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| Demonstration Type: | Flexible Funding /Assisted Guardianship – Phase II1 |
| Approved: | June 18, 2004 |
| Implemented: | January 1, 2005 |
| Expected Completion Date: | June 30, 2009 |
| Interim Evaluation Report Expected: | June 30, 2007 |
| Final Evaluation Report Expected: | December 30, 2009 |
Eligible children include those residing in experimental group counties who are at “imminent risk” of foster care placement or who are already in placement. Each participating county may choose to implement initiatives aimed at improving outcomes for all of these children. Both title IV-E eligible and non-title IV-E eligible children may participate in the demonstration.
To develop a broader picture of the impact of its Phase II demonstration on placement rates, the State has modified the definition of the population at risk of placement to include all children with a report of abuse or neglect. This definition differs from that used for the evaluation of the State’s original waiver demonstration, which was limited to children with a substantiated maltreatment report.
The eligible population consisted of children residing in experimental group counties at imminent risk of placement or who were already in placement. Each participating county, however, could choose to implement initiatives that affected some or all of these children.
Nineteen out of 100 counties in the State participated in Phase I of the demonstration. For Phase II, the State has expanded demonstration services to 38 counties, including 17 original Phase I counties (two of the original Phase I counties elected not to participate) plus 21 additional counties.
Phase II of North Carolina’s demonstration enables participating counties to use Federal title IV-E foster care funds to develop and implement strategies that reduce costs for out-of-home placement while improving or maintaining permanency, safety, and well being outcomes for children. Each participating county has developed a unique set of services and interventions, which are outlined in a detailed proposal and were approved by the State prior to implementation. All participating counties seek to use title IV-E funds flexibly to institute new contracted services, ranging from substance abuse and mental health services, to respite care, intensive family preservation, and parenting classes. In addition, experimental group counties have proposed to use flexible IV-E funds to implement one or more of the following services:
The evaluation includes process and outcome components, as well as a cost analysis. The State is using a comparison group evaluation design in which changes in child welfare outcomes for 34 selected “comparison counties” not receiving flexible IV-E funds are compared with changes in outcomes for the 38 “experimental” counties that are receiving flexible IV-E dollars. Factors used to select comparison group counties include (1) total title IV-E maintenance expenditures, (2) total administrative expenditures, and (3) number of children initially entering out-of-home placement during the past three State fiscal years. Multivariate analyses involving data from all 100 counties in North Carolina will supplement statistical comparisons of outcomes for experimental and comparison counties.
Sampling Plan
The State’s evaluators are using two samples of cases selected from large and medium-sized counties to assess changes in service utilization and child welfare outcomes. To study placement prevention outcomes, the State’s evaluators randomly selected 840 children from 24 large and medium-sized experimental counties who had experienced a first substantiated report of abuse or neglect during the baseline year. They then matched these children to 840 children from 23 large and medium comparison counties using propensity score matching. This sample is referred to as the “prevention sample.” For the second, or “permanency” sample, the State randomly selected 400 children from the 24 large and medium experimental counties who initially entered placement during the baseline year and matched these children to 400 children from the 23 large and medium-sized comparison counties using propensity score matching.
Data Collection
Two primary data collection efforts support the process evaluation: (1) case record abstractions to collect client-level data on service utilization and (2) a Web-based survey of county child welfare managers to obtain data on county-level service needs and availability. Data from these sources are supplemented using a “Day Sheet” data collection form, which tracks information at the case level regarding services provided to children by caseworkers. Information from Day Sheets is abstracted from both State records and from county case records.
The outcome evaluation relies primarily on data from the State’s Service Information System, which tracks information on maltreatment reports, CPS case openings, and out-of-home placements. The most recent data set used to track placement outcomes includes 339,426 children with a maltreatment report between July 1, 1998, and December 31, 2005, as well as 35,478 children who initially entered placement between July 1, 2000, and December 31, 2005.
Process Evaluation
The process evaluation seeks to answer the following research questions:
Specific activities and services that are tracked through the process study include the following:
Outcome Evaluation
The outcome evaluation compares experimental and comparison group counties for significant differences in the following measures: rate of entry into out-of-home care, length of stay in out-of-home care, frequency of change in placement settings for children in out-of-home care, rate of re-entry into out-of-home placement, and maltreatment recurrence rates.
A significant challenge faced by the State in tracking maltreatment recurrence involves North Carolina’s adoption of the Multiple Response System (MRS) for Child Protection Services. Using this new approach, reports of maltreatment are handled differently depending on the nature and severity of the alleged maltreatment. Rather than a formal investigation that determines whether alleged maltreatment can be substantiated, most reports of maltreatment are now addressed through a family needs assessment. Consequently, no determination of abuse or neglect is made in these cases. The State and its evaluator continue to examine alternatives for classifying maltreatment reports under the MRS system in a way that will accurately reveal an actual incidence of abuse or neglect. In addition, the shift toward tracking out-of-home placement entries for all reported cases of abuse and neglect, rather than for substantiated maltreatment cases only, will affect reported rates of foster care entry and complicate the analysis of placement data over time.
Cost Analysis
A cost analysis is being conducted to assess how child welfare spending patterns have changed as a result of the demonstration. Baseline cost indicators will be compared with child welfare expenditures over time to identify changes in spending patterns across experimental and comparison counties. A database has been developed to track Federal IV-E expenditures related to administrative and foster care placements. In addition, data on Medicaid claims for children with a report of abuse or neglect between July 2001 and June 2005, including information on the types and costs of medical services, is being analyzed.
Process Evaluation
Availability of Child Welfare Services
As of January 2006, child welfare staff from 79 out of 100 NC counties have completed the Web-based survey that explores the need for and availability of child welfare services in 23 service categories. According to initial survey results, some of most prevalent services offered by experimental counties include housing, childcare, mental health services, Family Team Meetings, and payments for case-specific services. The most common one-time uses of IV-E funds include payments for rent deposits and other housing expenses; utility bills; travel expenses; furniture purchases; day care registration fees; medical supplies; counseling and treatment services; and vehicle repairs.
Use of Assisted Guardianship
As of September 2006, 100 children have achieved permanency through assisted guardianship since the onset of Phase II of North Carolina’s Child Welfare Demonstration Project.
Outcome Evaluation
Outcome findings are pending continued implementation of the State’s Phase II demonstration.
North Carolina’s Final Evaluation Report (2002) can be found at this link: http://www.unc.edu/~lynnu/ncwaivrpt.htm
The Web-Based Services Survey Report on Service Needs in North Carolina Counties can be found at the following link: http://www.unc.edu/%7Elynnu/svcreport.pdf
A description of North Carolina’s MRS system in may be found at the following link: http://www.dhhs.state.nc.us/dss/mrs/index.htm
A report of an evaluation of the Multiple Response System by the Duke University Center for Child and Family Policy, titled Multiple Response System (MRS) Evaluation Report to the North Carolina Division of Social Services (NCDSS), is available online at the following link: http://www.dhhs.state.nc.us/dss/publications/docs/MRSReport.pdf
1Based on information submitted by the State as of January 2007. Back
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