Child Welfare Waiver Demonstrations
Child welfare (Title IV-E) waiver demonstration projects are funded by the Children's Bureau and provide states with opportunities to use federal funds to test innovative approaches to child welfare service delivery and financing. The Center has been involved with the evaluation of five such waiver demonstrations.
In 1994, Congress gave the U.S. Department of Health and Human Services (HHS) the authority to implement
Title IV-E waiver demonstration projects, which allow states greater flexibility in spending federal funds by waiving certain provisions of Titles IV-E and IV-B of the Social Security Act. Since 1994, over 30 states have taken advantage of this opportunity to implement and test a wide variety of innovative strategies to improve outcomes for children and families involved in the child welfare system, including subsidized guardianship, flexible funding, managed care payment systems, services for caregivers with substance use disorders, intensive service options, and adoption and post-permanency services. In recent waiver demonstration projects, a special emphasis has been placed on projects that test approaches designed to produce positive well-being outcomes for children, youth, and their families, with particular attention given to addressing the trauma experienced by children who have been maltreated.
Each approved waiver demonstration project must include a strong evaluation component that will help state and local child welfare agencies learn the extent to which new interventions are successful in improving outcomes and addressing identified targets for change. Each Title IV-E agency authorized to conduct a demonstration project must obtain an evaluation by an independent contractor to assess the effectiveness of the project. The evaluations must include:
A process evaluation that examines how the demonstration has been implemented, including the policies and procedures that have been put in place, the types and volumes of services delivered, and the characteristics of the population served.
An outcome evaluation that examines whether the child, family, and system outcomes observed under the demonstration are different than those that would have been achieved under “services as usual” conditions, and if the observed changes can be attributable to activities conducted under the demonstration.
A cost analysis that examines services received by children and families in various cost categories, and may include a longitudinal examination of changes in costs over time or a comparative analysis of service costs between children and families who did or did not receive services under the demonstration.
The Children and Family Research Center has been involved with five of the IV-E waiver demonstration evaluations:
Wisconsin Post-reunification Support (P.S.) Program Evaluation
Under the direction of our Director, Tamara Fuller, CFRC partnered with the Wisconsin Department of Children and Families (DCF) to evaluate their waiver demonstration project, known as the Post-Reunification Support (P.S.) Program. The P.S. Program provides up to 12 months of post-reunification services and support to families with children who have reunified from substitute care who are at higher risk of re-entry into care. The goals of the P.S. Program are to reduce repeat maltreatment and re-entry into substitute care, as well as improve child and family well-being post-reunification. CFRC conducted the data collection process, outcome, and cost evaluations of the Wisconsin waiver demonstration evaluation. In addition, we developed a predictive risk model that is being implemented in Wisconsin to target services to those children and families that are at highest risk of re-entry into substitute care within 12 months of reunification.
Illinois Alcohol and Other Drug Abuse (AODA) Waiver Demonstration Evaluation
CFRC evaluated the implementation and outcomes of an intervention targeted at parents with drug or alcohol abuse whose children were removed from home and placed into substitute care. To qualify for the demonstration, parents in the substance-affected families were referred to the Juvenile Court Assessment Program (JCAP) at the time of their temporary custody hearing or at any time within 90 days of that hearing. In addition to receiving traditional child welfare services, parents in the demonstration group also received multiple services from outreach workers known as "recovery coaches," who made efforts to engage parents to participate in substance abuse treatment. Processes and outcomes examined in the evaluation included: rates of treatment access, time between referral and entry into substance abuse treatment, reunification rates and time to reunification and other exits to permanency, repeat maltreatment, and re-entry into substitute care following reunification.
Illinois Subsidized Guardianship Waiver Demonstration Evaluation
The Illinois Department of Children and Family Services was one of the first states to receive approval to implement a Title IV-E waiver in 1996. Under the direction of former CFRC Director, Mark Testa, Illinois' first waiver demonstration project tested the benefits of offering subsidized guardianship to children in substitute care for whom reunification and adoption were not viable permanency options. The Illinois Subsidized Guardianship evaluation used an experimental design with randomization to treatment groups to determine whether the demonstration resulted in improvement in the percentages of children who exited substitute care to permanency without increases in the rate of subsequent reports of maltreatment.
