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Fostering a Permanent Home : A Mixed Methods Evaluation of the ZERO TO THREE Court Teams for Maltreated Infants and Toddlers Initiative Kimberly L. McCombs-Thornton,

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Presentation on theme: "Fostering a Permanent Home : A Mixed Methods Evaluation of the ZERO TO THREE Court Teams for Maltreated Infants and Toddlers Initiative Kimberly L. McCombs-Thornton,"— Presentation transcript:

1 Fostering a Permanent Home : A Mixed Methods Evaluation of the ZERO TO THREE Court Teams for Maltreated Infants and Toddlers Initiative Kimberly L. McCombs-Thornton, PhD University of North Carolina at Chapel Hill December 10, 2011

2 Outline Background and significance ZTT Court Teams program Quantitative study Qualitative study Limitations and Discussion 2

3 Background and Significance Infants experience highest rate of victimization; toddlers second – Infants (< age 1): 20.6 per 1000 – Toddlers (age 1): 11.9 per 1000 – Toddlers (age 2): 11.3 per 1000 Developmental needs of young children are time sensitive The caregiver is important for the childs healthy development Infants and toddlers in child welfare are at risk for – Attachment disorders – Poor physical health 3

4 Background and Significance The Adoption and Safe Families Act (ASFA) of 1997 seeks to expedite the time to reach a permanent, stable home for children in child welfare A permanent home may include: – family reunification – legal guardianship – or traditional adoption More children appear to be reaching permanency since ASFAs enactment, though the need is still great – Adoptions rose 64.5% in the three years following ASFAs enactment – Represents only 28% of children eligible for adoption during these years 4

5 ZTT Court Teams Project Judge Community Coordinator Court Team -DHS case worker -CASA -Attorneys -Providers -Etc. Monthly Case Reviews Referral to Child- focused Services Child-Parent Psychotherapy Evidence-Based Parent Education ZTT National Office Activities -Training and TA -Resource materials -M and E Decrease in Time to Permanency Reduction in Recurrence of Maltreatment Improved Child Well-being LOCAL ACTORSACTIVITIESLONG-TERM OUTCOMES TARGET GROUP: CHILDREN ENTERING FOSTER CARE BEFORE AGE 3 5

6 Previous Evaluation JBA completed evaluation in 2009 – Process oriented – 95% of closed cases reached permanency – 55% of those reached permanency within one year Problem of causal No comparison Problem of causal inference group inference 6

7 Study Aims Aim 1: Determine the effect of the ZTT Court Teams project on time to permanency. Aim 2: Assess the influence of the ZTT Court Teams program on how children exit the foster care system. Aim 3: Examine successful and unsuccessful cases to understand how program components and/or client characteristics contribute to time to permanency. 7

8 Causal Inference Q: How do we know outcomes are due to the program? A: Need a comparison group Basic Advanced Pre/post Secondary Matched Randomized Test Data as Comparison Experiment Comparison Group (w/ control group) 8

9 Quantitative Data 9

10 10

11 Case Characteristics 11

12 Propensity Score Propensity score = association between covariates and group membership 12

13 Selection into ZTT Court Teams How child selected within a site: -Child under age of 3 at time of entry into child welfare system -Either all young children assigned to Court Teams judge or randomly assigned 13

14 Predictors of Time to Permanency Reasons for Removal Community Characteristics Child Characteristics Parent Characteristics 14

15 Aim 1 Determine the effect of the ZTT Court Teams project on time to permanency. 15

16 Aim 1 2 Outcome Measures: – Time to move in permanency – Time to official permanency Methods : – Time to event analysis with propensity score weights – Test for proportional hazards – Diagnostics 16

17 Aim 1 Time to move in permanency 17 ZTT cases move into what becomes the permanent home 1.5 to 2 months faster on average

18 Aim 1 Time to move in permanency -Kaplan Meier -Time to Event Analysis Parametric model (Gompertz): HR = 1.06 (CI.67, 1.65) p=.81 18

19 Aim 1 Time to official permanency 19 ZTT cases exit foster care one year earlier on average

20 Aim 1 Time to official permanency -Kaplan Meier 20

21 Aim 1 Time to official permanency -Time to Event Analysis ZTT cases exit foster care nearly three times as fast as the comparison group 21 Parametric model (Weibull ): HR = 2.67 (CI 1.65, 4.31) p=.000

22 Aim 2 Assess the influence of the ZTT Court Teams program on how children exit the foster care system. 22

23 Aim 2 4 ways to exit foster care: -Reunification -Adoption -Relative custodianship -Non-relative legal guardian fastest slowest 23

