Foster Care Reentry and Placement Stability Outcomes: Understanding Californias Performance and Prac

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Foster Care Reentry and Placement Stability
Outcomes Understanding Californias
Performance and Practices to Improve Outcomes
The Leadership Symposia on Evidence-Based
Practice in Human ServicesJanuary 30, 2009San
Diego, California Kathy Lemon Osterling Ph.D.,
MSWAssistant Professor Amy DAndrade, Ph.D.,
MSWAssistant ProfessorAlice M. Hines, Ph.D.,
MSWDirector ProfessorSchool of Social
WorkSan Jose State University
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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 DAndrade, 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

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Purpose of Workshop

• To review the literature on factors related to
  foster care reentry and placement stability and
  promising practices to address these outcomes.
• 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.
• 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.
• To discuss implications of findings for
  evidence-based/evidence-informed practice.

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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

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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
  childrens 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

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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.

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Foster Care Reentry Placement Instability are
Harmful to Childrens 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 childrens 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

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Literature Review

• Literature Review Questions
• What factors are related to foster care reentry
  and placement instability?
• What practices may improve performance on foster
  care reentry and placement stability outcomes?
• Process of conducting the literature review
  included
• Structured literature review methods used for
  searching academic databases and selecting
  studies
• 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

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Literature Review Factors Related to
Foster Care Reentry
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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)
  
• Family Reunification Services
• 3) Aftercare Services

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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

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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

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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

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Literature Review Factors Related to Placement
Instability
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Literature Review on Placement Stability
Practices

• Four types of practices were identified
• Assessment of childs placement needs and
  caregivers 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

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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)

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Literature Review on Placement Stability
Practices Recruitment of Foster Parents

• 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

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Literature Review on Placement Stability
Practices Support Training

• 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

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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

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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

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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)

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Main Points of Literature Findings
Placement Stability Risk factors Children with
health and/or mental health problems Non-kin
placements A lack of resources for foster and kin
caregivers Some evidence for TDM or
FGDM Standardized assessments of foster
parents Foster parent training CASAs Wraparound T
reatment Foster Care
Reentry Risk factors Significant problems Short
initial stays in foster care and more placement
change Some evidence for TDM or FGDM Specific FR
services Differential response
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Purpose of Study

• 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?
• What are the strategies or practices states and
  counties implemented to improve performance on
  these outcomes?
• Among counties targeting these issues, and
  improving performance, what issues arose in the
  implementation of these strategies?
• Among these counties, what is the perceived
  effectiveness of the strategies?

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Only CA Counties Used in this Analysis

• Federal definitions of measures for PS and RE
  changed between R1 and R2
• Comparisons cant 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

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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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PS Federal Measure
PS CSSR Measure
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Measures are Inter-related
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County Indicator Data PS Improving
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County Indicator Data RE Improving
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PIP and SIP Foster Care Reentry Strategies

• Top 4 State Strategies (n29 states)
• Improve assessment processes (34)
• Family conferencing or team decision-making (28)
• After-care services (24)
• Improve data entry and reporting (21)

• Top 4 County Strategies (n28 counties)
• Team decision-making (43)
• Improve assessment processes (39)
• Improve use of available services (32)
• After-care services (25)

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PIP and SIP Foster Care PS Strategies

• Top 4 State Strategies (n29 states)
• Improve supports for foster parents (79)
• Expand recruitment of foster parents(72)
• Improve assessment/ placement matching (69)
• Provide technical assistance to social
  workers/other staff (38)

• Top 4 County Strategies (n19 counties)
• Improve supports for foster parents (53)
• Expand recruitment of foster parents(47)
• Conduct research or needs assessments (37)
• Team decision making (32)

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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)

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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 anothers analyses as a
  reliability check. Reviews were then discussed
  and themes clarified

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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
• Well Utilized Strategies
• Less Utilized Strategies
• Strategies used by few Counties with Little
  Detail on Content or Effectiveness

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Reentry Well Utilized Strategies

• 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

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Reentry Less 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

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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

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Placement Stability Less Utilized Strategies

• Improve the assessment process
• Various activities to improve assessment of
  childrens 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

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Cross-indicator Analysis of Implementation Issues

• Common challenges in implementation
• Insufficient funding and/or impending budget cuts
• Organizational culture influences how quickly new
  practices are adopted
• Common facilitators in implementation
• Strong collaboration and/or pre-existing
  partnerships between service providers
• Well-planned implementation process

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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

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Discussion

• Counties are simultaneously implementing numerous
  strategies their influence on reentry
  placement stability is largely unknown
• Rationale for how the strategy would influence
  the outcome was not often clear
• Although the influence of insufficient funding is
  a significant implementation barrier, the
  challenges facilitators in implementation of
  strategies are not solely budgetary
• Strategies may influence interrelated indicators
  in unanticipated ways

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Discussion Questions

• Are there other promising practices not discussed
  yet today that you are aware of that may improve
  performance on these outcomes?
• What are the most important influences on foster
  care reentry and placement stability in your
  county?
• What do you see as the main obstacles to improved
  performance on these indicators? What are your
  recommendations to address these challenges

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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

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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

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Recommendations for Future Research

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