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Arizona

Demonstration Type:	Expedited Reunification Services1
Approved:	June 30, 2005
Implemented:	April 17, 2006
Expected Completion:	March 30, 2011
Interim Evaluation Report Expected:	November 30, 2008
Final Evaluation Report Expected:	October 2011

Target Population

The target population for Arizona’s demonstration includes title IV-E-eligible and non-IV-E-eligible children (1) in out-of-home placement for no more than nine months in a congregate or licensed foster care setting (e.g., shelter facilities, group homes, residential placements, and licensed foster homes); (2) for whom reunification is the case plan goal; (3) whose caregivers agree to participate in the waiver demonstration; and (4) for whom a juvenile court concurs with a plan of expedited reunification.  Children who meet these eligibility criteria at the start of project implementation, or who enter placement in a congregate or licensed foster care setting during the effective dates of the waiver, may participate in the demonstration. 

Jurisdiction

Arizona’s demonstration involves two project phases.  Phase I is being implemented for a 15-month period in randomly selected Child Protective Services (CPS) units in the Mesa, Thunderbird, and Tempe Child Welfare Offices in Maricopa County.  Depending in part on initial evaluation findings from Phase I, the State may expand the demonstration to other CPS offices in Maricopa and Pima Counties and to one or more rural Arizona counties. 

Intervention

Arizona’s demonstration is testing innovative child welfare services that focus on expediting family reunification for children in congregate and licensed foster care settings.  Participants in the waiver demonstration have access to a variety of services:

• Home-Based Strategies and Interventions include counseling (individual, family, and marital therapy), family assessments, case planning, and intensive case management in accordance with the child’s safety plan and family assessment.  Services also include counseling and skill development related to conflict resolution, anger management, communication and negotiation, parenting education and child behavior management, problem solving, stress management, home management, job readiness, and linkages to community-based resources. 

• Child and Family Teams (CFTs) provide a framework for facilitating the reunification of children in out-of-home placement with their caregivers.  CFT participants include the Family Reunification Specialist, extended family, family friends, the child welfare case manager, and other significant people.  These teams work together to support the family in the assessment, planning, intervention, and aftercare phases of the intervention.
  CFT members work with the family’s child welfare case manager to complete a Strengths and Risk Assessment and develop a safety and family plan.  The CFT identifies the core strengths and needs of the family and works with it to create an action plan for obtaining needed resources and overcoming barriers to the child’s reunification.  The CFT meets as frequently as needed and monitors the family’s progress towards maintaining a stable and safe living environment after a child’s reunification and during an aftercare phase lasting up to six months.

• Flexible Funds are available for use when the CFT and/or Family Reunification Specialist identify basic or immediate family needs that cannot be met through existing resources.  The use of flexible funds is specific to the individual needs and circumstances of each family.  Examples of the use of flexible funds include provision for basic physical needs (e.g., food, clothing, shelter, or furniture); home repairs; financial support for a parent mentor; or counseling, therapeutic, or similar services that would otherwise be unavailable to the family.

Evaluation Design

Arizona’s evaluation is testing the hypothesis that intensive home-based early reunification services will (1) reduce children’s length of stay in congregate and licensed foster care settings; (2) decrease the likelihood of re-entry into out-of-home care; (3) prevent the recurrence of child abuse and neglect; and (4) improve family well-being and functioning. 
The State’s evaluation approach involves a modified comparison group design in which CPS units in three Maricopa County CPS offices - Mesa, Thunderbird, and Tempe -  have been randomly selected to serve as experimental and control groups.  In Arizona, each CPS office contains three investigation units and three case management units.  Within each of the three participating CPS offices, the State chose two case management units to comprise the experimental group and one case management unit to serve as the control group. 

At the onset of the project’s implementation, existing cases from CPS units in the experimental group that met the demonstration’s eligibility criteria were offered enhanced demonstration services.  A matching group of comparison cases receiving “traditional services” will be selected based on case and demographic characteristics that most closely match those of the existing experimental group cases.  New child protection cases are then randomly assigned to CPS units in either the experimental or control group; cases assigned to the experimental group receive enhanced services, while cases assigned to the control group receive a standard set of traditional child welfare services.  To the extent possible, the State assigns children to the experimental or control group at the time of the first court hearing, which usually occurs within five to seven working days of out-of-home placement.

