state of maine iv-e child welfare demonstration...

State of Maine IV-E Child Welfare Demonstration Project

Maine Adoption Guides Project

Not to be used without author's permission.

STATE OF MAINE

IV-E CHILD WELFARE DEMONSTRATION PROJECT

MAINE ADOPTION GUIDES PROJECT

INTERIM EVALUATION UPDATE

December 31, 2002

Submitted To: Virginia S. Marriner, Adoption Program Specialist Bureau of Child and Family Services Department of Human Services Prepared By: Michel Lahti, PhD, Principal Investigator Institute for Public Sector Innovation Edmund S. Muskie School of Public Service University of Southern Maine

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project i

TABLE OF CONTENTS

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24 Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i -ii List of Figures, Tables and Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii-vi Chapter I - Introduction A. Overview of the Demonstration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1. Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Adoption Guided Services Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

B. Research Design & Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1. Population Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2. Research Design & Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

a. Guided Services Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 b. Guided Services Model - Process Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 c. Outcome Evaluation - Guided Services Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 d. Outcome Evaluation - Research Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

C. Data Collection & Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1. Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2. Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Chapter II - Process Analysis A. Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

1. What Is the Maine Adoption Guides (MAGS) Model of Intervention . . . . . . . . . . . . . . 12 2. Types of Services Provided Through MAGS Intervention . . . . . . . . . . . . . . . . . . . . . . . 16 3. How is MAGS Implemented. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

a. Results of Referral . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 b. MAGS Implementation Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 c. Focus Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

B. Sample Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1. Children Involved in MAGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2. Select Family Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3. Select Child Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

C. Service Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 1. Types of Services Provided . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 2. Types of Services Families Utilize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 3. Families Access Natural Forms of Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 4. Barriers Families Experience In Responding to Child’s Needs . . . . . . . . . . . . . . . . . . . 87

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project ii

Chapter III - Outcomes A. Description of Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 B. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

1. Family Level Variables – Mean Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 2. Child Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Chapter IV – Status of Cost Effectiveness/Benefit Analysis . . . . . . . . . . . . . . . . 145 Chapter V – Summary & Challenges A. Evaluation Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

1. Accomplishments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 2. Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project iii

LIST OF FIGURES Figure 1: Post Legalization Program Model Differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Figure 2: Maine Adoption Guides – Guided Services Intervention Program Logic Model . . . . . 6-7 Figure 3: Outcomes Study Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 4: Casey Family Services: Maine Adoption Guides Service Codes & Definitions . . . . 16-18

LIST OF TABLES

Table 1: Social Worker Territories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 2: Guided Services Population By Project Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 3: Non Participants by District – Year 3 to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 4: Adoptions: Adoption Finalizations by Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 5: Adoption Finalizations by Month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 6: Total Number of Children by Cohort and Assigned Group . . . . . . . . . . . . . . . . . . . . . . 26 Table 7: Total Number of Families by Cohort and Assigned Group. . . . . . . . . . . . . . . . . . . . . . 27 Table 8: Child Gender by Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 9: Child Age by Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 10: Average Child Age (mean score) at Entry in the Program. . . . . . . . . . . . . . . . . . . . . . . . 28 Table 11: Type of Adoption – Foster Parent and Non-Foster Parent . . . . . . . . . . . . . . . . . . . . . . 29 Table 12: Current Total Annual Income Before Taxes by Assigned Group. . . . . . . . . . . . . . . . . . 30 Table 13: Child Race by Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 14: Family Structure by Assigned Group. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 32 Table 15: Pre-Adoption Relationship to Child by Assigned Group .. . . . . . . . . . . . . . . . . . . . . . . 33 Table 16: Number of Children: Current or Previous Adoption Baseline by

Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 17: Average Number of Children’s Previous Foster Care Placements

by Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 18 Average Number of Years Child Has Been in a Foster Care by

Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 19 Average Time Child Has Lived in Home (Months) by Assigned Group . . . . . . . . . . . . 36 Table 20 Average # Days Child Out of Home Past Six Months by Assigned Group . . . . . . . . . . 37 Table 21: Time in Study (months) by Cohort and Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 22: Percent of Children in Study Legally Adopted – 6, 12 & 18 Months by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Table 23: Child Behavior Problems Before Legalization - Baseline . . . . . . . . . . . . . . . . . . . . . . . 38 Table 24: Is the Child Currently Attending School by Assigned Group . . . . . . . . . . . . . . . . . . . . 38 Table 25: Child’s Grade Level by Cohort and Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 26: Child Has Individualized Education Plan (IEP) Children Age Five and Older by

Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 27: Clinically Diagnosed Disabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 40 Table 28: Child Taking Behavioral/Emotional Medication by Assigned Group . . . . . . . . . . . . . . 41 Table 29: Quality of Home Life in Past Six Months at Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 30: Quality of Home Life in Past Six Months at 6, 12 & 18 Months in Study . . . . . . . . . . 42 Table 31: Satisfaction with Marriage/Partnership at Baseline Only . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 32: Concerns about Adopting a Child – Baseline Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 33: Reasons for Adopting a Child – Baseline of Total Study Population . . . . . . . . . . . . . . 44 Table 34: Background of Adoptive Parents – Total Population. . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 35 : Spouse/Partner Attitude Toward Adoption – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 36 : Caregiver Rates Overall Level of Communication w/Adopted Child – Baseline . . . . . .46 Table 37: Caregiver Rates Overall Level of Communication w/Adopted Child at 6, 12, 18 & 24 Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 38: Do You Trust Your Child – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project iv

Table 39: Do You Trust Your Child at 6, 12, 18 & 24 months . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 40: When Did You Feel Child was Permanently Yours at Baseline . . . . . . . . . . . . . . . . . . 48 Table 41: Level of Agreement with: I Believe the Child is Permanently Mine

at 6, 12, 18 & 24 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 42: Family Members Attachment to Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 43: Family Members Attachment to Child – 6, 12, 18 & 24 months . . . . . . . . . . . . . . . . . . 50 Table 44: Overall Satisfaction with Adoption – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 45: Child Contact with Birth Family – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 46: Talk to Child About Birth Family – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 47: Talk to Child About Birth Family – 6, 12, 18 & 24 months . . . . . . . . . . . . . . . . . . . . . 53 Table 48: Total Mean Scores of Parent Caregiving Behaviors – Baseline . . . . . . . . . . . . . . . . . . . 53 Table 49: Total Mean Scores of Parent Caregiving Behaviors – 6, 12, 18 & 24 months . . . . . . . . 54 Table 50: Total Mean Scores of Parent/Child Disagreements - Baseline . . . . . . . . . . . . . . . . . . . 54 Table 51: Total Mean Scores of Parent/Child Disagreements – 6, 12, 18 & 24 months . . . . . . . . 55 Table 52: Health Status of Primary Caregiver – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 53: Health Status of Primary Caregiver – Six Months in Study. . . . . . . . . . . . . . . . . . . . . . 56 Table 54: Health Status of Primary Caregiver – Twelve Months in Study. . . . . . . . . . . . . . . . . . . 57 Table 55: Health Status of Primary Caregiver – Eighteen Months in Study. . . . . . . . . . . . . . . . . . 58 Table 56: Health Status of Primary Caregiver – Twenty-Four Months in Study . . . . . . . . . . . . . . 59 Table 57: Cohesion & Adaptability of Family FACES II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 58: Parenting Practices: Authoritarian or Authoritative – Cohort One - Baseline. . . . . . . 61 Table 59: Parenting Practices: Authoritarian or Authoritative – Baseline, 12, & 24 months. . . . 62 Table 60: Rating of Child’s Overall Health – Baseline, 6, 12, 18 & 24 months . . . . . . . . . . . . . . 64 Table 61: Rating of Child’s Physical Growth/Development Compared to Peers . . . . . . . . . . . . . . 65 Table 62: Frequency of Positive Behavior Child to Parent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 63: Frequency of Child Positive Traits/Moods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Table 64: Frequency of Child Negative Traits/Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 65: Child Attachment to Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 66: Child Satisfaction with Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 67: Child Functioning Measure – CBCL Scores: Clinical Needs Young / Old Child Scores at Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 68: Mediam Number of Days Out of Home/Displacement Days Past Six Months. . .. . . . . 72 Table 69: Families and Services as Reported by Caseworkers . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table 70: Amounts of Each Type of Service Provided As Reported by Caseworkers . . . . . . . . . 74 Table 71: Mean Number of Minutes Provided for Each Service Type . . . . . . . . . . . . . . . . . . . . . 75 Table 72: Mean Service Time Minutes Per Service By Cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 73: Contact Type for Services Provided Reported by Caseworkers . . . . . . . . . . . . . . . . . . . 76 Table 74: To Whom Services Were Provided Reported by Caseworkers . . . . . . . . . . . . . . . . . . . 77 Table 75: How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 76: How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline by Type of Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 77: Satisfaction with Pre-Legalization Services to Family/Child at Baseline by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 78: Satisfaction with Pre-Legalization Services to Family/Child at Baseline by Type of Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 79: Satisfaction with Post-Legalization Services to Family/Child by Assigned Group. . . . 80 Table 80: Satisfaction with Post-Legalization Services to Family/Child by Type of Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 81: Percent of Caregivers Obtaining Services – Types of Services at 6, 12 & 18 Months into Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 82: Mean Number of Days of Service Time Reported by Family at 6, 12 & 18 Months into Study by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 83: Mean Family Centeredness Scores by Assigned Group at 6, 12 & 18 Months into Study by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project v

Table 84: Types of Services Provided by Primary Caseworker at 6, 12 & 18 Months into Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 85 Type of Aid – Support Caregivers Prefer Most – Total Population . . . . . . . . . . . . . . . . 85 Table 86: Percent of Respondents Who Routinely Access Natural Supports – Total Sample Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 87: Sample Characteristics Length of Time in Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 88: CRPR Results – Authoritarian / Authoritative Practices Cohort One – Baseline. . . . . 99 Table 89: Median Number of Days Child Out of Home Past Six Months By Assigned Group . . 111 Table 90: Age Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 91: Average Medicaid Costs – Foster and Non Foster . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table 92: Medicaid Hospital Spending Average per Child. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 149 Table 93: Medicaid Physician / Practitioner / Dental Costs Average per Child. . . . . . . . . . . . . . . 150 Table 94: Medicaid Prescription Drugs and Related Costs Average per Child. . . . . . . . . . . . . . . 151 Table 95: Medicaid Behavioral Health Services Average Costs per Child. . . . . . . . . . . . . . . . . . 152 Table 96: Medicaid Other Services Average Costs per Child. . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Table 97: Long Term Care Costs per Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table 98: Case Management Costs per Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

LIST OF CHARTS Chart 1: Child’s Total Time in Foster Care – National Figures Compared to MAGS . . . . . . . . 36 Chart 2: Parent Health: General Health . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Chart 3: Parent Health: Energy/Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Chart 4: Parent Health: Social Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Chart 5: Parent Health: Physical Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Chart 6: Parent Health: Physical Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Chart 7: Parent Health: Emotional Well Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Chart 8: Parent Health: Role Limitation Due to Physical Health . . . . . . . . . . . . . . . . . . . . . . . . . 96 Chart 9: Parent Health: Role Limitation Due to Emotional Problems. . . . . . . . . . . . . . . . . . . . . 97 Chart 10: Caregiver Satisfaction With Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Chart 11: Parenting Practices – Authoritarian . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 100 Chart 12: Parenting Practices – Authoritative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Chart 13: Family Cohesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Chart 14: Family Adaptability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Chart 15: Family Attached to Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Chart 16: Percent of Caregivers Who Trust Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Chart 17: Parent and Child Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Chart 18: Frequency of Parent and Child Disagreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Chart 19: Frequency of Parent Positive Caregiving Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Chart 20: Family Quality of Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Chart 21: Caseworker Family Centeredness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Chart 22: Child Attached to Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Chart 23: Somatic Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . . . . . . . . . . . . . 114 Chart 24: Somatic Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . 115 Chart 25: Withdrawn/Depressed Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . 116 Chart 26: Withdrawn/Depressed Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . 117 Chart 27: Anxious/Depressed Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . . . 118 Chart 28: Anxious/Depressed Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . 119 Chart 29: Attention Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . 120 Chart 30: Attention Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . 121 Chart 31: Aggressive Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . 122 Chart 32: Aggressive Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . . . 123 Chart 33: Internalizing Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . 124

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project vi

Chart 34: Internalizing Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . 125 Chart 35: Externalizing Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . .126 Chart 36: Externalizing Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . 127 Chart 37: Total Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . . . . 128 Chart 38: Total Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Chart 39: Emotionally Reactive – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Chart 40: Sleep Problems – Younger Child Ages 1 ½ -5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Chart 41: Social Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Chart 42: Thought Problems Child Behaviors - Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . 133 Chart 43: Rule Breaking Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . 134 Chart 44: Competencies – Activities T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . 135 Chart 45: Competencies – Social T-Scores Child Behaviors - Child Ages 6-18 . . . . . . . . . . . . . 136 Chart 46: Competencies – School T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . . . . 137 Chart 47: Competencies – Total T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . . . . . 138 Chart 48: Child’s Overall Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Chart 49: Child Growth Development Compared to Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Chart 50: Frequency of Child Positive Traits / Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Chart 51: Frequency of Child Negative Traits / Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Chart 52: Child Satisfaction With Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Chart 53: Frequency of Child Positive Behaviors to Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Chart 54: Total Medicaid Amounts – MAGS Study Population. . . . . . . . . . . . . . . . . . . . . . . . . . 145 Chart 55: Average per Child Medicaid Amounts - MAGS Study Population. . . . . . . . . . . . . . . . 146 Chart 56: Average Medicaid Costs – Foster and NonFoster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Chart 57: Medicaid Hospital Spending Average per Child. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 149 Chart 58: Medicaid Physician / Practitioner / Dental Costs Average per Child. . . . . . . . . . . . . . . 150 Chart 59: Medicaid Prescription Drugs and Related Costs Average per Child. . . . . . . . . . . . . .. . 151 Chart 60: Medicaid Behavioral Health Services Average Costs per Child. . . . . . . . . . . . . .. . . . . 152 Chart 61: Medicaid Other Services Average Costs per Child. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Chart 62: Long Term Care Costs per Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Chart 63: Case Management Costs per Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Chart 64: Guided Services Families: IVE Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Chart 65: Average per Family IVE Expenditures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Appendices are available upon request and include:

! Copies of all measures/instruments ! Univariate analysis of all items (frequencies) ! Bivariate analysis on select items (cross-tabulations) ! Multivariate analysis on outcome variables (2x2 ANOVA)

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides Project 1

MAINE ADOPTION GUIDES INTERIM EVALUATION REPORT:

EXECUTIVE SUMMARY - December 2002

I. BACKGROUND

The evaluation of the MAINE ADOPTION GUIDES PROJECT, Title IV-E Child Welfare Waiver is conducted for the Department of Human Services, Bureau of Child and Family Services (DHS). It is comprised of two parts: 1.) a process and an impact evaluation of the adoption competency-training program for public and private providers of adoption related services; and 2.) a process and outcome evaluation, and a cost effectiveness/benefit analysis, of the purchase and delivery of post legalization adoption support services to children and families. The training evaluation component began on April 1, 1999 and continued through the end of November 2000. Statewide implementation and evaluation of the post legalization Guided Services model began on April 1, 2000 and will end no later than December 31, 2004. This Executive Summary will focus on the post legalization Guided Services evaluation results to date, for a full copy of the final training evaluation results please contact the evaluator.

This federal Department of Health and Human Services Child Welfare

Demonstration Project is the result of planning on the part of the state DHS agency since the mid 1990s. As a result of a series of interactions with parents, adoption agencies and other stakeholders, the state DHS developed a specific focus on post-legalization services. Two pressures drove this policy and program development on the adoption system: (1) increasing numbers of children requiring adoption services; and (2) pending implementation of the Adoption and Safe Families Act. In response to those pressures, state agency managers, parents and non-governmental adoption agencies undertook a process that resulted in this Child Welfare Demonstration Project - Maine Adoption Guides Project. The guiding principles that drive this initiative are:

! Adoption is a life-long process. ! Most adoptive families experience normal crisis in their development. ! Families need more support services post-legalization.

Adoption Guided Services Description

The core principle of this program is that adoption is different. The dynamics of a family created by adoption are different from the dynamics of a family created by birth. Adoption is lifelong and its impact creates unique opportunities and challenges for families and communities. Adoption is mutually beneficial to parent, child and society. Society is responsible for supporting and aiding integration and preservation of adoptive families.

Participants are recruited from the overall population of families adopting children with special needs from the Foster Care system of the state Department of Human Services (DHS). Every year for four years 140 children and their families are


recruited into the project. At the time that families meet with state DHS adoption caseworkers to plan for Title IVE subsidy arrangements, about three months prior to legalization, families are invited to participate in the project. Families are then randomly assigned to either the Standard Services (control) group or Guided Services (experimental) group. Standard Services families receive the normal sets of supports and subsidy from the state DHS. Guided Services families receive the normal supports and subsidies and have access to a Maine Adoption Guide social worker from Casey Family Services. All families who participate in the project commit to a set of interviews once every six months. Families in the Guided Services group commit to being contacted by their assigned social worker at least once every six months. This case-management type of service delivery model is delivered statewide and is provided by a partnership of the state DHS and Casey Family Services. The Guided Services intervention is a community-based delivery of service program designed to be family driven. The adoptive parent(s) is viewed as the expert on their child. The social worker assigned to the family functions as a guide who consults with the family through the expected and normal crisis in the life of an adoptive family. The long-term plan, based on the positive outcomes of this study, is that these same guided services could be expanded to the general population of adopting families. II. RESEARCH DESIGN AND METHODOLOGY

The research design is a longitudinal control group design with random assignment and observations both before the intervention and then conducted every six months for the duration of the study. There will be four cohorts observed in the study. The outcome evaluation assesses the extent to which the children/families who received the Guided Services Model (experimental group) and the children/families who received Standard Services (control group) differ in regard to a number of outcome measures. The outcome measures include:

" Rates of Adoption Dissolutions " Number of Days Child in the Home / Displacement Rates " Assessment of Family Functioning " Assessment of Child Functioning/Well Being " Assessment of Access to and Utilization of Services

III. INTERIM EVALUATION RESULTS A. IMPLEMENTATION Implementation: Perspectives of Project Participants In order to assess the project’s implementation, e-mail surveys are conducted each year with the DHS and Casey Family Services caseworkers and supervisors who are involved in the project. At this point in time, the referral process has not yet been completed for the year, and the surveys have not yet been completed. Please refer to the Maine


Adoption Guides Project Interim Report June 2002 for a summary of last year’s implementation survey results. Focus Groups with MAGS Social Workers

In addition to the implementation survey, focus groups with social workers provide valuable information on the project model and its process. Focus groups are held with Adoption Guides social workers and supervisors approximately every six months. Staff members are asked to define their roles in the project and provide general feedback on the project’s implementation—how the project model compares to their day-to-day work.

