Child Welfare Legislation by pengxiang

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									Outcomes of Children in Care:
          Sustaining Results
                                               Mark Testa
                 Spears-Turner Distinguished Professor
                                 School of Social Work
             University of North Carolina at Chapel Hill




                                Illinois Child Welfare Data Summit
                                            First Annual Leadership
                                               January 27-28, 2010




                                                                      1
Overview
   Post-permanency world

   Dynamics of change

   What the evidence says

   Sustaining the results
                             2
Post-Permanency World: Illinois

  60,000
                 51,331   July 2000
  50,000


  40,000
                                            36,156

   30,000
                Foster
                Care
   20,000
                              Adoption &       15,780
    10,000
                             Guardianship
            0
IL Caseload Reduction Dynamics




                                 4
IL Caseload Reduction Dynamics




         Front-End Reforms




                                 5
IL Caseload Reduction Dynamics




                  Back-End Reforms




                                     6
    What does the Evidence Say?

Front-End Reforms:
•   Alternative Response – Extended Family Support (EFS)
    for children in pre-existing kinship care.
•   Safety Assessment– Child Endangerment Risk
    Assessment Protocol (CERAP).

Back-End Reforms:
•   Adoption and Guardianship – Subsidized Guardianship
    Waiver Demonstration.
•   Post-Permanency Services – Adoption Preservation &
    Linkages (APAL) and Maintaining Adoption Connections
    (MAC)
                                                       7
PICO Components of Well-Built
Evaluation Questions

P – Conditions of the target population for
   which one wishes to draw inferences.
I – Intervention or program whose efficacy
   and effectiveness one is interested in
   evaluating.
C – The alternative course of action with
   which one wants to draw a comparison.
O – Intended outcome one hopes to achieve.
                                              8
Well-Built Evaluation Questions
•   Alternative Response: Does the diversion of children in
    pre-existing kinship care arrangements (P) to Extended
    Family Support Programs (I) safely reduce the number of
    children in foster care (O) compared to regular
    investigation practices (C)?

•   Safety Assessment: Is the rate of short-term recurrence of
    indicated maltreatment reduced (O) for children and
    young persons under 18 years old (P) when structured
    safety assessments are conducted (I) compared to
    investigation processes that do not feature structured
    assessments(C)?
[

                                                             9
Well-Built Evaluation Questions
•   Adoption and Guardianship: Does the offer of
    subsidized guardianship (I) in addition to the usual
    permanency options of reunification and adoption (C)
    increase overall family permanence (O) for children in
    stable kinship foster care (P)?

•   Post-Permanency Services: Do former foster youth aged
    12 to 17 years old who currently reside in adoptive or
    guardianship arrangements (P) have fewer unmeet service
    needs and lower risks of placement rupture (O) if their
    families receive APAL assessments and referrals (I)
    compared with similar youth whose families are eligible
    only for regular post- permanency services (C)?
                                                             10


[
The Problem of Selection Bias

      Intervention v. Comparison group

                          δ + bias


                                                     Outcome


      εrror component (unobserved systematic & random influences)
                                                                    11
                          Selection Bias
   Selection of intervention & comparison groups.




                               vs.

         Intervention Group                Comparison Group



• Is this a valid comparison?
                                                              12
                  Balanced Groups
   Selection of intervention & comparison groups.




                              vs.

         Intervention Group          Comparison Group



• This is a much better comparison
                                                        13
Approximating the Counterfactual

     Stronger   Randomized controlled experiments

                Quasi-experiments
                -Instrumental variables
                -Regression discontinuity

                Observational studies
                -Propensity score matching
                -Regression analysis


     Weaker     Historical cohort comparisons
                                                    14
Approximating the Counterfactual

     Stronger   Randomized controlled experiments

                Quasi-experiments
                -Instrumental variables
                -Regression discontinuity

                Observational studies
                -Propensity score matching
                -Regression analysis

     Weaker     Historical cohort comparisons
                                                    15
Subsidized Guardianship
Question (PICO)

   Does the offer of subsidized guardianship (I) in
    addition to the usual permanency options of
    reunification and adoption (C) increase overall
    family permanence (O) for children in stable kinship
    foster care (P)?




