Establishing Case Typologies in Foster Care

1. Establishing Case Typologies in Foster Care Susan J. Wells, Margaret Skrypek & Kimberly Ford A project conducted by the Gamble-Skogmo Chair in Child Welfare and Youth Policy University of Minnesota School of Social Work Susan J. Wells, PI; Research Assistants: Margaret Griesgraber, Kimberly Ford, Tamara Kincaid, Lucy Alderton, Jose Diaz, Kristin Bauerkemper , Laura Koranda, Amber Link Funded by the USDHHS Children’s Bureau, Grant # 90-CA-1719/02

2. Need for the Study: Emphasis on Outcomes in Child Welfare • Helps us think more systematically about intervention and measuring progress of children and families and the systems that serve them • Begins to lay the basis for identifying and documenting evidence-based practice – however…. • Can cause confusion in comparisons among local and state child welfare agencies Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

3. The Value of Case Typologies • Help workers apply appropriate intervention strategies • Allow agencies to measure success by identifying the probable outcomes of various case types • Permit workers to understand changing family and community trends and anticipate service needs • Facilitate tracking and comparing data across programs Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

4. Historically, Major Classifications in Developing Case Typologies Related to Child Welfare…. 1. According to the characteristics of the parent(s) 2. According to environmental factors 3. Based on child characteristics Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

5. Research Question • Is it possible to identify different types of cases in foster care that are reliably associated with different outcomes? • If yes, what are these types and how are outcomes affected? Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

6. Overview of Methods • State administrative survey • AFCARS analysis • Worker/Supervisor focus groups Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

7. Child Welfare Worker Perspectives A qualitative study of focus group data gathered in five counties in Minnesota Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

8. Demographics of the Focus Groups • Five Minnesota counties • Focus groups of 4 to 12 participants • Mean number of participants = 8.6 • Mean participation rate = 10.5% • Majority of participants were Caucasian women • Child welfare experience of participants ranged from 2 months to 25 years • Mean years of experience = 7.6 yrs Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

9. Data Collection Focus Group participants were asked to identify: • types of cases they encounter other than abuse and neglect cases • characteristics of these cases • services offered to clients in these cases • outcomes of the cases • Participants were asked to be specific and to respond in their own words. Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

10. Data Analysis • Coding process • Each researcher individually coded the data from the first focus group • Researchers compared categories to check for interrater reliability • Each researcher coded data for the two focus groups she attended • Researchers used data from individual counties to create a comprehensive typology • Researchers conducted second-level coding Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

11. Study Findings • Final Typology of 18 case types within four broad categories: • Parent’s Capacity or Behavior • Child Reasons • Problems in Parenting • Previous Unsuccessful Child WelfareIntervention Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

12. Case Types by Category • Parent’s capacity or behavior • Parent’s inability to care for child because of parent’s mental health • Parent’s inability to care for child because of parent’s medical reason/disability • Parent’s inability to care for child because of parent’s substance abuse • Child is exposed to domestic violence • Parent absent from the home Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

13. Case Types by Category (cont.) • Child Reasons • Parent’s inability to provide care because of child’s medical reasons • Parent’s inability to care for child because of child’s mental health • Child behavior (including child substance abuse) Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

14. Case Types by Category (cont.) • Problems in Parenting • Physical abuse: parent or caretaker • Sexual abuse: parent or caretaker • Emotional abuse • Parent abandons child • Neglect (unsafe in home, basic needs unmet, etc.) • Physical or sexual abuse (parent’s failure to protect from perpetrator) • Parent–child conflict Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

15. Case Types by Category (cont.) • Previous unsuccessful child welfare intervention • Pregnant mother with prior involuntary termination of parental rights • Failed adoptive placements • Relative lack of follow-through in transfer of custody Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

16. Factors Affecting the Level or Type of Service • Age of child • Vulnerability of the child • Court involvement Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

