1. Latest Findings from Assisted Guardianship Waivers: Tennessee and Wisconsin
Presentation to the 12th Annual Title IV-E Child Welfare Demonstration Projects Meeting
June 17, 2008

2. Tennessee Subsidized Guardianship Waiver Demonstration:
Preliminary Outcomes
Leslie Cohen
Children and Family Research Center
Viola Miller, Commissioner TN DCS
Mark Testa, Director CFRC
June 17, 2008

3. National Perspective Enter page title here! Fostering Results
Currently, 35 states and DC have subsidized Guardianship Programs (funding sources vary)
Since 1996, 12 states have been given waiver authority to test a federally supported guardianship program: Tennessee, Delaware, Illinois, Iowa, Maryland, Minnesota, Montana, New Mexico, North Carolina, Oregon, Wisconsin, and Virginia.

4. National Perspective Enter page title here!
Fostering Results
Legislation to provide a federally subsidized guardianship program has been proposed in the 110th Congress:
H.R.2188 Kinship Caregiver Support Act
S.661 Kinship Caregiver Support Act
S Adoption Incentive and Relative Guardianship Support Act of 2008

5. Availability of SG boosted legal permanence
At wave I of the evaluation (1998) there was a 8% permanency advantage for children in the experimental group who were offered the choice of subsidized guardianship compared to children in the control group.
Illinois
}8.3%

6. Availability of SG boosted legal permanence
} 6.0%
Illinois
At wave II of the evaluation (2000) there was still a 6% permanency advantage.
Are These Results Generalizable?

7. Tennessee Subsidized Guardianship Waiver Demonstration Project
In October of 2005, the Tennessee Department of Children’s Services (DCS) received HHS approval to operate a five-year demonstration of permanent guardianship as a federally subsidized permanency option under title IV-E.

8. Tennessee Subsidized Guardianship Waiver
Waiver demonstrations should demonstrate that a policy change would be in the best interest of children:
The goal of Tennessee’s Subsidized Permanent Guardianship Demonstration is to improve permanency and safety outcomes for children and families in approved relative and kin settings. The State is using the waiver authority to test whether the introduction of a subsidized permanent guardianship benefit will result in an increase of permanence and safety for children and an improvement in a range of child outcomes such as reduced length of stay in foster care and improved stability of substitute care.

9. Target Population
The target population consists of all title IV-E eligible and non-IV-E eligible children in Tennessee, aged 0 to years old, who meet the following criteria: have been in foster care for at least nine (9) months (of the latest 12 months); live in a approved relative setting or resided with the same kin caregiver continuously for at least six (6) months (allowing for temporary absences from the home); and for whom reunification and adoption are not viable permanency options.

10. Target Population
Implementation of the demonstration began in December of 2006 and will initially occur in 16 counties (see Map 1). In addition, the State made eligible for assignment all children statewide who have a goal of planned permanent living arrangement (PPLA) and meet other program requirements.
Guardianship Program will initially occur in 16 counties throughout the State.
Approximately 1,500 children will be a part of the five-year waiver demonstration.

11. Enter page title here! Ten Objectives
Evaluate the impact of the subsidized permanent guardianship waiver on:
children’s safety.
the number of children in PPLA.
permanence for children with relatives and kin.
the length of stay in foster care.
the rates of reunification and adoption.
the rate of re-entry into foster care.

12. Ten Objectives (cont’d)
Enter page title here!
Ten Objectives (cont’d)
In addition, the evaluation will:
Track the number and proportion of guardianships that are disrupted or dissolved and the reasons for the displacement.
Assess the implementation of the subsidized guardianship waiver.
Estimate the overall savings accrued from a greater level of permanence achieved by the treatment group.

13. Experimental Design
The classic experimental design used in this study is the best way to determine causal connections between interventions and outcomes.
The control group will receive the “regular services” and full range of permanency options in effect in Tennessee prior to October 2006 for which they are eligible—including reunification, subsidized adoption, and PPLA. Those in the treatment group will be offered the additional option of subsidized permanent guardianship. This is a value added program because nothing is taken away from the control group.
Thus, we will study the effects of the treatment services relative to services that would have been provided in the absence of the subsidized guardianship option.

