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Prepared for:
Children’s Bureau
Administration on Children, Youth, and Families
Administration for Children and Families
U.S. Department of Health and Human Services
May 2007
In 1994, the Congress passed Public Law 103-432, which established section 1130 of the Social Security Act (the Act) and provided the Secretary of Health and Human Services (HHS) with the authority to approve State demonstration projects involving the waiver of certain provisions of titles IV-E and IV-B of the Act (Federal programs relating to foster care and other child welfare services). 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 (particularly title IV-E foster care funds) for alternative services and supports that promote safety, permanency and well-being for children in the child protection and foster care systems. The Adoption and Safe Families Act (ASFA) of 1997 extended and expanded HHS' authority to use waivers for child welfare programs by approving up to 10 new waiver projects each year.1
Typically, HHS has approved child welfare waiver demonstrations for up to five years, although at the discretion of the Secretary projects may be extended beyond five years. Since the enactment of the child welfare waiver authority, 23 States have implemented one or more demonstrations involving a variety of service strategies. Some States have implemented discrete interventions focused on specific child welfare populations, while others have experimented with the flexible use of funds to effect system-wide reforms. Among the requirements for waiver demonstrations are that they must undergo rigorous program evaluation to determine their efficacy and remain cost-neutral to the Federal government (i.e., States cannot receive more in Federal reimbursement than they would have received in the absence of the demonstration). Most States expect to realize title IV-E cost savings through their demonstration projects.
Strategies and service interventions implemented through current and past demonstrations include:
As of May 2007, 15 States have active title IV-E waiver agreements, including several projects approved in March 2006 which have not yet been implemented. Table 1 summarizes all current and completed waiver demonstrations and provides a brief description of the types of interventions undertaken in the demonstration projects as well as of their current status.
Table 1 - Title IV-E Waiver Demonstration Projects
Type of Project | Description of Intervention | ||||||
Active Demonstrations |
Completed |
Approved, Not Yet Implemented |
|||||
Under Original Waiver |
Under Short-Term Ext. |
Under 5-Year Ext. |
Completed As Scheduled |
Terminated Early |
|||
Assisted Guardianship/Kinship Permanence |
Relatives/other caregivers who assume legal custody of children are eligible for a monthly subsidy equal or comparable to monthly foster care payments. |
IA (2012)2 |
MT (2007) | IL (2008) |
DE (2002) |
Blank Cell | VA |
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 allocation of title IV-E funds. |
FL (2011) |
Blank Cell |
IN (2010) |
Blank Cell | Blank Cell | CA |
Services to Caretakers with Substance Use Disorders |
States used title IV-E dollars to fund services and supports for caretakers with substance abuse disorders. |
Blank Cell | Blank Cell | IL (2011) |
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) |
IA |
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. |
AZ (2011) |
Blank Cell | Blank Cell | CA (2005) |
MS (2004) |
MI |
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 | Blank Cell |
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. |
Blank Cell | Blank Cell | Blank Cell | NM (2005) |
Blank Cell | Blank Cell |
Enhanced Training for Child Welfare Staff |
Training for public and private-sector child welfare professionals to improve permanency and safety outcomes for children and their families. |
Blank Cell | Blank Cell | Blank Cell | Blank Cell | IL (2005) |
Blank Cell |
A. Assisted Guardianship/Kinship Permanence
To date, 11 States have completed or continue to implement assisted guardianship/kinship permanence waiver demonstrations: Delaware, Illinois, Iowa, Maryland, Minnesota, Montana, New Mexico, North Carolina, Oregon, Tennessee, and Wisconsin. Montana's and New Mexico's demonstrations offered a guardianship option for children in either Tribal or State custody, with procedures for processing the cases of children in Tribal custody 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 original five-year demonstration projects; three of these States (Illinois, North Carolina and Oregon) have received approval to extend their demonstrations for an additional five years. Wisconsin and Minnesota3 began implementation of their guardianship demonstrations in 2005, Tennessee started its demonstration in December 2006, and Iowa commenced implementation of its guardianship project in February 2007. Virginia has postponed implementation of its waiver pending the completion of needed changes to its state child welfare information systems and the passage of enabling legislation for subsidized relative custody.