In November 2002, the fourth round of focus groups was held with the Adoption

Guides social workers. One group was held in southern Maine with 11 social workers and two team leaders. The other group was conducted via telephone with two social workers and one supervisor who work in northern Maine. Unless otherwise noted, the following is a summary of results from both discussions.

The focus group questions focused on gathering in-depth descriptions of a few of

the services social workers provide to families. The first type of service discussed was “General Parent Education and Support.” This service code is distinguished from “Building/Maintaining Relationships,” and from “Clinical Conversations,” and serves as a type of miscellaneous category for the kind of education and support social workers provide to families. Workers mentioned that this code includes such things as educating families (and themselves) on a diagnosis; working with a child’s developmental stages; educating a family about the therapy process, and helping families decide what they may need for support. Workers also may help a parent think about a child’s behavior in a different way. Participants mentioned seeing themselves as a “safety net” or as a “coach” for families and feel that “General Parent Education/Support” is a major element of the model because it allows a more meaningful connection with the family. Through the home-based work done with families, workers see the family in the context of the family’s home and have a depth of understanding of the child and his/her whole situation. This enables the social workers to have more accurate hypotheses about what is happening with a child or family than other professionals who may only be seeing the child by him/herself. Workers also mentioned that the flexibility of the model enhances parent education and support because there is no agency mandate on how to support a family. The model allows workers to provide each family with tailored services. The support given to families seems casual and therefore easy to discount, but it is the core of the program.

The next service code discussed was “Collateral Contacts.” Social workers described this as identifying needs and building resources. It can be case management or it can be clinical. Workers also help to educate the collateral contacts. MAGS workers are trained specifically on adoption issues and attachment whereas others involved with a family may not be. Due to this, the Adoption Guides workers’ assessments are valued for their clinical insight. Flexibility also plays a role in this service—workers have the


opportunity to attend meetings with families, etc., which in turn enables them to have a greater understanding of a family’s situation.

The code “General Advocacy” can include services similar to “Concrete Services.” Often it’s a mixture of the two codes. Again, social workers’ clinical experience and adoption awareness benefits them in advocating for a family. People begin listening to workers differently when they learn of their knowledge of adoption issues. The role workers play as advocates is important because parents sometimes get discouraged by the difficulty in finding services. The model’s flexibility enables workers to have more time to devote to advocacy, because they don’t have to capture everything they do into a billable timeslot. Houlton workers have not yet had much opportunity to advocate for families but see an important future role working as advocates in the schools.

“Non-therapeutic” services include recreational and informal activities with families, such as having lunch or dinner, going to picnics, attending parties, going to the movies, or playing with children. These types of services are seen as very important to the model because they break down artificial boundaries—making families feel more comfortable and able to trust workers. Often times, non-therapeutic services pave the way to doing clinical work with a family that may have been initially reluctant. The informal activities allow for families’ progression. Therefore, this is not a short-term service. Non-therapeutic activities allow parents the opportunity to network with other parents and allow kids with similar issues to come together. Kids and families can connect through these gatherings and can get support in a non-threatening way. These activities also are a great way for families to relieve stress without worrying about the stigma of needing therapy. Workers view these informal connections as a major component of the model.

Focus group participants also discussed the coding process. Most agreed that the coding does not hinder their work and mentioned that the database set-up makes entering information relatively time-efficient. Some feel that coding enhances their work because it makes them take the time to think purposefully about the services being provided. Coding also helps some keep organized. There is still confusion about where certain services should fit but workers have operationalized a number of definitions and the codes seem to be working better. The Houlton workers stated that getting up to speed with their computers has been a challenge. They have not received feedback on their coding and so assume it is accurate.

These focus group discussions are important to the research process because they help track the changes in the evolving model. Getting clear and timely descriptions of the model ensures accurate reporting of the services provided as well as the process of the project. The next round of focus groups will take place in May 2003.


B. STUDY SAMPLE CHARACTERISTICS Children

• As of December 2002 there are a total of 120 children in Cohort I (Year One), 153 children in Cohort II (Year Two), and 86 children in Cohort III (Year Three); N = 359.

• Mean age of children in the study is 8 years of age.

o Guided Services Group Child Age = 8.35 o Standard Services Group Child Age = 7.73 o Children Currently Adopted – Total Sample = 7.66 years o Children Previously Adopted – Total Sample = 10.02 years

• Gender of Children: o 178 male (49.6%) and 181 female (50.4%)

• Racial Characteristics: o 92% are White; this is in keeping with the general demographics of Maine

as a mostly White, non-Hispanic population. African-American is the next highest racial group with 13 out of 319 (4%) overall children identified in this category.

• Legally Adopted – By six months into the study, 89% of children were legally

adopted. By 12 months into the study, 99% of children were legally adopted. By 18 months, 100% were legally adopted.

• Type of Adoption:

o Approximately 88 percent of all children in the study are adopted by current foster parents; this is similar across all Cohorts.

• Previous versus Current Adoption: 83 percent of all children in the study are

current adoptions. o Cohort I: 88% of children are current adoptions o Cohort II: 77% of children are current adoptions o Cohort III: 87% of children are current adoptions

• Number of Previous Placements in Foster Care - Administrative data from state DHS records was available for 268 child study participants. The number of previous placements refers to permanent placements—long-term placements in locations such as foster family homes, residential facilities and hospitals. As counted since the most recent removal from home, the mean overall is two placements per child (2.09 for Guided and 1.87 for Standard).

• Length of Time in Foster Care - Administrative data from state DHS records

was available for 268 child study participants. The average (mean) number of


years these children have been in Foster Care to entry to study is approximately 4.4 (4.5 for Guided and 4.2 for Standard).

• Time Child in Home Previous to Entry to Study – for the entire sample,

children are in this home on average for 35 months (36 months for Guided and 35 months for Standard children).

• School Age Children: 82 percent of children in the study are attending school (86 percent of Guided and 77 percent of Standard children).

• Receives Special Education Services at School – For children who are attending school, 47% overall have an Individualized Education Plan (47 percent of Guided; 47 percent of Standard).

• Clinical Diagnosis – Parents report that overall, 28% of Guided children and 24%

of Standard children have a clinically diagnosed disability. • Use of Psychotropic Medication –In the entire sample, 29 percent of children are

taking some type of psychotropic medication (30% of Guided children and 28% of Standard children)

Families

• Twenty-four percent of families report an annual average income of more than $65,000. Twenty percent earn between $35,000 - $45,000. Only 2% make less than $15,000.

• Family Structure: o 84% are married couples and 12% are single female-headed households.

• Relationship to Child – As Reported by Parent: o 88 percent are Foster Parents

Sixty-nine percent are foster parents who were not related to the child—only 7 (3%) parents thus far in the study have been foster parents and relatives to the child. Five percent of respondents were relatives of the child or friends of the family. Twenty-three percent were neither foster parents nor relatives to the child. C. ISSUES AT PRE-LEGALIZATION

• Reasons for Adopting a Child – Most common reasons cited by all caregivers were: Wanted to Make Relationship Legal; Felt Close to Child; Wanted Child to Feel Secure; and Our Other Children Are Attached to Child.

• Concerns About Adoption – Most common concerns cited by all caregivers

were: How to Meet Child’s Needs; Other Children’s (in family) Reactions;


Child’s Acceptance of Me (caregiver); Ability to Continue to Work; Effect of Adoption on Marriage; and Ability to Afford Additional Costs.

• Satisfaction with DHS Adoption Caseworkers Pre-Legalization:

o Majority of all Caregivers satisfied with DHS Caseworkers – on a scale 1=Very Satisfied to 4=Very Dissatisfied. Means are:

! Guided = 1.44 ! Standard = 1.49

o Majority of all Caregivers consistently felt that DHS Caseworkers knew about them the most and about their family the least.

D. SERVICES AND SUPPORT FOR FAMILIES Services Provided through the Intervention – MAGS There is currently the full-time equivalent of 11.5 social workers providing direct services to 115 families and 195 children. These workers are Casey employees or contracted staff from another agency. The social workers document the types of services they provide to the family/child, along with the length of service unit(s) and how it is provided.

• The most common service provided to families is Parent Education and Support: approximately 35 percent of all the types of services provided. As of May 2002, the service code for Parent Education and Support was broken into three categories for further clarification: General Parent Education and Support, Building/Maintaining Relationships, and Clinical Conversations. These new codes will provide a clearer picture of the services provided to families in this category. (For further discussion, see Focus Group Results in Chapter II, Section A: Implementation). The second most common type of activity is Collateral Contacts, which accounts for 16 percent of all services. A Collateral Contact is the act of sharing and/or gathering information with other professionals about the child and/or the family. The next most common types of direct services to the family are conducting Initial Assessments and Group Therapy to Adults.

• The amount of time spent providing services varies depending on the type of

service. Casey social workers apparently spend the largest amount of time (per service) providing group therapy to children (mean 107 minutes per service), providing non-therapeutic services, or recreational activities (mean 107 minutes per activity) conducting individual therapy with adults (mean 96 minutes per activity), and conducting group therapy with adults (mean 91 minutes per activity). The Parent Education and Support services provided most frequently average only about 37 minutes per contact. The average minutes for all services in general was 45 minutes per service.


• Overall, Casey social workers have provided an average of 227 services per family in Year One, an average of 130 services per family in Year Two, and an average of 29 services per family in Year Three. The range of the amount of time spent with each family is very wide; from the minimum of a phone call check-in once every six months to one family receiving 866 hours of services – or at least an hour each month. The average number of hours spent with each family is 99. Families are most frequently provided services through telephone contacts and then secondly through at-home visits.

• Parents are the primary recipient of a service (48% for Year One; 44% for

Year Two; and 43% for Year Three). Next is the family as a whole (30% for Year One; 42% for Year Two; and 47% for Year Three), followed by a service to the adopted child (20% for Year One; 13% for Year Two; and 9% for Year Three), and finally services to other siblings in the family (less than 1% for all three years).

• As this is a statewide model, there is an interest in the amount of time the

workers need to travel. Seventy-five percent of the services did not require any travel time, 9% required 1 hour or less of travel time, 12% involved between 1 and 2 hours of travel and less than 3% required more than two hours of travel.

Parent Support Groups One important service Casey Family Services also provides as part of the Adoption Guides project is support groups. Support groups offer adoptive families an opportunity to share parenting strategies and struggles with other parents in similar situations. Called “Parents of Challenging Children,” these groups help parents who are raising children with special needs, which may include learning disabilities, psychiatric disorders, socialization/behavioral difficulties, or children who are hospitalized, or have received day treatment or residential services. Currently, six Casey Family Services “Parents of Challenging Children” support groups are underway in Lewiston, Biddeford, Ellsworth, Caribou, Lincoln and Portland. The parent support group meetings are potluck dinners and include child-care and dinner for children, except for the Biddeford group, which meets in the daytime. A Casey Family Services therapist leads each group. An evaluation of the support groups began in October 2002. Support group members will complete surveys about their satisfaction with their group as well as about their own parenting stress levels. Surveys will be completed during the group and then follow-up surveys will be completed six months after the group officially ends. Many of the current groups have continued past their timeframe and members meet informally on their own. An additional group will begin meeting in Augusta early next year. A girls’ support group (for girls ages 10-13) has also been established in the past


year. This group will continue, and plans exist for a similar group for boys in the upcoming year. Types of Services Families Access in the Community – As Reported by Respondents

• Contact with DHS: At six months, the majority of all caregivers in (Guided 75%; Standard 79%) reported ongoing contact with DHS adoption staff. At this point they were contacting DHS staff for assistance with monthly subsidy issues, adoption legalization questions and a child’s new emotional needs. At twelve months the overall number of those contacting the DHS offices drops slightly, but is still a majority (Guided 64%; Standard 61%). The reasons for contact were the same.

• Services Sought and Received: Caregivers are asked which type of service do

they seek and the top four results are: (1) Individual Counseling Services; (2) Respite Care; (3) Adoption Support Groups; and (4) Other Services*. Caregivers were also asked to identify how many hours of service they received from a service provider. The top services by number of hours were: (1) *Other Services; (2) Respite Care for Adopted Child; and (3) Counseling for Adopted Child.

*The Other Services category includes services such as occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatments, neuropsychological evaluations, and homeopathic medicine. There are a few children in the study with very significant medical needs and these services require a large number of service hours. Some children have daily services.

• Natural and Professional Types of Supports/Services: Caregivers were asked

which types of supports/services are most important and from where are they provided – either naturally through a friend or family or other social network, or paid for from a service provider. Caregivers stated that their most important source of support was professional (54%) in the forms of: (1) Case Management, (2) Counseling, (3) School/School Services, (4) Financial Supports, and (5) Medical Services. Forty-six percent of the caregivers stated that their most important sources of support were natural and included: (1) Family Support, (2) Friends, (3) Spousal Support, and (4) Support Groups. At six months into the study, 79% of respondents stated they “routinely” access natural forms of support. The most frequently accessed are: (1) Family Members other than Spouse (44%); (2) Friends (37%); (3) Support Group (6%); (4) Church/Pastoral (5%); and Other, including other adoptive parents, spouse, neighbors, co-workers, other caregivers/parents (10%).

• Case-Manager/Worker: At six months into the study, 60% of all respondents

stated that they had a regular case manager; 83% of those in Guided Services and 32% in Standard Services. At twelve months, 64% reported having a case manager; 89% of Guided and 30% of Standard. At 18 months, 67% reported having a case manager; 97% of Guided and 35% of Standard. At six months in the


study, 18% of families that are assigned a caseworker reported having more than one case manager per family. At twelve months, 28% reported having more than one case manager. At 18 months, 36% had more than one caseworker. The table below displays the number of caseworkers by assigned group as reported by caregivers.

1 Caseworker 2 Caseworkers 3 Caseworkers 4 Caseworkers Guided Standard Guided Standard Guided Standard Guided Standard6

months 30

(79%) 14

(88%) 6

(16%) 1

(6%) 2

(5%) 0 0 1 (6%)

12 months

28 (76%)

8 (62%)

7 (19%)

5 (39%)

2 (5%) 0 0 0

18 months*

17 (63%)

6 (67%)

10 (37%)

2 (22%) 0 0 0 0

24 months

10 (59%)

5 (83%)

6 (35%)

1 (17%)

1 (6%) 0 0 0

*One Standard caregiver reported having five caseworkers at this point in time.

• All caregivers across both groups report that case managers provide the following types of direct services/supports: (1) Assist to Develop and Broker for Services; (2) Provide General Supports/Education; (3) Advocates on Behalf of Child(ren); and (4) Provides Direct Therapeutic Services. The major difference between Guided and Standard Services groups was in the provision of direct therapeutic services by the caseworker—at six months 26% of the Guided Services caregivers reported receiving therapeutic services as opposed to only 11% of the Standard Services; at twelve months 22% of Guided as opposed to 3% of Standard and at 18 months 44% of Guided and 0% of Standard caregivers reported receiving therapeutic services from their caseworker. Statistically, there were significant differences between groups for:

o Case-Manager Develops/Brokers Services (at 12 months) o Case-Manager Provides General Support/Educational Services (at 12 and

18 months)

Barriers to Receiving Services Caregivers identified the following as the four biggest barriers in their pursuit of services or supports for their child/family:

1. Child’s Own Needs Creates a Barrier – Not External to Family 2. Lack of Services/Support in Own Community 3. Lack of Accurate Information about Child’s Needs 4. Lack of Time


E. REVIEW OF KEY VARIABLES AND OUTCOMES

The following results are based on data collected at Baseline, 6 months, 12 months, 18 months and 24 months into study. The number of study participants at each point in time is outlined in the table below.

Sample Characteristics Length of Time in Study December 2002

TIME IN STUDY

GUIDED SERVICES (E)

STANDARD SERVICES (C)

Baseline Child: n = 198 Family: n = 107

Child: n = 161 Family: n = 96

6 Months Child: n = 147 Family: n = 75








• Number of Days Child in Home – Displacement Days: At baseline, there

were seven children who were reported to be out of the home due to a problem—the median number of days was 20. At 6 months, there were ten children out for a median number of 10.5 days. At twelve months, there were nine children out for a median number of nine days; at 18 months, three children were out for a median number of 51 days, and at 24 months, one child was out for five days. The table below displays the medians by assigned group.

Median Number of Days Out of Home – Displacement

December 2002 Baseline 6 Months 12 Months 18 Months 24 Months Guided 86 (n=5) 12.5 (n=6) 5.5 (n=2) 51 (n=3) 5 (n=1) Standard 10.5 (n=2) 3.5 (n=4) 95.5 (n=4) -- -- Overall 20 (n=7) 10.5 (n=10) 9 (n=6) 51 (n=3) 5 (n=1)

• Number of Adoption Dissolutions: There are no dissolutions reported for

either group. • Child Attached to Family: Caregivers from both groups rate levels of

attachment of child to family as high with no statistical difference between groups over time. At 6 months, Guided Services children rated at 1.15 and Standard Services children rated at 1.09; At 12 months, Guided Services children rated at 1.10 and Standard Services children rated at 1.15. At 18 months, Guided Services children rated at 1.50 and Standard Services


children rated at 1.16; at 24 months, Guided Services rated at 1.10, and 1.09 for Standard. The scale is 1=Very Attached to 4=Not at All Attached.

• Children’s Mental Health – Child Functioning: Levels of child

functioning are measured once for children age 1.5 to 5 and once for children age 6 to 18. Twenty-three percent of the younger children and 45% of older children score in the clinical range on the Internalizing Problem Behavior scale; 25% of younger children and 62% of older children score in the clinical range on the Externalizing Problem Behavior scale; and 23% of younger children and 65% of older children score in the clinical range on the Total Problem Scale. Older children are scoring at higher levels of clinical need at the time of adoption.

• Child’s Health and Development: For both groups, caregivers rate the

child’s overall health as positive. There are no statistical differences between groups. When caregivers rated their child’s growth and development to other children of the same age, both groups rated their child’s growth as being similar to other children.

• Child Positive and Negative Traits: For both groups, caregivers rated the

frequency in which the child demonstrates positive traits as high and for negative traits, the frequencies are low. Using the scale, 1=Never to 4=Everyday, scores were: At 6 months Positive Traits for Guided = 3.49 and Standard = 3.45; At 12 months Positive Traits for Guided = 3.46 and Standard = 3.39; At 18 months Positive Traits for Guided = 3.37 and Standard = 3.31. For the frequency of Negative Traits, at 6 months Negative Traits for Guided = 2.25 and Standard = 2.34. At 12 months Negative Traits for Guided = 2.27 and Standard = 2.52. At 18 months Negative Traits for Guided = 2.30 and Standard = 2.74. There are no statistical differences between groups on these outcomes.