                                                       16
Randomized Controlled Experiments


         Intervention v. Comparison group
                             δ + bias


   ∆=0
                                                        Outcome




         εrror component (unobserved systematic & random influences)
                                                                       17
Statistical Equivalence at Baseline

                                             Intervention     Comparison     Difference
      Child characteristics
       Age at interview                                 9.9           10.1             -0.2
       Age at removal                                   4.8            4.8              0.0
       Female                                        49.5%          49.7%            -0.2%
       White                                          9.9%           9.4%             0.5%
       Black                                         83.6%          85.3%            -1.7%
      Caregiver characteristics
       Age at interview                                51.2           51.8             -0.7
       White                                         10.7%          10.8%            -0.1%
       Black                                         82.5%          83.2%            -0.8%
       Married                                       32.5%          32.2%             0.3%
       Less than high school                         40.0%          39.9%             0.1%
       High school graduate                          17.2%          19.3%            -2.1%
       Some college                                  28.5%          24.8%             3.7%
       Full-time employment                          34.8%          34.2%             0.6%
       Not in labor force                            47.6%          48.7%            -1.1%
       Intend to raise child to adulthood            78.7%          79.6%            -0.9%
      Caregiver-child relationships
       Grandparent-grandchild                        43.4%          48.3%            -4.9%
       Aunt/Uncle-niece/nephew                       18.0%          18.1%            -0.1%
       Foster parent-foster child                    18.5%          17.2%             1.3%
       Matched ethnic backgrounds                     2.8%           3.3%            -0.5%
                                                                                              18
                                  Sample N            1,197          1,228
Availability of SG boosted legal permanence
    100%

                   Illinois                          At wave I of the evaluation (1998)
     80%
                                                     there was a 8% permanency
                                                     advantage for children in the
                                                     intervention group who were offered
     60%                                             the choice of subsidized guardianship
                                                     compared to children in the
     40%
                                                     comparison group.
                          }8.3%

     20%
                                                     Increase in both adoptions and
                                                      guardianships

     0%
           Experimental       Control

      Already       Already SG          Already AA
      Reunified


                                                                                         19
      Internal Validity


      SG v. Comparison group
                     δ = 8 additional permanencies
                              per 100 children

∆≈0
                                                     Permanence




      εrror component (unobserved systematic & random influences)
                                                                    20
             External Validity

   Concern: Do these findings generalize beyond
    the state’s unique historical circumstances and
    distinctive policies on kinship foster care?

   Fact: Two replications of Illinois’ waiver
    demonstrations in Tennessee and Milwaukee find
    that subsidized guardianship increases overall
    family permanence.
                                                      21
                         Waiver Findings

                 Illinois                               Wisconsin                              Tennessee
100%
               (June, 2007)              100%
                                                    (November, 2007)              100%
                                                                                            (November, 2008)


80%
                        } 6.6%           80%                                      80%

                                                                                                          } 15.0%
                                                                 }19.9%
60%                                      60%                                      60%



40%                                      40%                                      40%



20%                                      20%                                      20%



 0%                                       0%                                       0%
         Intervention    Comparison               Intervention    Comparison               Intervention    Comparison

       Guardianship     Custody to Kin          Guardianship     Custody to Kin          Guardianship      Custody to Kin
       Reunificatioon   Adopted                 Reunificatioon   Adopted                 Reunificatioon    Adopted
No Adverse Impact on Reunifications

Concern: SG will discourage CW agencies from
 reunifying children with their parents.

Fact: All three randomized experiments find that
 reunification rates were not significantly
 different between families offered subsidized
 guardianship vs. families denied this choice.

                                               23
No Adverse Impact on Reunifications


Differences in Reunification Rates, Intervention vs. Comparison Groups


                               Intervention Comparison Difference
 Illinois (June 2007)                 5.2%         7.7%       -2.6%
 Tennessee (December 2008)           13.2%        13.7%       -0.5%
  Wisconsin (November 2007)           9.6%         8.6%        1.0%



                                                                  24
              Cost-Effective

Concern: SG will end up costing more money in the
  long-run.

Fact: In Illinois after 10 years, offering families the SG
  option reduced the average length of foster care by
  269 days or 22% compared to what would have
  happened in the absence of the offer. In Wisconsin
  after 3 years, offering family the SG option reduced
  the average length of foster care by 133 days or
  24%. In Tennessee, analysis is underway.
                                                         25
With success, comes new concerns:
Post-Permanency Services

   Did the push for adoption and guardianships pressure
    too many families into making ill-considered
    commitments that will eventually translate into
    children’s returning to foster care?

