Children's Bureau Website - Summary of IV-E Child Welfare Waiver Demonstrations

Summary of the Title IV-E Child Welfare Waiver Demonstrations

Prepared for:
Children’s Bureau
Administration on Children, Youth, and Families
U.S. Department of Health and Human Services

Prepared By:
James Bell Associates
Arlington, Virginia
June 2005

Public Law 103-432, authorized by Congress in 1994, introduced the concept of Federal waivers to child welfare programs. Conceived as a strategy for generating new knowledge about innovative and effective child welfare practices, waivers grant States flexibility in the use of Federal funds for alternative services and supports that promote safety and permanency for children in the child protection and foster care systems. The Adoption and Safe Families Act (ASFA) of 1997 extended and expanded the authority to use waivers for child welfare programs, authorizing the Secretary of Health and Human Services to approve up to ten new demonstration projects each year.

Through the waivers, States may spend Federal title IV-E funds for supports and services other than foster care maintenance payments that protect children from abuse and neglect, preserve families, and promote permanency. Some States have proposed discrete interventions focused on specific child welfare populations, whereas others are experimenting with the flexible use of funds to produce system-wide reforms. Waiver demonstrations must remain cost-neutral to the Federal government, (i.e., States cannot receive more in Federal reimbursement than the State would have received in the absence of the demonstration) and they must undergo rigorous program evaluation to determine their efficacy. Most States expect to realize title IV-E costs savings through their demonstration projects.

The Department of Health and Human Services typically approves child welfare waivers for up to five years, although at the discretion of the Secretary they may be extended beyond five years. Since 1996, 17 States have implemented 25 child welfare waiver demonstrations. These projects have examined innovative child welfare service strategies in several areas, including:

Assisted guardianship/kinship care;
Capped IV-E allocations and flexible funding to local agencies;
Managed care payment systems;
Services to substance-abusing caretakers;
Intensive service options;
Enhanced training for child welfare staff;
Adoption services; and
Tribal administration of IV-E funds.

As of May 2005, nine States are actively implementing 14 different waiver projects. Several States continue to operate their original demonstrations under short-term or longer, five-year waiver extensions. In 2004, two additional States - Minnesota and Wisconsin - received approval for, but have not yet implemented, their child welfare waiver demonstrations. Among the States that have completed their demonstrations, several terminated their projects early because of problems with meeting the Federal cost neutrality requirement or because of other implementation problems. Table 1 provides an overview of the types of demonstration projects and their current status.

Table 1 - Title IV-E Waiver Demonstration Projects

Type of Project	Description of Intervention	Status of Demonstrations By State
		Active Demonstrations			Completed		Approved, Not Yet Implemented
		Under Original Waiver	Under Short-Term Ext.	Under 5-Year Ext.	Completed As Scheduled	Terminated Early	Approved, Not Yet Implemented
*Assisted Guardianship/Kinship Permanence*	Relatives/other caregivers who assume legal custody of children are eligible for a monthly subsidy equal or comparable to foster care payments.	MT (2006)¹ NM (2005)	Blank Cell	IL (2008) NC (2009) OR (2009)	DE (2002) MD (2004)	Blank Cell	MN WI
*Capped IV-E Allocations and Flexibility to Local Agencies*	States give counties or other local entities flexibility in spending child welfare dollars for new services and supports in exchange for a capped per child/per family allocation of title IV-E funds.	Blank Cell	IN (2005)	NC (2009) OH (2009) OR (2009)	Blank Cell	Blank Cell	Blank Cell
*Services to Caretakers with Substance Use Disorders*	States used title IV-E dollars to fund services and supports for caretakers with substance abuse disorders.	IL (2005)	NH (2005)	Blank Cell	DE (2002)	MD (2002)	Blank Cell
*Managed Care Payment Systems*	States test alternative managed care financing mechanisms to reduce child welfare costs while improving permanency, safety, and well-being outcomes for targeted families.	Blank Cell	Blank Cell	Blank Cell	MI (2003)	CO (2003) CT (2002) MD (2002) WA (2003)	Blank Cell
*Intensive Service Options*	States increase the variety and intensity of services and supports to reduce out-of-home placement rates and improve other permanency and safety outcomes.	Blank Cell	CA (2005)	Blank Cell	Blank Cell	MS (2004)	Blank Cell
*Adoptions and Post-Permanency Services*	States strengthen existing or provide new post-adoption and post-permanency services and supports.	Blank Cell	Blank Cell	Blank Cell	ME (2004)	Blank Cell	MN
*Tribal Administration of IV-E Funds*	Tribes develop administrative and financial systems to administer title IV-E foster care programs independently and claim Federal reimbursement directly.	NM (2005)	Blank Cell	Blank Cell	Blank Cell	Blank Cell	Blank Cell
*Enhanced Training for Child Welfare Staff*	Training for public and private-sector child welfare professionals serving children in placement and their families to improve permanency and safety outcomes.	IL (2007)	Blank Cell	Blank Cell	Blank Cell	Blank Cell	Blank Cell

