements than did the

county foster group (.18 placements). Although not statistically significant, the county foster


group (25 days) had fewer subsequent residential placement days than did the CPA foster

group (28 days), while the CPA foster care group (0 days) had fewer subsequent DYC

commitment days than did the county foster group (1 day).

Table 11

Subsequent Placement Outcomes by Foster Care Placement Type for 6-12 Age Group

Outcome

County Foster Mean

CPA Foster Mean

Any Placements within 12 Months of Exit* 1.10 1.19 Any Placement Days within 12 Months of Exit* 165 185 Community Placements within 12 Months of Exit* .92 1.02 Community Placement Days within 12 Months of Exit* 140 157 Residential Placements within 12 Months of Exit .18 .17 Residential Placement Days within 12 Months of Exit 25 28 DYC Involvement Days within 12 Months of Exit 1 1 DYC Commitment Days within 12 Months of Exit 1 0 * Statistically significant difference (p < .05)


As displayed in Table 12, there was a statistically significant difference between the

groups on permanency at discharge with the county foster group (26.7%) having higher rates of

permanency at discharge than did the CPA foster group (22.9%). Although not statistically

significant, the county foster group (17.3%) had a lower reentry rate than did the CPA foster

group (21.5%). There was a statistically significant difference between the groups on

institutional abuse rates with the CPA foster group (0.7%) having a lower rates of institutional

abuse than did the county foster group (1.9%).


outcomes for any placement days and community placements within 12 months of exit. As

displayed in Table 13, the county foster group (153 days) had fewer subsequent any placements

days than did the CPA foster group (166 days), and fewer subsequent community placements

(.84 placements) than did the CPA foster group (.93 placements). There were no statistically

significant differences between the groups on the placement outcomes for subsequent any

placements, community placement days, residential placements, residential placement days,

DYC involvement days, and DYC commitment days within 12 months of exit. Although not

statistically significant, the county foster group (1.29 placements) had fewer subsequent any

placements than did the CPA foster group (1.37 placements), and fewer subsequent community


placement days (108 days) than did the CPA foster group (119 days). Although not statistically

significant, the CPA foster group (.44 placements) had fewer subsequent residential placements

than did the county foster group (.45 placements), while the county foster care group (45 days)

had fewer residential placement days than did the CPA foster group (47 days). Although not

statistically significant, the CPA foster group (15 days) had fewer subsequent DYC involvement

days than did the county foster group (18 days), and fewer subsequent DYC commitment days

(12 days) than did the county foster group (15 days).

Table 12

Permanency and Safety Outcomes by Foster Care Placement Types for 13-18 Age Group

Outcome



Permanency at Discharge* Permanency 249 26.7 401 22.9 No Permanency 684 73.3 1,349 77.1


Institutional Abuse* Abused 18 1.9 12 0.7 Not Abused 915 98.1 1,738 99.3


Table 13

Subsequent Placement Outcomes by Foster Care Placement Type for 13-18 Age Group

Outcome

County Foster Mean

CPA Foster Mean

Any Placements within 12 Months of Exit 1.29 1.37 Any Placement Days within 12 Months of Exit* 153 166 Community Placements within 12 Months of Exit* .84 .93 Community Placement Days within 12 Months of Exit 108 119 Residential Placements within 12 Months of Exit .45 .44 Residential Placement Days within 12 Months of Exit 45 47 DYC Involvement Days within 12 Months of Exit 18 15 DYC Commitment Days within 12 Months of Exit 15 12 * Statistically significant difference (p < .05)


6. Cost Comparison

The foster care groups within each age range were compared on average daily rate,

average daily administration rate, average daily provider rate, and average cost per episode of

care. The average daily rate for CPA foster care is based on an administration rate paid to the

governing agency and a provider rate paid to the specific provider. The administration costs are

a combination of administrative services (e.g., case management) and administrative

maintenance (e.g., salaries/benefits, occupancy, insurance, mileage, etc.). However, counties

have different practices for how they record these costs, so the administration rate was not

separated out by service and maintenance rates for CPA foster care cost calculations.