   Do these families have the necessary supports to
    weather the challenges of parenting special-needs
    children, especially as they enter adolescence?


                                                           26
Illinois Adoption Preservation and
Linkages (APAL) Program:

   To address such concerns, the Illinois Department of
    Children and Family Services (DCFS) funded APAL to
    assess the needs of adolescents aged 13 or 16 in adoptive
    or guardianship homes.
   Private child welfare agencies in the city of Chicago
    conducted needs assessment either in person or over the
    phone when the family’s annual subsidy renewal was
    due.
   DCFS commissioned the Children and Family Research
    Center (CFRC) to evaluate the impact of the program.
                                                            27
APAL Question (PICO)

   Do former foster youth aged 12 to 17 years old who
    currently reside in adoptive or guardianship arrangements
    (P) have fewer unmeet service needs and lower risks of
    placement rupture (O) if their families receive APAL
    assessments and referrals (I) compared with similar
    youth whose families are eligible only for regular post-
    permanency services (C)?




                                                           28
Intervention v. Comparison

   All covered families, in which one of the children was
    aged 13 or 16 years old, were targeted to receive an in-
    person or telephone APAL assessment of the needs of the
    focal child and other children in the home.
   Caregivers who requested assistance with any unmet
    needs of the focal child or other children were referred to
    a post-permanency program or agency for follow-up.
   A stratified random sample of comparison families in
    the same geographical areas with children aged 12,
    14, 15, or 17 years old is the comparison group.
                                                              29
Prevalence of Unmet Needs

An estimated 76% to 84% of caregivers reported no unmet needs for the
focal child under their care.

Number of       Population     95% CL         % of Total     95%CL         Unweighted
Unmet Needs     Estimate                                                       Count
None                  3,257   3,092 – 3,422       80.4%    76.0% -84.2%           363
1                       567      423 - 712        14.0%    10.8% - 18.0%           59
2                        88        29 - 146        2.2%      1.1% - 4.2%           11
3                       109       40 – 178         2.7%      1.4% - 5.0%           11
4+                       30          0 - 66        0.7%     0.2% - 2.5%             3
TOTAL                 4,051                      100.0%                           447
Types of Met Needs
Sought and usually received:
Counseling was the biggest need – 1,450 or 38% of caregivers said that they
needed this service, and most who sought it out received this service. The
following other services were usually received if sought (86%-100%):

                %        %        %                             %        %        %
Service         Needed   Sought   Received    Service           Needed   Sought   Received
Counseling         38%      83%         86%   Psychiatrist         17%      84%        90%
Day Care           24%      77%         93%   Speech Therapy       10%      90%        87%
Camp               21%      77%         87%   Psychiatric           8%      89%        99%
                                              hospitalization
Psychological      19%      79%         86%   Specialized           7%      96%       100%
                                              medical care
Family             17%      71%         90%
Therapy
Types of Partially Met Needs

Not as likely to be received if sought:
Educational services, support groups and mentoring were not as likely to be
received if sought – 83% to 77% of the time caregivers were able to get these
services if they sought them out.


                %         %         %                      %         %         %
Service         Needed    Sought    Received   Service     Needed    Sought    Received
Educational         12%       72%        83%   Mentoring       23%       66%         77%
Support Group       9%        69%        80%




                                                                                          32
 Types of Unmet Needs


Least likely to be received:
Three types of services fall into this category where caregivers who sought these
services were least likely to receive them.

               %             %         %                          %        %        %
Service        Needed        Sought    Received    Service        Needed   Sought   Received
Preservation            5%       57%         62%   Respite Care       6%      64%        42%
Services
Orthodontia         14%          76%         57%




                                                                                               33
Behavior Problem Index


An estimated 25% to 34% of focal children fall above 90th percentile
of national norms for BPI.

National                Estimate          95% CL              Cumulative
Norms
10th percentile                    5.6%         3.7% - 8.4%                5.6%
25th percentile                    6.7%         4.6% - 9.7%            12.4%
50th percentile                20.3%          16.6% - 24.6%            32.7%
75th percentile                18.9%          15.2% - 23.2%            51.5%
90th percentile                19.4%          15.6% - 23.8%            70.9%
Above 90th percentile          29.1%          24.7% - 33.9%           100.0%
Total
                                                                                  34
Think of Ending Arrangement


How often do you think of ending the [Adoption/Guardianship]?