¹Dates in parentheses denote completion date or expected completion date of the demonstration. Back

Part I: Overview of the Demonstrations

A. Assisted Guardianship/Kinship Permanence

To date, seven States have completed or continue to implement assisted guardianship waiver demonstrations: Delaware, Illinois, Maryland, Montana, New Mexico, North Carolina and Oregon. Montana and New Mexico’s demonstrations offer a guardianship option for children in either Tribal or State custody; procedures for processing the cases of children in Tribal custody are determined by appropriate Tribal government authorities. In two States – North Carolina and Oregon – assisted guardianship is one component of larger, flexible funding waiver demonstrations. Delaware, Illinois, Maryland, North Carolina, and Oregon have completed their initial five-year demonstration projects. Three of these States (Illinois, North Carolina and Oregon) have been granted approval to extend their waiver demonstration projects for an additional five years. Wisconsin recently received approval to implement a guardianship demonstration similar to those of these original seven States. Minnesota also received approval for a new demonstration testing the impact of enhanced permanency services, including the use of Federal funds for assisted guardianship.

Under Delaware’s demonstration, caregivers received a guardianship subsidy equal to the State’s monthly foster care payment. In addition, participating families were eligible to receive case management, child health care, mental health care, and post-adoption support services. Eligibility was limited to title IV-E-eligible children aged 12 or older who had been in placement with the same caregiver for at least one year. Only licensed foster care providers – whether kin or non-relatives – were eligible to receive the assisted guardianship subsidy.

Illinois offers legal guardianship to eligible relative caretakers and licensed foster parents for children in their care. Through its program, participating caregivers receive a guardianship subsidy equal to the State’s monthly adoption assistance payment. Both title IV-E and non-IV-E eligible children aged 12 or older are eligible to participate; this age restriction is waived for children in the care of relatives or kin. Illinois is currently implementing a second phase of its guardianship program to evaluate innovative strategies for pursuing permanency for older wards. Building on its original assisted guardianship waiver, Illinois will test the efficacy of an enhanced guardianship option that offers post-permanency transition services to children who exit to guardianship or adoption after age 14.

Maryland’s demonstration offered kinship caregivers and relative foster parents the option of becoming legal guardians. The State’s guardianship subsidy was substantially lower than its monthly foster care payment but was higher than the TANF child-only payment made to kinship caregivers. Both title IV-E eligible and non-eligible children of all ages who had been in placement with the same caregiver for at least six months were eligible to participate in Maryland’s demonstration.

Minnesota’s demonstration will allow for expanded eligibility and services within the State’s title IV-E foster care program to support a continuous set of benefits for foster families who adopt or accept permanent legal custody (i.e., assume guardianship) of children in their care. Foster caregivers who adopt or accept a transfer of legal custody of a child will be offered a monthly payment that is equal to the child’s existing monthly foster care maintenance payment. Title IV-E eligible children of all ages who have resided in the same foster home for at least 6 months may participate in the State’s demonstration. The demonstration will place particular emphasis on American Indian children in long-term foster care and children with special needs (e.g., older children, children who are part of a sibling group, or children with intense psychological, physical, and behavioral problems). Both kin and non-kin caregivers must meet all State foster care licensure requirements. The State currently plans to begin implementation of its demonstration in October 2005.

Through Montana’s demonstration, licensed kin and non-relative foster care providers who accept guardianship of a child in their care receive a guardianship subsidy that is $10 less than the State’s monthly foster care payment. In addition, guardianship families may access social and mental health services typically available to adoptive families. Children’s participation is limited to title IV-E eligible children in placement with the same caregiver for at least six months. Originally restricted to children ages 12 or older, Montana eliminated all age requirements in the third year of its demonstration.