• Child Positive Behaviors to Parent: For both groups, caregivers rated the

frequency in which the child demonstrates positive behaviors to them as high. At 6 months Positive Behaviors for Guided = 3.19 and Standard = 3.26; At 12 months Positive Behaviors for Guided = 3.26 and Standard = 3.21; At 18 months Positive Behaviors for Guided = 3.27 and Standard = 3.18. The scale is 1=Never to 4=Everyday. There are no statistical differences between groups on these outcomes.

• Child’s Satisfaction with Adoption: For both groups, caregivers rate that

the child is very satisfied with the process of adoption. At 6 months the child’s satisfaction was rated for Guided = 1.49 and Standard = 1.58; At 12 months child’s satisfaction was rated for Guided = 1.29 and Standard = 1.58. At 18 months, child’s satisfaction was rated for Guided = 1.29 and Standard = 1.55. The scale is 1=Very Satisfied to 4=Not at All Satisfied. There are no statistical differences between groups on these outcomes.


Family Level Outcomes

• Caregiver Health – Stress: Caregivers complete a health assessment rating themselves in eight areas. There are no statistical differences between groups on these outcomes. Using a scale of 0 - 100 with a higher score defining a more favorable health state, caregivers rated their overall general health: at 6 months Guided = 75.50 and Standard = 76.02; at 12 months Guided caregivers = 76.84 and Standard = 75.00. At 18 months, Guided = 77.86 and Standard = 73.32.

• Caregiver Satisfaction with Adoption: For both groups, caregivers rate

high levels of satisfaction with the adoption process. There are no statistical differences between groups on these outcomes. At 6 months, Guided caregivers = 1.23 and Standard = 1.17; At 12 months Guided caregivers = 1.18 and Standard = 1.34; At 18 months, Guided caregivers = 1.15 and Standard = 1.18. The scale is 1=Strongly Satisfied and 4=Not at All Satisfied.

• Parenting Practices: Caregivers are asked to rate themselves on a set of

parenting behaviors that are classified as either Authoritarian or Authoritative. For both groups, parents tend to view themselves as more Authoritative than Authoritarian in their own parenting style. Authoritative practices include: display of affection towards child; sharing feelings and experiences with child; respect/encourage child’s independence; supervision of child; and establishment of family rules and responsibilities. There are no statistical differences between groups on these outcomes.

• Family Adaptability and Cohesion: Family Cohesion is defined as the

emotional bonding that family members have towards one another. Family Adaptability is defined as the extent to which a family system is flexible and able to change. For Cohesion (scores in the range of 51 to 70 are considered balanced and healthy), at 6 months, Guided = 68.80 and Standard = 68.97; at 12 months, Guided = 67.63 and Standard = 67.44; at 18 months, Guided = 67.16 and Standard = 68.12. For the Adaptability measure (scores in the range of 40 to 54 are considered balanced and healthy), at 6 months, Guided = 48.59 and Standard = 53.68; at 12 months, Guided = 48.04 and Standard = 45.87. At 18 months, Guided = 47.59 and Standard = 47.96. For both groups on both measures, their overall scores were within the moderate/normal ranges.

• Family Attachment to Child: Both groups of caregivers rate family

members attachment to the child as very attached. At 6 months, the Guided Services mean score is 1.97 and Standard Services mean score is 2.01. At 12 months Guided Services mean score is 1.92 and Standard Services mean score is 1.70; At 18 months Guided Services mean score is 1.79 and Standard Services mean score is 2.31. The scale used is 1=Very Attached


and 4=Not at All Attached. There are no statistical differences between groups on these outcomes.

• Percent of Caregivers Who Trust Child: Caregivers are asked if they trust

their child, Yes or No. At Baseline, there were no statistical differences between groups. At 6 months, 73% of Guided and 61% of Standard report trusting their child. At 12 months, 69% of Guided and 52% of Standard report trusting their child. At 18 months, 71% of Guided and 41% of Standard report trusting their child. At 18 months there is a statistically significant difference between groups. The Pearson’s Chi Square value for 18 months is 8.947, df=1 and p=.003.

• Parent and Child Communication: Both groups of caregivers rate their

overall level of communication with their child as very positive. At 6 months for Guided Services the rating = 1.73 and for Standard Services = 1.77; At 12 months for Guided Services the rating = 1.71 and for Standard Services = 1.96; At 18 months for Guided Services the rating = 1.71 and for Standard Services = 1.96. The scale is 1=Excellent to 4=Poor. There are no statistical differences between groups on these outcomes.

• Frequency of Parent and Child Disagreements: Both groups of caregivers

appear to experience very low levels of parent-child disagreements. At 6 months, Guided Services caregivers report 1.66 and Standard Services caregivers report 1.68. At 12 months, Guided Services caregivers report 1.64 and Standard Services caregivers report 1.75; At 18 months for Guided Services the rating = 1.65 and for Standard Services = 1.82. The scale is 1=Never to 4=Everyday. There are no statistical differences between groups on these outcomes.

• Frequency of Parent to Child Positive Care giving Behaviors: Both

groups of caregivers appear to demonstrate high levels of positive care giving behaviors. At 6 months, Guided Services caregivers report 3.36 and Standard Services caregivers report 3.61; At 12 months Guided Services caregivers report 3.58 and Standard Services caregivers report 3.59; At 18 months for Guided Services report 3.55 and Standard Services report 3.49. The scale is 1=Never to 4=Everyday. There are no statistical differences between groups on these outcomes.

• Overall Quality of Home Life: Both groups of caregivers rate their overall

quality of home life as positive. At 6 months, Guided Services caregivers = 2.03 and Standard Services caregivers = 2.05. At 12 months, Guided Services caregivers = 2.00 and Standard Services caregivers = 2.21; At 18 months Guided Services caregivers = 2.07 and Standard Services caregivers = 2.42. The scale is 1=Excellent to 5=Poor.


• Family Empowerment - Caseworker Family Centeredness: In families that are receiving regular case management services, caregivers are asked to assess the family centeredness of those services. Supports are provided based on the family needs and not based solely on the adopted child’s needs or professional provider recommendations. Caregivers in both groups rate their caseworkers as functioning in a family-centered fashion. At 6 months Guided Services casework = 4.5 and Standard Services casework = 4.52; At 12 months, Guided Services casework = 4.52 and Standard Services casework = 4.56; At 18 months Guided Services casework = 4.64 and Standard Services casework = 4.57. The scale used is 1=Very Low Levels of Family Centeredness to 5=Very High Levels of Family Centeredness. Scores of 3 or below are considered negative results. There are no statistical differences between groups on these outcomes.

F. FINANCIAL COSTS

Total Medicaid AmountsMAGS Study Population

December 2002

$1,190,427$2,039,354

$7,378,497

$5,906,420

$8,502,200

$6,775,558

$3,785,949

$3,228,144

$0 $2,500,000 $5,000,000 $7,500,000

Previous Year

Year 1

Year 2

Year 3

Total Dollars

Standard

Guided

The total amount of Medicaid dollars spent on this population (n=340) of children in foster care the year previous to study entry was $14, 154, 055. For those children (n=338) who are one year into the study, after approximately 90% are legally adopted, the total amount decreases to $9, 692, 369; a difference of nearly $4.5 million dollars. One reason given for this sharp decrease in this first year is the fact that therapeutic foster care costs are no longer accrued as these children are legally adopted. Total costs for those children (n = 233) in the study for two years are approximately $11, 730, 344. For Year 2, there were three children with a total of $7, 011, 618 in costs. Removing costs associated for these three provides a revised Year 2 total of approximately $4, 718, 726. For those children in the study for three years (n = 110) the total Medicaid costs are $3, 229, 871.


Average per Child Medicaid AmountsMAGS Study Population

December 2002

$19,515

$41,620

$39,040

$31,086

$65,909

$44,871

$25,581

$31,040

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000

Previous Year

Year 1

Year 2

Year 3

Average Dollars

Standard

Guided

*$20,516

For these results there are no differences between groups at baseline, Medicaid costs for the previous year prior to study entry. At baseline the Guided Services results are; n=189, mean = $39, 040 and SD = $41, 123. At baseline Standard Services n=151, mean = $44, 871 and SD = $61, 408. As mentioned above, just three children in the Guided Services group account for almost 60% of the total costs for all children in Year 2. Results for the Guided Group for Year 2 without these three children included yields an average of approximately $20, 516 per child. Using this revised average amount, note line on bar, there is a decrease in average costs per child over time for both the Guided and Standard Services groups.


Average Medicaid Costs - Foster and NonFoster December 2002

$39,730

$30,608

$53,432

$57,669

$12,953

$20,733

$0 $15,000 $30,000 $45,000 $60,000

1 Yr. Prior to Study

1 Year in Study

2 Years in Study

Total Dollars

Non-Foster

Foster

*$38, 850

Comparing Medicaid costs by type of adoption indicates that during the year previous to entry to study, while these children were still in the foster care system not yet adopted, average costs for those children who would be adopted by non-foster parents was higher than those who would be adopted by foster parents; $57, 669 to $39, 730 comparatively. However, after legalization, that pattern changes and then foster parent adoptions have higher average costs than non-foster parent adoptions. For Year 1 results only, these differences are found to be statistically significant. When removing the previously mentioned three children with unusually high costs in Year 2, the average for foster parent adoptions at $38, 850 is still higher than non-foster average at $20, 733; although this difference is not statistically significant. The following table does not include these three high cost children in the results.

Average Medicaid Costs – Foster and Non-Foster

December 2002 Previous Year –

Baseline Year 1 in Study Year 2 in Study

Foster Parents: N

Mean SD

207

$34, 962 $42, 957

204

$31, 372 $78, 087

208

$38,850 $71, 523

NonFoster Parents:

N Mean

SD

22

$45, 501 $35, 468

22

$15, 648 $20, 697

22

$20, 733 $64, 884


Of particular interest to this study are Medicaid costs associated with Case Management activities. This is the only Medicaid related cost that Casey Family Services claims for reimbursement for this model.

Case Management Costs per Child MAGS Study Population by Assigned Group

December 2002

$4,170

$2,591

$5,979

$1,928

$11,699

$11,994

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000

Cas

e M

anag

emen

t

Average Dollars

Year 2 - StandardYear 2 - GuidedYear 1 - StandardYear 1 - GuidedPrevious Year - StandardPrevious Year - Guided

Case Management Costs per Child By Assigned Group



Guided Services (E):

N Mean

SD

173 $11,699 $8,588

130 $4,170 $3,087

43 $5,979 $3,514

Standard Services (C):

N

Mean SD

136 $11,994 $8,042

77 $2,591 $2,354

21 $1,928 $1,130

Although Guided Services per child costs for Case Management are larger than related costs for Standard Services, both groups show significant decreases in costs as compared to the year previous to entry to study. Given such a large difference, efforts should be made to better understand the cost drivers pre-legalization for case management services.


In addition, program staff track the use of IV-E dollars for other types of services not covered by Medicaid or the families insurance carrier.

Guided Services Families: IVE ExpendituresDecember 2002

$25,431

$19,092

$360

$12,283

$10,466

$180

$13,148

$8,626

$180

$0 $10,000 $20,000 $30,000

Cohort 1 Families

Cohort 2 Families

Cohort 3 Families

Total Dollars

Total Expenditures

DHS Reimbursement

Family Contribution

This chart, and the one following, tracks costs that are Title IV-E dollars provided only to Guided Services (E) families. These funds are for services of various types that are not paid for from current options such as Medicaid and/or private insurance carriers. These services include such activities as respite, educational activities and/or special therapeutic activities. The intent is for the family to share equally in the costs of these services. Requests are made to Casey social workers and then approved by the state DHS adoption program manager on a case-by-case basis. Cohort 1 (n=18) families are those families accessing these funds that entered the project in the first year, Cohort 2 (n=14) families entered in the second year and Cohort 3 (n=3) in the current or third project year. Therefore, Cohort 1 families have had more time to accumulate costs as they have been in the project longer. Approximately 56% of Cohort 1 families have accessed this funding, 30% of Cohort 2 families and only 11% of Cohort 3 families. The types of activities paid for from these funds is varied; one arbitrary categorization of these activities is respite related services and all others.

• Cohort 1 Families: 31% Respite and 69% Other Types of Services • Cohort 2 Families: 38% Respite and 62% Other Types of Services • Cohort 3 Families: 67% Respite and 33% Other Types of Services


Average per Family IV E ExpendituresDecember 2002

$118

$209

$126

$173

$0 $50 $100 $150 $200 $250 $300

Cohort 1

Cohort 2

Total Dollars

DHS Reimbursement

Family Contribution

This chart depicts average overall expenses per family for Cohort 1 and Cohort 2 families. This data indicates that the intent of co-equal contributions from families and the Title IVE dollars appears to be evident; there are no statistical differences to report. Looking closer at costs for types of expenses:

• There were a total of 157 requests for financial support from 35 families to date. • 54 requests for Respite type services, at an average total (family and DHS

combined) cost of $276.00 per request. • 103 requests for Other types of services, at an average total cost of $289.00. • Average costs per activity are:

o Family Contribution: $145.00 o DHS Contribution: $139.00 o Total Combined: $284.00

• Minimum Contribution by Family = $12.50 • Minimum Contribution by DHS = $12.50 • Maximum Contribution by Family = $1,800.00 • Maximum Contribution by DHS = $600.00.

One of the goals of the intervention process was to create a shared approach to costs with families for services to meet their child’s unique needs. It appears that MAGS social workers are successful at creating this shared approach to paying for unique services.


G. FINDINGS Implementation of MAGS Model According to interviews with stakeholders and review of documents associated with project implementation, the model appears to be implemented as intended. Casey social workers are working to connect with DHS caseworkers and from there, establish relationships with the family. Services appear to be provided as needs in the family come forward in the form of a family-centered model of practice. Significant problems with implementation included no service delivery to Aroostook County for the first year, 2000-2001, due to a failure in establishing service contracts between Casey and other services providers in a timely fashion. Since 2001, a contract has been in place with an additional agency to provide services to the northern region. It appears uncertain as to the effects on quality due to services provided through a contracted agency instead of directly by Casey Family Services. At the very least Aroostook County social workers appear somewhat disconnected from the rest of the Casey staff. In the second year of the project, 2001-2002, problems occurred with the referral process. Some DHS adoption workers were not inviting families to participate in the Project. This issue was identified and steps were taken to insure that all families are approached about the Project. However, referrals are still not coming in as quickly as estimated. Keeping track of the referral process and reiterating its importance to social workers will remain ongoing throughout the Project. Another factor that will undoubtedly affect the orchestration of the Project is that a key Project member, the contact at DHS, has retired. A major concern at this point of the study is the rate of attrition as families are dropping out of the study over time. These and other issues of implementation will continue to be evaluated for the remainder of the study. Services and Supports to Families DHS adoption caseworkers receive generally high marks in terms of caregivers being satisfied with their work. However, there is a significant difference between how well previous foster parents and non-foster parents believe caseworkers know their child—non-foster parents report higher levels for how well their worker knows their child. After legalization, DHS staff continues to be involved with families especially in an informational type of role related to the adoption subsidy. The MAGS intervention model appears to be a type of case-management process that is intended to be based on family need; not just driven by child need or the judgments and biases of a professional provider. Interview data from the social workers substantiates this intent. In terms of amount of time spent with families, the most common type of activity that the MAGS social workers are engaged in is providing educational and more general forms of support to families. The other most common activities are (1) collateral contacts (gathering information from other professionals);


(2) conducting initial family assessments, and (3) conducting adult/parent support groups.

Fifty-four percent of all caregivers report that the types of services they most often seek are professional in nature and are:

1. Social workers/Case management 2. Professional Therapy/Counseling 3. School/School Services

Forty-five percent of all caregivers report that they prefer natural forms of support including:

1. Support from Family Members 2. Support from Friends 3. Support from Spouse 4. Support Groups

Caregivers report the biggest barriers to receiving services are:

1. Child’s Own Needs – barrier is not external to family 2. Lack of Services/Supports in Community 3. Lack of Accurate Information – both about child’s needs and what to do 4. Lack of Time due to full-time employment

The MAGS model, based on a philosophy of family-driven supports and provided

by a social worker who can also provide therapeutic services, seems to be similar to what families are stating they need in terms of professional supports. Providing support groups for parents is also recognized by the MAGS designers as important for maintaining a successful adoption and is part of this model of intervention. These results would also indicate that it is crucial to involve other family members or friends as part of a support system to the identified family and child(ren).

Child and Family Outcomes

A critical continued finding from this study is the level of need for mental health

services for many of these children. Using the Child Behavior Checklist (Achenbach, 1991) as a measure of functioning, anywhere from 45% to 65% of the children (age 6 – 18 years old) in this study are considered in need of clinical mental health services depending upon the particular scale score: Internalizing Behaviors (45% in clinical range); Externalizing Behaviors (62% in clinical range); and Total Problems (65% in clinical range). Of younger children (age 1 ½ - 5 years old), 23 % to 25 % are considered in need of clinical mental health services: Internalizing Behaviors (23% in clinical range); Externalizing Behaviors (25% in clinical range); and Total Problems ( 23% in clinical range).

Caregivers appear to feel positive about the adoption process and rate the level of attachment of child to family and family to child as positive. Ratings of overall communication with the child and overall quality of home life are also positive. The


parenting styles reported, Authoritative, and degree of family Cohesion and Adaptability are all results in favor of positive family functioning.

For this report, there are 34 separate child and family outcome variables analyzed

for group differences over time. Of those, only three outcomes revealed statistical differences over time in favor of the Guided Services model and those are: • Caregiver Level of Trust with Child; • Case Manager Develops/Brokers Services • Case Manager Provides General/Educational Support Analyses for other group differences over time were not found to be statistically significant. CONCLUSION

At this point in the study there are results for most participants who have been in the study for at least 18 months, n = 107 children and n = 54 families. Results to date provide reasons for both concern and optimism. As these results are considered, it is very important to remember that this intervention is being evaluated as it develops. Although the study design is strengthened by the use of random assignment and valid and reliable measures, the fact remains that this research is conducted in a live setting, not in a controlled setting. Questions that need to be explored while considering these results are:

• Fidelity of Implementation of the Intervention - Are all families receiving the

same quality and quantity of service/support from their assigned social worker/case manager/Guide?

• Appropriateness of Outcomes – Are the outcomes chosen the best to measure success?

• Sensitivity of Measurement – Are the measures selected sensitive enough to pick up on changes over time?

• Group Differences – Are families/children in the control group (Standard Services) receiving services/supports in such a way that is similar to the experimental group (Guided Services) and therefore minimizes ability to detect between group differences?