Table 2 summarizes the key features of current and past guardianship demonstrations. As indicated in the table, the demonstrations vary in terms of their eligibility requirements for children and caregivers, guardianship subsidy rates, and availability of supplemental support services. For example, five States (Delaware, Minnesota, Montana, New Mexico, and Oregon) limited participation to title IV-E-eligible children, while demonstrations in the remaining States are open to both title IV-E-eligible and non-eligible children, with subsidies for non-eligible children paid from State or local funds. In six States (Delaware, Minnesota, Montana, New Mexico, Tennessee, and Wisconsin), both relative and non-relative guardians must be licensed foster care providers, while demonstrations in other States are open to unlicensed kin. In addition, recently approved demonstrations differ from past projects in that they make older youth eligible for independent living and transitional services (e.g., education and training vouchers) funded through the Chafee Foster Care Independence Program (CFCIP).
Table 2 - Key Features of Assisted Guardianship Waiver Demonstrations
State Name and Start Date | Program Features and Services | Payment Amount | Eligibility Requirements |
||||
Length of Time with Prospective Guardian |
Child Age |
Caregiver Relationship |
Child's IV-E Eligibility |
Caregiver Licensing Status |
|||
Delaware (7/1/96) |
Family and child were eligible to receive case management, child health care, mental health care, and "post-adoption" services. |
Equal to monthly foster care payment |
1 year |
12+ |
Relatives or kin4 and non-relatives |
IV-E only |
Licensed foster care providers only |
Illinois (5/1/97) (Phase 2: 6/30/05) |
Preliminary screenings and counseling; payment of one-time court costs and legal fees; periodic casework assistance; emergency stabilization; and other special services (e.g., physical therapy). Youth enrolled in "enhanced program" eligible for independent living and transitional services funded through CFCIP. |
Equal to monthly adoption assistance payment |
Originally 2 years; changed to 1 year in 7/01 |
All ages if placed with relatives or kin; 12+ if placed with non-relative "Enhanced" program targets youth 14+ |
Relatives or kin and non-relatives |
IV-E and non-IV-E |
Licensed (non-relatives) and unlicensed (relatives only) |
Iowa (approved 2/1/07) |
One-time payment for costs and legal fees associated with establishing the guardianship. Children 16+ eligible for education and training vouchers funded through CFCIP. |
Equal to monthly foster care maintenance payment |
6 months |
All ages if placed with a relative; 12+ if placed with non-relative |
Relatives and non-relatives |
IV-E and non-IV-E |
Licensed (non-relatives) and unlicensed (relatives only) |
Maryland (3/1/98) |
Guardians given priority for receiving support services, including individual and family counseling, parent training, medical support, and mental health assessments. |
$300 monthly subsidy |
6 months |
All ages |
Relatives or kin only |
IV-E and non-IV-E |
Licensed and unlicensed |
Minnesota (11/16/05) |
Additional services and supports similar to those available under the State's existing Adoption Assistance and Relative Custody Assistance programs. |
Equal to child's existing monthly foster care payment |
6 months |
All ages |
Relatives or kin and non-relatives |
IV-E only |
Licensed foster care providers only |
Montana (6/21/01) |
Targets children in both State and Tribal custody. Families may access social and mental health services typically available to adoptive families. |
$10 less than monthly foster care payment | 6 months | Originally 12+; age requirement eliminated in year 3. | Relatives or kin and non-relatives | IV-E only | Licensed foster care providers only |
New Mexico (7/1/00) |
Two separate components: (1) Native American children in Tribal custody; and (2) children in State custody. |
Equal to monthly adoption assistance payment | No minimum | All ages | Relatives or kin and non-relatives | IV-E only | Licensed foster care providers only |
North Carolina (7/1/97) |
No additional services specified. |
Originally less than monthly foster care payment; increased 10/02 to equal foster care payment | 6 months | All ages | Relatives and non-relatives | IV-E and non-IV-E | Licensed (non-relatives) and unlicensed (relatives only) |
Oregon (7/1/97) |
One-time payment for costs and legal fees associated with establishing guardianship. Access to same post-permanency services as adoptive families. |
Equal to basic monthly foster care rate | 6 months | All ages if placed with relative; 12+ if placed with non-relative | Relatives or kin and non-relatives | IV-E only | Licensed (non-relatives) and unlicensed (relatives only) |
Tennessee (12/1/06) |
Pre- and post-permanency services, including information and referral; family advocacy; children's activity groups, respite care; and recreational activities. Up to $1,000 to cover legal fees and other non-recurring costs to finalize guardianship. Children ages 15+ eligible for education and training vouchers funded through CFCIP. |
Equal to the State's base monthly foster care subsidy | 6 months | All ages | Relatives and non-relatives | IV-E and non-IV-E | Licensed foster care providers only |