The average daily rate for county foster care is based on administration costs for county

agencies to operate the foster care unit and a provider rate paid to the specific provider. The

administration costs are a combination of administrative services (e.g., personnel salary and

benefits for case management including administrators, supervisors, and caseworkers) and

administrative maintenance. The administrative maintenance costs collected for this study

include contract payments for home studies, operational costs for office supplies, document

copies, computers, postage, foster parent training incentives, telephone charges, special

services for foster parents, mileage, training, advertising, and promotional items, and

interdepartmental direct billing costs for accounting, legal fees, human resources, IT training,

rent, security and facilities.

To calculate an average cost per day per child, the total administration costs were

divided by the total placement days (as derived from FY09 ADP numbers from Colorado Trails).

However, the county foster care administration costs were not calculated for the different age

groups. Broomfield, Douglas, and El Paso were not included because administration cost data

were not available. However, these three counties only accounted for three percent of the total

ADP for the ARCH counties for the 0-5, 6-12, and 13-18 age groups.

6.1. O-5 Age Group

The average cost per episode for CPA foster care and county foster care was compared

for the 0-5 age group. As displayed in Table 14, the weighted average daily rate for CPA foster

care placements for the 0-5 age group across the 10 ARCH counties was $40.94 with an average

daily administration rate of $16.56, an average daily provider rate of $24.38, and an overall ADP

of 490 children.


Table 14

CPA Average Daily Rate, Administration Rate, and Provider Rate by County for 0-5 Age Group

County Average Daily Rate

Average Daily Administration

Rate

Average Daily Provider Rate

Average Daily Placement

Adams 44.71 16.89 27.82 59.6 Arapahoe 41.39 15.04 26.36 50.0 Boulder 56.24 43.97 12.27 0.6 Broomfield 53.00 43.76 9.25 1.0 Denver 43.06 17.05 26.01 166.1 Douglas 59.34 20.44 38.90 0.1 El Paso 36.46 15.79* 20.67 153.0 Jefferson 41.37 15.17 26.21 31.4 Larimer 66.25 48.14 18.12 2.2 Pueblo 40.75 17.49 23.26 25.8 Total 40.94 16.56 24.38 489.8 *The administration rate for El Paso County does not include the $10 daily rate paid for casework services

As displayed in Table 15, the weighted average daily rate for county foster care

placements for the 0-5 age group across the seven counties that reported administrative costs

was $42.13 with an average daily administration rate of $22.26, an average daily provider rate

of $19.87, and an overall ADP of 408 children.

Table 15

County Foster Care Average Daily Rate, Administration Rate, and Provider Rate by County for

0-5 Age Group



Rate



Adams 39.51 22.82 16.69 64.5 Arapahoe 38.93 20.86 18.07 67.3 Boulder 59.01 42.91 16.10 43.1 Denver 42.36 18.04 24.32 105.3 Jefferson 39.58 18.21 21.37 59.2 Larimer 36.53 20.76 15.77 40.8 Pueblo 42.56 19.18 23.38 28.1 Total 42.13 22.26 19.87 408.3

As displayed in Table 16, the average cost per episode of care was $617 lower for CPA

foster as compared to county foster for the 0-5 age group. Based on a per episode length of


stay of 200 days and an average daily rate of $40.94, CPA foster care averaged $8,188 per

episode of care, as compared with $8,805 per episode of care for county foster care, which was

based on a per episode length of stay of 209 days and an average daily rate of $42.13.

Table 16

Foster Care Comparison for Average Daily Rate, Administration Rate, Provider Rate, and

Average Cost per Episode of Care for 0-5 Age Group

Service Type Average Daily Rate

Average Daily

Admin. Rate

Average Daily

Provider Rate

Per Episode Length of

Stay

Average Cost per

Episode of Care

County Foster 42.13 22.26 19.87 209 $8,805 CPA Foster 40.94 16.56 24.38 200 $8,188

6.2. 6-12 Age Group

As displayed in Table 17, the weighted average daily rate for CPA foster care placements

for the 6-12 age group across the 10 ARCH counties was $48.19 with an average daily

administration rate of $17.59, an average daily provider rate of $30.60, and an overall ADP of

352 children.