14. Group Assignment Criteria Group Assignment occurs when:
The child has been in the custody of the state for 9 months or more immediately prior to establishing subsidized permanent guardianship and is likely to remain in care.
The child has lived with a relative or kin caregiver for at least six months immediately prior to establishing subsidized permanent guardianship.
The child’s committed county must be Shelby, Davidson, or an Upper Cumberland County.

15. Group Assignment Criteria
Relative vs. Kin
Relative:
The child and the caregiver must be related by blood, marriage, or adoption.
Kin:
A person with whom the child has a significant relationship that pre-exists placement such as godparent, friend, neighbor, church member, minister, teacher or
A relationship that develops over time after placement has been made.

16. Group Assignment Control Group Experimental Group
A child between the ages of 0 and is eligible for group assignment when he or she:
is in the foster care system for 9 months
is living with an approved relative caregiver or kin for 6 months
has a committed county of Shelby, Upper Cumberland, or Davidson
When eligibility is met the child
will be randomly assigned to
the experimental group
or control group at a 1:1 ratio
Experimental Group
Eligible for
subsidized perm. guardianship
and eligible
for all traditional permanency
alternatives
Control Group
Not eligible for
subsidized perm. guardianship.
Eligible
alternatives, including permanent
guardianship

17. Randomization
Randomization was successful in balancing (within the bounds of chance variation) the characteristics of children and their caregivers who were assigned to the demonstration and cost neutrality groups.
Because the two groups look statistically similar at the start of the waiver, any differences that later emerge with respect to permanency outcomes and days spent in foster care can reasonably be attributed to the offer of subsidized guardianship to the demonstration group.

18. Randomization Demonstration Cost Neutrality Difference
Demonstration
Cost Neutrality
Difference
Child age at assignment
11.0 yrs.
11.1 yrs.
-0.1
Age at removal
7.2 yrs.
7.4 yrs.
-0.2
Female
48.1%
48.4%
-0.2%
White
32.4%
30.0%
2.4%
Black
65.9%
65.6%
0.3%
Caregiver age at interview
47.9 yrs.
48.5 yrs.
-0.6
32.8%
31.1%
1.6%
63.9%
66.7%
-2.8%
Grandparent-grandchild
26.7%
23.8%
2.9%
Aunt/Uncle-niece/nephew
25.7%
28.2%
-2.5%
Other Relatives
16.2%
15.0%
1.2%
Non-biological kin
31.4%
33.0%
-1.6%
Sample N
293
273

19. Randomization
 Site at Assignment
Demonstration
Cost-neutrality
Difference
Davidson
35.8%
37.7%
-1.9%
Shelby
41.0%
40.3%
0.7%
Upper Cumberland
23.2%
22.0%
1.2%
Sample N
293
273
The demonstration and cost neutrality groups are well balanced with respect to geographical distribution: nearly equivalent proportions of children were assigned in the principal demonstration sites of Davidson, Shelby, and Upper Cumberland.

20. Outcomes
The December 2007 data extract for Tennessee shows a 12.9 percentage point higher rate of discharge to permanent homes from foster care in the demonstration group compared to the cost neutrality group. This is an important and statistically significant difference that replicates similar results previously reported for Illinois and currently for Milwaukee, Wisconsin-- the two jurisdictions that also operate a IV-E waiver program similar to Tennessee’s program.

21. Outcomes Enter page title here! Fostering Results
78 Guardianships were completed between December 2006 and November 2007
Of the 78 guardianships finalized in the demonstration group, 28 were completed in the first quarter of 2007, 22 in the second quarter of 2007, and 20 in the third quarter of As of November 30, 8 guardianships were completed during the fourth quarter of 2007.