Virginia5 (approved 3/31/06) |
One-time payment to cover costs and legal fees associated with establishing relative custody. Intensive short-term counseling; information and referral; crisis intervention; payment for special services (counseling, tutoring, or physical therapy). Children ages 16+ eligible for education and training vouchers funded through CFCIP. |
Equal to the child's monthly foster care maintenance payment | 6 months | All ages | Relatives only | IV-E and non-IV-E | Licensed and unlicensed |
Wisconsin (10/14/05) |
Assistance in applying for subsidies, referrals to community services, and access to post-guardianship resource centers. Children 15+ eligible for education and training vouchers, "room and board," and other transitional services funded through CFCIP. |
Equal to the child's monthly foster care maintenance payment | 12 months | All ages | Relatives and non-relatives | IV-E and non-IV-E | Licensed foster care providers only |
B. Flexible Funding and Capped IV-E Allocations
The States of Indiana, North Carolina, Ohio and Oregon have all received five-year extensions of flexible funding waiver demonstrations originally approved during the 1990s. Each State's flexible funding demonstration attempts to establish a new array of services to prevent out-of-home placement or facilitate permanency with the expectation that the costs of these services will be offset by subsequent savings in foster care expenditures. Florida began implementation of a new flexible funding demonstration in October 2006, while California has received approval for but has not yet implemented a new demonstration. The key features of these States' flexible funding waivers are summarized below.
C. Services for Caregivers with Substance Use Disorders
Four States—Delaware, New Hampshire, Illinois, and Maryland—have implemented waiver demonstrations focused on families in which parental substance abuse places children at risk. Delaware completed its demonstration project in December 2002 and submitted its final evaluation report in March 2002. New Hampshire began its project in 1999 and continued under a short-term waiver extension through November 2005. Maryland terminated its demonstration early in December 2002 due to various implementation problems. Illinois received approval for a five-year extension of its substance abuse waiver in January 2007.
D. Managed Care Payment Systems
Five States—Colorado, Connecticut, Maryland, Michigan, and Washington—tested alternative managed care financing strategies 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.
E. Intensive Service Options
Three States—Arizona, California, and Mississippi—implemented demonstration projects aimed at improving permanency and safety outcomes through an increased variety and intensity of child and family services. A fourth State—Michigan—has received approval for but has not yet implemented its intensive services waiver.
F. Adoption and Post-Permanency Services
Maine received a waiver to provide services and supports that promote and strengthen adoption as a permanency option. Completed in December 2004, the State's 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 adoptive families and children; and (2) post-adoption support services to families that chose to adopt. Post-adoption services included case management, parent education, information and referral, support groups, respite care, advocacy, crisis stabilization, and therapeutic services.
G. Tribal Administration of IV-E Funds
Under the second component of its two-part waiver agreement, New Mexico implemented a unique demonstration that sought to foster enhanced Tribal independence and increase the efficiency and effectiveness of child welfare services delivered to Native American children. Under the terms of the demonstration, the State could enter into agreements with eligible Tribes and Pueblos to delegate the administration of title IV-E programs to Tribal government authorities. These agreements granted authority to the Tribes to develop foster care licensure standards, license foster homes, determine the title 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. During the course of the demonstration, only one Tribal authority—Pueblo of Zuni—chose to enter into a Title IV-E Waiver Agreement with the State. New Mexico completed this demonstration in December 2005.
H. Enhanced Training for Child Welfare Staff
Illinois implemented an enhanced training demonstration targeted at new public and private-sector child welfare workers that sought to enhance their skills in assessing child and family needs, providing services, and making evidence-based permanency decisions. In addition to an enhanced six-week classroom-based training curriculum, private sector child welfare workers were to receive one year of structured field support that included coaching, on-the-job shadowing, and "booster sessions" led by a team of case management trainers. Chronic problems with enrollment, staff turnover, and data collection culminated in the early termination of the demonstration in June 2005. One challenge faced by the State was the ongoing operational needs of private child welfare agencies, which prevented the release of many new employees to participate in enhanced trainings and depressed enrollment rates during the early months of the demonstration.