• Amount of Intervention – Are children/families who are receiving the Guided Services intervention in fact getting the amount (dosage) of support that they need in order to improve?

• Length of Exposure to Intervention – Are children/families exposed to the Guided Services intervention for a long enough period of time in order to receive benefits?

• Limitations to Case Management Models – A core function of case management models is to refer and/or connect families to other services/supports in the community. What is the quality of the other services families receive and how does that influence outcomes?


For those participants in the study for 18 months, there are few statistically significant differences to report that would lend support to the Guided Services intervention. Even with positive trends on a number of other child and family functioning outcomes, there is little evidence to support effectiveness based on differences between groups on these outcomes at this point in time. This finding needs further interpretation in order to decide how effective this type of case management model is at influencing change for children and families.

Turning to reasons for optimism, it is clear that this intervention model is

designed and implemented to meet needs expressed by these adoptive families. The philosophical intent of providing services in a family driven framework appears to be evident. The partnership between the Casey Family Services agency and the state DHS adoption program appears to function in support of this project. Both agencies have demonstrated willingness to collaborate and work through a uniquely difficult process with families at various stages of engagement.

The results of the descriptive analyses of the financial data, use of Medicaid funds

and Title IVE funds, provides another area of focus for potential improvements to the post-adoption system. Medicaid costs drop substantially after legalization and for Guided Services children, on average costs continue to decrease. It appears evident that Guided Services participants are receiving services in such a way that is not increasing costs to the Medicaid system. This finding needs to be further studied in order to discern which types of costs are most evident for which types of child/family needs. In addition, the Title IVE funds provided to Guided Services families appear to be utilized in an equitable way amongst families and the state DHS funds are fairly matched by family contributions. This process may provide a model of how to increase flexibility of access to services for children/families in need.

Finally, these results clearly indicate a substantial need for behavioral health

services and supports for the majority of children who are adopted from the state child welfare system. The evidence from this study to date, from parents and providers, clearly supports the need for post-adoption services for a majority of the children entering into adoptive families. In the midst of caring for children with substantial needs, caregivers continue to report overall levels of satisfaction with the adoption, their services from DHS staff, and with the supports they receive from the Guided Services social workers. These results are encouraging and are a testament to the grace exhibited by many of these families. For more information: Virginia S. Marriner Michel Lahti, Evaluator MAGS Program Manager I.P.S.I./Muskie School Department of Human Services University of Southern Maine 11 State House Station 295 Water Street Augusta, ME 04333 Augusta, ME 04330 P: 207.287.5060 P: 207.626.5274

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report - Maine Adoption Guides Project 1

CHAPTER I – INTRODUCTION

A. OVERVIEW OF THE DEMONSTRATION 1. PURPOSE

The evaluation of the MAINE ADOPTION GUIDES PROJECT, Title IV-E Child Welfare Waiver is conducted for the Department of Human Services, Bureau of Child and Family Services (DHS). It is comprised of two parts: 1.) a process and an impact evaluation of the adoption competency-training program for public and private providers of adoption related services; and 2.) a process and outcome evaluation, and a cost effectiveness/benefit analysis, of the purchase and delivery of guided post legalization adoption support services to children and families. The design of the training evaluation was a nonrandomized pre-post design with follow up interviews to map the impacts of the training on knowledge and application of skills. The design of the post-legalization Adoption Guide support services evaluation is randomized. This interim report focuses on this model of supports to families adopting children with special needs.

The training evaluation component began on April 1, 1999 and continued through end of November 2000. The final training evaluation report is available upon request. Statewide implementation of the Guided Services model began on April 1, 2000 and will terminate on March 31, 2004. The entire evaluation will end no later than 9 months after the end date of the Waiver Demonstration Project, on or before December 31, 2004. The Maine Adoption Guides Project has both system level and program level intended outcomes. System Level - Permanency Related Outcomes: ! Reduce Time in Foster Care to Adoption Legalization without Increasing the Number

of Adopted Children whom Re-Enter Foster Care. ! Increase Permanency for Special Needs Children These outcomes will be considered system level outcomes and will be tracked through current state Department of Human Services administrative data systems. Measures will be taken on an annual basis and comparisons made pre-Demonstration Project and over time. Program Intervention Level Outcomes: ! DECREASED RATE OF ADOPTION DISSOLUTIONS ! SUPPORTED AND STRENGTHENED ADOPTIVE FAMILIES ! MAINTAINED OR ENHANCED THE WELL-BEING OF THE CHILD IN THE

ADOPTIVE FAMILY ! INCREASED ADOPTION RELATED AWARENESS, KNOWLEDGE, SKILLS AND

THE APPLICATION OF THOSE SKILLS AMONG PROVIDERS AND RELATED PROFESSSIONALS WHO SERVE ADOPTIVE FAMILIES.


The outcomes listed above are conceptualized in relationship to the proposed interventions by the following logic model.

INTERVENTIONS

Adoption Competency Training / Enhanced Supportive Services

SHORT TERM OUTCOMES

" Increased adoption related awareness, knowledge, skills and the application of those skills by providers

and related professionals who serve adoptive families " Decreased Rate of Adoption Dissolutions " Supported and Strengthened Families

" Maintained or Enhanced the Well-being of the Child in the Adoptive Family

LONGER TERM OUTCOMES

" Reduce Time in Foster Care to Adoption Legalization without Increasing the Number of Adopted Children whom Re-Enter Foster Care

" Increase Permanency for Special Needs Children


2. BACKGROUND

The evaluation of the MAINE ADOPTION GUIDES PROJECT, Title IV-E Child Welfare Waiver is conducted for the Department of Human Services, Bureau of Child and Family Services (DHS). It is comprised of two parts: 1.) a process and an impact evaluation of the adoption competency-training program for public and private providers of adoption related services; and 2.) a process and outcome evaluation, and a cost effectiveness/benefit analysis, of the purchase and delivery of guided post legalization adoption support services to children and families. The design of the training evaluation was a nonrandomized pre-post design with follow up interviews to map the impacts of the training on knowledge and application of skills. The design of the post-legalization Adoption Guide support services evaluation is randomized. This report will focus on the Guided Services evaluation results to date, for a full copy of the final training evaluation results please contact the evaluator.

The training evaluation component began on April 1, 1999 and continued through end of November 2000. Statewide implementation of the Guided Services model began on April 1, 2000. The entire evaluation will end no later than 9 months after the end date of the Waiver Demonstration Project, on or before December 31, 2004.

This Child Welfare Demonstration Project is the result of planning on the part of the state DHS agency since the mid 1990s. As a result of a series of interactions with parents, adoption agencies and other stakeholders the state DHS developed a specific focus on post-legalization services. This policy and program development was driven by two pressures on the adoption system: (1) increasing numbers of children requiring adoption services; and (2) pending implementation of the Adoption and Safe Families Act. In response to those pressures, state agency managers, parents and non-governmental adoption agencies undertook a process that resulted in this Child Welfare Demonstration Project - Maine Adoption Guides Project.

The guiding principles that drive this initiative are the following: " Adoption is a life-long process. " Most adoptive families experience normal crisis in their development. " Families need more support services post-legalization.

In addition to realizing the need for a more concentrated effort to provide post-legalization services, the initiative also intends to impact the adoption competencies of clinicians providing services to adoptive families. Parents involved in the planning process were forceful in their concerns about an apparent lack of understanding of the dynamics of adoption on families on the part of mental health clinicians.


3. ADOPTION GUIDED SERVICES DESCRIPTION

The core principle of this program is that adoption is different. The dynamics of a family created by adoption are different from the dynamics of a family created by birth. Adoption is lifelong and its impact creates unique opportunities and challenges for families and communities. Adoption is mutually beneficial to parent, child and society. Society is responsible for supporting and aiding integration and preservation of adoptive families.

This program description will focus on the services to the guided supportive services (experimental) group. The standard services (control) group will get the same level of post legalization adoption assistance services that are presently in place, either through D.H.S. or generally available in the community. The guided service model is intended to differ from the standard practice in several ways, see Figure 1 below for a comparison. In addition, see Figure 2 following for a program logic model of the Guided Services intervention. We recruit the participants from the overall population of families adopting children with special needs, out of the Foster Care System of DHS. The families are selected at the time they are approved for adoption assistance. We will be covering the entire state of Maine, which includes all eight districts of the DHS. This service delivery will be provided by a partnership of DHS/BCFS and Casey Family Services. It may also include Casey Family Services subcontracting with other service providers to meet statewide needs. Families assigned to the standard services, adoption assistance group will not be eligible for the Guided post legalization adoption services. No family will receive any less service than is presently provided. The long-term plan, based on the positive outcomes of this study, is that these same guided services could be expanded to the general population of adopting families. This is a community-based delivery of service program designed to be child-centered and family focused. The adoptive parent(s) is viewed as the expert on their child. The adoption staff are guides who consult with the family through the expected and normal crisis in the life of an adoptive family. Therefore, the major hypothesis of the study is: Families and children who receive guided supportive services will be strengthened, have fewer dissolutions, and report higher levels of child and family well being than families and children that receive standard services.


Figure 1 Post Legalization Program Model Differences

Program Standard Guided Supportive Attribute Services Services Target Population Children w/Special Needs, Children w/Special Needs, and their Families and their Families Program Goals - Provision of Adoption - Decrease Dissolutions Assistance Funds - Increase Family Strengths Funds - Maintain/Increase Child - Assistance with and Family Functioning process to Legalization - Provision of Adoption Assistance Funds Staffing D.H.S. Adoption Worker D.H.S. Adoption Worker and Casey Adoption Staff Services Provided - One time Assessment/ - Initial and ongoing Planning Session support based on family - Financial Support for needs identified in “Family Post Adoptive Services as Permanency Assessment”. per Entitlements - Scheduled check-ins with - Annual Financial Planning family and Casey staff at for Continuance of Adoption least once every six months. Assistance - Permanent assignment of Casey staff to family in an empowerment role. - Financial Support for Post Adoptive Services, not limited to services pre- defined in subsidy agreement. - Annual Financial Planning for Continuance of Adoption Assistance Access to Trained - Provided with List of - Provided with List of Providers Trained Providers Trained Providers


Figure 2 - Maine Adoption Guides - Guided Services Intervention Program Logic Model

INPUTS ACTIVITIES OUTPUTS IMMEDIATE OUTCOMES 0 - 6 MONTHS

INTERMEDIATE OUTCOMES 7 - 18 MONTHS

LONG TERM OUTCOMES 19-48 MONTHS

• Social Worker Staff • Financial Supports

for Families • Formal and

Informal Supports for Families

• Initial Assessment with Family - Strength Based, Family Centered planning

• Case Management Activities

• Therapy Sessions • Resource

Brokerage • Regular Check-ins

with Family, at least once every 6 months

• Social Worker meets with family for initial strengths based, family centered assessment, with DHS/IASC Adoption worker; before legalization.

• Regular Check-Ins Occur; at least 2x per year.

• Social Worker available to family for case management - supportive services, therapy; ongoing.

• Family is supported and empowered as they respond to their child's needs.

• Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains.

• Families access needed resources, formal and informal supports.

• Family & Social Worker staff expresses satisfaction with Guided Services model.

• Adoption is maintained

• Few to No Displacements - Child Lives at Home


• Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains.


• Few to No Displacements - Child Lives at Home


• Family & Social Worker staff satisfied with Guided Services model given normal developmental crises.


• Selected Child(ren) maintains or improves functioning; school, social and emotional domains.


• Few to No Displacements- Child Lives at Home


• Family & Social Worker staff satisfied with Guided Services model given normal developmental crises.


Program Logic Model: Outcome Definitions

Family is supported and empowered as they respond to their child's needs. " Parent - Child Communication " Parent - Child Relationship " Feelings about Adoption " Attachment " Satisfaction with Adoption " Caregiver Health (Stress) " Quality of Home Life " Family Cohesion/Adaptability/Satisfaction (FACES II) Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains. " Juvenile Justice Involvement " Physical Status " Emotional/Intellectual Status " Relations with Peers " Personality Traits " Competencies and Problems - Functioning (CBCL, YSR, TRF-CRF) " Academics/School (CBCL, YSR, TRF) Families access needed resources, formal and informal supports. " Formal Supports include: Case Management; Respite; Advocacy Support by Case Manager;

Counseling/Therapy; Family Therapy; Marriage Counseling; Adoption Support Group; Special Education services; Residential Treatment; and other Institutional Placement.

" Informal Supports: identified by the family - documented. Family & Social Worker staff expresses satisfaction with Guided Services model given expected normal developmental crises. " Family: Satisfaction with support and services as provided through their Adoption Guide social

worker. " Adoption Guide Social Worker: Satisfaction with their role and performance in the Maine Adoption

Guides Program and how they are supported in their work with families. Adoption is Maintained " The legalized adoption does not dissolve with the child returning to the state's custody and foster care

system. Few to No Displacements - Child Lives at Home " The child/adolescent lives in her/his home on a permanent basis - number of days child is at home. A

displacement is when a child/adolescent is hospitalized or otherwise removed from the home in order to receive treatment so that the child may return home. Child is considered not at home when she runs away, is incarcerated, lives somewhere else against parents will or is hospitalized for other than a medical necessity.


B. RESEARCH DESIGN AND METHODOLOGY 1. POPULATION CHARACTERISTICS

This component of the project targets children who are in the state child welfare system who are classified as having special needs. The criteria for special needs in Maine results in nearly all children falling into this category. In April 1999, at the beginning of the Project, Maine had approximately 3,100 children in foster care. In January of 1999 there were 641 children requiring adoption services. As of January 2000, there were 806 children requiring adoption services. For the year 2000, 423 adoptions were legalized in Maine; for the year 2001, 304 adoptions were legalized in Maine; and, for 2002 through November, 265 adoptions were legalized. (See Table 5, page 25). All three years show an increase from 1999 when 240 children legalized. These figures represent the continuation of an upswing in adoptions in Maine, experienced after a four-year decrease from 1990 to 1994.

2. RESEARCH DESIGN AND METHODOLOGY

a. Guided Services Evaluation

As mentioned above, the Guided Services component of this initiative commenced in November 1999 through March 2000 with pilot implementation of the intervention. This pilot period was crucial for the evaluation as it provided an opportunity to design, test and implement the necessary procedures for random assignment, data collection, data entry and reporting. The pilot period resulted in the implementation of an evaluation process that is fairly well integrated with the two organizations that are part of this Demonstration project. The following is the basic evaluation plan developed for the Guided Services component of the project.

b. Guided Services Model - Process Evaluation

A process evaluation is critical in describing the program strengths and

weaknesses to guide implementation, and to understand the outcome data. For this project, the process evaluation will include the monitoring of:

! DHS and Casey Family Program Organizational Aspects ! Staffing Structures and Profiles ! Financial Commitments ! Level of Acceptance by Field Staff ! Methods of Project Implementation - Fidelity of Guided Services Model ! Contextual Factors ! Demographic Profiles of Families and Children Served ! Utilization of Services and Unmet Needs ! Satisfaction with Services ! Differences in Experimental and Standard Groups ! Family Assessment of Long Term Permanency Needs ! Results of Individual, Family Focused, Series of Regularly Scheduled

“Maintenance” Checkups


c. Outcome Evaluation - Guided Services Model

The outcome evaluation began in Year 2 of the Demonstration Project on 4/1/2000 and will commence through March 2004. The selection or development of measures and data collection strategies, including a piloting process, was conducted during the Year One, 4/1/1999 - 3/31/2000. The outcome evaluation assesses to what extent the children/families who received the Guided Services Model (experimental group) and the children/families who received Standard Services (control group) differ in regard to a number of outcome measures. The outcome measures include: ! Rates of Adoption Dissolutions ! Number of Days Child in the Home / Displacement Rates ! Assessment of Family Functioning ! Assessment of Child Functioning/Well Being ! Assessment of Access to and Utilization of Services ! Levels of Satisfaction with Services

d. Outcome Evaluation - Research Design

This study makes use of a randomized design with blocking on a few child and family characteristics. The Figure 3 below outlines the proposed design which is a two-group randomized experimental design such that any family/child meeting the participation criteria will have an equal chance of being assigned to either of the two groups.

Figure 3 - Outcomes Study Design

This design intends for at least 60 children assigned to the Guided Services - experimental group and 60 children assigned to the Standard Services - control group each year. Actual recruitment will be for 70 children in each group to work against possible attrition. Sample size estimates are as follows: ! Year 2, 2000-2001: 120 children (60E, 60C) ! Year 3, 2001-2002: 240 children (120E, 120C) ! Year 4, 2003-2004: 360 children (180E, 180C) ! Year 5, 2004-2005: 480 children (240E, 240C) This design results in the following sample sizes for longitudinal study: ! Four years in Project: 120 children ! Three years in Project: 240 children ! Two years in Project: 360 children ! One year in Project: 480 children

Guided Services: Group A Randomization --- (Baseline) O --- X --- O (Every 6 mos.) -- O Standard Services: Group B Randomization --- (Baseline) O ---------- O (Every 6 mos.) -- O


C. DATA COLLECTION & ANALYSIS

1. Data Collection Data is collected from:

(1) self-selected primary caregivers to report on child level and family level variables;

(2) Casey Family Services social workers to report on implementation of model and theory of change;

(3) DHS state agency staff and administrators to report on implementation of overall program; and

(4) Casey and DHS administrative records. Data is collected by; telephone interviews with parents, individual and group interviews with clinical staff and DHS staff, and data extraction forms with secondary data. Data is collected from primary caregivers at baseline upon entry to the study and every six months thereafter through the completion of the project. Both a written survey and a telephone survey are completed at baseline and at every six months. In general, telephone surveys are scheduled upon receipt of the written survey. The average time between the written survey and the telephone interview at baseline is 1.24 months. At six months the average amount of time is 0.9 months; at 12 months, 0.7 months; at 18 months, 0.6 months; and at 24 months, 0.3 months. Contact evaluator for; (1) a complete description of the measures selected/developed for this component of the evaluation; and (2) a description of the data collection schedule(s).

2. Data Analysis Plan

The estimated sample size is sufficient for both descriptive and inferential statistical analyses. Descriptive statistics, such as percentages, rates, frequency distributions and means, will be employed to describe the two groups. Descriptive statistics will be produced to answer each of the evaluation questions. Inferential statistics will be used to test the statistical significance of any differences within and or between groups as established in the research questions. Open-ended questions and results of focus group interviews are analyzed through coding for common themes emerging from the narrative data. For a complete data analysis plan, please contact the evaluator.