Table 17




Rate



Adams 53.47 17.84 35.62 50.6 Arapahoe 43.92 15.59 28.33 26.6 Boulder 108.20 93.68 14.52 1.7 Broomfield 48.30 23.14 25.16 4.2 Denver 48.32 17.90 30.42 109.5 Douglas 60.00 19.66 40.34 1.0 El Paso 41.90 15.46* 26.43 94.5 Jefferson 54.70 16.98 37.72 23.8 Larimer 57.20 26.31 30.89 6.4 Pueblo 51.20 17.92 33.28 33.7 Total 48.19 17.59 30.60 352 *The administration rate for El Paso County does not include the $10 daily rate paid for casework services


As displayed in Table 18, the weighted average daily rate for county foster care

placements for the 6-12 age group across the seven counties that reported administrative costs

was $49.54 with an average daily administration rate of $21.16, an average daily provider rate

of $28.38, and an overall ADP of 230 children.

Table 18


6-12 Age Group



Rate




As displayed in Table 19, the average cost per episode of care was $1,992 lower for CPA



episode of care, as compared with $12,979 per episode of care for county foster care, which

was based on a per episode length of stay of 262 days and an average daily rate of $49.54.

Table 19




Average Daily

Admin. Rate

Average Daily

Provider Rate

Full per Episode

Length of Stay

Average Cost per

Episode of Care




As displayed in Table 20, the weighted average daily rate for CPA foster care placements

for the 13-18 age group across the 10 ARCH counties was $52.83 with an average daily

administration rate of $18.99, an average daily provider rate of $33.83, and an overall ADP of

652 children.

Table 20




Rate



Adams 55.11 18.81 36.30 100.7 Arapahoe 55.95 18.70 37.25 54.9 Boulder 62.64 46.30 16.34 12.8 Broomfield 53.75 19.07 34.69 3.4 Denver 49.57 18.52 31.05 181.3 Douglas 49.20 27.83 21.37 6.5 El Paso 54.15 16.65* 37.50 130.9 Jefferson 56.84 18.51 38.33 48.0 Larimer 47.76 20.10 27.67 23.4 Pueblo 51.06 19.19 31.87 90.3 Total 52.83 18.99 33.83 652.2 *The administration rate for El Paso County does not include the $10 daily rate paid for casework services

As displayed in Table 21, the average daily rate for county foster care placements for the

13-18 age group across the seven counties that reported administrative costs was $59.52 with

an average daily administration rate of $20.51, an average daily provider rate of $39.01, and an

overall ADP of 329 children.


Table 21


13-18 Age Group



Rate




As displayed in Table 22, the average cost per episode of care was $1,116 lower for CPA



episode of care, as compared with $13,690 per episode of care for county foster care, which

was based on a per episode length of stay of 230 days and an average daily rate of $59.52.

Table 22




Average Daily

Admin. Rate

Average Daily

Provider Rate

Full per Episode

Length of Stay

Average Cost per

Episode of Care



7. Discussion

The following discussion presents the conclusions, limitations, and implications of the

outcome and cost findings for the comparison of public and private foster care in Colorado.

7.1. Conclusions

Similar to the studies cited in the literature, the results for the outcome and cost

comparisons for public and private foster care were mixed and varied by age group. Overall, the

outcomes for county foster care were greater than or comparable to the outcomes for CPA

foster care, but CPA foster care had lower costs per episode of care than did county foster care.

Furthermore, there were differences in client acuity but no definitive sense of which placement

type was serving higher risk cases. It should be noted that the outcome results were very

similar to an earlier analysis of data from fiscal years 2004-2007. This indicates some stability

across a six year period, which gives more credence to these findings.