17. How Outcomes Differ by Case Type • Higher rates of re-entry: • Cases involving parents with chemical dependency • Cases that are particularly complex • Participant responses were inconsistent regarding cases with lowest rates of re-entry Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

18. Advantages and Limitations of Focus Group Study • Case typology used child welfare workers’ perspectives • Rich level of data with important detail regarding case types • Qualitative methodology with no objective test of validity • Sample population from MN only - not generalizable Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

19. AFCARS Analysis • Analyzed AFCARS data from 10 states using two-step cluster analysis to determine if certain types of cases cluster together • Using cluster analysis and literature on different case types, identified groups of case characteristics to develop 19 case types • Combined the case types in logistic regressions for each of the 10 states to predict 2 federal outcome measures – placement stability and re-entry into foster care Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

20. Advantages and Limitations of Using the 2001 AFCARS Data • Information on numerous child and case characteristics • Cross-sectional snapshot of children in the foster care system rather than change over time • Inconsistencies in foster care reporting among states • Variation in the demographic composition of the children and in types of cases captured. • Quality and consistency of descriptive data collected Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

21. Cluster Analysis • For state sampling, identified homogenous groupings of states based on 3 common variables related to: • Demographics • Performance • Size of foster care system • 58 AFCARS variables were used to perform a cluster analysis on data from the selected states • Discriminant analysis was used to validate case cluster membership Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

22. Resulted in over 100 clusters or sub-clusters; Identified variables characterizing clusters… • Significant in formation of clusters • Representing a large portion of cases in a specific cluster or… • Equally distributed among clusters and constituting at least 33% of a cluster • Developed maps of relationships of variables in different clusters Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

23. Final Case Types Were Established by • Using the variable/cluster mapping to identify case groupings and then • Developing a hierarchy of membership so case types were mutually exclusive • Using vars from clusters, beginning with the case characteristics recog. in prior literature as associated with varying case dynamics Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

24. Percentages of Case Type by State for Children Who Entered Foster Care Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

25. Percentages of Case Type by State for Children Who Entered Foster Care (cont.) Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

26. Percentages of Case Type by State for Children Who Entered Foster Care (cont.) Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

27. Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

28. Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work [1] The overall ranking reflects the average ranking when all states (N=9) are taken into account and occurs only for case types that show relative consistency, e.g. individual state ranking is generally within 3 digits across states. [2] Manually removed because the case type contained a low number of frequencies (indicated by an inflated standard error) [3] SPSS automatically removed from model because variable contained 0 frequencies [1] The overall ranking reflects the average ranking when all states (N=9) are taken into account and occurs only for case types that show relative consistency, e.g. individual state ranking is generally within 3 digits across states. [2] Manually removed because the case type contained a low number of frequencies (indicated by an inflated standard error) [3] SPSS automatically removed from model because variable contained 0 frequencies

29. Table Notes [1] The overall ranking reflects the average ranking when all states (N=9) are taken into account and occurs only for case types that show relative consistency, e.g. individual state ranking is generally within 3 digits across states. [2] Manually removed because the case type contained a low number of frequencies (indicated by an inflated standard error) [3] SPSS automatically removed from model because variable contained 0 frequencies Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

30. Some Notable Findings • Clusters broke out by age and race of child • Clusters highly related to child problems and reasons for entry into care • Most likely to re-enter: behavior problem, all races, ages 11 and older • Some similarities and some great differences among states in case types and assoc. outcomes Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

31. Multi-method Integrated Findings • Emotional problems, clinically diagnosed disabilities and behavior problems were primary issues in quantitatively identified case typologies and outcomes • Yet, the way these cases are served and reported varies greatly among states • And fed’l stds apply equally across all states Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work

32. Multi-method Integrated Findings (2) • Common multi-method findings • Child’s medical, mental health, behavior • Sexual abuse • Neglect • Additional qualitative findings • Positive toxicology in newborns (low #s) • Failed child welfare intervention (important add.) • Child MH and parent/child conflict Contact: Susan J. Wells swells@umn.edu University of Minnesota School of Social Work