Information summarized in this report is primarily presented in two ways: at

baseline (from surveys received upon a family’s entry into the study) and by six-month waves (corresponding to each wave of data collection from families). In addition, the data is analyzed by assigned group: Guided (experimental group) and Standard (control


group). Until this point, information had also been presented by Cohort. However, at this time, with a sufficient number of families in each of four waves of data collection, and with no statistical differences between cohorts, we feel that our data would be more clearly understood if displayed simply by the amount of time in the study. In order to do this, we have combined all cohorts together and will describe the results by assigned group at baseline, and at every six months of data collection.


CHAPTER II – PROCESS ANALYSIS

A. IMPLEMENTATION 1. WHAT IS THE MAINE ADOPTION GUIDES (MAGS) MODEL OF

INTERVENTION?

A description of the Guided Services program is provided in Chapter I. Essentially this intervention appears to be a case management type of model. Casey Family Services social workers liaison with DHS Adoption Caseworkers and meet with the selected family approximately 3 months before legalization. This is the target point in time, however, this time period is somewhat arbitrary as the actual timeframe for legalization depends solely on the courts’ capacity to litigate these cases. During this initial meeting with the family, or sometimes over the course of two or three meetings, an assessment is conducted. Based on this assessment, driven by the needs of the family, services and supports are provided. Families are required to meet with the Casey Family Services social worker at least once every 6 months.

It is anticipated that this intervention model will evolve as the project develops.

The evaluator has and will meet with the clinical staff as they further refine this approach to post-legalization supports and services. The clinical staff, in consultation with the DHS program manager, has developed the following mission and standards statements (Casey Family Services, March 2000) that begin to define this intervention model.

Maine Adoption Guides Mission Statement and Case Practice Standards

Mission Statement: Adoption is a common and acceptable way to create a family. Still, a family formed by adoption has unique dynamics and issues. Bonding and attachment between an adoptive parent and child is not automatic, rather it is a process. And in this process of building a cohesive family, crises are predictable and normal. A child who is adopted brings to the family a unique history that includes the trauma of separating from his or her birth parents and often includes other life trauma. Adoptive parents also bring unique histories to the relationship. In addition, they have expectations about parenting that are sometimes not met by their adopted child. Siblings, by adoption, birth, or by fostering significantly contribute to the family dynamics. Communities are responsible for supporting and aiding integration and preservation of adoptive families. The process of building a cohesive family can be supported by community services and extended family, or it may be hindered if the community and/or extended family is not informed about adoption related issues, or is not supportive. Communities may need support in developing adoption competent resources. Consideration and respect is given to all triad members. The child’s birth family as well as adoptive family is vital to the child’s development and overall sense of well-being. The type of contact or the amount of information the child has regarding his or her birth family should be based on the child’s developmental


and therapeutic needs. Adoptive families may need encouragement to increase their comfort with birth family issues so that they can support their child’s integration of his or her history. A child’s family of origin may differ culturally from his or her adoptive families’. It is important for a child who is adopted to develop a positive understanding of his or her cultural heritage in order to form a healthy identity. Adoptive parents may need assistance finding ways to facilitate their child’s positive identity formation. Services delivered will be client-centered reflecting families’ interest, ability and desires. Parents will be supported in creating a safe and nurturing environment for their children. The Maine Adoption Guides will have the goal of empowering parents to claim their children and maintain hope. Case Practice Standards: Assessment The assessment of an adoptive family will take into account the normal struggles adoptive families are bound to have. Within this “normative crisis” framework, the interplay of the parent/child dynamics and the influence of the community will be assessed.

Child factors will include: • ability to attach; • history of trauma; • stages of normal child development; • educational, medical, social recreational and psychological needs.

Parent factors will include:

• parenting style; • the parent’s perspective and ability to respond to normative crises; • parent history; • the parent’s ability to seek and use support; • parent’s knowledge and understanding of their child’s cultural heritage; • parent’s medical and mental health needs will be assessed; • parent’s previous experience with service providers.

Resources:

• the availability of adoption competent providers; • the ability to meet the special needs of the child and family; • extended family support.

Service Plan

• service plans will be individualized and will reflect the assessment of the parent’s and child’s needs;

• service plans will be re-evaluated regularly to adapt to changing needs and abilities in a family;

• service plans will identify the current community supports; • service plans will support family connections regardless of whether a child is able to live in

the home at any given time; • service plans will recognize the importance of the adopted child’s birth and cultural heritage; • time frames identified in service plans will be realistic and reflect the family’s stage of

development; • barriers to achieving goals and services needed will be identified and documented.


Contact with Family:

• will occur minimally every six months; • will occur regularly and will coincide with the normative stages of family development; • will be driven by family needs.

Use of Community Resources:

• referrals will be made to adoption competent providers; • respite providers will have the knowledge and experience necessary to provide the level of

care necessary to meet the child’s needs; • communication between the agencies, providers and families will occur regularly to assure

that goals and treatment plans are agreed upon.

The Adoption Guides model is statewide. During the first year of the project, there were no social workers available in Aroostook County, the northern part of the state. Therefore, the program was not available to families in that county. In order to combat this problem, Casey Family Services developed a contract with Community Health Counseling Services, to provide social workers in Aroostook. Staffing Casey Family Services staff members working on the Adoption Guides project all have Master’s Degrees in Social Work and are licensed as LCSWs or LMSWs. Social workers provide intake and permanency planning services to special needs children, with birth, adoptive and foster families. They perform professional casework, group work and advocacy for children and families, function as clinical team members, and participate in individual and peer supervision. Responsibilities include providing ongoing education for families; gathering and presenting clinical information for disposition of referrals; providing ongoing assessment of each child or family’s needs; developing and administering case plans; and providing individual, family or group treatment. Social Workers’ territories are as follows:

Table 1 Social Worker Territories

December 2002 Region Number of Social

Workers Greater Portland/York County/Kennebec County 6 Lewiston/Auburn/Skowhegan/Waterville 1 Bangor/Ellsworth/Machias/Kingfield 4 Aroostook County 2 social workers cover

cases on as needed basis Two social workers are team leaders—one overseeing Greater Portland and York County and the other working outside the Portland area.


Team leaders provide clinical supervision to staff delivering services to children and families referred to Casey Family Services. Team Leaders are members of the Divisional Management Team and participate in planning program development and other special projects. Responsibilities include planning, assigning, supervising and evaluating the work of social workers; assessing staff training needs; reviewing and monitoring case progress; and providing direct services to children and families when appropriate. Following are the Guided Services population total currently being served:

Table 2 Guided Services Population Served By Project Year

December 2002

April 2000-March 2001

April 2001-March 2002

April 2002 –December 2002 Total

Children Served

53 87 55 195

Families Served

30 42 32 104


2. TYPES OF SERVICES PROVIDED THROUGH MAGS INTERVENTION?

Casey Family Services provides a wide variety of services to families as part of the Adoption Guides project. For further discussion of the amounts and types of services used, please see Section C: Service Characteristics (page 73). Service codes were developed with Casey Family Services in order to categorize the work they do with children and families. When a Casey social worker provides any of the following services to a child or family, the worker enters the corresponding code into the database.

Figure 4 Casey Family Services: Maine Adoption Guides Service Codes & Definitions

01 Initial Assessment

The Collection and assessment of information regarding the child, family and other relevant persons, to determine the nature of individual and family issues and the services needed to foster strengths and provide supportive services to a family. Activities consist of interviewing, making an assessment of need, assessing the availability and accessibility of services, making case recommendations and setting objectives. This activity includes conducting family assessment at time of referral to MAGS. Services Rendered to: Family

02 Case Plan (Initial and Subsequent Reviews)

Case plans are developed in accordance with overall MAGS program philosophy of family strengthening and empowerment. A case plan is developed in conjunction with the family and in consultation with a supervisor and other professionals as needed. The case plan identifies the client's needs, and delineates the objectives designed to meet those needs. The case plan is developed at completion of the intake process and is reviewed every six months or as needed. Services rendered to: Family

03a Parent Education and Support Effective 5-1-02, do not use 03a. Please use 03a1, 03a2, or 03a3.

03a1 Building Relationship/Maintenance Contacts with the primary purpose to engage the client, build trust, or to maintain an existing relationship. Services rendered to: Parent

03a2 Clinical Conversation

Conversations focused on identifying, clarifying and addressing client's multiple needs. Social workers address interpersonal and intrapsychic issues that might be affecting the individual or family. These conversations are therapeutic in nature but are more global than traditional counseling. Services rendered to: Parent


Figure 4 Continued:

03a3 General Parent Education and Support Providing information to parent to educate and support including preparation for PETs, assistance with parenting skills, information regarding such topics as birth family, normative developmental stages, attachment. Services rendered to: Parent 03b Crisis Stabilization/Follow-up Activities in response to a situation when a specific and urgent issue requires immediate attention from MAGS social worker or on-call staff member. Subsequent contacts may also be included to assess any additional services needed to insure ongoing stability. This requires that some action be done other than just supporting the parent by phone. Any situation requiring a critical incident report will be coded under this category.

03c Referral to Mental Health/Substance Abuse Services Coordinating information that results in a referral to an outpatient community based mental health and or substance abuse service agency. Referral can be for the child and or any member of the family who is recipient of services.

03d Referral to Community Resources (other than Mental Health, include Coordinating information that results in a referral to a community based resource and or support. Referral can be for the child and or any member of the family.

03e Provision of concrete services (include type in DOC) Activities that result in the purchase of concrete goods or services for the child and or family. Financial Assistance that is provided in addition to the Adoption Subsidy paid to the family through D.H.S. IV-E funding.

03f Collateral Contacts Sharing with and gathering information from other parties associated with the child and or family.

03g Non-Therapeutic Services Informal social/recreational activities such as agency-sponsored picnics or attendance at legalization celebrations. These also may include recreational activities completed alone with children or with groups of children. Effective May 1, 2002, this code includes child care provided during parent support groups.

04 Advocacy Effective 5-1-02, do not use 04. Please use 04a or 04b. 04a General Advocacy Contacts with others who have influence/power in the client's life with the goal of insuring that their needs are met. Negotiating and coordinating services on behalf of children and families to assist them to obtain otherwise inaccessible or unavailable services. Negotiating the development of new resources or services.


Figure 4 Continued:

04b Educational Advocacy Similar to the general advocacy defined above but specifically related to the educational needs of the child. Includes attendance at PETS. Services rendered to: Child

05 Preparation and Placement Providing support to family/child when the child requires placement out of the home. Services Provided To: Child 06a Therapeutic Services: Child

Goal directed, therapy sessions for Individual child; may include therapeutic Life Book work.

06b Therapeutic Services: Parent

Goal directed, therapy sessions for Individual parent.

06c Therapeutic Services: Family

Goal directed, therapy sessions for the family; may include therapeutic Life Book work; Dan Hughes.

06d Therapeutic Services: Group Children

Goal directed, therapy sessions for children group.

06e Therapeutic Services: Group Adult

Goal directed, therapy sessions for adult group.

06f Therapeutic Services: Multiple Social Workers

Therapeutic services delivered to parent, family, group children or group adult by more than one clinician. (Effective 9-1-02)

07 Case Related Documentation

Reviewing of written materials and any written work including assessment reports, case plan, contact logs, critical incident reports, reading records, letters, reports, etc. Anything that requires 15 minutes or more is documented.

08 Psychiatric Services

Psychiatric Consultation and/or medication monitoring provided by the Casey Family Services psychiatric consultant. (Effective 9-1-02)

77 Delete this record

Error made. This record will be deleted in Augusta before placing in Master File.

88 No Contact This Month Per Family Request


Support Groups One important service Casey Family Services also provides as part of the Adoption Guides project is support groups. Support groups offer adoptive families an opportunity to share parenting strategies and struggles with other parents in similar situations. Called “Parents of Challenging Children,” these groups help parents who are raising children with special needs, which may include learning disabilities, psychiatric disorders, socialization/behavioral difficulties, or children who are hospitalized, or have received day treatment or residential services. Facilitated by therapists, the groups offer adoptive parents a safe environment to discuss their problems, as well as the opportunity to meet and connect with other adoptive parents. In general, the groups meet once a week, or every other week for 6 to 8 week sessions in each region. Intended Outcomes: Goals of the parent support groups include:

• Parents feel more capable to meet the special needs of their child(ren) • Parents feel more supported • Parents feel more satisfied with their adoption(s) • Fewer dissolutions

Target Population: Parent support groups are open to any adoptive parent of children with special needs (support groups are available to adoptive parents in all agencies, private or DHS). For the purposes of these support groups, “special needs” are defined mostly as behavioral or psychiatric conditions—not special physical needs. Adoptive parents contact Casey if they are interested in joining a group and are then invited into Casey for an interview. Parents joining a group commit to attending consecutive weekly meetings for the 6 to 8 weeks. Currently, six Casey Family Services “Parents of Challenging Children” support groups are underway in Lewiston, Biddeford, Ellsworth, Caribou, Lincoln and Portland. The parent support group meetings are potluck dinners and include child-care and dinner for children, except for the Biddeford group, which meets in the daytime. A Casey Family Services therapist leads each group. Many of the current groups have continued past their timeframe and members meet informally on their own. An additional group will begin meeting in Augusta early next year. A girls’ support group (for girls ages 10-13) has also been established in the past year. This group will continue, and plans exist for a similar group for boys in the upcoming year.


3. HOW IS MAGS IMPLEMENTED? Every family who is adopting a child from the state DHS, unless the family is moving out of state, is invited to participate in the project. Based on random assignment, the family then receives the intervention. The protocol for referral and randomization is stated in Chapter 1, page 9.

a. Results of Referral Processes During the second year of the project, there was a slow down in referrals. DHS investigated why this was happening and it no longer is a problem. When DHS caseworkers invite families to participate in the project, they complete a brief questionnaire with families who refuse to participate in the project.

Table 3 Non-Participants by District – Year 3 to Date

December 2002

District 1

District 2

District 3

District 4

District 5

District 6

District 7

District 8

Total

15 0 4 4 4 3 8 2 40

b. MAGS Implementation Survey Results

Between August 2001 and March 2002, USM research staff conducted the second implementation survey of the Maine Adoption Guides Project in order to assess the project’s implementation. Surveys were administered via email to those involved in the project—caseworkers and supervisors from DHS and Casey Family Services. In total, 28 surveys were received; from 16 DHS Adoption Unit caseworkers, eight Casey Family Services staff, and four DHS Adoption supervisors. In order to assess the project’s implementation, e-mail surveys are conducted each year with the DHS and Casey Family Services caseworkers and supervisors who are involved in the project. At this point in time, the referral process has not yet been completed for the year, and the surveys have not yet been completed. Please refer to the Maine Adoption Guides Project Interim Report June 2002 for a summary of last year’s implementation survey results.

c. Focus Groups In addition to the implementation survey, focus groups with social workers provide valuable information on the project model and its process. Focus groups are held with Adoption Guides social workers and supervisors approximately every six months. Staff members are asked to define their roles in the project and provide general feedback on the project’s implementation—how the project model compares to their day-to-day work.


In November 2002, the fourth round of focus groups was held with the Adoption Guides social workers. One group was held in southern Maine with 11 social workers and two team leaders. The other group was conducted via telephone with two social workers and one supervisor who work in northern Maine. Unless otherwise noted, the following is a summary of results from both discussions. The focus group questions focused on gathering in-depth descriptions of a few of the services social workers provide to families. The first type of service discussed was “General Parent Education and Support.” This service code is distinguished from “Building/Maintaining Relationships,” and from “Clinical Conversations,” and serves as a type of miscellaneous category for the kind of education and support social workers provide to families. Workers mentioned that this code includes such things as educating families (and themselves) on a diagnosis; working with a child’s developmental stages; educating a family about the therapy process, and helping families decide what they may need for support. Workers also may help a parent think about a child’s behavior in a different way. Participants mentioned seeing themselves as a “safety net” or as a “coach” for families and feel that “General Parent Education/Support” is a major element of the model because it allows a more meaningful connection with the family. Through the home-based work done with families, workers see the family in the context of the family’s home and have a depth of understanding of the child and his/her whole situation. This enables the social workers to have more accurate hypotheses about what is happening with a child or family than other professionals who may only be seeing the child by him/herself. Workers also mentioned that the flexibility of the model enhances parent education and support because there is no agency mandate on how to support a family. The model allows workers to provide each family with tailored services. The support given to families seems casual and therefore easy to discount, but it is the core of the program. The next service code discussed was “Collateral Contacts.” Social workers described this as identifying needs and building resources. It can be case management or it can be clinical. Workers also help to educate the collateral contacts. MAGS workers are trained specifically on adoption issues and attachment whereas others involved with a family may not be. Due to this, the Adoption Guides workers’ assessments are valued for their clinical insight. Flexibility also plays a role in this service—workers have the opportunity to attend meetings with families, etc., which in turn enables them to have a greater understanding of a family’s situation. The code “General Advocacy” can include services similar to “Concrete Services.” Often it’s a mixture of the two codes. Again, social workers’ clinical experience and adoption awareness benefits them in advocating for a family. People begin listening to workers differently when they learn of their knowledge of adoption issues. The role workers play as advocates is important because parents sometimes get discouraged by the difficulty in finding services. The model’s flexibility enables workers to have more time to devote to advocacy, because they don’t have to capture everything they do into a billable timeslot. Houlton workers have not yet had much opportunity to advocate for families but see an important future role working as advocates in the schools.


“Non-therapeutic” services include recreational and informal activities with families, such as having lunch or dinner, going to picnics, attending parties, going to the movies, or playing with children. These types of services are seen as very important to the model because they break down artificial boundaries—making families feel more comfortable and able to trust workers. Often times, non-therapeutic services pave the way to doing clinical work with a family that may have been initially reluctant. The informal activities allow for families’ progression. Therefore, this is not a short-term service. Non-therapeutic activities allow parents the opportunity to network with other parents and allow kids with similar issues to come together. Kids and families can connect through these gatherings and can get support in a non-threatening way. These activities also are a great way for families to relieve stress without worrying about the stigma of needing therapy. Workers view these informal connections as a major component of the model. The focus groups also discussed the process of social workers teaming up to work together. The decision to team up is driven by the needs of the child and the family. If a particular worker doesn’t feel that he or she has the needed skills for working with a family, he or she can team up with someone who can help with the family and/or teach the necessary skills. Sometimes a family may have more needs than one worker can assist with and another worker can help provide services. Working in teams helps social workers reflect on their cases and provides opportunities for them to bounce ideas off of each other. Supervision was noted as a key piece of the model. Workers have regular meetings but also have frequent informal supervision where they exchange ideas and ask for advice. This informal supervision doesn’t occur in many other agencies because workers need to bill for every hour of work. The social workers in Houlton are not able to team together due to the great distance between where families live. Lastly, focus group participants discussed the coding process. Most agreed that the coding does not hinder their work and mentioned that the database set-up makes entering information relatively time-efficient. Some feel that coding enhances their work because it makes them take the time to think purposefully about the services being provided. Coding also helps some keep organized. There is still confusion about where certain services should fit but workers have operationalized a number of definitions and the codes seem to be working better. The Houlton workers stated that getting up to speed with their computers has been a challenge. They have not received feedback on their coding and so assume it is accurate. The Portland focus group participants were not asked about the barriers they face in their work. The Houlton social workers mentioned that working with computers has been a struggle, but is getting better due to administrative support. With time, the workers are coming to understand the computer system. Another barrier mentioned is the unavailability of state DHS workers when first meeting with a family. DHS have an established relationship with the families and it is easier to be introduced to a family with the DHS worker instead of going alone. Houlton workers also are separated by distance from the rest of the MAGS workers and do feel some isolation. Being able to share ideas would benefit them in their work.