Illinois Enhanced Subsidized Guardianship Waiver Demonstration Evaluation
The Illinois Department of Children and Family Services was granted a five-year extension of their subsidized guardianship demonstration project in 2004. Under its Phase II demonstration, Illinois retained its standard subsidized guardianship program and added an enhanced component that provided independent living and transitional services to older wards ages 14-17 who were eligible for guardianship or adoption. The waiver demonstration evaluation, led by former CFRC, Director Mark Testa, tested whether the availability of enhanced transition services resulted in significant differences in safety, permanency, and placement stability between youth in the experimental and control groups.
Illinois Enhanced Training for Child Welfare Staff
The Illinois Department of Children and Family Services implemented an outcome-focused training and development program to equip new caseworkers with the knowledge and skills necessary to perform in an outcome-focused child welfare environment. The Enhanced Training curriculum was built on competencies taught as part of the State's foundation training, and was provided to all new child welfare workers, and included classroom instruction, on-the-job training, shadowing, and post-training booster sessions. CFRC conducted the process and outcome evaluation components of the waiver demonstration evaluation; however, the demonstration was terminated early due to low enrollment.
Conducting Meaningful Cost Analysis
Michael T. Braun and Satomi Wakita
Cost analysis is an important consideration when deciding whether a new program or practice is sustainable. This presentation explores practical considerations of conducting cost analyses to help produce meaningful results that are useful to decision-makers and stakeholders. It was originally presented at the third annual Continuous Quality Improvement conference in Champaign, IL.
The P.S. Program: Using Predictive Analytics in Program Implementation
Tamara Fuller, Theodore Cross, Vaughn Brandt, and Colleen McGroarty
As part of their Title IV-E waiver demonstration project, the Wisconsin Department of Children and Families (DCF) was interested in developing a way to target post-reunification services to those families that were at highest risk of re-entry into substitute care. The CFRC used historical data to develop a predictive risk model, known as the Re-entry Prevention Model (RPM) that was implemented in each county that was part of the waiver demonstration project. The CFRC and DCF gave an overview of the RPM development and implementation process at the 16th annual child welfare waiver demonstration projects meeting, including a discussion of the lessons learned.
Illinois AODA IV-E Waiver Demonstration Final Evaluation Report
Joseph P. Ryan and Hui Huang
This report presents findings from Illinois Department of Children and Family Services Title IV-E Alcohol and Other Drug Abuse (AODA) Waiver Demonstration. Implemented in 2000, the AODA waiver randomly assigned substance-involved parents with children in substitute care to either a control group (services as usual) or a treatment group (services as usual plus the services of a recovery coach). Results indicate the parents assigned to the recovery coach group are more likely to achieve family reunification as compared to parents assigned to the control group. In addition, children in the treatment group spent significantly fewer days in foster care as compared to children in the control group. It is estimated that the waiver demonstration saved the State of Illinois at least $6,141,925 through March 2012.
Illinois Permanence for Older Wards Waiver: Final Evaluation Report
Liz Quinn, Crystal MacAllum, Janet Ciarico, John Rogers
The Illinois Permanency for Older Wards Waiver (2005-2008) tested the effects of offering an enhanced set of transition and post-permanency services to youth who were considering subsidized guardianship or adoption. A previous Illinois subsidized guardianship waiver demonstration (1997-2002) found that the availability of subsidized guardianship boosted permanency rates, but more so for younger children than for teenagers. In response, the Older Wards Waiver was designed to determine whether the prospect of losing eligibility for some enhanced transition services after adoption or subsidized guardianship was the reason for the lower permanency rate for teens.
Illinois Alcohol and Other Drug Abuse IV-E Waiver Demonstration: Interim Evaluation Report, September 2009
Mark Testa, Joseph Ryan, Pedro Hernandez, Hui Huang
The AODA waiver was based on the premise that Recovery Coaches could engage families more quickly in the substance abuse treatment process. Moreover, through monitoring, encouragement, and advocacy, it, was hypothesized that the use of Recovery Coaches would have a positive effect on treatment duration and treatment completion and via more timely access and higher completion rates, children in the demonstration group would experience higher rates of family reunification. The evidence indicates that parents assigned to the recovery coach group were significantly more likely to achieve family reunification as compared to parents assigned to the control group. There were no differences with regard to subsequent reports of maltreatment - indicating that families are not being reunified too quickly. Moreover, children in the recovery coach group spent significantly fewer days in foster care as compared with children in the control group. Finally, the Illinois AODA waiver demonstration saved the State almost 7 million dollars through June 30, 2009.