As part of their waiver agreements, all States are required to conduct rigorous evaluations of their demonstrations that include process and outcome components. Random assignment designs are employed whenever feasible, although alternative designs (e.g., comparison site, matched case comparison) have been approved and implemented. Table 3 below provides an overview of the evaluation designs that have been implemented or proposed for the waiver demonstrations to date. Well over half (22, or 63 percent) 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 in which a county or other geographic region serves as the unit of analysis. Recently, time series designs in which historical changes in child welfare outcomes are tracked and analyzed over time have been approved for California and Florida. Evaluations in three States (Arizona, Indiana, and Michigan) involve variations on a matched case comparison design.
Table 3 - Evaluation Designs of the Title IV-E Waiver Demonstrations
Demonstration Type | Research Design | |||
---|---|---|---|---|
Random Assignment | Comparison Sites | Matched Case Comparison | Time Series Analysis | |
Assisted Guardianship/Kinship Permanence |
IA, IL, MD, MT, NM, WI, MN, TN, VA |
NC, OR |
Blank Cell | Blank Cell |
Flexible Funding/Capped IV-E Allocations |
Blank Cell | NC, OH, OR |
IN |
CA, FL |
Substance Abuse Services |
IL, MD, NH |
DE |
Blank Cell | Blank Cell |
Managed Care Payment Systems |
CO, CT, IA, MD, MI, WA |
Blank Cell | Blank Cell | Blank Cell |
Intensive Services Options |
CA, MS |
Blank Cell | AZ, MI |
Blank Cell |
Adoption Services |
ME |
Blank Cell | Blank Cell | Blank Cell |
Tribal Administration of IV-E Funds |
Blank Cell | NM |
Blank Cell | Blank Cell |
Enhanced Child Welfare Training |
IL |
Blank Cell | Blank Cell | Blank Cell |
The availability of evaluation findings from the States depends on the implementation status of their waiver demonstrations. Interim evaluation reports generally focus on project implementation and may contain preliminary outcome data, while final evaluation reports are expected to provide a comprehensive overview of all process and outcome findings. Table 4 on page 16 summarizes the status of interim and final evaluation reports submitted by the States as of May 2007. To date, final reports are available for 18 demonstrations that have been completed or terminated early under their original five-year waivers. States are generally expected to submit a final evaluation report within six months of the completion or termination of a demonstration.6
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 research questions focus on the effectiveness of the waiver demonstrations in:
Evaluation findings to date suggest that the demonstrations have met with mixed success in effecting positive changes in these areas. Key child welfare outcomes from five major clusters of demonstrations—assisted guardianship, capped title IV-E allocations/flexible funding, services for caregivers with substance use disorders, intensive service options, and post-adoption services—are summarized in the following sections.7
Table 4 - 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 |
||
Arizona |
Intensive Services |
Nov. 2008 |
Oct. 2011 |
Blank Cell | Blank Cell |
California |
Intensive Services |
√ |
√ |
Blank Cell | Blank Cell |
Colorado |
Managed Care |
N/A8 |
√ |
Blank Cell | Blank Cell |
Connecticut |
Managed Care |
√ |
√ |
Blank Cell | Blank Cell |
Delaware |
Assisted Guardianship/Substance Abuse |
√ |
√ |
Blank Cell | Blank Cell |
Illinois |
Assisted Guardianship |
√ |
√ |
Dec. 2007 |
June 2009 |
Substance Abuse Services |
√ |
√ |
August 2009 |
July 2012 |
|
Enhanced Training |
N/A |
√ |
Blank Cell | Blank Cell | |
Indiana |
Flexible Funding |
√ |
√ |
March 2008 |
Jan. 2011 |
Iowa |
Assisted Guardianship |
Oct. 2009 |
August 2012 |
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 |
Guardianship/Single Benefit Program |
May 2008 |
March 2011 |
Blank Cell | Blank Cell |
Mississippi |
Intensive Services |
N/A |
√ |
Blank Cell | Blank Cell |
Montana |
Assisted Guardianship |
N/A |
√ |
Blank Cell | Blank Cell |
New Hampshire |
Substance Abuse Services |
√ |
Pending |
Blank Cell | Blank Cell |
New Mexico |
Guardianship/Tribal IV-E Administration |
√ |
√ |
Blank Cell | Blank Cell |
North Carolina |
Flexible Funding/Assisted Guardianship |
√ |
√ |
June 2007 |
Dec. 2009 |
Ohio |
Flexible Funding |
√ |
√ |
August 2007 |
March 2010 |
Oregon |
Flexible Funding/Assisted Guardianship |
√ |
√ |
Oct. 2006 |
Sept. 2009 |
Tennessee |
Assisted Guardianship |
July 2009 |
June 2012 |
Blank Cell |
Blank Cell |
Washington |
Managed Care |
N/A |
√ |
Blank Cell | Blank Cell |
Wisconsin |
Assisted Guardianship |
May 2008 |
March 2011 |
Blank Cell | Blank Cell |
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 State's 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. In New Mexico, net permanence was also somewhat higher in the experimental group (63.8 percent) than in the control group (59.2 percent) by the end of its demonstration, a difference of 4.6 percent. Early findings from Minnesota suggest a net permanency trend in favor of the experimental group, with 38 percent of all experimental group children having exited to permanency as of November 2006 compared with 30 percent of control group children. To date, no other States have found conclusive evidence regarding the effect of the availability of assisted guardianship on permanency rates.