These focus group discussions are important to the research process because they help track the changes in the evolving model. Getting clear and timely descriptions of the model ensures accurate reporting of the services provided as well as the process of the project. The next round of focus groups will take place in May 2003.


B. SAMPLE CHARACTERISTICS 1. WHO ARE THE CHILDREN INVOLVED IN MAGS? Children entering this study are part of a historical event in terms of adoption legalizations in Maine. The increase in the number of these legalizations in the past few years, see Tables below, is part of the rationale for developing approaches such as Maine Guides to assist families.

Table 4 ADOPTIONS

Adoption Finalizations by Years AS OF 12/1/02

Office 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Pending

Biddeford/ Sanford

63

32

41

18

Portland

17

13

21

34

27

19

32

46

57

31

33

14

Lewiston

26

15

5

18

9

17

30

49

70

28

30

18

Augusta

15

22

10

29

26

32

17

50

92

80

51

9

Rockland

11

4

Bangor

12

16

14

18

35

21

26

30

64

54

47

13

Ellsworth/ Machias

10

29

31

47

60

36

9

Houlton

8

9

16

15

25

15

15

17

30

19

16

10

TOTAL

78

75

66

114

122

114

149

223

423

304

265

95


Table 5 Adoption Finalizations by Month

AS OF 12/1/02 Month

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002 as of 12/1/02

January 9 1 0 9 5 4 6 9 31 26 25 February 5 9 4 7 15 5 8 17 17 23 12 March 9 7 4 2 18 10 8 17 31 23 23 First Quarter 23 17 8 18 38 19 22 43 79 72 60 April 10 3 15 7 5 9 8 12 36 15 23 May 6 2 12 8 12 6 16 14 44 31 33 June 6 1 8 20 11 10 5 27 22 34 35 Second Quarter 22 6 35 35 28 25 29 53 102 80 91 July 6 10 1 8 13 8 16 28 35 18 28 August 5 6 5 5 13 16 15 13 34 24 19 September 7 10 4 6 10 8 11 11 35 30 31 Third Quarter 18 26 10 19 36 32 42 52 104 72 78 October 5 11 1 17 7 20 15 15 33 25 18 November 5 8 1 12 4 2 18 9 43 22 18 December 5 7 11 13 9 16 23 51 62 33 Fourth Quarter 15 26 13 42 20 38 56 75 138 80 36 TOTAL

78

75

66

114

122

114

149

223

423

304


NOTE: Data used for analysis differs slightly from the actual study data (number of children and families currently served) due to attrition from the project. The MAGS research team asks families who drop out of the study for permission to keep their data. Therefore, the data from participants who agree remains in the analysis databases. The number of children and families in the following tables reflects that total (actual plus attrition combined) unless the table refers to actual number of children or families served. As mentioned in Chapter I, all children entering this study are coming into adoption from the state child welfare system. The following are a set of selected variables that are being investigated for change between groups and over time. Most Tables display the data (from all Cohorts combined) by Assigned Group. The figures represent data collected through early December 2002. A Pearson Chi-Square statistic was used to test for differences between groups for nominal - categorical data and Independent T-tests were calculated for ordinal -continuous type data. There were significant differences between assigned groups at Baseline for two variables: Is Child Attending School; and Child Satisfaction with Adoption. However, these are not key variables in the research. There were no significant differences found between assigned groups for any major outcome variables at Baseline. This result verifies the randomization process.

Table 6 Total Number of Children

by Cohort and Assigned Group December 2002

Assigned Group

Guided (E)

Standard (C)

Total

CWave Cohort One Baseline Count 59 61 120 Expected Count 66.2 53.8 120.0 % within CWave 49.2% 50.8% 100.0% % within Assigned Group 29.8% 37.9% 33.4% Residual -7.2 7.2 Cohort Two Baseline Count 93 60 153 Expected Count 84.4 68.6 153.0 % within CWave 60.8% 39.2% 100.0% % within Assigned Group 47.0% 37.3% 42.6% Residual 8.6 -8.6 Cohort Three Baseline Count 46 40 86 Expected Count 47.4 38.6 86.0 % within CWave 53.5% 46.5% 100.0% % within Assigned Group 23.2% 24.8% 24.0% Residual -1.4 1.4 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within CWave 55.2% 44.8% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Table 7

Total Number of Families by Cohort and Assigned Group

December 2002

Assigned Group Guided

(E) Standard

(C)

Total

CWave Cohort One Baseline Count 32 33 65 Expected Count 34.3 30.7 65.0 % within CWave 49.2% 50.8% 100.0% % within Assigned Group 29.9% 34.4% 32.0% Residual -2.3 2.3 Cohort Two Baseline Count 47 38 85 Expected Count 44.8 40.2 85.0 % within CWave 55.3% 44.7% 100.0% % within Assigned Group 43.9% 39.6% 41.9% Residual 2.2 -2.2 Cohort Three Baseline Count 28 25 53 Expected Count 27.9 25.1 53.0 % within CWave 52.8% 47.2% 100.0% % within Assigned Group 26.2% 26.0% 26.1% Residual .1 -.1 Total Count 107 96 203 Expected Count 107.0 96.0 203.0 % within CWave 52.7% 47.3% 100.0% % within Assigned Group 100.0% 100.0% 100.0%

Table 8

Child Gender by Assigned Group

December 2002


(E) Standard

(C)

Total

Gender Male Count 95 83 178 Expected Count 98.2 79.8 178.0 % within Gender 53.4% 46.6% 100.0% % within Assigned Group 48.0% 51.6% 49.6% Residual -3.2 3.2 Female Count 103 78 181 Expected Count 99.8 81.2 181.0 % within Gender 56.9% 43.1% 100.0% % within Assigned Group 52.0% 48.4% 50.4% Residual 3.2 -3.2 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within Gender 55.2% 44.8% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Table 9

Child Age by Assigned Group

December 2002


(E) Standard

(C)

Total

CWave 0 – 5 years old Count 52 55 107 % within Age Categories 48.6% 51.4% 100.0% % within Assigned Group 26.3% 34.2% 29.8% % of Total 14.5% 15.3% 29.8% 6 – 10 years old Count 91 62 153 % within Age Categories 59.5% 40.5% 100.0% % within Assigned Group 46.0% 38.5% 42.6% % of Total 25.3% 17.3% 42.6% 11 – 17 years old Count 50 43 93 % within Age Categories 53.8% 46.2% 100.0% % within Assigned Group 25.3% 26.7% 25.9% % of Total 13.9% 12.0% 25.9% 18 + years old Count 5 1 6 % within Age Categories 83.3% 16.7% 100.0% % within Assigned Group 2.5% .6% 1.7% % of Total 1.4% .3% 1.7% Total Count 198 161 359 % within Age Categories 55.2% 44.8% 100.0% % within Assigned Group 100.0% 100.0% 100.0% % of Total 55.2% 44.8% 100.0%

Table 10

Average Child Age (Mean Scores) at Entry in the Program

by Assigned Group December 2002

Age at Intake by Years Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 7.31 198 3.910 6.50 Standard (C) 6.65 161 3.797 6.25 Total 7.02 359 3.868 6.33


An important part of our analysis is to compare the differences between adoptive parents who were originally foster parents and those that were not foster parents. Currently, 88 percent of the parents in the study were formerly foster children. The actual numbers are as follows:

Table 11 Type of Adoption – Foster Parent and Non-Foster Parent


Assigned Group

Guided (E)

Standard (C)

Total

Type of Foster Parent Count 176 141 317 Adoption Expected Count 174.8 142.2 317.0 % within Type of Adoption 55.5% 44.5% 100.0% % within Assigned Group 88.9% 87.6% 88.3% Residual 1.2 -1.2 Non-Foster Parent Count 22 20 42 Expected Count 23.2 18.8 42.0 % within Type of Adoption 52.4% 47.6% 100.0% % within Assigned Group 11.1% 12.4% 11.7% Residual -1.2 1.2 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within Type of Adoption 55.2% 44.8% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Twenty-four percent of families have a total family annual income of more than $65,000. The next highest grouping percentage is 20 percent—earning between $35,000 and $45, 000 per year. Annual income varied fairly evenly over the different categories from less than $15, 000 to more than $65,000.

Table 12 Current Total Annual Income Before Taxes


Current Total Annual Income Before Taxes * AssignedGroup Crosstabulation

2 1 366.7% 33.3% 100.0%

2.0% 1.1% 1.6%9 7 16

56.3% 43.8% 100.0%9.1% 7.7% 8.4%

9 15 2437.5% 62.5% 100.0%

9.1% 16.5% 12.6%20 18 38

52.6% 47.4% 100.0%20.2% 19.8% 20.0%

19 17 3652.8% 47.2% 100.0%19.2% 18.7% 18.9%

17 8 2568.0% 32.0% 100.0%17.2% 8.8% 13.2%

22 24 4647.8% 52.2% 100.0%22.2% 26.4% 24.2%

99 91 19052.1% 47.9% 100.0%

100.0% 100.0% 100.0%

Count% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroupCount% within Current Total Annual Income% within AssignedGroup

Less than $15,000

$15,000 - $25,000

$25,000 - $35,000

$35,000 - $45,000

$45,000 - $55,000

$55,000 - $65,000

Over $65,000

Total

Guided (E) Standard (C)AssignedGroup

Total


The race of adopted children is also predominant in one category—92 percent of all children in the study are White. Roughly four percent are Black, and a small percentage are American Indian/Alaskan Native, Asian & Pacific Islander, and Unable to Determine.

Table 13

Child Race by Assigned Group

December 2002


(E) Standard

(C)

Total

Race White Count 184 146 330 Expected Count 182.0 148.0 330.0 % within Race 55.8% 44.2% 100.0% % within Assigned Group 92.9% 90.7% 91.9% Residual 2.0 -2.0 Black Count 5 8 13 Expected Count 7.2 5.8 13.0 % within Race 38.5% 61.5% 100.0% % within Assigned Group 2.5% 5.0% 3.6% Residual -2.2 2.2 American Indian / Count 2 3 5 Alaskan Native Expected Count 2.8 2.2 5.0 % within Race 40.0% 60.0% 100.0% % within Assigned Group 1.0% 1.9% 1.4% Residual -.8 .8 Asian & Pacific Count 1 1 2 Islander Expected Count 1.1 .9 2.0 % within Race 50.0% 50.0% 100.0% % within Assigned Group .5% .6% .6% Residual -.1 .1 Unable to Determine Count 6 3 9 Expected Count 5.0 4.0 9.0 % within Race 66.7% 33.3% 100.0% % within Assigned Group 3.0% 1.9% 2.5% Residual 1.0 -1.0 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within Race 55.2% 44.8% 100.0% % within Assigned Group 100.0% 100.0% 100.0% When parents were asked if they are the same race as the child, the majority said yes. Of the ten percent who said no (35 parents), 11 percent (four parents) said this racial difference made a difference in their relationship with the child. Parents explained that they noticed reactions from people in the community and people’s curiosity due to the low number of bi-racial families in their area. Two parents mentioned their efforts in trying to learn about the child’s culture and background.


Adopted children in the study live with families that largely are married couples. Eighty-four percent of families are married couples, 3 percent are unmarried couples, 12 percent are single mothers, and 1 percent are single fathers.

Table 14

Family Structure by Assigned Group

December 2002

Assigned Group

Guided (E)

Standard (C)

Total

FamStruc Married Couple Count 90 80 170 Expected Count 87.5 82.5 170.0 % within FamStruc 52.9% 47.1% 100.0% % within Assigned Group 86.5% 81.6% 84.2% Residual 2.5 -2.5 Unmarried Couple Count 4 2 6 Expected Count 3.1 2.9 6.0 % within FamStruc 66.7% 33.3% 100.0% % within Assigned Group 3.8% 2.0% 3.0% Residual .9 -.9 Single Female Count 9 15 24 Expected Count 12.4 11.6 24.0 % within FamStruc 37.5% 62.5% 100.0% % within Assigned Group 8.7% 15.3% 11.9% Residual -3.4 3.4 Single Male Count 1 1 2 Expected Count 1.0 1.0 2.0 % within FamStruc 50.0% 50.0% 100.0% % within Assigned Group 1.0% 1.0% 1.0% Residual .0 .0 Total Count 104 98 202 Expected Count 104.0 98.0 202.0 % within FamStruc 51.5% 48.5% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Table 15

Pre-Adoption Relationship to Child by Assigned Group

December 2002

As mentioned earlier, the majority of families were first foster parents to the child. Sixty-nine percent are foster parents who are not related to the child—only 7 (3%) parents thus far in the study have been foster parents and relatives to the child. Five percent of respondents are relatives of the child or friends of the family. Twenty-three percent were neither foster parents nor relatives to the child.


(E) Standard

(C)

Total

Pre-Adoption Foster Parent and Count 5 2 7 Relationship Relative % within Relationship to Child 71.4% 28.6% 100.0% to Child % within Assigned Group 4.7% 2.1% 3.4% Foster Parent Count 75 65 140 Non-relative % within Relationship to Child 53.6% 46.4% 100.0% % within Assigned Group 70.1% 67.7% 69.0% Relative Count 4 3 7 % within Relationship to Child 57.1% 42.9% 100.0% % within Assigned Group 3.7% 3.1% 3.4% Friend of Biological Count 1 2 3 Family % within Relationship to Child 33.3% 66.7% 100.0% % within Assigned Group .9% 2.1% 1.5% None of the Above Count 22 24 46 % within Relationship to Child 47.8% 52.2% 100.0% % within Assigned Group 20.6% 25.0% 22.7% Total Count 107 96 203 % within Relationship to Child 52.7% 47.3% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Sometimes children who are newly adopted join a family with a child(ren) who has previously been adopted and is receiving federal Title IVE subsidy. This then qualifies both the current and previously adopted child(ren) to be in the study sample. However, the fact that some children in the study are part of the same family could potentially be a limitation to the research. Most inferential statistical techniques assume that members of a population are randomly and independently drawn—that the fact that one child became a member of the sample should not have any relationship to the probability of another child becoming a member of the sample. Lack of independence of observations can compromise the significance and power of certain statistical tests. Therefore, we plan to closely monitor the percentages of the two groups (Current and Previous) as well as any differences between them. Overall, 83 percent of children are current adoptions (84% of Guided; 81% of Standard) and 17 percent (16% of Guided; 19% of Standard) are previous adoptions.

Table 16

Number of Children: Current or Previous Adoption Baseline by Assigned Group

December 2002


(E) Standard

(C)

Total

Is Child Current Adoption Count 167 130 297 Current or Expected Count 163.8 133.2 297.0 Previous Adoption?

% within is Child Current or Previous Adoption?

56.2% 43.8% 100.0%

% within Assigned Group 84.3% 80.7% 82.7% Residual 3.2 -3.2 Previous Adoption Count 31 31 62 Expected Count 34.2 27.8 62.0 % within is Child Current

or Previous Adoption? 50.0% 50.0% 100.0%

% within Assigned Group 15.7% 19.3% 17.3% Residual -3.2 3.2 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within is Child Current

or Previous Adoption? 55.2% 44.8% 100.0%

% within Assigned Group 100.0% 100.0% 100.0%


We receive state data on children from the Maine Automated Child Welfare Information System (MACWIS). This data provides us information on the number of a child’s previous placements in foster care and how long he/she has been in the foster care system. The overall average number of previous placements is two (2.1 for Guided and 1.90 for Standard). The number of placements ranged from one to eight. The average number of years a child has been in foster care is 4 (4.5 for Guided and 4.2 for Standard).

Table 17 Average Number of Child's Previous Foster Care Placements


Table 18 Average Number of Years Child Has Been in Foster Care


Number of Previous Placements Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 2.09 144 1.424 2.00 Standard (C) 1.87 124 .855 2.00 Total 1.99 268 1.198 2.00

Total Years in Foster Care Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 4.527 144 2.8711 3.792 Standard (C) 4.194 125 2.3342 3.583 Total 4.372 269 2.6357 3.667


The General Accounting Office issued a report in June 2002, “Foster Care: Recent Legislation Helps States Focus on Finding Permanent Homes for Children but Long-Standing Barriers Remain.” Based on national child welfare data sets, statistical reports, and state surveys, the report examined foster care and adoption trends since the 1997 Adoption and Safe Families Act (AFSA). One of the variables analyzed was children’s average length of stay in foster care. Specifically, the GAO examined length of stay for children who were adopted from foster care (FY 1998-2000). The graph below displays how length of stay compares between the Adoption Guides study children and the GAO national sample.

Chart 1 National Data Compared to Adoption Guides

Table 19 Average Time Child Has Lived in the Home (mean amounts -- in months)


Assigned Group

N

Mean

Std. Deviation

Std. Error Mean

Time in Home

Guided (E) 194 35.71 28.672 2.059

Standard (C) 156 34.72 29.623 2.372

On average, children have lived in their present home for just under four years (35.7 months for Guided children and 34.7 months for Standard children).

Child's Total Time In Foster Care

0 20 40 60 80 100

0 - 12 Months

13 - 24 Months

25 - 36 Months

37 - 48 Months

More than 4 years

Tim

e in

Fos

ter C

are

Percent of Children

Federal Report

Adoption Guides

MAGS June 2002


Table 20 Median Number of Days Child Has Been Out of the Home in Past Six Months


Median Number of Days Out of Home

Baseline 6 Months 12 Months 18 Months 24 Months Guided 86 (n=5) 12.5 (n=6) 5.5 (n=2) 51 (n=3) 5 (n=1) Standard 10.5 (n=2) 3.5 (n=4) 95.5 (n=4) -- -- Overall 20 (n=7) 10.5 (n=10) 9 (n=6) 51 (n=3) 5 (n=1)

At baseline, there were seven children who were reported to be out of the home due to a problem—the median number of days was 20. At 6 months, there were ten children out for a median number of 10.5 days. At twelve months, there were nine children out for a median number of nine days; at 18 months, three children were out for a median number of 51 days, and at 24 months, one child was out for five days.