Subsidized Guardianship Demonstrations: What We Have Learned and How Those Lessons Are Guiding Policy and Practice
In the late 1990s, the Federal Government instituted IV-E Waiver Subsidized Guardianship Demonstrations in six states to test the feasibility of a new option to achieve permanency. These experiments offered subsidies to relative caregivers who were willing to assume guardianships to provide long-term permanency for foster children. The findings and policy implications of the IV-E Subsidized Guardianship Demonstrations in several states will be presented. Additionally, findings that highlight the advantages of foster children who are reared by relatives will be shown.
Illinois Alcohol and Other Drug Abuse IV-E Waiver Demonstration: Semi-Annual Progress Report, June - December 2007
This semi-annual report is submitted by the Illinois Department of Children and Family Services as required by the Terms and Conditions of its child welfare demonstration project with the Children's Bureau of the Administration for Children and Families. The report covers the period June 2007 - December 2007. Unless otherwise indicated, analysis data in the report covers April 2000 through December 2007, the last reporting quarter for which complete data were available from our data collection agency. Client demographic and treatment participation totals are complete through December 2007 unless otherwise indicated. The format for this report follows the requirements for child welfare demonstration projects in the ACF draft Program Instruction issued February 2001 (Log No. ACYF-CB-PI-2001).
Recovery Coaches and Substance Exposure at Birth
Joseph Ryan, Sam Choi, Jun Sung Hong, Pedro Hernandez, Christopher Larrison
Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. The objective of the current study is to evaluate the use of recovery coaches in child welfare. The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth. Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth.The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.
Ryan, J. P., Choi, S., Hong, J., Hernandez, P. & Larrison, C. (2008). Recovery coaches and substance exposure at birth. Child Abuse and Neglect, 32, 1072-1079.
Child Welfare and Allied Services: Substance Abuse and Juvenile Justice
Presented November 8, 2007 to the Child Care Association of Illinois. Describes the results of the Illinois Alcohol and Other Drug (AODA) waiver demonstration evaluation, and also examines the relationship between child welfare and juvenile justice outcomes.
Recovery Coaches and Substance Exposed Births: An Experiment in Child Welfare
Joseph Ryan, Sam Choi, Jun Sung Hong, Pedro Hernandez, Christopher Larrison
Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. Such outcomes include but are not limited to strained parental attachments, child maltreatment, and extended stays in substitute care settings. The current study focuses on an experimental evaluation of the effectiveness of recovery coaches in child welfare to prevent new substance exposed births. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group and 670 in the experimental group. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth.
Integrating Substance Abuse Treatment and Child Welfare Services: Findings from the Illinois Alcohol and Other Drug Abuse Waiver Demonstration
Joseph Ryan, Jeanne Marsh, Mark Testa, Dick Louderman
Alcohol and other drug abuse is a major problem for children and families involved with public child welfare. Substance abuse compromises appropriate parenting practices and increases the risk of child maltreatment. A substantial proportion of substantiated child abuse and neglect reports involve parental substance abuse. Once in the system, children of substance-abusing families experience significantly longer stays in foster care and significantly lower rates of reunification. To address these problems, child welfare systems are developing service integration models that incorporate both substance abuse and child welfare services. This study provides an initial examination of the effectiveness of one service integration model that emphasizes the provision of intensive case management to link substance abuse and child welfare services. The authors used an experimental design and focused particular attention on two outcomes: access to substance abuse services and family reunification.The findings indicate that the families assigned to the experimental group used substance abuse services at a significantly higher rate and were more likely to achieve family reunification than were families in the control group.
Ryan, J.P., Marsh, J.C., Testa, M.F., & Louderman, R. (2006). Integrating substance abuse treatment and child welfare services: Findings from the Illinois alcohol and other drug abuse waiver demonstration. Social Work Research, 30, 95-107.