New Mexico’s demonstration includes two distinct components: (1) assisted guardianship for children in the legal custody of a Tribe or Pueblo in the State; and (2) assisted guardianship for children in the legal custody of the State. In both components, licensed kin and non-relative foster care providers receive a subsidy that is similar to but does not exceed the monthly adoption assistance payment. Title IV-E eligible children of all ages may participate in the demonstration regardless of their length of placement with their foster caregiver.

Experimental counties participating in North Carolina’s demonstration had the option of providing assisted guardianship to licensed non-relative foster care providers and licensed or unlicensed relative caregivers. The State originally set the guardianship subsidy at less than its monthly foster care payment, but later increased it to equal the foster care payment. Both title IV-E-eligible and non-eligible children of all ages who had been in placement with the same caregiver for at least one year are eligible to participate in North Carolina’s demonstration. North Carolina will continue to operate an assisted guardianship demonstration component during its five-year waiver extension.

In Oregon, both kin caregivers and non-relative foster parents are eligible to receive a guardianship subsidy equal to the State’s basic monthly foster care rate. Title IV-E-eligible children of any age who have been in placement with a relative for at least six months may participate in the State’s demonstration; children placed with non-relatives must be aged 12 or older and have been in placement with the same caregiver for at least one year. Oregon will continue offering assisted guardianship during its five-year waiver extension.

Through Wisconsin’s Guardianship Permanency Initiative, licensed relative and non-relative foster care providers will receive a guardianship payment based on the foster care payment amount in effect for the child at the time s/he enters guardianship. Title IV-E-eligible and non-eligible children of all ages who have been in the same placement for a least one year are eligible to participate. Wisconsin plans to implement its guardianship demonstration no later than February 2006, pending legislative changes to the State’s guardianship statutes and necessary budget approvals.

B. Capped IV-E Allocations and Flexibility to Local Agencies

A total of four States – Indiana, Ohio, Oregon, and North Carolina – have implemented flexible funding waiver demonstrations. North Carolina, Ohio, and Oregon have recently received five-year extensions of their flexible funding waivers into 2009, and Indiana continues to operate under a short-term extension through June 2005 while completing an application for a five-year extension. Each State’s flexible funding demonstration attempted to establish a new array of services to prevent placement or facilitate permanency with the expectation that the costs of these services would be offset by subsequent savings in foster care expenditures.

Indiana’s demonstration focuses on building local capacity to provide community-based services and home-based placement alternatives to restrictive institutional placements. The State implemented its demonstration statewide, allocating a percentage of “flexible funding slots” to each participating county based on the size of its foster care population. A sum of $9,000 was assigned to each slot to provide any type of service (including foster care) that would facilitate permanency. Through its proposed five-year waiver extension, Indiana will maintain its existing funding mechanism of capitated waiver “slots”, with slots allocated to counties based on variables such as population size, poverty rates, and number of children in out-of-home placement.

In North Carolina, 19 counties receive a capped amount of IV-E funds that can be used flexibly to meet the needs of children and families in the child welfare system. Each county is allowed to develop its own initiative contingent on State approval. Sixteen counties have used flexible funds for new contracts with outside service providers, while nine counties have used the funds to expand or implement new in-house services. North Carolina recently began a five-year extension of its flexible funding waiver that will continue through June 2009. During this extension, the State will continue to explore the use of flexible funds to improve child welfare outcomes in 17 of its original experimental counties while expanding the demonstration to 21 new counties.

Fourteen counties in Ohio experimented with a diverse array of managed care strategies to improve child welfare outcomes while controlling costs. The State provided participating counties with a capped amount of IV-E funds; each county then developed its own strategy for managing expenditures within this allotment. Strategies employed by counties have included establishing capitated or case rate contracts with private providers, developing utilization review strategies, and establishing quality assurance procedures. Ohio recently received a five-year waiver extension through September 2009 that will place less emphasis on managed care strategies and will instead focus on the use of capped allocations of IV-E funds to implement a more limited range of services, including Family Team Meetings, visitations between parents/caregivers and children in out-of-home placement, and services to facilitate and maintain kinship and adoptive placements.