For the 0-5 age group, there were statistically significant differences between the foster

care groups on permanency at discharge, institutional abuse, subsequent any placements, and

subsequent any placement days, with county foster care having an advantage for these

outcomes. However, there was no difference between the foster care groups on reentry. The

cost per episode of care was more expensive for county foster care, with county foster care

having higher administration costs and CPA foster care having higher provider costs. The higher

provider costs suggest that children in the 0-5 age range have higher needs as measured by the

Needs Based Care (NBC) instrument which sets CPA foster parent rates. Furthermore, the CPA

foster group was comprised of a higher percentage of non-Caucasian children. However, the

county foster group was comprised of a higher percentage of children in Program Area 6. As a

result, the difference in client acuity between the foster care groups for this age range is

unclear.


foster care groups on subsequent any placements, subsequent any placement days, subsequent

community placements, and subsequent community placement days, with county foster care

having an advantage for these outcomes. There were no differences between the groups on

permanency at discharge, reentry, institutional abuse, subsequent residential placements and

placement days, and subsequent DYC involvement days and DYC commitment days. The cost

per episode of care was more expensive for county foster care, with county foster care having

higher administration costs and CPA foster care having higher provider rates. The two foster


care groups appeared to be equivalent for the 6-12 age group, as there were no demographic

differences.


foster care groups on permanency at discharge, subsequent any placement days, and

subsequent community placements, with county foster care having an advantage for these

outcomes. There also was a statistically significant difference for institutional abuse with CPA

foster care having an advantage for this outcome. There were no differences between the

groups on reentry, subsequent any placements, subsequent community placement days,

subsequent residential placements and residential placement days, and subsequent DYC

involvement days and DYC commitment days. The cost per episode of care was more expensive

for county foster care, with CPA foster care having higher administration costs and county

foster care having higher provider costs. However, CPA foster care appeared to serve higher

risk cases based on ethnicity and prior placement.

7.2. Limitations

The outcome study faced numerous methodological challenges common to most

research on child welfare interventions using comparative research designs and secondary

data. The most notable limitation is the differences in populations served by the private and

public foster care agencies due to client acuity. However, these differences were not consistent

within and across age groups. Nonetheless, these observed differences in child characteristics

along with other unobserved differences (e.g., behavioral functioning) likely explain some of

the differences in outcomes between the foster care groups. Although the Colorado Client

Assessment Record is used as a measure of initial functioning for children placed in residential

settings, a pre-placement behavioral measure is needed for children placed in foster care

settings.

The integration of cost data into a child welfare outcome study brings its share of

complications. It is important to note the context behind county foster care cost data, as

counties have different practices that lead to different cost accounting. The major issue is the

difficulty in capturing the administration costs to provide county foster care. These cost data

are not available in Colorado Trails and it is up to the counties and the State to calculate and

report this information. Thus, counties provided cost data from their own data systems for

administration costs associated with county foster care placements. One limitation of this

approach was that the daily administration rate for county foster care could not be calculated

by age group because the cost data were not collected in that way. Thus, the same daily


administration rate was used for each age group. This yielded a somewhat imprecise estimate

in that administration costs are typically less expensive for younger children and more

expensive for older children. The difference in administration rates between the 0-5 and 6-12

age groups for CPA foster care was 5.9%, while the difference between the 6-12 and 13-18 age

groups was 8.0%. As a result, the average cost per episode of care for county foster care may be

slightly overestimated for the 0-5 age group and slightly underestimated for the 13-18 age

group. Lastly, the cost comparisons have limitations because they are so heavily based on per

episode length of stay.

This study should be interpreted in light of the reality that foster care providers are only

partially responsible for child outcomes, particularly length of stay, permanency at discharge,

reentry, and subsequent placements. For example, child placement agencies typically do not

provide services to biological parents who are directly responsible for whether and how quickly

a child returns and/or stays home. Furthermore, caseworkers and courts often have the most

influence in regard to where and when a child is placed.

The generalizability of the findings to the larger child welfare population in Colorado is

somewhat problematic because of the lack of random sampling and the criteria used to select

the sample. In addition, the findings are most applicable to larger child placement agencies and

larger counties, as smaller agencies and counties have a lower percentage of the overall sample

size. Even with these limitations, this study has important implications for child welfare

practice, policy, and research in Colorado.