Table 21 Time in Study (mean amounts -- in months)

By Cohort and Assigned Group December 2002

CWave

Assigned Group

N

Mean

Std. Deviation

Std. Error Mean

Cohort One - Baseline

Guided (E) 59 31.39 3.414 .444

Standard (C) 61 30.87 3.717 .476 Cohort Two - Baseline

Guided (E) 93 15.51 3.996 .414

Standard (C) 60 15.78 3.420 .442 Cohort Three – Baseline

Guided (E) 46 6.65 2.549 .376

Standard (C) 40 6.45 1.632 .258

Table 22

Percent of Children in Study Legally Adopted – At 6, 12, and 18 Months In Study by Assigned Group

December 2002

6 Months 12 Months 18 Months

Guided Services

89% 99% 100%

Standard Services

88%

99% 100%


Table 23 Child Behavior Problems Before Legalization – Baseline

December 2002

Respondents answered per child and chose from one or more of 11 problem type behaviors. Means represent the sum of the total behavior problems.

Guided Services Standard Services

N = 186

Mean = 3.92 SD = 2.898

N= 149

Mean = 3.67 SD = 2.976

Table 24 Is the Child Currently Attending School



(E) Standard

(C)

Total

Is Child Yes Count 170 124 294 Attending Expected Count 162.2 131.8 294.0 School? % within is Child Attending

School? 57.8% 42.2% 100.0%

% within Assigned Group 85.9% 77.0% 81.9% Residual 7.8 -7.8 No Count 28 37 65 Expected Count 35.8 29.2 65.0 % within is Child Attending

School? 43.1% 56.9% 100.0%

% within Assigned Group 14.1% 23.0% 18.1% Residual -7.8 7.8 Total Count 198 161 359 Expected Count 198.0 161.0 359.0 % within is Child Attending

School? 55.2% 44.8% 100.0%

% within Assigned Group 100.0% 100.0% 100.0%


Table 25 Child's Grade Level by Assigned Group

December 2002

Table 26

Child Has Individualized Education Plan (IEP) Children Age Five and Older



(E) Standard

(C)

Total

Child has Yes Count 56 42 98 Individualized % within Child has IEP? 57.1% 42.9% 100.0% Education Plan? % within Assigned Group 46.7% 46.7% 46.7% No Count 58 45 103 % within Child has IEP? 56.3% 43.7% 100.0% % within Assigned Group 48.3% 50.0% 49.0% Don’t Know Count 0 1 1 % within Child has IEP? .0% 100.0% 100.0% % within Assigned Group .0% 1.1% .5% NA/Refused Count 6 2 8 % within Child has IEP? 75.0% 25.0% 100.0% % within Assigned Group 5.0% 2.2% 3.8% Total Count 120 90 210 % within Child has IEP? 57.1% 42.9% 100.0% % within Assigned Group 100.0% 100.0% 100.0%

Assigned Group Group Total Guided (E) Standard (C)

Count Col% Count Col%

Count

Col% Child’s Not in School 64 32.3% 68 42.2% 132 36.8% Grade 1 19 9.6% 18 11.2% 37 10.3% Level 10 2 1.0% 2 1.2% 4 1.1% 11 3 1.5% 3 .8% 12 2 1.0% 1 .6% 3 .8% 2 16 8.1% 10 6.2% 26 7.2% 3 19 9.6% 10 6.2% 29 8.1% 4 10 5.1% 10 6.2% 20 5.6% 5 10 5.1% 15 9.3% 25 7.0% 6 11 5.6% 3 1.9% 14 3.9% 7 6 3.0% 3 1.9% 9 2.5% 8 4 2.0% 5 3.1% 9 2.5% 9 5 2.5% 2 1.2% 7 1.9% K 24 12.1% 14 8.7% 38 10.6% Pre K 3 1.5% 3 .8% Group Total 198 100.0% 161 100.0% 359 100.0%


Less than one-third of children in the study have clinically diagnosed disabilities—28 percent of Guided children and 24 percent of Standard children. The most common diagnoses are emotionally disturbed, ADHD, and “other” conditions such as post-traumatic stress disorder, attachment disorder, asthma, Fetal Alcohol Syndrome, ODD, and speech problems. Percentages of diagnoses are in the following table.

Table 27 Clinically Diagnosed Disabilities

December 2002

51 27.6% 134 72.4%16 8.6% 170 91.4%33 17.7% 153 82.3%17 9.1% 169 90.9%54 29.0% 132 71.0%43 23.1% 143 76.9%

102 54.8% 84 45.2%35 23.5% 114 76.5%

8 5.4% 141 94.6%22 14.8% 127 85.2%

8 5.4% 141 94.6%42 28.2% 107 71.8%40 27.0% 108 73.0%87 58.4% 62 41.6%

Clinically Diagnosed DisabilityMental RetardationVisual or Hearing ImpairmentPhysically DisabledEmotionally DisturbedADHDOther Diagnosed Condition

Guided(E)

Clinically Diagnosed DisabilityMental RetardationVisual or Hearing ImpairmentPhysically DisabledEmotionally DisturbedADHDOther Diagnosed Condition

Standard(C)

Count %Yes

Count %No


Table 28 Child Taking Behavioral/Emotional Medication


Child Taking Behavioral/Emotional Medication? * AssignedGroup Crosstabulation

56 42 9857.1% 42.9% 100.0%30.1% 28.2% 29.3%

130 107 23754.9% 45.1% 100.0%69.9% 71.8% 70.7%

186 149 33555.5% 44.5% 100.0%

100.0% 100.0% 100.0%

Count% within Taking Medication?% within AssignedGroupCount% within Taking Medication?% within AssignedGroupCount% within Taking Medication?% within AssignedGroup

Yes

No

Child TakingBehavioral/EmotionalMedication?

Total

Guided (E) Standard (C)AssignedGroup

Total


2. SELECT FAMILY LEVEL VARIABLES The following are a set of results on some of the key family level variables for this study. Unless otherwise noted, the between group comparisons are not statistically significant.

Table 29 Quality of Home Life in Past Six Months at Baseline

December 2002 1 = Excellent to 5 = Poor


N=107 Mean = 1.53

SD = .555

N=96 Mean = 1.57

SD = .557

Table 30 Quality of Home Life in Past Six Months at 6, 12 & 18 Months in Study



Six Months N = 75 Mean = 2.03

SD = .900

N=64 Mean = 2.05

SD = .765 12 Months N=49

Mean = 2.00 SD = .842

N=42 Mean = 2.21

SD = .925 18 Months N = 28

Mean = 2.07 SD = 1.086

N=26 Mean = 2.42

SD = .902 24 Months N = 20

Mean = 1.90 SD = .912

N=13 Mean = 2.46

SD = .877

Table 31 Satisfaction with Marriage/Partnership at Baseline Only

December 2002 1 = Very High to 5 = Very Low

Guided Services Standard Services N=98

Mean = 1.53 SD = 1.007

N=83 Mean = 1.54

SD = .591


Table 32 Concerns about Adopting a Child - Baseline Only

December 2002 Respondents could indicate more than one concern.

GUIDED

SERVICES (n=107)

STANDARD SERVICES

(n=95)

TOTAL (n=202)

HOW TO MEET CHILD’S NEEDS

74% 63% 69%

OTHER CHILDREN’S REACTION

52% 42% 48%

CHILD ACCEPTING ME 46% 43% 44% ABILITY TO CONTINUE

TO WORK 41% 29% 36%

EFFECT ON MARRIAGE 36% 32% 35% ABLE TO AFFORD

ADDITIONAL COSTS 37% 32% 35%

HOW RELATIVES/FRIENDS

WOULD FEEL

30% 31% 31%

BEING QUALIFIED ENOUGH TO DEAL

WITH CHILD NEEDS

27% 30% 29%

OTHER CONCERNS 17% 21% 19% MEETING LEGAL

OBLIGATIONS 13% 11% 10%


Table 33 Reasons for Adopting a Child – Baseline of Total Study Population

December 2002 Respondents could indicate more than one reason to adopt. Respondents were asked different questions

depending on relationship to child. Reasons are in order of most to least common.

GUIDED SERVICES STANDARD SERVICES TOTAL WANTED TO MAKE IT

LEGAL 83 67 150

(n = 157) FELT CLOSE TO CHILD 83 67 150

(n = 150) WANTED CHILD TO

FEEL SECURE 84 62 146

(n = 157) OUR CHILDREN WERE ATTACHED TO CHILD

49 45 94 (n = 156)

DID NOT WANT TO LOSE CONTACT WITH

CHILD

45 31 76 (n = 157)

WANTED TO PREVENT

STRANGERS FROM RAISING CHILD

37 36 73 (n = 154)

COULD NOT HAVE ANY BIRTH CHILDREN

37 32 69 (n = 192)

PREFERRED ADOPTION TO FOSTER CARE

40 26 66 (n = 155)

HAD SUCCESS WITH OTHER ADOPTIONS

23 26 49 (n = 103)

CHILD WOULD FEEL REJECTED IF WE DID

NOT ADOPT

31 23 54 (n = 155)

ALWAYS WANTED A BOY/GIRL

25 23 48 (n = 202)

CHILD WOULD BE GOOD COMPANION

FOR OTHER CHILD(REN)

20 25 45 (n = 200)

OUR OTHER CHILDREN ARE GROWN

21 14 35 (n = 202)

TO PREVENT OTHER RELATIVE FROM RAISING CHILD

5 4 9 (n = 17)

FELT OBLIGATION TO CHILD

3 3 6 (n = 17)

HAD A CHILD WHO DIED

2

3 5 (n = 203)

FAMILY MEMBERS URGED US TO ADOPT

3 0 3 (n = 155)

AGENCY PRESSURED US TO ADOPT

1 0 1 (n = 63)


Table 34

Background of Adoptive Parents - Total Population December 2002

Respondents could indicate more than one characteristic.

Primary Caregiver

Spouse/ Partner

TOTAL Number

CAME FROM LARGE FAMILY

111 (55%) 84 (47%) 195

IS A RELATIVE/FRIEND OF FOSTER/ADOPTIVE PARENT

81 (40%) 41 (23%) 122

WORKED WITH HANDICAPPED CHILDREN

76 (38%) 21 (12%) 97

IS A RELATIVE/FRIEND OF ADOPTED/FOSTER CHILD

56 (28%) 25 (14%) 81

WAS ABUSED AS A CHILD 32 (16%) 8 (5%) 40

HAD ADOPTED/FOSTER SIBLINGS

23 (11%) 11 (6%) 34

PARENT DIED IN CHILDHOOD

18 (9%) 9 (5%) 27

WAS SERIOUSLY NEGLECTED AS A CHILD

13 (6%) 9 (5%) 22

WAS AN ADOPTED CHILD 11 (5%) 8 (5%) 19 WAS A FOSTER CHILD 7 (3%) 7 (4%) 14

RAISED BY NON-RELATIVES 5 (3%) 5 (3%) 10 ABANDONED BY PARENTS 7 (4%) 2 (1%) 9 LIVED IN/OUT OF FOSTER

HOMES/INSTITUTIONS AS A CHILD

4 (2%) 3 (2%) 7

LIVED IN AN INSTITUTION AS A CHILD

1 (.5%) 0 1


Table 35

Spouse/Partner Attitude Toward Adoption – Baseline December 2002

Partner's Attitude Towards Adoption * AssignedGroup Crosstabulation

65 62 12751.2% 48.8% 100.0%67.7% 74.7% 70.9%

5 4 955.6% 44.4% 100.0%5.2% 4.8% 5.0%

20 16 3655.6% 44.4% 100.0%20.8% 19.3% 20.1%

4 0 4100.0% .0% 100.0%

4.2% .0% 2.2%1 1 2

50.0% 50.0% 100.0%1.0% 1.2% 1.1%

96 83 17953.6% 46.4% 100.0%

100.0% 100.0% 100.0%

Count% within Partner's Attitude Towards Adoption% within AssignedGroupCount% within Partner's Attitude Towards Adoption% within AssignedGroupCount% within Partner's Attitude Towards Adoption% within AssignedGroupCount% within Partner's Attitude Towards Adoption% within AssignedGroupCount% within Partner's Attitude Towards Adoption% within AssignedGroupCount% within Partner's Attitude Towards Adoption% within AssignedGroup

Felt the Same Way YouDid

Was More Eager toAdopt

Had More Concerns thanYou

Was Indifferent To It

Was Against It

Partner'sAttitudeTowardsAdoption

Total

Guided(E)

Standard(C)

AssignedGroup

Total

Table 36 Caregiver Rates Overall Level of Communication w/Adopted Child – Baseline

December 2002 Respondent answers for each adopted child.

1 = Excellent to 4 = Poor


Mean = 1.73 SD = .689

N=144 Mean = 1.72

SD = .665


Table 37 Caregiver Rates Overall Level of Communication w/Adopted Child

At 6, 12, 18 & 24 Months December 2002

Respondent answers for each adopted child. 1 = Excellent to 4 = Poor


6 Months N = 135 Mean = 1.73

SD = .777

N=100 Mean = 1.77

SD = .709 12 Months N=89

Mean = 1.71 SD = .710

N=69 Mean = 1.96

SD = .775 18 Months N = 51

Mean = 1.71 SD = .710

N=51 Mean = 1.96

SD = .747 24 Months N = 40

Mean = 2.00 SD = .847

N=22 Mean = 1.82

SD = .907

Table 38 Do you trust your child at Baseline

December 2002 1 = Yes 2 = No


78% state YES N=144

69% state YES

Table 39 Do you trust your child at 6, 12, 18 & 24 Months

December 2002 1 = Yes 2 = No

Guided Services Standard Services 6 Months 73% state YES 61% state YES 12 Months 69% state YES 52% state YES 18 Months* 71% state YES 41% state YES 24 Months 70% state YES 55% state YES

*There is a statistically significant difference between groups at this wave of data collection.


Table 40 When Did You Feel Child was Permanently Yours -- at Baseline

December 2002 Caregiver answered for each adopted child.

When Child Was Permanently Yours * AssignedGroup Crosstabulation

45 44 8950.6% 49.4% 100.0%25.0% 33.8% 28.7%

31 12 4372.1% 27.9% 100.0%17.2% 9.2% 13.9%

95 69 16457.9% 42.1% 100.0%52.8% 53.1% 52.9%

1 1 250.0% 50.0% 100.0%

.6% .8% .6%8 4 12

66.7% 33.3% 100.0%4.4% 3.1% 3.9%

180 130 31058.1% 41.9% 100.0%

100.0% 100.0% 100.0%

Count% within When Child Was Yours% within AssignedGroupCount% within When Child Was Yours% within AssignedGroupCount% within When Child Was Yours% within AssignedGroupCount% within When Child Was Yours% within AssignedGroupCount% within When Child Was Yours% within AssignedGroupCount% within When Child Was Yours% within AssignedGroup

When He/She FirstCame to Live With You

When the AdoptionWas Finalized

At Some Other Point inTime

Don't Know

NA/Refused

When ChildWasPermanentlyYours

Total

Guided(E)

Standard(C)

AssignedGroup

Total


Table 41 Level of Agreement with: I Believe the Child is Permanently Mine

at 6, 12, 18, & 24 Months December 2002

Caregiver answered for each adopted child.

Table 42 Family Members Attachment to Child - Baseline


1 = Very Attached to 4 = Not at All Attached


Mean = 1.25 SD = .870

N=138 Mean = 1.24

SD = .925

132 91.7% 104 93.7% 86 93.5% 63 91.3% 49 94.2% 48 94.1% 38 95.0% 22 100.0%

10 6.9% 3 2.7% 5 5.4% 4 5.8% 3 5.8% 2 3.9% 2 5.0%

2 1.4% 4 3.6% 1 1.1% 2 2.9% 1 2.0%

When He/She FirstCame to Live With YouWhen the AdoptionWas FinalizedAt Some Other Point inTime

Guided (E) Standard (C)

6 Months in Study


12 Months in Study


18 Months in Study

Guided (E) Standard(C)

24 Months in Study

Time by Wave


Table 43 Family Members Attachment to Child at 6, 12, 18 & 24 Months


1 = Very Attached to 4 = Not at All Attached

Guided Services Standard Services 6 Months N = 145

Mean = 1.97 SD = 1.618

N=113 Mean = 2.01 SD = 1.800

12 Months N = 93 Mean = 1.92 SD = 1.569

N=71 Mean = 1.70

SD = .868 18 Months N = 52

Mean = 1.79 SD = 1.126

N=51 Mean = 2.31 SD = 1.965

24 Months N = 40 Mean = 2.20 SD = 1.911

N=22 Mean = 1.86 SD = 1.167


Table 44 Overall Satisfaction with Adoption – Baseline


1 = Strongly Satisfied to 4 = Not at All Satisfied

133 72.7% 35 19.1% 9 4.9% 5 2.7%

118 64.5% 32 17.5% 8 4.4% 9 4.9%

111 60.7% 30 16.4% 5 2.7% 11 6.0%

140 76.9% 16 8.8% 7 3.8% 6 3.3%

103 74.6% 20 14.5% 7 5.1% 7 5.1%

93 68.4% 18 13.2% 6 4.4% 8 5.9%

74 54.8% 20 14.8% 6 4.4% 7 5.2%

98 71.5% 10 7.3% 4 2.9% 4 2.9%

Satisfaction withAdoption ProcessSpouse's Satisfactionwith AdoptionOther Children'sSatisfaction withAdoptionChild's Satisfaction withAdoption

Guided(E)

Satisfaction withAdoption ProcessSpouse's Satisfactionwith AdoptionOther Children'sSatisfaction withAdoptionChild's Satisfaction withAdoption

Standard(C)

Very Strongly Moderately Slightly Not at All


Table 45 Child Contact with Birth Family - Baseline

December 2002

Birth Family Contact Since Living With You? * AssignedGroup Crosstabulation

138 104 24257.0% 43.0% 100.0%75.4% 75.4% 75.4%

45 34 7957.0% 43.0% 100.0%24.6% 24.6% 24.6%

183 138 32157.0% 43.0% 100.0%

100.0% 100.0% 100.0%

Count% within Birth Family Contact% within AssignedGroupCount% within Birth Family Contact% within AssignedGroupCount% within Birth Family Contact% within AssignedGroup

Yes

No

Birth Family ContactSince Living With You?

Total

Guided(E)

Standard(C)

AssignedGroup

Total

Table 46 Talk to Child About Birth Family – Baseline

December 2002 Caregiver answer for each adopted child.