Local child welfare agencies in Oregon developed plans to use flexible funds in three service categories: (1) “innovative services,” such as enhanced visitation, in-home parenting, and early childhood assessments; (2) expansion of existing services, including Family Decision Meetings (FDM), Family Mediation, and Family Resource Worker programs; and (3) emergency one-time payments to prevent foster care placement. Oregon has received a five-year waiver extension through March 2009, during which it will continue its demonstration of the flexible use of title IV-E funds and undertake a special study of Family Decision Meeting Service Coordination (FDM-SC) for families entering Oregon’s child welfare system for the first time.

C. Services for Caretakers with Substance Use Disorders

Four States have implemented substance abuse waiver demonstrations: Delaware, New Hampshire, Illinois, and Maryland. Delaware completed its demonstration project in December 2002 and submitted its final evaluation report in March 2002. New Hampshire began its effort in 1999 and continues to operate under a short-term waiver extension through November 2005, while Illinois will finish its original five-year demonstration in June 2005. Maryland terminated its demonstration early in December 2002 due to various implementation problems.

Delaware’s project operated primarily as a referral program, in which privately-contracted substance abuse counselors were co-located with child protection case managers in county CPS offices to engage in joint case planning and decision-making. The State established one such “treatment unit” with a co-located substance abuse counselor in each of its three counties. The primary responsibilities of the substance abuse counselor included linking clients to substance abuse treatment and providing support services to clients while they awaited treatment entry.

Through New Hampshire’s Project First Step waiver demonstration, licensed alcohol and drug abuse counselors (LADCs) work with child protection workers in an advisory and supportive capacity, using their clinical skills to provide training, assessment, treatment, and case management services. LADCs conduct an initial drug and alcohol assessment concurrently with CPS’ maltreatment investigation. Depending on a parent’s level of cooperation, LADCs may provide direct outpatient treatment or facilitate treatment access by removing resource barriers and engaging in outreach on the parent’s behalf.

Illinois’ demonstration focuses on treatment retention and recovery for caregivers referred to, but not yet enrolled, in treatment, and who already have a child in out-of-home placement. Illinois’ model incorporates a proactive, intensive service model in which privately-contracted case management specialists known as “Recovery Coaches” directly engage families throughout the treatment process and provide post-treatment support.

Maryland planned to implement a collaborative case management model in which privately-contracted chemical addiction counselors would work with child welfare case managers, parent aides, and volunteer mentors in “Family Support Service Teams” to assess the needs of family members and determine appropriate treatment options. Caregivers participating in Maryland’s demonstration could be assigned to one of three pre-determined treatment modalities: (1) inpatient care for women and their children, (2) intermediate care (28-day residential care), and (3) intensive outpatient treatment.

D. Managed Care Payment Systems

Five States - Colorado, Connecticut, Maryland, Michigan, and Washington - tested alternative managed care financing mechanisms to reduce child welfare costs while improving permanency, safety, and well-being outcomes for targeted families. As indicated in Table 1, most States terminated their managed care demonstrations early because of problems with maintaining cost neutrality and other implementation problems.

In Colorado, the pilot county negotiated a performance-based, risk-sharing contract with a consortium of children’s service providers. Eligible children were those aged 10 and older who were deemed to be at high risk of aging out of the foster care system without a permanent family relationship or who were placed in high-cost residential care settings. Each month, the county paid the consortium established rates for case coordination and residential care treatment for each referred child. Colorado terminated its demonstration early in June 2003 due to State budget problems, low county participation, high staff turnover, and difficulties in developing a fixed payment rate.

Connecticut contracted with lead service agencies in two sites to provide a continuum of services in treatment facilities and community-based settings to children ages 7 to 15 who were in group or residential care and had behavioral problems. The contractors provided case management, group care, and home-based, outpatient, and aftercare services. Contractors received a case rate for each referred child based on an estimated service period of 12 months in out-of-home care and three months of aftercare. Connecticut discontinued its project after three years of operation because of low referral rates and comprehensive changes in the State’s behavioral health system that eliminated the need for a title IV-E waiver.

