Foster Care Reentry and Placement Stability Outcomes: Understanding California’s Performance

and Practices to Improve Outcomes

The Leadership Symposia on Evidence-Based Practice in Human Services

January 30, 2009San Diego, California

Kathy Lemon Osterling Ph.D., MSWAssistant Professor

Amy D’Andrade, Ph.D., MSW

Assistant Professor

Alice M. Hines, Ph.D., MSWDirector & Professor

School of Social WorkSan Jose State University

Study Contributors

• CDSS: Linda Hockman, Glenn Freitas, Greg Rose & Linne Stout

• CalSWEC: Barrett Johnson, Director Child Welfare In-Service Training Project

• SJSU School of Social Work Research Team: Dr. Alice Hines (P.I.), Dr. Kathy Lemon Osterling, Dr. Amy D’Andrade, and graduate research assistants Emily Glickman and Laura Raymond

• A special thank you to Barbara Needell and her research team at CSSR for their assistance with interpretation of performance indicator data

Purpose of Workshop1) To review the literature on factors related to foster care

reentry and placement stability and promising practices to address these outcomes.

2) To present information from Program Improvement Plans (PIPs) and System Improvement Plans (SIPs) on practices and policies implemented in states and counties to address these outcomes.

3) To present findings from interviews with counties in California implementing strategies to improve performance on these outcomes, and to identify implementation issues and perceived effectiveness of these strategies.

4) To discuss implications of findings for evidence-based/evidence-informed practice.

Background: Child and Family Service Review (CFSR)

• First mandated in 1994 in amendments to the Social Security Act which allowed HHS to review states’ child and family services to assess conformity with requirements of Title IV-B and IV-E.

• Began implementation in 2001• Each state review includes:

– Administrative data on certain performance indicators

– On-site review of 50 cases in 3 counties – If state is out of compliance on any outcome, a

Program Improvement Plan is required

Background: CFSR Assessment of 7 Outcomes in 3 domains (safety, permanency & well-being) • Safety Outcome 1: Children are, first and foremost, protected

from abuse and Neglect • Safety Outcome 2: Children are safely maintained in their

homes whenever possible and appropriate• Permanency Outcome 1: Children have permanency and

stability in their living situations• Permanency Outcome 2: The continuity of family relationships

and connections is preserved for children• Child and Family Well-Being Outcome 1: Families have

enhanced capacity to provide for their children’s needs• Child and Family Well-Being Outcome 2: Children receive

appropriate services to meet their educational needs• Child and Family Well-Being Outcome 3: Children receive

adequate services to meet their physical and mental health needs

Permanency Outcome 1: Children have permanency & stability in their living situations

• Foster care reentry and placement stability are important performance indicators within permanency outcome 1.

Foster Care Reentry & Placement Instability are Harmful to Children’s Well-being

• Reentering foster care after reunification suggests that: Improvements in family problems were not sustained after

reunification Children and youth are experiencing disruptions in

consistent care-giving and the trauma of a second removal• Numerous placement changes are associated with:

Problems in children’s ability to form relationships Externalizing & internalizing behavior problems Trauma symptoms Academic problems Juvenile justice system (for males) Increased chances of reentering foster care after

reunification

Literature Review• Literature Review Questions:

1) What factors are related to foster care reentry and placement instability?

2) What practices may improve performance on foster care reentry and placement stability outcomes?