Sample Size

Arizona originally estimated that approximately 250 existing cases would be assigned to the experimental group at the start of the demonstration. However, at the project’s onset, out of 357 potential cases, only 64 existing cases were found eligible based on screening criteria developed during the initial planning stage. The primary reason for the difference between estimated and actual cases assigned to the experimental condition was the initiation of a district-wide effort to reduce the number of children in congregate care settings through placements with unlicensed relatives.  Selection of matching cases for this cohort has been completed.

In addition, the State originally estimated that 36 new cases would be eligible for the demonstration each month, of which 18 would be assigned to the experimental group and 18 to the control group. As of March 31, 2007, 52 new cases had been assigned to the demonstration, with 24 cases assigned to the experimental condition and 28 cases assigned to the comparison condition. Altogether over 170 children and their parents in the 88 experimental group cases have received enhanced services. Given the success of placements with unlicensed relatives, the State is currently considering alternative strategies for increasing assignment rates to the demonstration.

Process Evaluation

Arizona’s evaluation includes interim and final process evaluations that describe how the demonstration was implemented and that identify how enhanced services differed from traditional services received by families in the control group.  Questions addressed by the process evaluation include the following:

• What was the logic model for the demonstration and did it change over time?

• What were the processes for planning, organizing, implementing, and monitoring the project?

• What were the characteristics of staff involved with the project and what was their level of involvement?

• How were services delivered to families?  What types of services were received and what was the duration of services?

• What was the role of the juvenile courts in the project?  What was the nature and intensity of collaboration between the courts, the State, and local child welfare agencies?

• What contextual factors may have affected the implementation and outcomes of the project?

• What were the demographic and other important characteristics of participating families?

• What barriers were encountered during the implementation of the project and what steps were taken to address these barriers?

As part of the process evaluation, Arizona’s evaluation contractors are conducting formal interviews with social workers and supervisors in participating CPS offices, as well as with staff from contracted service providers involved in the delivery of intensive reunification services.  To measure caregiver satisfaction with demonstration services, the State’s contracted intensive reunification service providers are also administering satisfaction surveys to all enrolled caregivers, which are then submitted to the State’s evaluation team for analysis. 

Outcome Evaluation

Arizona’s outcome evaluation compares the experimental and control groups for significant differences in the following outcome measures:

• The proportion of children reunified with their parents/caregivers

• Length of stay in congregate care placements or in other out-of-home placement settings

• The proportion of children with a subsequent alleged or substantiated maltreatment report

• The proportion of children who re-enter out-of-home care

• The proportion of children and parents/caregivers who experience improvement in well-being and functioning as measured by the North Carolina Family Assessment Scale

In conducting its analysis, Arizona’s evaluation contractor is examining differences in outcomes by various subgroups (e.g., child age and presenting problems).

Cost Analysis

Arizona’s cost analysis compares the costs of key services received by children in the experimental group with the costs of traditional services received by children in the control group.  The cost analysis includes an examination of the use of key funding sources, including all relevant Federal sources such as titles IV-A, IV-B, IV-E, and XIX of the Social Security Act, as well as State and local funds.  In addition, the State is conducting a cost-effectiveness analysis where feasible to identify costs per successful outcome for the experimental group versus the control group. 

Evaluation Findings

Process Evaluation

As of September 30, 2006, evaluation staff have conducted five site visits to participating CPS units and the offices of contracted service providers.  Over 75 individuals, including both CPS and service provider staff, participated in focus group discussions or in one-on-one interviews with the evaluation team.  Focus group and interview participants reported that the overall efficacy of the demonstration project is increasing over time, and that communication and collaboration continue to improve among CPS staff and contracted service providers. Information from the interviews has led to the identification of areas in need of continued attention, including (1) increased information for staff regarding the nature of the project; (2) greater clarification of the respective roles and responsibilities of CPS case managers and contracted provider staff; and (3) additional meetings between the IV-E Project Manager, CPS case managers, and contracted provider staff to address ongoing needs and issues related to the demonstration.

Outcome Evaluation

As of September 30, 2006, children in three of the 68 experimental group cases have been reunified.  Length of time to reunification ranged from 39 to 157 days, and the median number of days from referral to reunification was 79 days.

Additional outcome findings will become available as implementation of the demonstration continues.

¹ Based on information submitted by the State as of September 2006. Back

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