Maryland contracted with a lead agency that was responsible for managing foster care services for children in out-of-home placement in Baltimore, Maryland. The State negotiated a case rate with the contractor for each of the 500 referred children. Foster care service providers assumed financial risks for the costs of care that exceeded 10 percent of this case rate. Maryland terminated its managed care project early in December 2002 because the fixed rate was insufficient to meet the lead agency’s costs of care. Other implementation challenges included confusion regarding the role and responsibilities of the lead agency and the unfamiliarity of the agency with the needs and issues of the local foster care population.

Michigan developed managed care contracts with providers in six counties to provide wraparound services for children in out-of-home care or at imminent risk of out-of-home placement. Initially, these contracts called for standard monthly payments of $1,500 per child. Michigan re-negotiated its contracts in October 2001 to pay a single case rate for each child served regardless of the length of time that services were provided. The State completed its demonstration in September 2003. Implementation challenges included low enrollment and problems with meeting the waiver’s cost neutrality requirement.

Washington State’s waiver agreement allowed it to test alternative managed care strategies in different participating counties. The State and county each contributed to a funding pool to pay for services delivered by the contractor to children in the experimental group. If costs for a specific child exceeded the fixed rate, the county could use pooled funds to cover those cost overruns; however, the county assumed the risk for service costs that exceeded the amount in the pool for all children. Washington terminated its demonstration project in June 2003 because of lower than expected referrals and problems with developing and managing a contract with the lead service provider.

E. Intensive Service Options

Two States - California and Mississippi - implemented demonstration projects that increased the intensity, variety, and availability of child and family services in an effort to improve permanency and safety outcomes.

In California, five counties developed intensive service programs to improve safety and permanency outcomes for children. Five counties (Alameda, Humboldt, Los Angeles, Sacramento, and San Luis Obispo) have implemented Wraparound programs, while two counties (Fresno and Riverside) have implemented Family Group Decision Making (FGDM). Since many human service programs in California (including child welfare) are county administered, each county developed a highly individualized approach to its intensive service intervention.

Mississippi's demonstration sought to test the effectiveness of a family-centered practice approach that gave participating counties broad latitude in using title IV-E funds to respond to the needs of child protection cases. The State provided families with a combination of existing and newly created services to prevent out-of-home placement, expedite permanency, reduce maltreatment risk, and improve the overall well-being of children and their adult caregivers. The State ended its waiver demonstration early in September 2004 because of ongoing problems with meeting the Federal cost neutrality requirement.

F. Adoption and Post-Permanency Services

Two States – Maine and Minnesota – received waivers to provide services and supports to promote and strengthen adoption as a permanency option. Maine completed its demonstration in December 2004, while Minnesota plans to begin implementation of its demonstration in October 2005.

Maine’s waiver demonstration consisted of two components: 1) an adoption competency training program for clinical social workers, case managers, psychologists, therapists, and other mental health professionals who work with adopting families or adoptable children; and 2) provision of post-adoption support services to families that choose to adopt. Post-adoption support services included case management, parent education and support, information and referral, support groups, respite care, advocacy, crisis stabilization, and therapeutic services.

Minnesota’s demonstration will support a continuous set of benefits for foster families who adopt or accept permanent legal custody of children in their care. The overall goal of the demonstration project is to increase the willingness of foster families (including relatives) to adopt or assume permanent legal custody of special needs children by eliminating the financial barriers to these permanency options. Currently, Minnesota’s adoption assistance and relative custody assistance benefits are up to 50 percent lower than foster care rates, which can create a financial barrier to families being able to assume permanent custody of children in their care. Under the demonstration, foster caregivers and relatives who adopt or assume legal custody of a child in their care will be offered a monthly payment that is equal to the child’s existing monthly foster care maintenance payment and will have access to post-permanency services and supports.

G. Tribal Administration of IV-E Funds

Under the second component of its two-part waiver agreement, New Mexico is implementing a unique demonstration that seeks to foster enhanced Tribal independence, efficiency, and effectiveness in the delivery of child welfare services to Native American children. The State may enter into agreements with eligible Tribes and Pueblos to delegate the administration of title IV-E programs to Tribal government authorities. These agreements grant authority to the Tribes to develop foster care licensure standards, license foster homes, determine the IV-E eligibility of individual children, and receive direct Federal reimbursement for foster care maintenance, adoption assistance, subsidized guardianship, independent living, and related administrative expenses.