7.3. Implications

Based on the overall comparability in outcomes and costs between public and private

foster care, the main implication of this study is that caseworkers can be confident in placing

children in the most appropriate foster home setting regardless of the placement type. Meezan

and McBeath (2008) believe this suggests the need for child welfare decisions to be driven by

the needs of children and families, not by financial decisions. However, the variability in

demographics, outcomes, and costs by age group should also be considered in out-of-home

placement decisions.

Some researchers suggest (e.g., Fein & Staff, 1991) that establishing a close working

relationship between private and public child welfare agencies can be critical to positive child

welfare outcomes. The literature indicates that agencies can increase retention rates, have

more satisfied foster parents, and improve child functioning within the system by providing


better financial support to foster parents (Chamberlain, Moreland, & Reid, 1992; Lowry, 2004).

Chamberlain et al. (1992) found that additional training and support as well as a small increase

in the monthly stipend minimized dropout rates because the foster parents felt more valued.

However, increasing foster care payments without adding additional support and training may

not produce enough buy-in from foster parents (Chamberlain et al., 1992).

This study added to the research on foster care by comparing administration costs for

county and child placement agencies. Critics of private foster care claim that there is an

increased administration cost due to greater demand for government oversight and increased

labor cost per case in private agencies (Kamerman & Kahn 1998; Poole, 1999; Meezan &

McBeath, 2008). The results from the cost comparison did not support this claim, as the daily

administration rate was actually lower for private foster care placement in all age groups.

Furthermore, the average cost per episode of care was lower for CPA foster care in all age

groups. One caveat is that the cost data were collected from FY08 and FY09, so it is possible

that the cost structure for foster care placements in some Colorado counties has shifted during

the past three years. This speaks to the need for ongoing evaluation of foster care outcomes

and costs. Furthermore, there is a need for more sophisticated outcome and cost analyses, so

that comparisons among foster care placements can be made more precise.

Another recommendation is for child placement agencies to have a more collaborative

role in conducting child welfare research in Colorado. Specifically, CPAs should provide input on

the measures used and the outcomes evaluated while providing data from their own systems to

complement the administrative data collected in Colorado Trails. For example, it might be

useful to collect agency leave reasons and compare them with county leave reasons. Lastly,

child placement agencies are encouraged to conduct their own outcome and cost studies to

contribute to the research-informed discussion about how best to design and implement a child

welfare system that is responsive to the needs of children and families.


8. References

Adoption and Safe Families Act - P.L. 105-89 (1997).

Center for Public Policy Priorities. (2008). Drawing the line between public and private responsibility in child welfare: The Texas debate. Retrieved from http://www.cppp.org/files/4/CPSreportweb.pdf.

Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for

foster parents: Effects on retention rates and outcomes for children. Child Welfare, 71, 387-401.

Else, J. F., Groze, V., Hornby, H., Mirr, R. K., & Wheelock, J. (1992). Performance-based contracting: The case of residential foster care. Child Welfare, 71, 513-526.

Fein. E., & Staff, J. (1991). Implementing reunification services. Families in Society: The Journal

of Contemporary Human Services, 72, 335-343. Freundlich, M., & Gerstenzang, S. (2003). An assessment of the privatization of child welfare

services: Challenges and success. Washington, DC: Child Welfare League of America.

George, R. M. (1990). The reunification process in substitute care. Social Service Review, 64, 422-457.

Kamerman, S. B., & Kahn, A. J. (1998). Privatization, contracting, and reform of child and family

social services. The Finance Project. Lowry, M. R. (2004). Putting teeth into ASFA: The need for statutory minimum standards.

Children and Youth Services Review, 26, 1021-1031. McBeath, B., & Meezan, W. (2008). Market-based disparities in foster care service provision.

Research on Social Work Practice, 18, 27-41. McBeath, B., & Meezan, W. (2009). Interorganizational disparities in foster care service

provision. Children and Youth Services Review, 31, 513‐525. doi:10.1016/j.childyouth.2008.10.007

Meezan, W., & McBeath, B. (2008). Market-based disparities in foster care outcomes. Children

and Youth Services Review, 30, 388-406.

http://www.cppp.org/files/4/CPSreportweb.pdf


Paulson, R. I., Armstrong, M., Fitzpatrick, J., Jordon, N., Kershaw, M.

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