Formative Evaluation: Illinois' Birth to Three IV-E Waiver

Background/Purpose: The child welfare field has begun to recognize the important role trauma plays in children who enter foster care, but the process of implementing evidence-based interventions to address their needs is complicated and understudied. The Illinois Birth to Three (IB3) Waiver sheds light on the complexities of tailoring an intervention within the context of a large-scale child welfare system. The IB3 Waiver is a five-year federal demonstration project that compares families assigned to receive intensive, evidenced-based, trauma-informed interventions to similar families who are provided foster care services as usual. Our research question is: Will children aged birth through three years old upon entry into foster care experience reduced trauma symptoms, increased permanency, reduced re-entry and improved child well-being if they are provided Child-Parent Psychotherapy or Nurturing Parent Program services compared to similar children who are provided services as usual? Results from the formative evaluation stage of this intervention will be presented.

Methods: The IB3 evaluation plan builds on the rotational assignment system that the child welfare system uses to assign foster care cases.  First, public and private agencies were randomly assigned to an experimental or comparison cluster. Second, eligible children in family cases that have been randomly assigned to the experimental or comparison cluster are rotationally assigned to the next available provider within each cluster designation. Rotational assignment helps to ensure that every team and private agency gets a “representative mix” of children as new referrals so that no team or agency has an unfair advantage through creaming of the “easy” cases.

The following instruments are used to assess trauma experiences and symptoms, and parental stress: (a) Child and Adolescent Needs and Strengths; (b) Infant Toddler Symptom Checklist; (c) Devereux Early Childhood Assessment; (d) Denver II Developmental Screening tool; (e) Parenting Stress Index; (f) Adult-Adolescent Parenting Inventory-2. We also collect data on child well-being, stability, and permanence, which are more distal measures of the effect of IB3.  The major source of primary data on child well-being outcomes will come from the administration of the child, caregiver and caseworker modules of Illinois Survey of Child Adolescent Wellbeing. We used chi-square analyses to explore the first 60 cases on each measure.

Results: Results from the formative evaluation found that our rotational assignment resulted in nearly identical cases on many characteristics. However, most (90%) of children in comparison group were screened as a 1-child case, while almost half (44%) of the intervention group were screened as part of a sibling group. Finally, the risk determination score appears imbalanced with more high-risk children (64%) in the intervention group compared to the comparison group (47%).

Conclusions: Our formative evaluation results indicate that our groups are well-matched on most key variables; however, observed group differences may require changes to the implementation procedures. This study highlights the importance of conducting preliminary formative analyses prior to the summative stage of assessing intervention impacts in order to ensure that the intervention and control groups are sufficiently similar.