Home > Programs & Funding > Profiles of the Title IV-E Child Welfare Waiver Demonstration Projects > Maine - Adoption Services

Maine

Demonstration Type:	Adoption Services1
Approval Date:	September 17, 1998
Implementation Date:	April 1, 19992
Completion Date:	December 20043
Interim Evaluation Report Date:	December 31, 2001
Final Evaluation Report Date:	December 31, 2004

Target Population

Demonstration participants were recruited from the overall population of families who adopted children with special needs from the Maine foster care system. Enrollment was restricted to children who were title IV-E eligible.

Jurisdiction

Maine Department of Human Services implemented the demonstration project in all eight of the State's districts.

Intervention

The intervention consisted of two parts: (1) an adoption competency training program that provided basic information about special needs adoption for mental health professionals who work with adopting families or adoptable children; and (2) provision of post-adoption support services, which the State calls "Guided Services," to families that choose to adopt.

In the initial phase of the demonstration, the State completed a two-part training program for clinical social workers, case managers, psychologists, and psychiatrists. These child welfare professionals then provided services to adoptive families. Eight training teams were formed, one for each of the State's districts. Each team was composed of an adoptive parent, a clinician/therapist, and a State adoption caseworker.

The second phase of the demonstration consisted of training workshops conducted by the eight district teams. The workshops targeted community members and professionals (such as therapists, school staff, and respite providers) who could provide support to stabilize and strengthen adoptive families. Subsequent training workshops were designed to educate the community on the needs of adoptive families. Training topics included family systems, child development, open adoptions, the integration of adopted children into existing families, the effects of abuse and trauma on children, infant mental health, and adoption subsidies.

Beginning in the second year of the demonstration, trained mental health and other professionals offered post-adoption support services to families. A family-centered assessment was administered which covered child and parent factors, normal developmental milestones, history of trauma, capacity for attachment, parenting styles, and family culture. Based on the assessment, a social worker, the previous adoption caseworker, and the adoptive family developed an initial service plan.

Post-adoption support services (e.g., case management, parent education and support, information and referral services, respite care, therapy, and advocacy) were delivered by a partnership between the Maine Department of Health and Human Services (DHHS) and Casey Family Services (a non-profit child welfare agency), the agencies used a community-based delivery of service program designed to be child-centered and family focused. The adoptive parent(s) was viewed as the expert on their child. The adoption staff functioned as guides who consulted with the family as needed to help them deal with issues that are common in the life of an adoptive family.

The major hypothesis of the post-adoption support services study was that families and children who receive guided supportive services will be strengthened, have fewer dissolutions, and report higher levels of child and family well-being than families and children that receive standard services.

Evaluation Design

The evaluation included process and outcome components, as well as a cost analysis. Families were randomly assigned to experimental⁴ and control⁵ groups. Control group cases received the standard adoption subsidy from the State, along with the support services that are traditionally available in their community. Experimental group cases had access to all of the above services plus a Maine Adoption Guide social worker from Casey Family Services.

Sample Size

There were a total of 117 children assigned to the demonstration in year one, 128 children assigned in year two, 120 children assigned in year three, and 134 children assigned in year four, for a total sample size of 499 children. Children were assigned to experimental and control groups at a 1:1 ratio.

A total of 76 families that were invited to participate in the project declined. A survey was given to eligible families that chose not to participate in the demonstration beginning in the second year of the project. Families were asked to give reasons for their decision. The most common reasons families gave were (1) "Enough contact with State agencies/want to be left alone"; (2) "Being contacted twice a year for questionnaires would be too time consuming"; and (3) "Participating in the project could make the adoption process more difficult."

Outcome Study

The evaluation compared the experimental and control groups for statistically significant differences in the following outcome measures: number of displacement days, adoption dissolution rate, child to family attachment, parents' trust in their child, use of family-centered case management practices, child well-being and functioning, and family well-being and functioning.

Evaluation Findings

Process Evaluation

1. Participant Characteristics: There were no significant differences between children in the experimental group and the control group with regard to age, gender, number of previous foster care placements, amount of time the child lived with his/her caregiver prior to entering the demonstration, and use of psychotropic medications.
   
   In addition, there were no significant differences in ethnicity, adoption rates, special education services received, or the prevalence of clinically-diagnosed disabilities between experimental and control groups. Both groups were also similar in income, family structure (e.g., single or married), and in the relationship of the family to the adopted child (e.g., relatives or non-relative caregivers).
   
   A total of 228 families over the life of the project (94 experimental group families and 134 control group families) either decided to drop out of the project or were asked to leave the demonstration.⁶ Anecdotal reports from the State child welfare agency indicated that three of the families that dropped out of the study left due to adoption dissolutions (one experimental group family and two control group families).
2. Service Availability and Utilization: The State noted some discrepancies between services caregivers wanted and those that they reported receiving. Caregivers sought out the following services in order of frequency: (1) individual counseling, (2) respite care, (3) behavioral specialists, (4) adoption support groups, and (5) "other" services.⁷ However, families reported that respite care was the most commonly received service, followed by other services, counseling for the adopted child, and services from behavioral specialists.
   
