Evaluation of the Illinois Birth through Three IV-E Waiver Demonstration: The Impact of Trauma-Informed Parenting Interventions on Child Permanency Outcomes

Background and Purpose: The child welfare field has prioritized the use of evidence-supported interventions to mitigate the adverse effects of child maltreatment on children in foster care. However, few evidence-based interventions have been implemented and rigorously tested using families involved in the child welfare system. The Illinois Birth through Three (IB3) Waiver aims to fill this gap by tailoring two evidence-based interventions to address the needs of infants and toddlers in foster care in Cook County.

Methods: The IB3 Waiver is a five-year federal demonstration project that compares families randomly assigned to receive one of two trauma-informed evidence-based interventions to similar families who are provided foster care services as usual. The waiver targeted children aged 3 years old and younger because research on child maltreatment and neuroscience confirm that the first four years of a child’s life are a critical period for healthy social and emotional development. The project tested whether infants and toddlers whose caregivers are equipped with the knowledge and skills to manage traumatic reactions in a positive, developmentally-appropriate manner will experience higher permanency rates compared to children who receive foster care services as usual.

The selected interventions of Child-Parent Psychotherapy (CPP) and Nurturing Parenting Program (NPP) were adapted to fit the needs of child welfare-involved children and support parents and caregivers in creating a supportive, parenting environment. At the time of analysis, nearly 2,000 children, majority of whom were black, were assigned to the waiver demonstration, and there were no statistically significant baseline differences between the intervention and comparison groups.

Results: Findings showed that children in the intervention group had substantially higher rates of family unification (reunification or guardianship with relatives) than their counterparts in the comparison group.  Nearly one-third of children assigned to the intervention group were reunified or discharged to the guardianship of kin compared to 22% in the comparison group. Also, children 6 months of age or older were more likely to reunify with a birth parent or relative compared to children removed at birth or before 6 month of age. Also, a survey administered to child welfare agency administrators showed that intervention agencies reported a higher average readiness to adopt a new trauma-informed program compared to administrators from comparison agencies. Administrators from intervention agencies also indicated a higher level of preparedness to evaluate evidenced-based programs compared to administrators from comparison agencies.

Conclusions and Implications: The positive findings for family permanence suggest that the availability of the IB3 program encouraged intervention agencies to enroll families in clinical services and to unify children with their families, who otherwise might have been adopted under permanency planning practices as usual. The IB3 interventions are intended primarily to engage and improve the parenting attitudes and practices of birth parents and secondarily those of foster and relative caregivers. Because agencies were randomly selected to offer IB3 services and children were rotationally assigned to intervention and comparison agencies, it may be reasonably inferred that the availability of IB3 services influenced the observed differences in the types of permanency outcomes.