22. Outcomes
There are substantial differences among demonstration sites with respect to how the offer of subsidized guardianship has impacted permanency outcomes:
Davidson- 28.6% of assigned children were discharged to permanent guardianship, which boosted the net permanency gain over the cost neutrality group to 11.6%.
Shelby- 33.3% of assigned children were discharged to permanent guardianship, which boosted the net permanency gain over the cost neutrality group to 19.5%.
Upper Cumberland- 11.8% of assigned children were discharged to permanent guardianship, which resulted in a statistically insignificant difference of 2.5% between the two groups

23. Next Steps
Determine whether the comparatively lower utilization of subsidized guardianship in Upper Cumberland reflects implementation shortfalls or other contextual differences that may limit the generalizability of the results for Davidson and Shelby to other geographical areas in Tennessee.

24. Expansion Sites
On July 1, 2008, the State will roll-out the demonstration to an additional 24 counties. An additional 12 counties will be brought in on October 1, 2008, and the remainder of the State will be included in 2009.
Approximately 1,500 children will be a part of the five-year waiver demonstration.

25. WISCONSIN SUBSIDIZED GUARDIANSHIP ASSESSMENT
AND EVALUATION
Interim Evaluation Report
Presentation to the 12th Annual Title IV-E Child Welfare Demonstration Projects Meeting
June 17, 2008

26. Presenters Denise Revels Robinson David Sorenson George Gabel
Director, Bureau of Milwaukee Child Welfare
David Sorenson
Performance Planner, Office of Program Evaluation and Planning, Wisconsin Department of Health and Family Services
George Gabel
Evaluation Project Director, Westat

27. Overview
Federal Waiver became effective on September 23, 2004 and was approved for a 5-year period.
State enabling legislation was approved as part of the 2005 state budget bill, Wisconsin Act 25.
Program implementation began in October 2005 in Milwaukee County.
DHFS completed a RFP for evaluation of the subsidized guardianship program.
Westat, based in Rockville, Maryland, was awarded the Evaluation Contract in November 2005.

28. Eligibility Requirements
Target population: Children currently in a licensed relative foster care placement who have been in out-of-home care for 9 months.
It has been determined that children will not be reunified and adoption as a permanency option has been discussed.
In rare instances, children placed with a licensed person who is recognized by the child as part of the extended family (distant relative, god-parent, etc.) will also be included in the program (like-kin).
In rare instances, children who have been in care for less than 9 months may be eligible for the subsidized guardianship program. These cases will be determined on a case-by-case basis.
Designed to increase the permanency options available to licensed relatives by creating the ability to provide payment in the amount of the foster care payment.

29. Waiver Specifics
Initial focus of subsidized guardianship is on Milwaukee County only.
Expansion to other counties may be considered at a later date on a voluntary basis.
Services are provided by the State of Wisconsin, Bureau of Milwaukee Child Welfare.
Implementation of subsidized guardianship is divided into 2 separate phases.

30. Phase 1: Special Experimental Group The “Grandfathered” Group
Children with a guardianship order previously transferred (including all children through December 31, 2005) who remained in foster care and met eligibility requirements.
209 children
128 converted to subsidized guardianship
0 closed to adoption
20 closed for other reasons
61 remain open in foster care
Close to aging out
Working towards reunification
AWOL
Placed with relative guardians who do not want to end services
Children were not subject to random assignment

31. Phase 2: Random Assignment
Children, who as of January 1, 2006, met eligibility criteria and did NOT have a guardianship order in place.
Once all eligibility criteria are met, children are randomly assigned to the intervention (experimental) or comparison (control) group.
Siblings/children in the same case are assigned together.
Caregivers are notified of their assignment by letters.
320 children received a program assignment
Intervention (Experimental) = 157
Comparison (Control) = 163

32. Phase 2: Requirements Children living in licensed family foster homes
Adoption rule-out not required
9 months in foster care
Currently with licensed relative
Children living with like-kin
Adoption has been ruled out
Approval of “like-kin” circumstance by supervisor and BMCW Program Manager
Fast-track children
Reasonable efforts of reunification not required or sibling of a child already in subsidized guardianship
Approval by supervisor and BMCW Program Manager

33. Phase 2: Where We Are Today
Children to be determined eligible for the remainder of the waiver period (through October 2010).
It is anticipated that approximately 80 children will be assigned each year of the waiver for a total of 400 children over the five year period.

