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| Demonstration Type: | Flexible Funding – Phase I1 |
| Approved: | July 18, 1997 |
| Implemented: | January 1, 1998 |
| Completed: | A short-term bridge extension was granted until September 30, 2004.2 |
| Interim Evaluation Report Date: | February 22, 2001 |
| Final Evaluation Report Date: | September 30, 2003 |
Indiana's Child Welfare Waiver Demonstration Project permitted any child (age 0-18) who was being served by the Indiana Division of Family and Children to be selected for services. Up to 4,000 children could be served at any given time. The pool of children targeted for the demonstration included: (1) children identified through the agency’s Child in Need of Services (CHINS) placement process, (2) children involved in substantiated reports of abuse or neglect, (3) adjudicated delinquent children, and (4) other children identified as being at risk of abuse, neglect, or delinquency. Participation by children who were ineligible for title IV-E services was limited to 25 percent of the population served at any given time.
Ninety of Indiana's 92 counties participated in the demonstration. Although the State originally planned to implement the demonstration statewide, local County autonomy in decision making resulted in Indiana achieving only a 97.8 percent county participation rate.
Indiana created a capitated payment of $9,000, which could be used to provide flexible services for a child who was in foster care or at risk of being placed in care.
The funds could be used to provide out-of-home care and/or services for the following purposes: preventing placement, reducing the need for institutional placement, and/or reducing the time necessary to achieve permanency. The State created 4,000 “slots” per year ($9,000 was allocated to each slot). Slots were allocated to counties according to population size and poverty data.
Each county had an interagency planning group, which developed plans for new or innovative services to meet the needs of children and families. Each county also created community-based service teams, including parents, mental health care providers, and child welfare staff. These teams were responsible for developing individualized service plans for children assigned to the demonstration slots.
The evaluation consisted of process, outcome, and cost-effectiveness components. The State assigned children to experimental and comparison groups through a matching process in which the evaluators matched each child assigned to a waiver slot with a corresponding non-waiver child, creating a comparison group of non-waiver children. The comparison and experimental groups were matched on a set of available demographic, geographic, and case-related variables. It was the State’s goal to serve 20,000 children in the experimental group over the life of the demonstration.
Because the demonstration encompassed 90 of the 92 counties, the initial process study design called for a more detailed examination of the demonstration in six selected counties, with a broader process review statewide. In the second half of the study, the focused process review was broadened to include 25 counties (referred to in the final report as “program counties”) that appeared to be making substantial and innovative use of the waiver.
The State examined the levels of child and family well-being, the number of placements in out-of-state facilities, the level of youth and caretaker satisfaction, and the achievement of permanency.
Process Evaluation
During the five-year demonstration period, the total number of children assigned to the experimental group was 5,277, and the average daily number served was 1,112. The State notes in its final report that one implementation barrier was identifying targeted numbers of title IV-E eligible children. Over the course of the demonstration, there were more cases assigned to the experimental group that involved families who were not eligible for title IV-E services (2,985) than families who met IV-E eligibility criteria (2,292). Over time, however, counties increased use of the demonstration for IV-E eligible children. By design, counties operated varied programs: some created new, innovative services; some funded existing programs with goals similar to those of the demonstration; others increased flexibility in meeting concrete needs; and still others made modest or no visible changes.
By the final year of the demonstration, the evaluators distinguished a group of 25 counties that use waiver funds to augment child protection services for children in the experimental group. They expanded ongoing local initiatives, services, and programs aimed at avoiding or shortening out-of-home placement. In these sites, the State reports that counties had increased, at a statistically significant level, delivery of the following services to cases in the experimental group: family preservation services, individual counseling, childcare and respite care, basic household assistance, and special education services.
Other counties made limited use of the new program. Reasons cited for a lack of change in service delivery included confusion over policy and requirements governing the demonstration and a lack of training. Many counties also reported difficulties identifying a sufficient number of eligible title IV-E cases.
Outcome Findings
Impact analyses for the demonstration included a comparison of all experimental to control cases, and a comparison of experimental cases in demonstration counties to their matched control cases. The State reported findings in several areas:
Placement Avoidance: The number of children placed in out-of-home care (including family, group, and institutional settings) declined each month during the demonstration. A year before the waiver began (January 1997), there were 10,139 children placed in care. This number fell to 9,377 by the end of the demonstration in December 2002.
During this time, a growing number of children who were not in out-of-home care were assigned to the demonstration. The proportion of experimental group children in program counties who were never placed while assigned to the experimental group was 45.6 percent, compared to 38 percent of control group children, a statistically significant difference.
Out-of-State Placement: The rate of children in placement settings outside Indiana declined during the demonstration from 45 per 1,000 in January 1998 to 25 per 1,000 in December 2002. The State found that 1.5 percent of children receiving experimental services were placed out of State, compared to 3.3 percent of control group children.
Distance to Placement Setting: For all children in care, the average distance placed from their home declined during the demonstration, from an average of 57 miles to 44 miles. For experimental group children, the average distance placed from their home was lower than that of the control group (22.2 miles for experimental cases vs. 26.3 miles for control children). However, this difference was not statistically significant.
Length of Placement:Within demonstration counties, mean length of placement for all experimental group children who were removed from their homes was 290 days, compared to 316 days for matched control group children (p=.083). The relative reduction in length of placement of experimental group children compared to their control group counterparts was 8.2 percent.
Permanency Outcomes:
Subsequent Placement: Subsequent placement refers to any new removal of a child after the end of the target case. No differences were found between experimental and control group children.
Recurrence of Child Abuse and Neglect:No differences were found between experimental and control cases in rates of new maltreatment reports or substantiations. There were also no differences found between experimental and control cases when specific types of child abuse and neglect were examined.
School Performance:To assess child well-being, the school performance of children in the experimental group was compared to that of children in the control group. The State found that a higher percentage of school-age children assigned to the experimental group were in school at case closure (91.1 percent), than was the case with control group children (83.6 percent). This difference was most notable for children adjudicated delinquent: 87 percent of delinquent youths in experimental cases were in school at case closure, compared to 71.6 percent of their control group counterparts.
The State concluded that utilization of the waiver during the demonstration varied considerably across the State with respect to its intensity, frequency, and method of use. Consistent with this finding, the positive effects of the demonstration on children welfare outcomes were relatively modest and most evident within counties that had utilized the waiver actively and with greater fidelity to the intensive services model.
1 Based on information submitted by the State as of September 2003. Back
2 A three year extension is being considered by the Children's Bureau. Back
3 In program counties, TPR occurred in 5.7 percent of experimental cases and 9.3 percent of control cases. Back
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