Saturday, 15 January 2005 - 4:00 PM
This presentation is part of: Outcomes in Foster Care
Placement Outcomes of Foster Children in an Incentive-Based Managed Care Setting: New Findings From the Wayne County Pilot EvaluationWilliam Meezan, DSW, University of Michigan School of Social Work and Bowen McBeath, MSW, University of Michigan School of Social Work.
Objective: Despite the expansion of performance contracting and managed care initiatives across state child welfare systems, there is little information concerning the effects of these initiatives on the placement outcomes of foster children. This presentation examines the effects of a managed care contracting initiative on foster child placement status, including rates of child return to home, kinship care, termination of parental rights, and adoption; child length of stay in foster care; and child’s return to care after discharge.
Methods: Data were collected on a sample of 243 foster children being served by nine nonprofit agencies in Wayne County, Michigan. These agencies have contracted with Michigan’s public welfare agency to provide foster care services under one of two contractual mechanisms: a per child, per-diem reimbursement system; or a managed care reimbursement system that contains performance bonuses for the movement of foster children into permanent placements. Because foster children in Wayne County are randomly assigned to nonprofit agencies, the study design is the equivalent of a true experimental design.
The panel dataset (which will be extended by the time of the conference) currently contains 570 days of data on children’s placement status, service histories, individual and familial characteristics, and the characteristics of caseworkers responsible for these children and families. Logistic regression models are used to examine whether children served by managed care agencies experienced different placement outcomes than children served by non-managed care agencies, controlling for child, family, and caseworker characteristics as well as the amount of non-therapeutic and therapeutic service provision provided to foster children. Hazard models are used to examine the relationship between child and caseworker characteristics, service provision, and child duration in foster care.
Results: Children served by agencies working under the incentive-based system were no more likely than children served by traditionally reimbursed agencies to be returned home or to enter into kinship care arrangements. Additionally, the two groups had their parental rights terminated at statistically indistinguishable rates, did not return to care at different rates, and their stays in foster care were equivalent. Factors associated with more negative placement outcomes include prenatal exposure to drugs and/or alcohol, parental use of drugs, parental neglect or abandonment, and the receipt of more therapeutic services while in care. Children were less likely to have their parental rights terminated as they aged and as their caseworkers’ caseloads rose. Additional analyses for this presentation will examine the factors associated with duration in foster care, factors associated with children not achieving any permanent placements, and factors associated with a child’s return to care.
Discussion: This study suggests that placement outcomes are not associated with incentive-based managed care models. These results provide information of use to policymakers and practitioners that are considering transitioning to various incentive-based contracting systems. Implications for research include the need for greater study of the effects of managed care and performance contracting on child safety and child and family well being.
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