34. Community Support
BMCW established communication with partners in the community early in the process.
BMCW worked closely with Milwaukee Children’s Court and legal parties to discuss legal procedural issues related to implementation.
BMCW has actively involved the Governor Appointed Partnership Council and Executive Committee in discussions and reports regarding the implementation of subsidized guardianship.

35. Evaluation Team Westat Children and Family Research Center
School of Social Work
University of Illinois at Urbana-Champaign
Institute for Research on Poverty
University of Wisconsin-Madison

36. Data Collection 315 caregiver phone surveys (Phase II)
95% response rate
Case manager survey (Phase II)
80% response rate on Part 1
67% response rate on Part 2
eWiSACWIS data on 529 children (Phase I&II)
Focus groups with case managers, caregivers, youth, judges and court staff
June-October 2006 (Phase I)
June-August 2007 (Phase II)

37. Implementation of the Waiver
The waiver has garnered support among the staff, courts, and families.
Adoption rule-out is not required, but in practice, many case managers and court staff believe rule-out is still necessary.
Families and case managers are concerned about potential loss of services.
Many intervention group families did not hear about the new SG option.
rule-out practice
lack of case manager training
Concern from court and workers about difficulty of converting SG to adoption.
DA loses grounds for TPR after CHIPS order is dismissed
caregivers may have to pay out of pocket for a private TPR
Families receive only Title XIX services after SG, which does not cover everything. Many families do not know whom to call for post-SG services, and end up calling their former case manager. Intervention group families who already had a TPR were not informed about SG in the first wave of RA. Later, case managers reported difficulty in determining a child’s assignment, and may also have not discussed SG with intervention families if there was a chance for adoption instead.

38. Who are the caregivers? Majority are African American
Nearly ¾ work full- or part-time
Nearly ¾ attended a religious service in the last month
Over half had college education
Almost all felt they had enough money to take care of their families
Almost all had support to help care for their children if the caregiver became ill

39. Who are the children? Majority are African American
Overall, half are between the ages of 6-13, ¼ are under 6 years old, and ¼ are 14 or older
Overall, half are male and half are female
Nearly half have IEPs
Over half have some type of reported disability

40. A positive outlook for the children
Nearly all children are in good or excellent health
Nearly half of the children between 6-13 years old display high levels of pro-social behavior
Over half of the children’s caregivers believe that their child will go to college

41. What are we trying to learn?
Does the waiver...
increase rates of permanence for children in foster care?
increase the use of licensed relatives as placement resources?
reduce the number of disrupted placements for children in foster care?
not change the rate of reunification and adoption for children in foster care?
not increase the costs of providing foster care?

42. The answers so far...
Has the waiver increased rates of permanence for children in foster care?

43. The answers so far...
Has the waiver increased the use of licensed relatives as placement resources?
The rate of licensed relative homes appears to have gone down
Case managers report concerns about burden of licensing on families
Family might not qualify
Family might end up in comparison group
Case managers reported reluctance to put families through the licensing process if they did not think the family would qualify, or if they thought the family might end up assigned to the comparison group. They also felt that the licensing standards were being applied more stringently now.

44. The answers so far...
Has the waiver reduced the number of disrupted placements for children in foster care?
No statistical difference in placement disruption between the intervention and control groups
To date, only one child in subsidized guardianship from Phase I has returned to foster care; none have returned from Phase II

45. The answers so far...
Has the waiver not changed the rate of reunification and adoption for children in foster care?
Rate of adoption remains the same
BMCW decided not to notify families with children with existing TPR about SG
Mainly assignments from January 2006
Needs to be watched closely for new assignments

46. What to watch for....
Will the culture around adoption rule-out change?
Will all families be informed about the waiver?
Will the increase in permanence continue?
Will cost neutrality be maintained?