Choices             Estimate          95% CL               Cumulative

Never                      79.3%          74.8% - 83.2%             79.3%
Not very often                 7.7%        5.4% - 10.9%             87.0%
Sometimes                  10.4%           7.6% - 14.0%             97.4%
Frequently                     2.6%            1.4%-4.9%           100.0%
Total                     100.0%




                                                                            35
Provider Helpfulness


Overall, how helpful has DCFS and its service providers been in
responding to your needs since the [Adoption/Guardianship] was
finalized?

        Choices              Estimate       95% CL

        Very helpful                30.3%       25.8% - 35.1%
        Somewhat helpful            18.8%       15.1% - 23.1%
        Not applicable              23.2%       19.1% - 27.8%
        Not very helpful            27.8%       23.4% - 32.7%
        Total                      100.0%


                                                                  36
Provider Contact by APAL
Since September 2007, were you contacted by a worker in person or
by phone who wanted to talk to you about service needs for
[FOCAL CHILD]?

APAL is associated with 3 to 9.7 times higher odds of provider
contact than non-APAL.
Contacted by     APAL           Non-APAL     Total   Odds Ratio       95%CL
Worker since
September 2007
Yes                     36.3%        9.6%   22.3%
No                      63.7%       90.4%   77.7%            5.4      3.0 – 9.7
TOTAL                   100%       100.0%   100.0%
                                                          13 Missing responses
 Regression Estimation of Intent to
 Treat (ITT) Effects

      Intervention v. Comparison group
                          δ + bias


∆≠0                                                  Outcome




      εrror component (unobserved systematic & random influences)
Statistical equivalence of groups
Child Variables                            APAL         Non-APAL           Sig.
                                    X/%       95%CL     X/%     95%CL
Age at interview                    15.4    15.1-15.6   15.9   15.6-16.2   .001
Female                              48%     41%-55%     41%    34%-49%
African American                    96%     92%-98%     92%    87%-95%
Health problems                     15%     11%-20%     21%    15%-27%
Mental diagnosis                    20%     15%-27%     28%    22%-35%
IEP/Special ed.                     26%     20%-32%     32%    25%-39%
Res. fos. care since finalization    2%       1%-5%      2%      1%-5%
Psy. Inpatient since finalization    4%       2%-8%      8%    5%-14%      .086
Runaway since finalization           9%      5%-13%     11%    7%-17%


                                                                              39
Statistical equivalence of groups
Caregiver Variables                  APAL          Non-APAL          Sig.
                              X/%       95%CL     X/%     95%CL
Age at interview              56.0    54.3-57.6   57.0   55.2-58.9
Female                        96%     92%-98%     95%    91%-97%
Married                       26%     20%-32%     21%    16%-28%
In paid labor force           41%     34%-48%     42%     35-50%
HS graduate                   73%     67%-79%     69%    63%-75%
Annual income under $31,000   64%     57%-71%     74%    67%-80%     .040
Grandparent                   43%     36%-50%     44%    35%-50%
Other relative                43%     36%-50%     36%    30%-44%
Non-relative                  14%     10%-20%     20%    15%-27%


                                                                        40
Statistical equivalence of groups
Support Variables                       APAL        Non-APAL       Sig.
                                  X/%      95%CL   X/%    95%CL
Trouble obtaining medical care     4%      2%-8%    6%    3%-11%
Trouble obtaining dental care      9%     5%-13%    9%   6%-14%
Subsidy is inadequate             67%    60%-74%   63%   56%-70%
Contact w. birth mom              77%    72%-84%   79%   72%-84%
Contact w. birth dad              45%    38%-52%   43%   36%-50%
Contact w. child’s siblings       72%    65%-78%   78%   72%-84%
Help with child care in HH        42%    35%-49%   37%   30%-44%
Help with child care outside HH   49%    42%-56%   50%   42%-57%
Family could care if CG ill       94%    90%-97%   88%   82%-92%   .006
Most people can be trusted        24%    19%-31%   19%   14%-25%
                                                                      41
Regression Adjustment

    APAL (v. Non-APAL)                    εrror component
                    δ



                                          Unmet needs
                                          BPI
                                          Think Ending
                    β                     Satisfaction
     Age at interview, SGH, Psy. Hosp.,   Placement ruptures
     HH Income & Family care if ill
General Linear Model Results
Variables                            Unmet Needs             BPI
                                     b        Sig.    b            Sig.
APAL                                -.076     n.s.   -1.57         .037
Annual income under $31,000         -.080            1.16
Subsidized guardianship             .035             1.87          .013
Family could care if CG ill         -.211            -.649
Psy. Inpatient since finalization   .301             9.18          .000
Age at interview                    -.013            -.229
Constant                            .738      .071