Placement Duration: Limited data from Maryland and New Mexico suggest that the availability of assisted guardianship may decrease the duration of out-of-home placements.
Placement Stability: Available data from Illinois and Maryland 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 control group children.
Maltreatment Recurrence: Findings from Illinois suggest that children placed with guardians are at least as safe from repeat maltreatment as children in other permanent settings (adoption and reunification). 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. The State observed no differences between the experimental and control groups in the proportion of permanent placements that were disrupted (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 (3 percent) re-entering substitute care during the first year following exit to guardianship.
Child Well-Being: Findings from Maryland, Montana, and Illinois 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 with 38 percent of control group children. In Oregon, children in counties with access to services paid for using flexible funds were over three times more likely to remain home as children in comparison counties. North Carolina reported that the probability of entering out-of-home placement among children with a substantiated maltreatment report declined significantly more in experimental counties than in either comparison counties or in other counties not participating in the 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 an original caregiver 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 effect on permanency rates.
Placement Duration: Indiana observed a significant positive association between the availability of flexible funds 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 their flexible funding demonstrations.
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 effect 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 was observed among children assigned to the matched comparison group.
Services for Caregivers with Substance Use Disorders
Treatment Participation and Completion: Delaware, Illinois, and New Hampshire collected data on the number of enrolled caregivers who remained in, or successfully completed, substance abuse treatment. Illinois reported significant positive effects from its demonstration on both treatment participation and completion rates. According to the State's final evaluation report, 71 percent of experimental group caregivers actively participated in treatment compared with 52 percent of control group caregivers, a statistically significant difference. In addition, 43 percent of experimental group caregivers completed at least one entire treatment episode compared with 23 percent of caregivers in the control group, a statistically significant difference.
In New Hampshire, no statistically significant differences emerged between experimental and control group caregivers in substance abuse treatment participation, with 26 percent of experimental group caregivers receiving treatment compared with 24 percent of control group caregivers. Delaware experienced serious difficulties in 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 both examined the effects of their substance abuse demonstrations on permanency rates, defined as exits from foster care to reunification, guardianship, or adoption. Illinois reported moderately positive effects of its demonstration on reunification rates, with 15.5 percent of experimental group children reunified compared with 11.6 percent of control group children, a statistically significant difference. New Hampshire observed no statistically significant effects of its demonstration as a whole on reunification rates. However, when the probability of reunification was examined at the CPS district office level, the State found that experimental group children served out of one district office (Manchester) were significantly more likely to be reunified than control group children.
Placement Duration: Three States—Delaware, Illinois, and New Hampshire—studied the effects of their demonstrations on the duration of out-of-home placements. The Delaware and Illinois demonstrations were associated with reduced time in foster care. In particular, findings from Illinois suggest that children from families with access to intensive substance abuse services spend considerably less time in foster care. According to the State's final evaluation report, average time to reunification for children in the experimental group was 522 days compared with 707 days for children in the control group, a statistically significant difference. In New Hampshire, the average length of placement per child did not differ significantly between the experimental and control groups.
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. Neither State has found evidence that access to enhanced substance abuse services improved placement stability.
