Improving Safety, Permanency and Wellbeing for Children in out-of-Home Care: Results from a Study of Trauma Interventions

Background/Purpose: 

Maltreated youth frequently exhibit trauma related symptoms, attachment issues, are prone to display aggression, have lower academic achievement, lower self-esteem, poor peer interactions, problematic classroom behaviors, cognitive immaturity, and display externalizing behaviors. The U.S. Department of Health and Human Services, Administration for Children and Families (ACF) aimed to address these concerns (2012) by funding a series of discretionary grants to test approaches to better serve maltreated youth through data-driven processes.

This presentation will report on safety, permanency, and well-being outcomes associated with an  ACF-funded project to implement the following interventions:  Standardized screening for trauma and behavioral health needs by child welfare workers, standardized functional assessment and measurement of progress by behavioral health providers, use of data from screening and assessment to inform treatment selection, and use of data on the organizational level for capacity building and service array reconfiguration. By connecting these iinterventions to these core outcomes driving child welfare practice, implementation sustainability was enhanced.

Methods:

Safety, permanency, and well-being were measured through state administrative data comparing youth who were enrolled in the project compared with those who were not using a quasi-experimental design in which intervention roll out was staged regionally over a three year period. Using Child and Family Service Review Indicators, safety was measured as repeat maltreatment, permanency based on number and length of placements, and the wellbeing indicator  mapped practice behaviors to wellbeing through a Continuous Quality Improvement case review process. Chi-square and T tests examined differences between groups. Qualitative data were collected from frontline staff and clinicians to understand perceptions of the mechanisms of influence interventions may have had on these outcomes.

Results:

There was a significant difference between groups related to repeat maltreatment (x²= 75.54, df=2, p<. 001) with SAFESPACE youth having a higher reporting rate of repeat maltreatment and a higher rate of substantiation. There was a significant difference between groups in number of placements (t= 1.843, df=11245, p<.001) and number of months in care (t= 12.48, df=3200, p<.001) with SAFESPACE youth having significantly fewer placements and fewer months in care. There was a significant difference in well-being domain (Children receive adequate services to meet their physical and mental health needs) (t= 2.09, df=7927, p<.05) with SAFESPACE youth having higher domain mean scores suggesting improvement. Though not significant on all well-being domains, youth enrolled in SAFESPACE consistently had higher mean scores compared with non-SAFESPACE youth. Qualitative results identified possible contributors to outcomes to informed statewide buy-in and practice change.

Conclusions and Implications:

Results demonstrated improved safety, permanency, and well-being for youth enrolled in project SAFESPACE. Safety outcomes may be reflective of greater monitoring of SAFESPACE youth.  Statistically significant permanency outcomes were particularly useful in promoting sustainability. While further analyses and ongoing research to further explicate the potential mechanism of impact, these preliminary results have implications for child welfare agencies considering investing in standardized trauma-informed interventions. Implications for researchers and administrators include the usefulness of  tying project interventions to these distal but critical child welfare outcomes beginning early to support and guide implementation and sustained investment.