                                                                          43
General Linear Model Results
Variables                            Think Ending     Satisfaction w
                                                        Providers
                                     b         Sig.    b         Sig.
APAL                                .100              -.035
Annual income under $31,000         -.121             .263       .048
Subsidized guardianship             .160       .044   -.302      .012
Family could care if CG ill         -.362      .048   .039
Psy. Inpatient since finalization   .470       .036   -.274
Age at interview                    -.024             .039
Unmet needs                         .080              -.012
BPI                                 .026       .000   -.012
Constant                            1.60       .000   2.20       .000
                                                                        44
Relative Risk of Rupture

As of September 30, 2009

             Sample Frame            Sample           Completions
              APAL     Non-APAL    APAL    Non-APAL   APAL    Non-APAL
N              1,980       2,178     355        355     232         215
Possible         94           85      11         10       5           2
ruptures
%             4.75%        3.90%   3.28%      2.99%   2.16%      0.80%




                                                                    45
Prevalence of Unmet Needs

Concern: Most families do not have the necessary
  supports to weather the challenges of parenting
  special-needs children, especially as they enter
  adolescence.
Fact: Seventy-six to 84% caregivers report focal
  children have no unmet needs.
     Orthodontia, respite care, and family preservation are least
      likely to be received.
     Unmet need is less an issue of linkage and more a problem
      of policy.
                                                                     46
Risk of Post-Permanency Ruptures

Concern: The late 1990s push for adoption and
 guardianships will eventually translate into thousands
 of children’s returning to foster care?
Fact: Less than 10% of adoptive and guardianship
  placements likely to rupture for host of reasons (e.g.
  CG death or disability, juvenile detention, runaways,
  and behavioral issues).



                                                           47
EFS Question (PICO)

   Does the diversion of children in pre-existing kinship
    care arrangements (P) to Extended Family Support
    Programs (I) safely reduce the number of children in
    foster care (O) compared to regular investigation
    practices (C)?




                                                         48
Alternative Response
      Extended Family Support




                                49
CERAP Question (PICO)

•   Is the rate of short-term recurrence of indicated
    maltreatment reduced (O) for children and young
    persons under 18 years old (P) when structured
    safety assessments are conducted (I) compared to
    investigation processes that do not feature structured
    assessments(C)?




                                                         50
      Safety Assessment: CERAP

   Secular trend study examines recurrence rates
    before and after the point in time (December 1,
    1995) when the implementation of CERAP
    occurred.
   This is the date that all Department of Children
    and Family Services (DCFS) workers and
    private providers had been trained in the use of
    the protocol and over 99 percent had been
    successfully certified.

                                                       51
60-day recurrence rates for first reports in
time period: Sequence A, Excluding PCs
  3.0

  2.5

  2.0                                                                           1.73
                                                                                        1.47
  1.5                                                                                           1.26
                                                                                                        1.08 1.11
  1.0                                                                                                                   0.85
                                                                               Implementation                                  0.73
                                                                               Year

  0.5

  0.0
        12/85 - 12/86 - 12/87 - 12/88 - 12/89 - 12/90- 12/91 - 12/92 - 12/93 - 12/94 - 12/95 - 12/96 - 12/97 - 12/98 - 12/99 - 12/00 - 12/01 -
         11/86 111/87 11/88 11/89 11/90 11/91 11/92 11/93 11/94 11/95 11/96 11/97 11/98 11/99 11/00 11/01 11/02



                                                                                                                                                 52
60-day recurrence rates for first reports in
time period: Sequence A, Excluding PCs
  3.0                    2.79
        2.63 2.65

  2.5                           2.23                                   2.30

                                                  1.84 1.79
  2.0                                   1.77 1.80                               1.73
                                                                                        1.47
  1.5                                                                                          1.26
                                                                                                       1.08 1.11
  1.0                                                                                                                   0.85
                                                                               Implementation                                  0.73
                                                                               Year

  0.5

  0.0
        12/85 - 12/86 - 12/87 - 12/88 - 12/89 - 12/90- 12/91 - 12/92 - 12/93 - 12/94 - 12/95 - 12/96 - 12/97 - 12/98 - 12/99 - 12/00 - 12/01 -
         11/86 111/87 11/88 11/89 11/90 11/91 11/92 11/93 11/94 11/95 11/96 11/97 11/98 11/99 11/00 11/01 11/02



                                                                                                                                                 53
Recurrence Controlling for Race




                                  54
Well-Being Question (PICO)

•   Is the well-being (O) of children at the margin of
    removal (P) improved if they are placed into foster
    care (I) compared to similar children who are left in
    their homes (C)?