Maltreatment Recurrence: Two States—Illinois and New Hampshire—assessed the effects of their demonstrations on the likelihood of abuse or neglect recurrence. Illinois' evaluation uncovered a significant positive effect of its demonstration on subsequent maltreatment. Overall, 25 percent of experimental group caregivers had a subsequent allegation of maltreatment compared with 30 percent of control group caregivers, a statistically significant difference. In addition, mothers in the experimental group were significantly less likely than mothers in the control group to be reported as having a subsequent birth of a substance-exposed infant (14 percent to 20 percent, respectively). In New Hampshire, the availability of enhanced substance abuse services resulted in a somewhat lower proportion of subsequent maltreatment substantiations for experimental group families (8.8 percent) than for control group families (11.4 percent), although this difference was not statistically significant.
Child and Family Well-Being: In its final evaluation report, New Hampshire described positive well-being outcomes for children and caregivers with access to enhanced substance abuse services. Interviews conducted using the Child Behavior Checklist (CBCL) indicated greater declines in problem behaviors in seven out of eight categories for experimental group children, including incidents of anxiety, depression, sleep problems, attention deficits, and aggressive behavior. Although these findings pointed in a positive direction, none reached statistical significance. However, when school status was examined, experimental group children were significantly less likely to repeat a grade than control group children. Among enrolled caregivers, those in the experimental group were significantly more likely to be employed full-time than control group caregivers (38 percent versus 24 percent) and were somewhat more likely to be enrolled in a vocational or educational program (28 percent versus 17 percent). Although many of these well-being findings lacked statistical significance, the pattern of somewhat improved outcomes for children and adults across several domains suggests a positive trend for families that received enhanced substance abuse services.
Intensive Service Options
Foster Care Placement Rates: Mississippi reported that experimental group children who had not been removed from their homes prior to the start of the demonstration were less likely to be removed and placed in foster care than control group children. Overall, 9.1 percent of experimental group children without a prior placement were removed from their homes compared to 14.1 percent of control children, a statistically significant difference.
Permanency Rates: Among all children who were in or entered out-of-home placement during Mississippi's demonstration, 22.4 percent of those in the experimental group and 19.6 percent of those in the control group were reunified with their families of origin. Although not statistically significant, this difference was in the hypothesized direction. In California's demonstration, no statistically significant differences emerged between the experimental and control groups in the likelihood of reunification.
Placement Duration: In Mississippi's demonstration, the mean number of days spent in non-emergency out-of-home placement was nearly identical for experimental group children (147 days) and control group children (145 days). However, when this analysis was restricted only to children who entered foster care following assignment to the demonstration, the mean number of days in placement was less for experimental group children (41 days) than for control group children (56 days). California found no statistically significant differences between experimental and control group children with respect to the average duration of out-of-home placements.
Maltreatment Recurrence: Experimental group children participating in Mississippi's demonstration were significantly less likely to have a new maltreatment report following assignment to the demonstration, with 14.5 percent of experimental group children experiencing a new maltreatment report compared to 19.7 percent of control group children. California's evaluation uncovered no statistically significant differences in maltreatment recurrence between the experimental and control groups in the two counties (Fresno and Riverside) that tracked maltreatment rates.
Post-Adoption Services
Adoption Disruptions and Dissolutions: Maine observed no statistically significant differences between the experimental and control groups in either adoption disruptions or dissolutions.
Child and Family Well-Being: Maine's evaluators used the Child Behavior Checklist to compare differences between the experimental and control groups in child behavior and family functioning. Overall, no statistically significant differences were found between the experimental and control groups on most child-level and family-level outcomes. However, a statistically significant difference in favor of the experimental group did emerge on the "Total Problem" subscale for children, with experimental group children having significantly lower average "Total Problem" scores than control group children. In addition, a higher, statistically significant percentage of parents in the experimental group reported that they trusted their child compared with parents in the control group.
Outcome findings reported by States over the past decade offer intriguing, yet incomplete insights into the effects of IV-E waivers on child safety, permanency, and well-being. As States complete their final evaluation reports or continue waivers under long-term extensions, and as several States move forward with new demonstrations, more conclusive evidence regarding the success of the title IV-E waivers in promoting positive changes in key child welfare outcomes may emerge.
Many states with past or current waiver demonstrations have posted reports or provided summary information about their projects on the Internet. Visit the following websites to view these reports (reports not posted online are available by request from the Children's Bureau).