• Process of conducting the literature review included:1) Structured literature review methods used for searching academic

databases and selecting studies

2) Identification of practices through The California Evidence-Based Clearinghouse for Child Welfare (CEBC)

• Criteria for selection of practice in literature review 1) The Scientific Rating Scale developed by the CEBC was used and practices that met criteria for a 1 (well-supported by research evidence), 2 (supported by research evidence), or 3 (promising research evidence). 2) For practices identified through the CEBC, the scientific rating scale assigned by CEBC was used. For practices identified in our review, the CEBC scientific rating scale was applied

Literature Review: Factors Related to Foster Care Reentry

ChildCharacteristics

Health/disability

Mental health

Behavior problems

African American race/ethnicity

Infant or preteen/teen age

Family CharacteristicsPoverty

Parental substance abuse

Neglect (vs. other forms ofmaltreatment)

Parenting problems

Lack of social support

Mental health problems

Prior child welfareinvolvement or previousunsuccessful reunification

Child Welfare ServiceAttributes

Short initial stays infoster care

More foster careplacements

Placement in group care

Placement with non-relatives

Unmet needs orunresolved problems

Literature Review on Reentry Practices

Three types of practices were identified:

1) Assessment & Decision-Making (when child first enters care and at the decision to reunify)

2) Family Reunification Services 3) Aftercare Services

Literature Review on Reentry Practices: Assessment & Decision-Making

• Team Decision Making (TDM) or Family Group Decision-Making (FGDM) Collaborative model of assessment and decision making

Literature Review on Reentry Practices: Family Reunification Services

Substance abuse (motivational interviewing, contingency management, 12-step support groups, family treatment drug court)

Mental health (trauma recovery focused counseling for child and parent)

Domestic violence (psycho-educational groups for batterers, support & advocacy, specialized counseling)

Parenting (parent-child interaction therapy, psycho-educational curriculums)

Housing assistance

Literature Review on Reentry Practices: Aftercare Services

• May include similar services as those offered in family reunification

• Differential Response may also be utilized as an aftercare strategy

Literature Review: Factors Related to Placement Instability

ChildCharacteristics

Health problems Mental health

problems Behavior problemsOlder age youth

FamilyCharacteristics

Having siblings in care Physical or sexual

abuse (vs. neglect or emotional abuse)

Child WelfareService Attributes

Placement with non-relatives (vs. placement with kin)

Lack of resources or support for foster parents

System or policy mandates related to placements

Literature Review on Placement Stability Practices

Four types of practices were identified • Assessment of child’s placement needs and

caregiver’s ability to meet those needs• Recruitment and outreach to increase the

number of available foster parents, or family finding efforts to increase the number of kin caregivers

• Support and training for foster parent and kin care providers

• Intensive support and behavioral interventions for youth with who cannot have their needs met in a lower level of care

Literature Review on Placement Stability Practices: Assessment & Decision Making

• Team Decision Making (TDM) or Family Group Decision-Making (FGDM)

• Standardized assessments of foster parents (Casey Foster Parent Inventory, Foster Parent Attitudes Questionnaire)

• No evidence-based practices were identified related to foster parent recruitment, however

• There is evidence that foster parents who learn of the need for foster parents from religious organizations remain foster parents for longer periods of time than those who were informed through the media

Literature Review on Placement Stability Practices: Recruitment of Foster Parents

• Parent training for foster parents• Neighbor to Neighbor professionalizes the

work of foster parents through a salary and benefits, and aims to keep sibling groups together

• Court Appointed Special Advocates Trained volunteers who advocate for and mentor foster children and youth

Literature Review on Placement Stability Practices: Support & Training

Literature Review on Placement Stability Practices: Intensive Interventions for Youth

• Multidimensional treatment foster care: Intensive support and monitoring for youth and foster parents to maintain youth in a foster family home rather than a higher level of care

• Wraparound services: Collaborative model of services with integrated case plans among all service providers with intensive, strength-based services

Community Context

• Geographic context: Rural, Urban, Suburban/Mixed, large county, small county, etc.

• Demographic context: Poverty rate, crime rate, racial/ethnic composition of county, etc.