H. Enhanced Training for Child Welfare Staff

Illinois is implementing an enhanced training demonstration targeted at new public and private-sector child welfare workers to improve their competence in assessing child and family needs, providing appropriate services, and making evidence-based permanency decisions. In addition to enhanced training, child welfare workers from the private sector benefit from structured field support for one year following completion of the classroom training. Field support includes coaching, shadowing, and post-training “booster sessions.”

Part II: Evaluation Designs

As part of their waiver agreements, all States are required to conduct rigorous evaluations of their demonstrations that include process and outcome components. The demonstrations have varied in terms of their evaluation designs, but random assignment designs are employed whenever feasible. Table 2 provides an overview of the evaluation designs that have been implemented or proposed for the waiver demonstrations to date. Eighteen of the demonstrations have used or are being evaluated using random assignment designs. Because some demonstrations involve systemic reforms that make random assignment infeasible, several States are using comparison site designs, with a county or other local geographic entity serving as the unit of analysis. For its evaluation, Indiana used a matched comparison group design in which each child receiving waiver-funded services was matched against a corresponding non-waiver child based on demographic, geographic, and case-related variables. Likewise, Minnesota will employ a matched comparison group design in rural counties participating in its waiver demonstration, while using random assignment in urban areas.

Table 2 - Evaluation Designs of the Title IV-E Waiver Demonstrations

Type of Demonstration	Research Design
Type of Demonstration	Random Assignment	Comparison Sites	Matched Comparison Groups
Assisted Guardianship/Kinship Permanence	IL, MD, MT, NM, WI, MN	NM, NC, OR	MN
Capped IV-E Allocations/Flexibility to Local Agencies	Blank Cell	NC, OH, OR	IN
Services to Substance-Abusing Caretakers	IL, MD, NH	DE	Blank Cell
Managed Care Payment Systems	CO, CT, MD, MI, WA	Blank Cell	Blank Cell
Intensive Services Options	CA, MS	Blank Cell	Blank Cell
Adoption Services	ME	Blank Cell	Blank Cell
Tribal Administration of IV-E Funds	Blank Cell	NM	Blank Cell
Enhanced Training for Child Welfare Staff	IL	Blank Cell	Blank Cell

Part III: Status of the Evaluations

The availability of evaluation data from the States varies depending on the implementation status of their waiver demonstrations. Interim reports usually focus on project implementation and may contain some preliminary data on outcomes, whereas final evaluation reports are expected to provide a comprehensive overview of all process and outcome findings. Table 3 summarizes the status of interim and final evaluation reports submitted by the States as of May 2005. To date, thirteen final evaluation reports have been submitted for the 16 demonstrations completed or terminated early under their original five-year waivers. Final reports are expected from several States that continue to implement demonstrations under their original five-year waivers, including Illinois, Montana, New Hampshire, and New Mexico. In addition, new interim and final reports will be submitted by the four States that have received five-year waiver extensions (Illinois, North Carolina, Ohio, and Oregon). States are usually expected to submit a final evaluation report within six months of the completion or termination of a demonstration.

Table 3 - Status of Evaluation Reports

State	Demonstration Components	Report Received (checked if yes) or Date Expected
		Original Waiver		5-Year Extension (where applicable)
		Interim Report	Final Report	Interim Report	Final Report
California	Intensive Services	√	√	Blank Cell	Blank Cell
Colorado	Managed Care	N/A²	√	Blank Cell	Blank Cell
Connecticut	Managed Care	√	√	Blank Cell	Blank Cell
Delaware	Assisted Guardianship/Substance Abuse Services	√	√	Blank Cell	Blank Cell
Illinois	Assisted Guardianship	√	√	December 2007	June 2009
	Substance Abuse Services	√	December 2005	Blank Cell	Blank Cell
	Enhanced Training	July 2005	June 2008	Blank Cell	Blank Cell
Indiana	Flexible Funding	√	√	Blank Cell	Blank Cell
Maine	Adoption Services	√	√	Blank Cell	Blank Cell
Maryland	Assisted Guardianship	√	√	Blank Cell	Blank Cell
	Managed Care	√	N/A	Blank Cell	Blank Cell
	Substance Abuse Services	√	N/A	Blank Cell	Blank Cell
Michigan	Managed Care	N/A	√	Blank Cell	Blank Cell
Minnesota	Assisted Guardianship/Single Benefit Payment	May 2008 (est.)	March 2011 (est.)	Blank Cell	Blank Cell
Mississippi	Intensive Services	N/A	June 2005	Blank Cell	Blank Cell
Montana	Assisted Guardianship	N/A	March 2007	Blank Cell	Blank Cell
New Hampshire	Substance Abuse Services	√	July 2005	Blank Cell	Blank Cell
New Mexico	Guardianship/Tribal Administration of IV-E Funds	√	December 2005	Blank Cell	Blank Cell
North Carolina	Flexible Funding/Assisted Guardianship	√	√	June 2007	December 2009
Ohio	Flexible Funding	√	√	August 2007	March 2010
Oregon	Flexible Funding/Guardianship	√	√	October 2006	September 2009
Washington	Managed Care	N/A	√	Blank Cell	Blank Cell
Wisconsin	Assisted Guardianship	Oct. 2008 (est.)	August 2011 (est.)	Blank Cell	Blank Cell