47. Permanence to guardianship
The rate of subsidized guardianship in comparison with reunification and adoption has declined through Phase II
Phase I
Exempt-
ions
Phase II
Phase II assignments
2006
1st Q
2nd Q
3rd Q
4th Q
2007
Total
Guardianships
117 11 26 3 1
160
Guardianship
Permanency Ratio
117:1
1.83:1
0.34:1
.75:1
.06:1
.09:1
.01:1
0:1
1.19:1

48. Next steps for the evaluation
Continue with random assignment through September 2010
Continue caregiver interviews through April 2010 assignments
Continue obtaining cost data
Medicaid expenditures
Revenues from child support orders
Additional analysis
Reentry
Incidents of maltreatment
Social capital
If funding is available, in-person survey of all caregivers and children

49. Questions?

50. For further information
DCFS:
David Sorenson (608)
BMCW:
Denise Revels-Robinson
(414)
Westat:
George Gabel (301)
Robert Hill (301)
CFRC:
Mark Testa (312)
IRP:
Kristen Shook Slack (608)

51. Discussion Topic

52. Availability of SG boosted legal permanence
At wave I of the evaluation (1998) there was an 8% permanency advantage for children in the experimental group who were offered the choice of subsidized guardianship compared to children in the control group.
Increase in both adoptions and guardianships
}8.3%
Illinois

53. }20.1% External Validity: SG boosted legal permanence
At wave I of the evaluation (2007) there was a 20% permanency advantage for children in the experimental group who were offered the choice of subsidized guardianship compared to children in the control group.
Increase in both adoptions and guardianships
}20.1%
Milwaukee, WI

54. }12.9% External Validity: SG boosted legal permanence
After one year of implementation (2007) there was a 13% permanency advantage for children in the experimental group who were offered the choice of subsidized guardianship compared to children in the control group.
But net gain came at the expense of adoptions
}12.9%
Tennessee

55. Future net gains also came at expense of adoptions in Illinois
At wave II of the evaluation (2000) there was still a 6% permanency advantage, but perhaps two-thirds of the completed guardianships might have eventually converted into adoptions in the absence of the option.
} 6.0%
Illinois
Is the net gain in permanence
worth the loss in adoptions?

56. Wider availability of guardianship is prompting a rethinking of the meaning of permanence
Original meaning of permanence as lasting
Rooted in the psychology of bonding and attachment that defines permanence as a lifelong relationship that arises out of feelings of belongingness among persons.
Newer meaning of permanence as binding
Rooted in law that defines permanence as a lifelong commitment that is legally enforceable.
Redefinition demotes guardianship as a permanency goal
Newer thinking establishes a hierarchy of permanency goals. Requires ruling-out of reunification and adoption prior to pursuing guardianship. Guardianship is less binding because it is more easily vacated by the caregiver & more vulnerable to legal challenge by birth parents than termination of parental rights and adoption.

57. Binding vs. Lasting Permanence as Binding Permanence as Lasting
Commitment needs to be legally binding to qualify truly as permanence.
Hierarchy of permanency goals: reunification, adoption, followed by guardianship.
Strict interpretation of “rule-out” that adoption needs to be ruled out independently of the desires of the family.
Supported by federal waivers, IL statute, ABA, NCJFCJ
Permanence as Lasting
Relationship not certain to last forever but intended to last indefinitely.
Least restrictive (most family like) principle.
Full disclosure of permanency options that allows kin to choose option that best fits cultural norms of belongingness.
Consistent with ASFA.

58. Issue
Are the biological bonds and social attachments of kinship sufficiently lasting to ensure a family's intention to raise a child to adulthood? OR
Must the commitment be made legally binding through formal adoption for the intention to endure?

59. Questions
Do the intentions of adoptive parents to raise a child to adulthood differ from the intentions of guardians?
Are guardian homes any more likely to disrupt than adoptive or foster homes?
Do private wards express any lesser sense of belonging to the family than children who are adopted?