                                                        55
Approximating the Counterfactual


   Most families are effectively randomized to
    investigators.
   Different investigators have different removal
    propensities (strict to lenient).
   What happens to cases when investigators
    disagree about removal recommendations?


                                                     56
Investigator Rotational Assignment
  The key variable is how lenient or strict an
  investigator is when it comes to making removal
  decisions.
  In the language of economics, we call this variable
  an ―instrumental variable‖ if it meets two primary
  conditions:
        (1) investigator removal differential predicts
       the likelihood of removal from the home;
       and
        (2) the differential itself doesn’t have a direct
       impact on the outcome, except through its
       effect on removal.
                                                            57
Instrumental Variable Model


     Intervention (v. Comparison group)             εrror component
                         δ
          π

              Z (Instrumental variable)             Outcome
            Here, Z = Investigator Removal Differential: In
            cases other than a particular family’s case, what
            fraction of children investigated by that family’s
                         β
            investigator are placed, relative to placement rates
     Populationother investigators on the same team in a given
            of conditions
            year.
                                                                   58
                       Marginal Cases
                                      Inv’gator 1     Inv’gator 2




                                             Area of
                                             Disagreement

                       Never placed                              Always placed



     Low Safety Risk                        SR1            SR2          High Safety Risk



Strict Investigator 1 removes if SR > SR1         Lenient Investigator 2 removes if SR > SR2
                                                                                           59
 Detrimental Impact of Foster Care
  Children at the margin of removal perform worse
  when they are removed from home1:
         3x Higher Arrest Rate
         3x Higher Delinquency
         2x Higher Teen Motherhood
         40% Lower Employment
         No Effects for Childhood Burns / Broken Bones;
         But 3x more likely to receive well-child visits.
1Doyle,  J. J. (2007a). Child protection and child outcomes: Measuring the effects of
foster care. The American Economic Review, 97(5), 1583—1610. Doyle, J. J. (2008).
Child protection and adult crime: Using investigator assignment to estimate causal
effects of foster care. Journal of Political Economy, 116(4), 746—770.                  60
                            U.S. Foster Care Rates

                          16.0


                          14.0


                          12.0
Per 1,000 Children 0-18




                          10.0

                                              U.S. Total Foster Care
                           8.0


                           6.0
                                                                       6.3 per 1000

                           4.0


                           2.0


                           0.0



                                                                                61
U.S. & IL Foster Care Trends

                           16.0       IL Foster Care


                           14.0


                           12.0
 Per 1,000 Children 0-18




                           10.0


                            8.0


                            6.0
                                  U.S. Foster Care
                            4.0


                            2.0


                            0.0



                                                       62
U.S., CA, & IL Foster Care Trends


                              16.0       IL Foster Care


                              14.0


                              12.0
                                                        CA Foster Care
    Per 1,000 Children 0-18




                              10.0


                               8.0


                               6.0
                                     U.S. Foster Care
                               4.0
                                                 2020 Goal 3.3 per 1000
                               2.0


                               0.0



                                                                         63
End of Foster Care as We Know It?


 Is it possible to reduce IL foster care below the 2020
 goal by further reducing detrimental removals of
 children from their homes and expediting permanence
 for children through reunification, adoption, and
 guardianship?




                                                      64
Contrasting Intra-State Dynamics




                                   65
                     Conclusions

   Strong evidence that subsidized guardianship is a
    cost-effective program for reducing the number of
    children in long-term foster care with relatives.

   Moderately strong evidence that direct outreach by
    agencies may not be the most effective means of
    linking families to needed post-permanency services.
       Better to facilitate self-reporting of unmet needs as part of
        annual recertification process.
       Establish ―hotline‖ for more pressing problems.
                                                                        66
                 Conclusions

   Weaker but compelling evidence that alternative
    response to children in pre-existing kinship care and
    the use of structured safety assessment can safely
    reduce the number of foster care removals.

   Moderately strong evidence that children at the
    margin of removal fare better when they remain
    home.


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