1. Ken Larimore, Ph.D., LISW-S
The Ohio Study: The Outcomes Data Project for Improving Foster Care Outcomes
Ken Larimore, Ph.D., LISW-S

2. Out of home placements in ohio
The number of kids in out of home care from 2009 to 2016 (This refers to kids in foster care, kinship care, group homes, and residential setting) in Ohio:
2009: 12,232
2011: 12,069
2013: 12,223
2015: 13,205

3. Background
The Ohio Association of Child Caring Agencies (OACCA) became a pioneer in developing one of the first software systems in the country for child welfare and behavioral health outcome management.
The OACCA Outcomes Data Project (ODP) was an innovative solution to support agencies’ abilities to measure their program performance and provide an objective basis for clinical and financial decisions.
The project was launched in 2007 with 22 OACCA member agencies participating in the pilot project. On January 1, 2010, the project became available to any OACCA agency desiring to participate. The project ended in June, 2016.
The project served its purpose and fulfilled its original goals including helping agencies improve child outcomes.

4. Goals of the project
To provide agencies with common outcome measurement tools at intake, through treatment, and into post-treatment;
To collect data to show the relationship between the presenting problems of children and families with the programs, settings, or services that provide the most effective, long-lasting treatment approaches;
To produce distinct, agency-owned data to support improvements to programs and services at the individual agency level;
To produce aggregate data analysis to support policy advocacy and to inform decision-makers about needed systemic changes at the state and county levels; and
To encourage participation in the Outcomes Data Project by all OAACCA member agencies.

5. Services Provided by participating agencies
Secure residential treatment
Open residential treatment
Group homes
Treatment foster care
Family foster care
Independent living

6. Outcome goals
1 – The problem severity of the child at admission will diminish through the course of treatment.
2 – The child will progress to a less restrictive living environment by the conclusion of the intervention and will maintain progress or improve to an even less restrictive environment post-discharge.
3 – By the conclusion of the intervention, grade performance will improve, the child will continue attending school or become employed, whichever is appropriate.
4 – The child will acquire developmentally appropriate skills required to function in the community.
5. The child will avoid involvement with law enforcement or the judicial system (excluding judiciary reviews, adoption, and traffic violations).

7. 6 –The child will will remain free of abuse and neglect post-discharge: there will be no need for contact or interaction with child protective services authority.
7 – The child will experience problem severity reduction through the course of treatment and progress to a less restrictive living environment upon conclusion of the intervention and post-discharge.
The findings from this study will be used by OACCA and member agencies as a tool for advancing project goals and improving services provided to children and their families.
One useful component of the project has been the development of monthly data reports for each participating agency to use for continuous quality improvement.

8. Population Characteristics: Observations
Children in Family Foster Care are overwhelmingly age 11 and below (81.3%)
Sixty percent of kids in Treatment Foster Care are age 12 or older.
Kids in Open Residential Treatment programs and Secure Residential Treatment programs are primarily ages 12 thru 17 (88.7% & 95.7%).
In both types of foster care, the sex of the kids served is divided nearly evenly; however, in Open Residential Treatment, males predominate (67.2%),, while in Secure Residential Treatment females predominate (57.2%).
Across the array of services, African-American kids disproportionately comprise the population mix. A somewhat smaller percentage of the kids in Family Foster Care are African-American (29.3%). In the other services, the percentage ranges form 32.4% to 46.7%.

9. 57.1% of kids in Family Foster Care have a stay of 6 months or less.
59.9% of the kids in Treatment Foster Care have a stay of six months or less.
Kids placed in Open Residential treatment and Secure Residential Treatment generally remain in care between 3 and 12 months (66.5% & 63.1%).
In all program types except Treatment Foster Care, agencies report that over 2/3 of the kids they serve experienced planned discharges. In Treatment Foster Care, the percentage drops to 55.5%.

10. Assessing the problems of kids: Ohio Scales & CANs
When the ODP was established, the Ohio Scales was the evaluation instrument utilized by many agencies across the state.
It was soon discovered that the Ohio Scales did not adequately address children ages 5 and below.
ODP began using the Devereux Early Childhood Assessment (DECA) for younger children.
Eventually, both instruments were abandoned and the Child, Adolescent Needs and Strengths (CANS) was adopted as a tool that could measure many of the outcomes identified in the ODP.