24 Aim 2 Type of Foster Care Exit ZTT Court Teams (n=298) NSCAW sample (n=511) pctsepctse Reunification37.6% (.047) 29.3% (.042) Adoption15.4% (.059) 40.7% (.045) Relative custodian24.8% (.085) 8.4% (.033) Non-relative guardian3.0% (.017) 1.6% (.007) Still in foster care at end of study period 19.1% (.068) 20.1% (.036) 24

25 Aim 2 Days until Exit Foster Care, by Type of Exit 25 8 months faster on average 10 months faster on average 3-4 months faster on average 10-13 months faster on average Patterns hold when use propensity scores in a competing risks analysis

26 Aim 3 Examine successful and unsuccessful cases to understand how program components and/or client characteristics contribute to time to permanency. 26

27 Aim 3 Examine successful and unsuccessful cases to understand how program components and/or client characteristics contribute to time to permanency. 27

28 Aim 3 Methods One-on-one open-ended phone interviews with each community coordinator; 2 interviews each Approach orientated to unique cases– discuss top and bottom decile in each site (Patton, 1990) Community coordinators perception of how each component of the program model contributed time to permanency for each case Record and transcribed calls Coded using Atlas.ti 28

29 Aim 3 Parents comply with service plan? Yes Reunification [The mother] is absolutely amazing that, what is she, 20 years old, she had two children with special needs that really require a lot of doctors visits. So she was able to show all the professionals in the system that she was able to follow through with all of these things. And at the same time, she was dealing with her own victimization issues and poor relationship choices…..The children were [ultimately] reunified with the mother. 29

30 Aim 3 Parents comply with service plan? YesNo ReunificationTerminate/Surrender/Suspend Parental Rights AdoptionLegal Guardian The mother would come into court every time positive for cocaine, refused to get any help….. She didnt approach it [the service plan]. She just didnt do anything….This child was only placed in one foster home… [who] adopted the child. 30

31 Aim 3 Parents comply with service plan? YesNoSomewhat ReunificationTerminate/Surrender/Suspend Parental Rights AdoptionLegal Guardian An inpatient drug treatment program was recommended for her. She went to one and she completed it. And then when she came out of course they recommended outpatient care and AA meetings and so forth. She started taking those and then slacked off. So that was a discussion in every hearing. Was she or was she not in compliance with the aftercare recommendation…. 31

32 Aim 3 32

33 Aim 3 Role of Judge in Time to Permanency: Motivate the parents [The judge] was very supportive and really wanted the children with their mother. And you know basically would encourage her and would actually praise her and tell her she was doing a good job and tell her to keep it up…assuring her we were going in the right direction… [The judge] is very good about praising when youve made progress on your service plan and youre doing what youre supposed to do. [The judge] became increasingly frustrated… and really confronted the mom on how the professionals were working harder than she was and her inability to take ownership for her part that she played in this. And confronting mom on not understanding the impact it had on the children. 33

34 Aim 3 Role of Judge in Time to Permanency: Motivate social support network Motivate the case workers Role as timekeeper 34

35 Aim 3 Role of Monthly Case Review in Time to Permanency: Keeping all on task Everybody stayed on task because they knew we were gonna be staffing and we were going to be in court. So there was no room for making, for example, making a referral a week before we go to court because we were always going to court. Usually CPS cases, the hearings are every 90 days. But with this, the parents know that they have to be in court every month. It gets them motivated to get on the ball so they dont have to go to the judge in 30 days to explain to the judge why they havent done what they are supposed to have done 30 days prior. Monitor parental compliance 35

36 Aim 3 Fast v. Slow case comparison Program is consistent across the cases - All have monthly case reviews -Judge has equal contact with cases 36

37 Aim 3 37

38 Conclusion The ZTT Court Teams program reduces time to official permanency, but not time to move in permanency More kids are exiting foster care through reunification and less through adoption Though – ZTT Court Teams cases are exiting faster regardless of type of exit The program operates consistently for both fast and slow cases The judge and the monthly case review components appear to be most linked to time to permanency 38

39 Limitations and Next Steps Quantitative study Propensity score subject to omitted variable bias Only considers childs first episode in child welfare Assess effect of number of court hearings Are all types of exits equal? Next step – cost effectiveness study 39

40 Limitations and Next Steps Qualitative study Only one person coded and analyzed data Sorted by time to move in permanency Collected before completed quantitative analysis Site differences – fidelity to the model? 40

41 Reflections Judge Constance Cohen Polk County, Iowa Judge Ernestine Gray Orleans Parish, Louisiana Judge Michael McPhail Forrest County, Mississippi 41


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