California Intensive Services Demonstration—Final Report (May 2004): http://cssr.berkeley.edu/research_units/cwrc/publications_details.html
Connecticut Managed Care Demonstration—Status Report (December 1999): http://www.openminds.com/indres/CT.htm
Illinois—Evaluation Reports for Illinois' Three Demonstrations:
Illinois Guardianship Demonstration—Final Evaluation Report (revised July 2003): http://cfrcwww.social.uiuc.edu/pubs/Pdf.files/sgfinalreport.pdf
Illinois Alcohol and Other Drug Abuse Demonstration—Final Evaluation Report (January 2006): http://cfrcwww.social.uiuc.edu/pubs/pdf.files/AODA.01.06.pdf
Illinois Child Welfare Training Demonstration—Project Report (March 2004): http://cfrcwww.social.uiuc.edu/pubs/Pdf.files/IVETrainingWaiver.pdf
Indiana Flexible Funding Demonstration—Final Evaluation Report (September 2003): http://www.iarstl.org/papers/INFinalReport.pdf
Maine Post-Adoption Services Demonstration—Final Evaluation Report (December 2004): http://muskie.usm.maine.edu/Publications/ipsi/maine_adopt_guides_05.pdf
Maryland—Evaluation Reports for Maryland's Two Waiver Demonstrations:
Guardianship Assistance Project—Research Findings: http://www.rhycenter.umaryland.edu/gap/
Managed Care Demonstration—Research Findings: http://www.rhycenter.umaryland.edu/managed_care/
Minnesota Continuous Benefit Program—General Information: http://www.dhs.state.mn.us/main/dhs16_137480
Mississippi Intensive Services Demonstration—Final Evaluation Report (June 2005): http://www.iarstl.org/papers.htm
Montana Subsidized Guardianship Demonstration—Fourth Annual Report (December 2004): http://www.healthmanagement.com/files/MT%20IVE%20Eval%204th%20Report.pdf
New Hampshire Substance Abuse Waiver Demonstration—Project Presentation (July 2004): http://www.unh.edu/ccrc/projects/DCYF.htm
New Mexico Subsidized Guardianship Demonstration—Evaluation Reports (2001, 2002): http://www.triwestgroup.net/projectDetail.aspx?pid=24
North Carolina Flexible Funding Demonstration—Evaluation Reports:
Final Evaluation Report, Phase I (November 2002): http://www.unc.edu/~lynnu/ncwaivrpt.htm
Web-based Survey Report, Phase II (November 2005): http://www.unc.edu/%7Elynnu/svcreport.pdf
Ohio—Evaluation Reports (1999-2004): http://jfs.ohio.gov/ocf/pohio.stm
Oregon Flexible Funding Demonstration (Phase I)—Final Evaluation Report (March 2003): http://www.cwp.pdx.edu/pdfs/Waiver%20Final%20Report%203-27-03.pdf
1 Federal legislative authority to approve new title IV-E waivers expired on March 31, 2006. However, States with projects approved before that date may continue to implement, and requests to extend demonstrations beyond their original period of approval may also be considered and approved at the Secretary's discretion. back
2 Dates in parentheses denote completion date or expected completion date of the demonstration. back
3 Minnesota's demonstration differs from other guardianship projects in that it allows the use of title IV-E funds to support guardianship subsidies (referred to as "relative custody assistance" in Minnesota) in the context of a project that tests the impact of a single benefit structure on permanency outcomes for children. Under the State's demonstration, a child who exits foster care to either adoption or relative custody continues to receive the same monthly subsidy and services as the child received while in foster care. In contrast, the State's traditional subsidy programs allow counties to negotiate separate relative custody or adoption payments with caregivers that are up to 50 percent lower than foster care maintenance payments. back
4 "Kin" may include other persons related to a child by blood, marriage, or adoption, or a non-related individual who is an important family friend or with whom the child has resided or has had significant contact. back
5 Implementation pending. back
6 Please see Appendix A at the end of this summary for a comprehensive list of evaluation reports available on the Internet for current and past State waiver demonstrations. back
7 In addition to this summary, the Children's Bureau has published synthesis papers that review evaluation findings from three clusters of demonstrations: assisted guardianship, substance abuse, and flexible funding. Electronic copies of these synthesis papers are available at: http://www.acf.hhs.gov/programs/cb/programs_fund/index.htm#child. back
8 Indicates that the State was exempt from submitting the report if it terminated early or made an alternative reporting arrangement with the Children's Bureau. back