11. Problem severity: Ohio Scales
The Ohio Scales problem severity rates kids on the frequency of engaging in certain described disruptive behaviors.
A higher score indicate more problems or issues.
A score of 20 and above indicates clinical interventions may be necessary.
The pretest administration of the Ohio Scales is based on the problems and issues the child experienced in the month prior to admission to the program.
The post-test administration is based on the month prior to discharge of the child from the program.

12. Intake & discharge scores using the ohio scales
Family Foster Care Problem Severity – Aggregate Comparison of Means Score
Intake Discharge
Parent
Youth
Worker

13. Treatment Foster Care Problem Severity – Aggregate Comparison of means Score
Intake Discharge
Parent
Youth
Worker

14. Open Residential Treatment – Aggregate Comparison of Means Score
Intake Discharge
Parent
Youth
Worker

15. Secure Residential Treatment – Aggregate Comparison of Means Scores
Intake Discharge
Parent
Youth
Worker

16. Problem severity: CANS
The CANS is scored differently using two dimensions of subscales to measure problems severity:
- The Child and Behavior Needs subscales, and
- The Child Behavior Risk subscale
Each item on the scales can be rated 0 to 3.
The scales are scored in a different manner from the Ohio Scales, resulting in a total possible score of 30.
Lower scores indicate less severe problems

17. Intake and discharge Scores Using the Child, Adolescent, Needs and Strengths (CANS)
Family Foster Care problem severity – Comparison of Means Scores for Children 5+
Intake Discharge
Worker

18. Family Foster Care problem severity – Comparison of Means Scores for Children under 5
Intake Discharge
Worker

19. Treatment Foster Care problem severity – Comparison of Means Scores for Children 5+
Intake Discharge
Worker

20. Treatment Foster Care problem severity – Comparison of Means Scores for Children under 5
Intake Discharge
Worker

21. Open Residential Treatment problem severity – Comparison of Means Scores
Intake Discharge
Worker

22. Secure Residential Treatment problem severity – Comparison of Means Scores
Intake Discharge
Worker

23. observations
Parent ratings for children in foster homes were completed by the foster parents.
Means scores for children in foster care (both Family & Treatment) show little or no progress in the area of addressing and treating the issues they experienced when entering care. This is the case when using both the Ohio Scales and CANS as evaluation tools.
When conducting a self-evaluation on the Ohio Scales, youth tend to minimize their problems (compared to parents & workers).
Problem severity diminishes significantly for children in residential treatment while they are in care.
Note that a score of 20 or higher indicates clinical intervention may be indicated. The scores for kids in residential treatment drop during the course of their intervention to a nearly sub-clinical level.

24. Implications of the study
The Ohio agencies involved as stakeholders in the study are still very much engaged in perfecting the way they provide continuing care and supervision to Ohio’s young people transitioning to adulthood from its child welfare system.
These stakeholders, as well as county children services agencies, have been challenged to rethink the approaches they have long used and to come up with new approaches that make sense for the success of these young adults.
Immediate goals:
Establish common outcome measurement tools for OACCA member agencies.
These tools would be designed to create a profile of children coming into care, to identify relationships between the presenting problems of children & the programs that serve them & to identify settings, lengths of stay or services that demonstrate the best outcomes of treatment.

25. To establish an electronic information system where data from the measurement tools can be analyzed.

26. Future considerations
These results demonstrate a significant gap between need for assessment for developmental and behavioral problems in kids in foster care/residential settings and practice in the community.
Research is needed to examine the relative benefits and limitations of assessments for physical, mental, and developmental health needs on entry into care as compared with assessments obtained after a period of stabilization in out-of-home care.
More longitudinal research is needed to address the benefits of early identification and intervention for physical, mental, and developmental health problems for these high-risk kids.
Final, research is needed to determine the relative efficacy & cost-effectiveness of different mechanism for assuring that kids problems are addressed when they enter foster care.