TITLE IV-E WAIVER SITE VISIT JULY 6, 2016 Birth & Beyond Home Visitation Program AmeriCorps Impact Evaluation | 2013 - 2015

Family Resource Centers 9 Birth & Beyond Family Resource Centers Arcade Community Center Firehouse Community Center Folsom Cordova Community Partnership La Familia Counseling Center Meadowview Family Resource Center North Sacramento Family Resource Center River Oak Family Resource Center at Dunlap House in Oak Park Valley Hi Family Resource Center WellSpace Health’s North Highlands Multi-Service Center 2 1 3 6 7 4 8 5

Birth & Beyond Family Resource Centers Sacramento County Child Protective Services Walk-ins, Hospitals, Schools, Community Partners Family Resource Center Parenting Workshops Crisis Intervention Services School Readiness NPP Home Visitation Differential Response and Aftercare for families with children 0-5 years Parent Support Line

CPS Referrals by Zip Code Sacramento County CPS Referrals by Zip Code

Children Served by B&B Visitor (2013-15) 4,588 Children 0-5 years old served B&B Families Served 24% 36% 42% 63% Mother pregnant at intake First time parents 2 or more children 0-5 years old 2 or more children of any age

Parents Served by B&B Visitor (2013-15) Race/Ethnicity Age Used a control group to compare 496 B&B parents who received B&B Home Visitation AND had previous CPS HX to 985 parents with similar CPS HX who did NOT receive B&B HV services Non HV comparison group “matched” (using Propensity Score Matching ) to HV B&B parents using series of available indicators (ethnicity, age, language, children in household This slide displays results for those families served by AmeriCorps Home Visitors partially funded by the Corporation for National and Community Service Snapshot of demographics of parents served by AmeriCorps Home Visitors Evaluation studied a parent’s changes in knowledge, skills, beliefs attitudes, and finally behaviors Marital Status

Since 2001 B&B has had positive results in reducing referrals to CPS Past Evaluation| Did Birth & Beyond Parents Have a Reduced Rate of CPS Referrals? CPS ‘look up’ study conducted annually since 2001 Consistently positive results for CPS outcomes Half of B&B parents had a prior history of CPS referral (including as victim) However, all B&B parents with at least 8 hours of HV had a reduced rate of CPS contact one year after their case closure Since 2001 B&B has had positive results in reducing referrals to CPS Past Evaluations were an OBSERVATION STUDY and found that - 50% of parents served by B&B had prior history with CPS ALL parents who received at least 8 hours of B&B home visitation services had reduced rate of CPS contact one year after closure from B&B home visitation

CPS Referrals for Birth & Beyond Parents Past Evaluation| CPS Referrals for Birth & Beyond Parents Receiving 8+ Hours of HV Programming (2010-2014) n = 2,512 Pre Program Post Program Substantiated Inconclusive 2010-2014 Past Evaluation for B&B Parents Evaluation looked at the Pre/post referral history of 2512 parents who started B&B PRE-PROGRAM (Prior to B&B services) 50% of parents had prior CPS history POST-PROGRAM ONLY 3.5% of parents with prior CPS history had any substantiated subsequent contact with CPS one year after B&B services ended Nearly 97% had no substantiated referrals Unfounded/unknown No history

AmeriCorps Home Visitors Only Current Evaluation| Will any parent participating in Birth & Beyond have a reduced rate of CPS referrals? Quasi-experimental study includes all HV parents, with CPS history, who were ‘touched’ by AC member in 2013-2015 program years Impact evaluation allows for the direct attribution of positive changes to HV program (i.e., provides ‘higher-level of evidence’ of program effectiveness) AmeriCorps Home Visitors Only Answer the Question – Will any parent receiving B&B home visitation services have a reduced rate of CPS referrals? For this study conducted by external evaluators LPC Consulting Associates and JBS International B&B used a quasi-experimental design that provides highest level of evidence possible (while not denying services as the higher rigor of Randomized Control Trials) given available data

Current Evaluation Compares HV parents (n=496) with previous CPS history to non-HV parents (n=985) with similar CPS history Controls for bias that some individuals are more willing/likely to participate in HV program Accounts for rolling program entries and exits Holds all demographic factors constant to compare CPS recidivism over time Included all parents served by AmeriCorps members who exited B&B HV services from 2013-2015 and had previously come to the attention of CPS Identified a similar group of parents from child welfare records and used them to see if participating in B&B HV made a difference in the likelihood they would have a future SUBSTANTIATED allegation of maltreatment Controlled for factors in the comparison group such as number and severity of previous allegations, time since eligibility for treatment and parent demographics

Current Evaluation | Findings All parents participating in HV were 41% less likely to have a substantiated referral over a four-year period than non-HV parents. Parents with 25-36 hours of HV were 173% less likely to have a substantiated referral over a four-year period than non-HV parents. Parents with at least 8 hours of HV showed an average decrease in risk/increase in parenting skills as measured by the AAPI (statistically significant at p < 0.01)

Study went out to about 4.5 years – 1600 days – used real data in that it followed both B&B HV parents and the comparison group to track recidivism Graph shows the llkelihood to recidivate generally increases over time AND how risk to recidivate is DIMINISHED with B&B HV parents 173% of HV B&B parents were less likely to have a future SUBSTANTIATED allegation than those who had not received services This result applies to the end of the study period - is the DIFFERENCE in having a SUBSTANTIATED allegation after 1600 days between those parents who received B&B NPP HV services and those who had not received services This is a SURVIVAL ANALYSIS model meaning We can expect these results from ANY parentswho participates in B&B HV not just those parents who actually did participate

Current Evaluation | Summary CPS Recidivism | All parents participating in HV have a reduced likelihood of new CPS referrals. Optimal Hours | Those parents receiving 25-34 hours of HV have the greatest reduction in the likelihood new CPS referrals. Results indicate participating in B&B Home Visitation makes a statistically significant positive impact on parents risk of future child maltreatment The findings of this study provide strong evidence that Birth & Beyond home visitation supports Sacramento County parents and their families by reducing the risk of child welfare referrals after participating in the program.

Birth & Beyond Home Visitation Return on Investment Average cost of Birth & Beyond home visitation - $700 per parent annually. Average cost per child protection case (Centers for Disease Control and Prevention 2011) - $210,000 annually. Sacramento County saves significant dollars annually by keeping children out of the child protection system.