The Increase and Impact of Relative Placements on Safety, Permanency, and Well-Being during Indiana's IV-E Wavier

Background and Purpose

In 2012, the Department of Health and Human Services authorized an extension of the Title IV-E Waiver granting states flexibility in the use of Federal funds for alternative services promoting three key outcomes: Safety, permanency, and well-being. The flexible funding provided support relative placements, and Indiana now places over 50% of out-of-home cases with relatives. The aim of this study is to investigate if the relative placements impact the three main goals of the Waiver.

Methods

Data were collected from quality service reviews administered by Indiana’s child welfare agency. This peer-review process of a random sample of child welfare cases is aimed at improving services to children and youth in each region of the state. Cases reviewed from July 2007 to July 2017 were used in this analysis (N=2611) and include cases from all 18 regions with oversampling in the highest populated regions. Key indicators were scored on a 6-point scale from adverse to optimal. ANOVA and post-hoc Tukey (SPSS 25) was used to compare children in their home, relative placements, and non-relative placements on safety, permanency, well-being, practice indicators, and demographics. Then multivariate stepwise linear regressions were performed to assess the impact of relative placements on safety, permanency, and well-being compared to non-relative out-of-home placements. Variables in the linear regression included child’s age, race, case length, relative vs non-relative placement, caregiver domestic violence, caregiver drug abuse, child’s behavioral problems, child’s emotional distress, birth mother was a ward, assessing and understanding the child, assessing and understanding the family, long term view, planning transitions/life adjustments, intervention adequacy, engaging, maintaining relationships with family, and case type.

Results

In the ANOVA, children in relative placements had significantly higher safety scores than children in-home, higher behavioral health scores than non-relative placements, lower permanency scores than children in-home, and higher well-being scores than in-home and non-relative placements (p<.01). Children with behavioral problems, emotional disturbances, sexual abuse, juvenile justice involved, and having a birth mother who was a ward of the state were more likely in to be in non-relative placements. Children who were white, those with caregivers who have a history of drug abuse, mental health problems, income stress, and domestic violence were more likely to be in relative placements (p<.05). Children in relative care, when compared to those in non-relative placements, had higher scores in cultural recognition, maintaining relationships with family members, and were younger (p<.01).

In the multivariate linear regression, relative placements were associated with lower safety scores (β=-.096. p<.01), but higher scores in permanency (β=.099, p<.001), and well-being (β=-.148, p<.001).

Implications and Conclusions

Relative placements provide a good alternative to in-home care when trying to reunify families by providing a safe environment compared to those in-home care. Keeping children at relative placements as alternative to foster placements supports permanency and well-being. The IV-E Waiver allowed flexible funding to expand and support relative placements over time, which impacted children’s permanency and well-being. The system should pay special attention to locating and securing relative placements for racial minorities.