Illinois Alcohol and Other Drug Abuse (AODA) Waiver Demonstration: Final Evaluation Report
This report examines the use of Recovery Coaches in promoting progress and success for drug-involved parents of children involved in the child welfare system. The use of a recovery coach was intended to increase the access to substance abuse services, improve substance abuse treatment outcomes, shorten the length of time children of drug-involved parents remain in substitute care placement, and affect child welfare outcomes including increasing rates of family reunification and decreasing the risk of continued maltreatment.
Integrated Services for Families With Multiple Problems: Obstacles to Family Reunification
Jeanne Marsh, Joseph Ryan, Sam Choi, Mark Testa
Child welfare clients with co-occurring problems are recognized as clients who have difficulty achieving positive child welfare outcomes. The current study focuses on families in the child welfare system with co-occurring problems and the impact of such problems on the likelihood of reunification. The current study contributes to the literature on service integration by examining whether it is necessary to go beyond assessment and service access to insure families make progress in each co-occurring problem area to achieve reunification. The sample is comprised of 724 substance-abusing families enrolled in the Illinois Title IV-E Alcohol and Other Drug Abuse (AODA) Waiver Demonstration. Data on client progress consisted of provider ratings completed quarterly to track progress related to problems of substance abuse, domestic violence, housing and mental health. The findings indicate that progress in resolving co-occurring problem areas does increase the likelihood of achieving family reunification. Thus, the provision of the child welfare service model alone is insufficient. In order for child welfare systems to increase reunification rates, services must target the specific needs of individual families and assist them in achieving progress within co-occurring problem areas. Successful integrated service programs must identify the range of specific problems that clients are dealing with and insure that they address and resolve these problems in order to increase the likelihood of family reunification.
Marsh, J.C., Ryan, J.P., Choi, S. & Testa, M. (2006). Integrated services for families with multiple problems: Obstacles to family reunification. Children and Youth Services Review, 28, 1074-1087.
Encouraging Child Welfare Innovation Through IV-E Waivers
The IV-E child welfare waivers program is an important but underutilized provision of the Social Security Act. Authorized by Congress in 1994, the program gives states greater spending flexibility while maintaining the basic child protection entitlement and ensuring that federal dollars are invested in innovations that are scientifically proven to work. This paper reviews the role of waiver demonstrations in advancing child welfare reform and explains the use of cost neutrality formulas to reward states for successful innovations and limit federal investment risk for failed experiments. It describes the limitations of the current waiver structure and how they could be addressed. The paper concludes with a set of policy options to amend the existing waiver program to encourage innovation, rigorous evaluation of hypothesized solutions, and widespread dissemination of proven practices to hold public child welfare systems accountable for achieving the outcomes valued by families, children, and society at large.
Subsidized Guardianship and Permanence
Leslie Cohen, Mark Testa
This brief summarizes results from the Illinois Subsidized Guardianship Waiver Demonstration evaluation.
Substance Abuse and Child Welfare: Experimenting with Recovery Coaches in Illinois
Joseph Ryan, Dick Louderman, Mark Testa
This brief describes the results of the Illinois Alcohol and Other Drug (AODA) Title IV-E waiver demonstration evaluation. This evaluation compared the efficacy of recovery coach services relative to the substance abuse service option that would have been available in the absence of the waiver.
Illinois Subsidized Guardianship Waiver Demonstration: Final Evaluation Report
Mark Testa, Leslie Cohen, Grace Smith, Westat
The Subsidized Guardianship Waiver Demonstration, is designed to assess whether the availability of federal subsidies for private guardianship increases the number of children discharged to permanent homes with relatives or foster parents.
Illinois Alcohol and Other Drug Abuse IV-E Waiver Demonstration: Interim Evaluation Report, May 2003
Mark Testa, Joseph Ryan, Dick Louderman, Joe Anna Sullivan, Sam Gillespie, Rosie Gianforte, Janelle Preuter, Dani Quasius
Substance abuse is a major problem for the children and families involved with public child welfare. Substance abuse may compromise appropriate parenting practices and increases the risk of child maltreatment. Moreover, barriers to substance abuse treatment delay reunification and permanence. It is hypothesized that the provision of Recovery Coach services will positively affect key child welfare outcomes (e.g. permanency). The purpose of this demonstration project is to improve permanency outcomes for children of parents with substance abuse problems. To achieve this purpose, Recovery Coaches assist parents with obtaining AODA treatment services and negotiating departmental and judicial requirements associated with drug recovery and permanency planning.