• Geographic and demographic contexts influence:

• The characteristics of families coming into contact with the child welfare system

• The relative availability of services and resources

Organizational Context

• Components of organizational context that may influence service effectiveness include:

• Organizational structure (role specialization, decentralization)

• Work conditions (e.g. leadership, workload, professional development, compensation, social support)

• Worker characteristics (demographics & attributes)• Worker responses (job satisfaction, burnout/stress,

commitment) • Contingency factors (environment, technology, size

& age)

Main Points of Literature Findings

Reentry:Risk factors Significant problems Short initial stays in foster care and more placement changeSome evidence forTDM or FGDMSpecific FR servicesDifferential response

Placement Stability:Risk factors Children with health and/or mental health problems Non-kin placementsA lack of resources for foster and kin caregiversSome evidence for:TDM or FGDMStandardized assessments of foster parentsFoster parent training CASAsWraparoundTreatment Foster Care

Purpose of Study 1) What states and counties are attempting to improve

performance on reentry and placement stability according to the most recent Program Improvement Plan (PIP) or System Improvement Plan (SIP) documents?

2) What are the strategies or practices states and counties implemented to improve performance on these outcomes?

3) Among counties targeting these issues, and improving performance, what issues arose in the implementation of these strategies?

4) Among these counties, what is the perceived effectiveness of the strategies?

Only CA Counties Used in this Analysis

– Federal definitions of measures for PS and RE changed between R1 and R2

– Comparisons can’t be made between time periods due to these differences

– CSSR calculates performance of CA and CA counties using the new federal measures back to 1998, so can examine performance over time

Different Measure of Placement Stablity Used

– Federal measure groups together children with different amounts of time in care

– Can distort understanding of PS– CSSR calculates a measure of PS that counts

number of placements for all children in care 1,2,3,4,5,6 years, at that point in time. No grouping together of children with different amounts of time in care.

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

12m 24m 36m 48m 60m

PS Federal Measure PS CSSR Measure

Measures are Inter-related

C A F os ter C are R e-entry and E ntry to C are

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1998 1999 2000 2001 2002 2003 2004 2005 2006

R e-entry within 12 m(ex it c ohort)

E ntry rate per 1000

C A F os ter C are R e-entry and R eunific ation <12 m (ex it c ohort)

0

20

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1998 1999 2000 2001 2002 2003 2004 2005 2006

R e-entry within 12 m(exit c ohort)

R eunif with 12 m (ex itcohort)

County Indicator Data: PS Improving

L arg e S outhern C ounty

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

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County Indicator Data: RE Improving

T hree Medium/L arg e C ounties

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1998 1999 2000 2001 2002 2003 2004 2005 2006

C ounty 1 C ounty 2 C ounty 3

PIP and SIP Foster Care Reentry Strategies

Top 4 State Strategies (n=29 states)1. Improve assessment

processes (34%)2. Family conferencing or

team decision-making (28%)

3. After-care services (24%)4. Improve data entry and

reporting (21%)

Top 4 County Strategies (n=28 counties)1. Team decision-making

(43%)2. Improve assessment

processes (39%)3. Improve use of available

services (32%)4. After-care services (25%)

PIP and SIP Foster Care PS Strategies

Top 4 State Strategies (n=29 states)1. Improve supports for foster

parents (79%)2. Expand recruitment of

foster parents(72%)3. Improve assessment/

placement matching (69%)4. Provide technical

assistance to social workers/other staff (38%)

Top 4 County Strategies (n=19 counties)1. Improve supports for

foster parents (53%)2. Expand recruitment of

foster parents(47%)3. Conduct research or

needs assessments (37%)

4. Team decision making (32%)

Methods for Interviews: Sampling Procedures

• Construction of the sample was based on two criteria: 1) the county targeted placement stability or foster care reentry as an overall improvement goal in their first and/or second System Improvement Plan (SIP)2) county performance on reentry or placement stability indicated improvement in the prior 10 years

• 5 counties were identified that experienced improved performance on placement stability

• 9 counties were identified that experienced improved performance on foster care reentry

• In order to increase the sample size, counties that described comprehensive or innovative strategies were also selected (4 for placement stability and 2 for foster care reentry)