² Indicates that the State was exempted from submitting the report if it terminated early or made an alternative reporting arrangement with the Children’s Bureau. Back

Part IV: Overview of Evaluation Findings

As more States have submitted evaluation findings through their interim and final evaluation reports, a clearer picture has emerged regarding the effects of the waiver demonstrations on key child welfare outcomes. Critical evaluation questions focus on the effectiveness of the waiver demonstrations in:

Preventing out-of-home placement;
Reducing the length of out-of-home placements and returning children home in a timely manner;
Improving placement stability, i.e., reducing the number of times a child changes placement settings while s/he is in foster care;
Increasing exits from foster care to permanency, including reunification, guardianship, and adoption;
Reducing the likelihood of future maltreatment;
Preventing re-entry into foster care; and
Improving the well-being and functioning of children and their caregivers.

Findings to date suggest that the demonstrations have met with mixed success in affecting positive changes in these child welfare outcomes. Key findings from three clusters of demonstrations addressing (1) assisted guardianship/kinship permanency, (2) capped IV-E allocations/flexible funding, and (3) services for substance abusing caretakers are summarized below.

Assisted Guardianship/Kinship Permanence

Permanency Rates: Illinois found strong, statistically significant evidence that the availability of assisted guardianship increased net permanence, defined as exits from placement to reunification, adoption, or guardianship. By the end of the original demonstration, only 19.7 percent of experimental group children had aged out of or remained in foster care compared with 25.7 percent of control group children. To date, no other State has found conclusive evidence that the availability of assisted guardianship improves permanency outcomes for children.

Placement Duration: Available data from Maryland and New Mexico suggest that the availability of assisted guardianship may decrease the length of out-of-home placements.

Placement Stability: Available data from the Illinois and Maryland evaluations indicate that experimental group children (i.e., those eligible to receive a guardianship subsidy) had comparable rates of placement stability – defined as the number of changes in placement settings over time – as children in the control groups.

Maltreatment Recurrence: Findings from Illinois suggested that children placed with guardians were at least as safe from repeat maltreatment as children in other permanent settings. No other States have reported findings regarding the effects of assisted guardianship on maltreatment recurrence.

Foster Care Re-Entry: Illinois reported low statewide rates of guardianship disruptions and foster care re-entries. Of the 6,820 children statewide who entered subsidized guardianship between May 1997 and March 2002, only 237 (3.5 percent) experienced a disruption of the guardianship placement. Of these, only 117 children (49 percent) required a return to child welfare public agency custody. Based on the State’s evaluation sample, there were no differences in the proportion of disruptions in permanent placements (guardianships and adoptions) between the experimental and control groups (1.2 percent versus 1.1 percent, respectively). Oregon also reported a very low incidence of foster care re-entry, with only four of 133 children (three percent) re-entering substitute care during the first year following entry into guardianship.

Child Well-Being: Data from the Maryland, Montana, and Illinois evaluations suggest that children in guardianship fare as well as those in other permanency settings on several measures of well-being, including school performance, engagement in risky behaviors, and access to community resources.

