Title IV-E Waiver Demonstration

 

Project Description:

The Title IV-E Waiver Demonstration was designed to reverse a trend in which the foster care population increased from 2000 to 2011, while the population receiving in-home services decreased over the same period. The Division of Child and Family Services (DCFS) wanted to use the waiver demonstration to increase the number of clients receiving in-home services and reduce the number of children entering foster care. In addition, DCFS wanted to increase the effectiveness of in-home services so that families would make lasting changes that resulted in improved child well-being and reduced the number of children that had repeat abuse or neglect. A systemwide demonstration was designed which would improve the effectiveness of caseworkers in helping families make enduring changes through evidence-based assessment, increasing protective factors, and providing community-based services.

 

Abstract:

SRI is evaluating the federally funded Title IV-E waiver demonstration looking at the effect of four components:

1. An evidence-based assessment adapted from the Child and Adolescent Needs and Strengths (CANS) assessment
2. A caseworker-led in-home family focused intervention (The Strengthening Families Protective Factor Framework, SFPF)
3. Trauma-informed care
4. Identification and building an array of services in the community to meet the needs of the target population including implementation of the Systematic Training for Effective Parenting (STEP) program

 

Desired outcomes include:

1. Increased child well-being
2. Reduced foster care use
3. Shorter length of foster care stays
4. Decreased further abuse and/or neglect
5. Cost neutrality or savings

 

The evaluation includes a process evaluation which focuses on the degree to which principles of implementation science are used along with measurement of evidenced based training and fidelity to each waiver component. The outcome evaluation uses a multi-group time series approach but incorporates analysis strategies similar to multilevel growth models. The cost analysis examines the specific cost components for services provided during the demonstration. Funding sources include Title IV-A, Titles IV-B, Title IV-E, Title XX, all state and local funds.

 

SRI’s partners on the project include the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine; the Louis de la Part Florida Mental Health Institute (FMHI), University of South Florida; and the Department of Economics at the University of Utah.

 

Outcomes:

The conceptual model we evaluated assumed that enhanced training for caseworkers on an evidence-based assessment would lead to more accurate understanding of the needs of children and families. By more accurately identifying needs, children and families could receive more appropriate caseworker interventions and community-based services. Caseworkers would be trained to provide enhanced in-home interventions using a protective factors framework. The provision of caseworker interventions and community services to children and families would lead to increased family functioning and well-being. Improvements in child well-being and family functioning would then lead to reductions in new incidents of maltreatment and foster care placement.

 

The conceptual model was evaluated with process, outcome, and cost studies. The process study examined the implementation of the waiver demonstration by measuring general implementation factors. In addition, the implementation of the waiver services; namely, the Utah Family and Children Engagement Tool (UFACET), Strengthening Families Protective Factors Framework (SFPF), and evidence-based community services. The outcome study consisted of two components designed to measure the impact of the waiver demonstration on well-being and system outcomes. The cost analysis examined the relative costs of achieving various positive outcomes, such as preventing an out-of-home placement.

 

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