• Final sample for placement stability: 9 responses (8 telephone interviews and 1 written response)

• Final Sample for foster care reentry: 9 responses (2 counties declined)

Methods for Interviews: Data Collection, Data Analysis, Reliability & Validity

• Data Collection: Semi-structured interview guide• Data Analysis: General analytic approach was to

review and categorize responses, identifying any general themes that emerged through an iterative review process

• Reliability & Validity: Each co-investigator conducted an in-depth review of one indicator and then reviewed one another’s analyses as a reliability check. Reviews were then discussed and themes clarified

Interview Results

• Foster care reentry: • 17 types of practices were identified

• Placement stability:• 14 types of practices were identified

• Practices were grouped into three categories:

a) Well Utilized Strategiesb) Less Utilized Strategiesc) Strategies used by few Counties with Little Detail

on Content or Effectiveness

• Team decision-making prior to reunification Collaborative case planning between

families, service providers and social workers• After care services

Contracted services with CBOs to provide services after child welfare case is closed

• Structured Decision Making or Comprehensive Assessment Tool Implementation involved training and

monitoring of workers in use of tools

Reentry: Well Utilized Strategies

• Dependency drug court Collaborative and intensive services for parents with

a substance abuse problem with increased monitoring through court appearances

• Wraparound Contracted services with CBOs to provide

collaborative and intensive services to youth & families

• Research and planning In-depth analysis of cases that reentered Development of collaborative work groups that

identified best practice areas

Reentry: Less Utilized Strategies

Placement Stability: Well Utilized Strategies

• Improving supports to caregivers Activities to improve outreach to foster parents

and provide training & support• Increasing successful placements with relatives

Activities such as Family finding efforts, streamlining process for approval of relative placements

• Team Decision-Making for placement changes Collaborative meetings to plan placement

changes or identify placement resources

• Improve the assessment process Various activities to improve assessment of children’s

needs and caregiver skills• Improve/increase caregiver recruitment efforts

Various activities to build connections with communities and recruit foster parents

• Creation of a centralized placement finding process Placement finding activities are centralized with one

or two workers, or a new unit

Placement Stability: Less Utilized Strategies

Cross-indicator Analysis of Implementation Issues

Common challenges in implementation:1) Insufficient funding and/or impending budget

cuts2) Organizational culture influences how quickly

new practices are adoptedCommon facilitators in implementation:1) Strong collaboration and/or pre-existing

partnerships between service providers 2) Well-planned implementation process

Cross-indicator Analysis of Effectiveness

• Difficult for respondents to answer questions about effectiveness of the strategy

• No county had implemented an evaluation plan that had yet provided results on the effectiveness of the strategy

• Respondents reported examining performance indicator data and tracking changes in the outcomes, but there was not a link to the strategy

Discussion

1) Counties are simultaneously implementing numerous strategies & their influence on reentry & placement stability is largely unknown

2) Rationale for how the strategy would influence the outcome was not often clear

3) Although the influence of insufficient funding is a significant implementation barrier, the challenges & facilitators in implementation of strategies are not solely budgetary

4) Strategies may influence interrelated indicators in unanticipated ways

Discussion Questions

1) Are there other promising practices not discussed yet today that you are aware of that may improve performance on these outcomes?

2) What are the most important influences on foster care reentry and placement stability in your county?

3) What do you see as the main obstacles to improved performance on these indicators? What are your recommendations to address these challenges

Recommendations for Policy Makers & Administrators

• Structures to facilitate collaborative partnerships, such as:– Subsidized projects between universities and

child welfare agencies to conduct evaluations of strategies on reentry and placement stability outcomes

– Incorporate SIP strategy evaluations as a CalSWEC funded research project

Recommendations for Training & Education

• Training for managers and analysts on logic-model planning processes and program evaluation

• Training on how to identify evidence-based practices

Recommendations for Future Research

• Rigorous evaluations of the strategies currently in use on reentry and placement stability outcomes