Capped IV-E Allocations and Flexibility to Local Agencies

Foster Care Placement Rates: In all three States that studied placement avoidance (Indiana, North Carolina, and Oregon), the flexible funding demonstrations were associated with a significantly reduced likelihood of out-of-home placement. In Indiana, 45.6 percent of children assigned to the experimental group never entered placement compared to 38 percent of control group children. In Oregon, children in child welfare branches with access to services paid for using flexible funds were over three times more likely to remain home as children in comparison sites. North Carolina’s evaluation indicated that the probability of entering out-of-home placement among children with a substantiated maltreatment report declined significantly more in experimental counties than in comparison counties or in other counties not participating in the waiver demonstration.

Permanency Rates: In Indiana, access to flexible funds had a significant positive effect on reunification rates, with nearly 77 percent of experimental group children in out-of-home placement reunified either with the original caretaker or a non-custodial parent compared with

66 percent of control group children. The flexible funding demonstrations in North Carolina, Ohio, and Oregon had no discernable impact on permanency rates.

Placement Duration: Indiana observed a significant positive association between the availability of the waiver and reduced length of stay in foster care placement. North Carolina and Ohio observed no statistically significant effects of their waivers on placement duration.

Maltreatment Recurrence: Of the States that studied maltreatment recurrence (Indiana, Ohio, and Oregon), none observed changes in subsequent maltreatment rates in either direction as a result of the flexible funding waiver.

Foster Care Re-Entry: Among the States that studied foster care re-entry (Indiana, North Carolina, and Ohio), access to services paid for using flexible funds had no significant effects in either direction on the likelihood of foster care re-entry.

Child and Family Well-Being: Indiana’s evaluation found a positive association between access to waiver-funded services and school attendance, with a higher percentage of school-age children assigned to the experimental group in school at case closure than children assigned to the matched comparison group.

Services for Caretakers with Substance Use Disorders

Treatment Retention and Completion: Delaware and Illinois collected specific data on the number of enrolled caregivers who remained in or successfully completed substance abuse treatment. Illinois reported modest improvements in substance abuse treatment retention and completion; as of June 2004, 59 percent of active clients in the experimental group had either completed or were actively engaged in treatment. Altogether, 73 percent of experimental group caregivers had participated in treatment at some point in time compared with 50 percent of caregivers assigned to the control group. Delaware experienced more difficulties retaining clients in treatment; by the end of that State’s waiver demonstration, only 24 percent of closed experimental group cases were actively engaged in or had completed treatment.

Foster Care Placement Rates: Both Delaware and New Hampshire studied the effects of their substance abuse demonstrations on foster care placement rates, defined as the proportion of in-home children enrolled in the demonstration who later entered out-of-home placement. Neither State found conclusive evidence that access to enhanced substance abuse services reduced rates of entry into foster care.

Permanency Rates: Illinois and New Hampshire examined the effects of their substance abuse demonstrations on permanency, defined as exits from foster care to reunification, guardianship, or adoption. Neither State has reported significant effects from its demonstration on reunification or other permanency outcomes.

Placement Duration: Three States – Delaware, Illinois, and New Hampshire – studied the effects of their demonstrations on the duration of out-of-home placements. Delaware and Illinois’ demonstrations were associated with reduced time in foster care. In particular, findings from Illinois suggest that children in families with access to intensive substance abuse services spend considerably less time in foster care. According to the State’s latest progress report, children in the experimental group who returned home spent an average of 421 days in out-of-home care compared with 563 days for control group children, a statistically significant difference of 142 days.

Placement Stability: Two States - Illinois and New Hampshire – assessed the effects of their demonstrations on placement stability, defined as the average number of times a child in foster care changes placement settings. To date, neither State has found evidence that access to enhanced substance abuse services improves placement stability.

Maltreatment Recurrence: The latest findings from Illinois indicate that families with access to enhanced substance abuse services may experience less subsequent maltreatment, with a smaller, statistically significant proportion of experimental group caregivers having a repeat maltreatment allegation compared with control group caregivers. To date, New Hampshire has uncovered no effect of its waiver demonstration on subsequent maltreatment referrals .

Child and Family Well-Being: New Hampshire has reported some initial positive well-being findings for families with access to enhanced substance abuse services, including declines in problem child behaviors, reduced public assistance participation, increased parent employment, and increased enrollment in education programs.

Outcome findings reported in this summary are preliminary in nature. As States complete and submit their final evaluation reports, more conclusive evidence regarding the success of the title IV-E waiver demonstrations in effecting positive changes in key child welfare outcomes may come to light.