   Parents were the most frequent recipients of services. Maine Adoption Guide social workers reported the most common service they provided was parent education and support. Other frequently provided services included relationship building, individual child therapy, and adult group therapy. Families were most frequently provided services over the phone or in their homes. Seventy-six percent of services did not require any travel time, seven percent of services involved 15 to 60 minutes of travel time, 12 percent of services required between one and two hours, and five percent of services required more than two hours of travel time.
   
   Facilitated by therapists, Parent Support Groups offered adoptive parents an environment in which to discuss their problems and gave them the opportunity to connect with other adoptive parents. In general, the groups met once a week or every other week. Most groups met on an ongoing basis. According to surveys completed by parents every six months after entering the demonstration, more than half of participating caregivers surveyed said that their most important source of support was professional (e.g. caseworkers), while 45 percent stated that their most important source of support was "natural" (e.g. family, friends, and/or support group members).

Outcome Evaluation

The State reported that the Maine Adoption Guides model achieved the following successes:

• Children and families received the same or better services and supports than they would have received in the absence of the demonstration.
• Caregivers reported overall satisfaction with the adoption process, services received from State DHHS staff, and supports from the Guided Services caseworkers.
• The intervention model was designed and implemented to meet adoptive families' needs.
• There were few statistically significant differences in child and family-level outcomes between the experimental and control groups, but any observed differences tended to favor the experimental group.
• The partnership between Casey Family Services and Maine DHHS functioned in support of the project.

Maine reported the following findings regarding its selected outcome measures (see Evaluation Design above):

• Trust: Parents were asked whether or not they trust their child every six months during the demonstration period. After 42 months, a significantly higher percentage of parents (73 percent) in the experimental group stated they trusted their child compared with 24 percent of parents in the control group.
• Children's Mental Health/Child Functioning: The Child Behavior Checklist was used to compare differences across experimental and control groups in child behavior and functioning over time. There was a statistically significant difference between experimental and control groups on the Total Problems measure for all ages combined. The experimental group had lower average Total Problem scores for a 24-month period compared with the control group.
• Family-Centered Case Management: Of those caregivers who reported receiving case management services, the majority reported that their caseworkers provided services in a family-centered manner. Parents in the experimental group reported a significantly higher level of assistance from their caseworkers than those in the control group. These parents reported that the caseworkers helped them get the information they wanted/needed; assisted parents in attaining help from their family, friends, and community; suggested things they could do for their child that fit into their family's daily life; and helped the family attain services from other agencies or programs.

No statistically significant differences were found between the experimental and control groups in the child-level outcomes of child's health and development; child's satisfaction with adoption; child's positive and negative behavioral traits; or child's positive behaviors toward the adoptive parent. In addition, no statistically significant differences were found between the experimental and control groups in the family-level outcomes of caregiver health and stress levels; caregiver satisfaction with adoption; parenting practices; family adaptability and cohesion; family attachment to child; parent and child communication; frequency of parent and child disagreements; or frequency of positive parent-to-child caregiving behaviors. Finally, no statistically significant differences were found between the experimental and control groups in the number of displacement days, adoption dissolutions, or level of child attachment over time.

Cost Study

The total amount spent on all children assigned to the demonstration during the project implementation period (four years) was $38,481,334. However, the State found that a high percentage of these funds were spent on a few children during a short time period. The median cost per child ($22,121) may therefore be a more accurate cost indicator.

The State's hypothesis was that Medicaid costs for those children in the experimental group would be equal or less than Medicaid costs for those children in the control group due to the fact that experimental group children and their families received effective services and support through the intervention, which would result in a reduced need for services over time. During the four-year study period, children in the experimental group had lower overall Medicaid costs than children in the control group. (Medicaid costs for children in the experimental group and those in the control group were similar before entering the demonstration).

Web Links

Maine's December 2004 Final Report is available on the following Web site: http://muskie.usm.maine.edu/Publications/ipsi/maine_adopt_guides_05.pdf (PDF - 1930 KB)

¹ Based on information submitted by the State as of December 2004. Back

² The training component operated from April 1, 1999 through November 30, 2000. The post-adoption services model began April 1, 2000. Back

³ Maine had originally requested a three-year extension of the project. However, the State withdrew its request in June 2004. Back

⁴ Also referred to as the "Guided Services" group. Back

⁵ Also referred to as the "Standard Services" group. Back

⁶ Families were asked to leave if they did not respond to surveys. Back

⁷ Other services included occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatments, neuropsychological evaluations, and homeopathic medicine. Back

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