Discuss Child's Birth Family With Him/Her * AssignedGroup Crosstabulation

138 99 23758.2% 41.8% 100.0%75.4% 71.7% 73.8%

45 39 8453.6% 46.4% 100.0%24.6% 28.3% 26.2%

183 138 32157.0% 43.0% 100.0%

100.0% 100.0% 100.0%

Count% within Discuss Birth Family% within AssignedGroupCount% within Discuss Birth Family% within AssignedGroupCount% within Discuss Birth Family% within AssignedGroup

Yes

No

Discuss Child's BirthFamily With Him/Her

Total

Guided(E)

Standard(C)

AssignedGroup

Total


Table 47 Talk to Child About Birth Family at 6, 12, 18 & 24 Months

December 2002 Caregiver answer for each adopted child.

Table 48 Total Mean Scores of Parent Caregiving Behaviors – Baseline


Mean overall scores for how often parent provided seven positive care-giving behaviors to child. Rating is 1=Never to 4=Everyday.


N=177 Mean = 3.77

SD = .594

N=137 Mean = 3.70

SD = .304

120 82.8% 89 78.8% 76 81.7% 52 73.2% 45 86.5% 41 80.4% 30 75% 19 86.4%25 17.2% 24 21.2% 17 18.3% 19 26.8% 7 13.5% 10 19.6% 10 25% 3 13.6%

YesNo

Talk with Child AbouBirth Family?

Guided (E) Standard (C)Assigned Group

6 Months in Study

Guided (E) Standard (C)Assigned Group

12 Months in Study


Assigned Group18 Months in Study


Assigned Group24 Months in Study

Time by Wave


Table 49 Total Mean Scores of Parent Caregiving Behaviors at 6, 12, 18 & 24 Months


Mean overall scores for how often parent provided seven positive care-giving behaviors to child. Rating is 1=Never to 4=Everyday.


6 Months N = 135 Mean = 3.36

SD = .377

N= 99 Mean = 3.61

SD = .394 12 Months N = 89

Mean = 3.58 SD = .418

N= 68 Mean = 3.59

SD = .391 18 Months N = 51

Mean = 3.55 SD = .359

N= 51 Mean = 3.49

SD = .437 24 Months N = 40

Mean = 3.66 SD = .633

N= 22 Mean = 3.47

SD = .462

Table 50 Total Mean Scores of Parent/Child Disagreements – Baseline


Mean overall scores for how often parent experiences eight disagreement type behavior with child. Rating is 1=Never to 4=Everyday.


N=166 Mean = 1.66

SD = .474

N=131 Mean = 1.68

SD = .463


Table 51 Total Mean Scores of Parent/Child Disagreements at 6, 12, 18, 24 Months


Mean overall scores for how often parent experiences eight disagreement type behavior with child. Rating is 1=Never to 4=Everyday.


6 Months N = 135 Mean = 1.66

SD = .402

N=100 Mean = 1.68

SD = .450 12 Months N = 89

Mean = 1.64 SD = .401

N=69 Mean = 1.75

SD = .393 18 Months N = 51

Mean = 1.65 SD = .352

N=51 Mean = 1.82

SD = .439 24 Months N = 40

Mean = 1.64 SD = .366

N=22 Mean = 1.82

SD = .467

Table 52 Health Status of Primary Caregiver – Baseline

December 2002 (Rand 36-Item Health Survey, 1992)

A high score (top score = 100) defines a more favorable health state.

Group Statistics

99 87.8732 13.20345 1.3270093 87.1296 13.83906 1.4350499 91.7929 19.81754 1.99174

93 91.2634 18.50244 1.91861

99 92.2559 17.05552 1.7141492 94.2029 16.09548 1.6780799 61.9529 17.87466 1.7964792 61.1413 15.70277 1.6371399 78.5859 12.23329 1.2294992 81.6087 10.70787 1.1163799 90.9091 17.93005 1.8020492 94.8370 11.14221 1.1616699 84.9747 15.80128 1.5880992 88.0978 14.01711 1.4613899 76.7677 10.39711 1.0449593 76.8280 10.67771 1.10723

AssignedGroupGuided (E)Standard (C)Guided (E)Standard (C)

Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)

Physical Functioning

Role Limitations Dueto Physical Health

Role Limitations Dueto Emotional HealthEnergy/Fatigue

Emotional Well-being

Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean


Table 53 Health Status of Primary Caregiver – Six Months in Study



Group Statisticsa

75 88.2000 10.12223 1.1688164 82.2483 18.60428 2.3255475 94.0000 15.28999 1.76554

64 87.8906 22.15663 2.76958

75 89.3333 21.33671 2.4637564 91.6667 19.69789 2.4622475 60.2667 17.53170 2.0243964 59.2188 15.48729 1.9359175 77.2267 11.83624 1.3667364 79.2500 12.94433 1.6180475 90.6667 17.44844 2.0147764 90.2344 20.34776 2.5434775 86.6000 13.06584 1.5087164 82.9688 18.37050 2.2963175 75.5000 11.54457 1.3330564 76.0156 12.18833 1.52354

Assigned GroupGuided (E)Standard (C)Guided (E)Standard (C)






Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean

Time by Wave = 6 Months in Studya.


Table 54 Health Status of Primary Caregiver – Twelve Months in Study



Group Statisticsa

49 88.6905 10.23091 1.4615642 84.6296 16.69010 2.5753449 94.8980 14.41533 2.05933

42 88.0952 22.07809 3.40672

49 91.1565 20.15623 2.8794642 89.6825 18.75255 2.8935849 63.4694 17.56548 2.5093542 61.4286 16.83078 2.5970549 79.9184 14.79842 2.1140642 79.7143 12.28580 1.8957449 88.5204 20.06447 2.8663542 86.9048 19.51242 3.0108349 86.4286 15.66246 2.2374942 84.1071 15.99182 2.4675949 76.8367 11.02525 1.5750442 75.0000 12.97277 2.00174







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean



Table 55

Health Status of Primary Caregiver – 18 Months in Study December 2002

(Rand 36-Item Health Survey, 1992) A high score (top score = 100) defines a more favorable health state.

Group Statisticsa

28 84.6032 13.80850 2.6095626 79.4231 28.45442 5.5803728 92.8571 17.48960 3.30522

26 82.2115 29.82723 5.84960

28 89.2857 22.32121 4.2183126 85.8974 26.95358 5.2860328 63.0357 13.76652 2.6016326 55.3846 20.82897 4.0849028 77.5714 14.16681 2.6772726 78.9231 16.61065 3.2576228 88.8393 19.34676 3.6561926 83.6538 28.01099 5.4934128 85.8929 17.41666 3.2914426 76.2500 24.25129 4.7560728 77.8571 7.74938 1.4645026 73.3173 15.08701 2.95881







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean



Table 56 Health Status of Primary Caregiver – 24 Months in Study



Group Statisticsa

20 89.1250 11.39237 2.5474113 82.8846 18.10980 5.0227520 96.2500 12.23401 2.73561

13 78.8462 32.02563 8.88231

20 95.0000 12.21158 2.7305913 71.7949 35.60627 9.8754020 64.2500 12.80162 2.8625313 51.5385 18.41474 5.1073320 81.8000 10.09221 2.2566913 74.1538 15.88420 4.4054820 95.6250 12.35109 2.7617913 92.3077 14.91160 4.1357320 86.0000 13.70267 3.0640113 77.6923 17.57311 4.8739020 78.2500 7.99260 1.7872013 71.5385 12.64658 3.50753







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean



Table 57

Cohesion and Adaptability of Family FACES II December 2002

GUIDED SERVICES STANDARD SERVICES

COHESION

A score of 80 reflects a family system that is Very Connected or Enmeshed. A score of 15 reflects

a family system in which members are Disengaged from

each other. Scores in the range of 51 to 70 are considered reflective

of balanced, healthy family systems.

Baseline = 69.28 6 Months = 68.80 12 Months = 67.63 18 Months = 67.16 24 Months = 67.08


ADAPTABILITY

A score of 70 reflects a family system that is Very Flexible. A score of 15 reflects a family that is Rigid. Scores in the 40 to 54

range are considered reflective of balanced, healthy family systems.




Table 58 Parenting Practices: Authoritarian or Authoritative – Cohort One Baseline Only

(Adapted from Block, 1965; Kochanska, Kuczynski & Radke-Yarrow, 1989) December 2002

Mean scores for how parent rates self on parenting practices; Authoritative and Authoritarian scales reported on. Two questionnaires were used – in the first year of the study a questionnaire was used that was an adaptation from Block (1965); a 90-item forced choice instrument asking parent to agree with statements about parenting, 1=Strongly Agree to 5=Strongly Disagree. In the second year and continuing, a shorter further adapted revised version of the Block CRPR was chosen (Kochanska, Kuczynski & Radke-Yarrow, 1989). Many parents expressed difficulty with completing the 90-item questionnaire. The shorter version is 29 items also asking for level of agreement with statements; 1=Not at All Like Me to 6=Highly Descriptive of Me. This shorter version is demonstrated to measure similar dimensions as the original Block CRPR (Kaufman, Gesten, Lucia, Salcedo, Rendina-Gobioff and Gadd, 2000).

Authoritarian Score

( 1 = More Authoritarian to 5 = Less Authoritarian )

Authoritative Score ( 1 = More Authoritative to 5 =

Less Authoritative) Guided Services ( n = 31)

Mean = 3.58

SD = .27

Mean = 2.17

SD = .30

Standard Services ( n= 42)

Mean = 3.52

SD = .29

Mean = 2.04*

SD = .21

Total for Cohort One at Baseline ( n = 73)

Mean = 3.55

SD = .28

Mean = 2.09

SD = .26

*These results indicate that this group of parents view themselves as more Authoritative than Authoritarian in their parenting style. Standard Services parents reporting that they are significantly less Authoritative than Guided Services parents at baseline ( p = .041).


Table 59 Parenting Practices: Authoritarian or Authoritative – Baseline, 12 & 24 Months

(Adapted from Block, 1965; Kochanska, Kuczynski & Radke-Yarrow, 1989) December 2002

GUIDED SERVICES STANDARD SERVICES

AUTHORITATIVE PRACTICES

Higher scores indicate a more authoritative approach to parenting. Means are against a 1 – 6 scale. *Note: Baseline for Cohort 2 & 3 only

*Baseline = 4.87 (n = 75) 12 Months = 4.81 (n = 56) 24 Months = 4.53 (n = 23)

*Baseline = 4.88 (n=65) 12 Months = 4.30 (n=44) 24 Months = 4.72 (n=17)

AUTHORITARIAN PRACTICES

Higher scores indicate a more authoritarian approach to parenting. Means are against a 1 – 6 scale. *Note: Baseline for Cohort 2 & 3 only




3. SELECT CHILD LEVEL VARIABLES

This section provides additional information intended to describe the sample of children in this study based on a select set of variables. Most of this information is collected through questionnaires that the self-selected caregiver completes, or is collected through a telephone interview with that same caregiver. Information is collected approximately once every 6 months.

Child Needs – Most Difficult

As part of the regular telephone interviews, caregivers are asked an open ended question: “In the last six months, if you had to list two or three things about your adopted child/ren’s particular needs that have been the most difficult for you and your family to deal with, what would they be?” The following is a compilation of responses collected over five periods of time; at 6, 12, 18, 24, and 30 months into the study. The responses were coded into common thematic categories and then categories were counted. There were a total of 328 responses 206 from Cohort I, 115 from Cohort II, and 7 from Cohort III. Parents’ identification of the most difficult types of needs are:

1. Behavioral Problems: 35% of all comments mentioned some type of specific behavior that was of a primary concern to a parent. Behaviors mentioned were numerous and included violent tantrums, not listening, difficulties in school, and sexual acting out behaviors. 2. Emotional Problems: 15% of all comments mentioned some type of emotional problem that a child was experiencing as a primary need to be addressed. Most often mentioned were problems with attachment or connection to family members. 3. Medical Needs: 14% of the responses focused on specific type of medical need that parents were having difficulty responding to: either through their own efforts or having difficulty finding appropriate professional services. 4. Other Issues: Approximately 15% of the responses covered areas such as lack of services, lack of social skills, internal family issues, and respondent’s own frustrations. 5. No Problems: 10% of respondents stated that they had no difficulties due to a child’s need. 6. School Related: 8% of the comments centered on various needs of the child at school that from the caregivers perspective were not getting met. 7. Financial Restraints: 2% of the total comments concerned how a lack of money prevented families from addressing a child’s need. 8. Contact with Birth Family: 1% of responses referred to problems arising from contact with birth parents and grandparents.


Table 60 Rating of Child’s Overall Health


Guided Services (E) Standard Services (C)

Baseline

N=186 Mean = 1.48 SD = .793

N = 149

Mean = 1.42 SD = .639

6 Months in Study

N = 144

Mean = 1.41 SD = .596

N = 112

Mean = 1.54 SD = .709

12 Months in Study

N = 93

Mean = 1.54 SD = .904

N = 71

Mean = 1.59 SD = .667

18 Months in Study

N = 52

Mean = 1.38 SD = .565

N = 51

Mean = 1.63 SD = .720

24 Months in Study

N = 40

Mean = 1.38 SD = .586

N = 22

Mean = 1.50 SD = .802


Table 61 Rating of Child’s Physical Growth/Development Compared to Peers

December 2002 1 = More Advanced to 3 = Less Advanced


Baseline

N = 184 Mean = 2.12 SD = .759

N = 149

Mean = 2.08 SD = .673

6 Months in Study

N = 145

Mean = 2.04 SD = .875

N = 112

Mean = 2.13 SD = .608

12 Months in Study

N = 93

Mean = 2.13 SD = .875

N = 71

Mean = 2.13 SD = .608

18 Months in Study

N = 52

Mean = 2.06 SD = .539

N = 51

Mean = 2.18 SD = .684

24 Months in Study

N = 40

Mean = 2.05 SD = .552

N = 22

Mean = 2.18 SD = .588


Table 62 Frequency of Positive Behavior Child to Parent

December 2002 Frequency of instances of traits/moods that child exhibits as reported by caregiver;

1 = Never to 4 = Everyday


Baseline

N = 180 Mean = 3.31 SD = .594

N = 143

Mean = 3.33 SD = .445

6 Months in Study

N = 134

Mean = 3.19 SD = .501

N = 99

Mean = 3.26 SD = .506

12 Months in Study

N = 88

Mean = 3.26 SD = .430

N = 68

Mean = 3.21 SD = .510

18 Months in Study

N = 51

Mean = 3.27 SD = .459

N = 51

Mean = 3.18 SD = .560

24 Months in Study

N = 40

Mean = 3.22 SD = .443

N = 22

Mean = 3.10 SD = .612


Table 63 Frequency of Child Positive Traits/Moods

December 2002 Frequency of instances of traits/moods that child exhibits as reported by caregiver;

1 = Never to 4= Everyday


Baseline

N = 185 Mean = 3.54

SD = .542

N = 148

Mean = 3.55 SD = .448

6 Months in Study

N = 144

Mean = 3.49 SD = .580

N = 113

Mean = 3.45 SD = .583

12 Months in Study

N = 92

Mean = 3.46 SD = .544

N = 71

Mean = 3.39 SD = .542

18 Months in Study

N = 52

Mean = 3.37 SD = .550

N = 51

Mean = 3.31 SD = .634

24 Months in Study

N = 40

Mean = 3.39 SD = .534

N = 22

Mean = 3.31 SD = .650


Table 64 Frequency of Child Negative Traits/Moods

December 2002

Frequency of instances of traits/moods that child exhibits as reported by caregiver; 1 = Never to 4= Everyday


Baseline

N = 185 Mean = 2.23

SD = .702

N = 148

Mean = 2.28 SD = .729

6 Months in Study

N = 144

Mean = 2.25 SD = .733

N = 113

Mean = 2.34 SD = .781

12 Months in Study

N = 92

Mean = 2.27 SD = .652

N = 71

Mean = 2.52 SD = .766

18 Months in Study

N = 52

Mean = 2.30 SD = .648

N = 51

Mean = 2.74 SD = 1.637

24 Months in Study

N = 40

Mean = 2.51 SD = 1.952

N = 22

Mean = 2.39 SD = .640


Table 65 Child Attachment to Family

December 2002

Respondent rates level of attachment for each child: 1 = Very Attached to 4 = Not at All Attached


Baseline

N = 183 Mean = 1.43 SD = 1.136

N = 138

Mean = 1.25 SD = .554

6 Months in Study

N = 145

Mean = 1.15 SD = .379

N = 113

Mean = 1.09 SD = .315

12 Months in Study

N = 93

Mean = 1.10 SD = .332

N = 71

Mean = 1.15 SD = .402

18 Months in Study

N = 52

Mean = 1.50 SD = 2.921

N = 51

Mean = 1.16 SD = .464

24 Months in Study

N = 40

Mean = 1.10 SD = .304

N = 22

Mean = 1.09 SD = .426


Table 66 Child Satisfaction with Adoption

December 2002

Respondent answers for each child: 1= Very Strongly Satisfied to 4 = Not at All Satisfied


Baseline*

N = 182 Mean = 1.79 SD = 1.942

N = 137

Mean = 2.36 SD = 2.675

6 Months in Study

N = 145 Mean = 1.49 SD = 1.487

N = 113

Mean = 1.58 SD = 1.700

12 Months in Study

N = 93

Mean = 1.29 SD = 1.079

N = 71

Mean = 1.58 SD = 1.470

18 Months in Study

N = 52

Mean = 1.29 SD = 1.035

N = 51

Mean = 1.55 SD = 1.836

24 Months in Study

N = 40

Mean = 1.13 SD = .335

N = 22

Mean = 1.59 SD = 1.790

*Significant difference at Baseline (.000)


Table 67 Child Functioning Measure CBCL: Scores in Clinical Need

Young/Old Child Scores at Baseline December 2002

Internalizing

Scores Externalizing

Scores Total Problem

Scores Young Children

Total: n = 96 Mean Age: 4 yrs. Male = 54% Female = 46%

Within Clinical Range = 23%



Older Children

Total: n = 252 Mean Age: 10 yrs. Male = 48% Female = 52%




Levels of child functioning are being measured through the use of the Child Behavior Checklist (Achenbach et al, 1991). This is an important outcome variable and more information is provided in the next chapter. The table above illustrates the level of need of these children as they exit foster care and join families through adoption. Within clinical range means that those children are functioning at a level where they would need a referral to mental health services. Older children are scoring at higher levels of clinical need at the time of adoption.






At baseline, there were there were seven children who were reported to be out of the home due to a problem—the median number of days was 20. At 6 months, there were ten children out for a median number of 10.5 days. At twelve months, there were nine children out for a median number of nine days; at 18 months, three children were out for a median number of 51 days, and at 24 months, one child was out for five days. In November 2001, 867 Maine Post-Legalization Adoption Services surveys were mailed to DHS adoptive parents. This was a statewide sample of adoptive parents who receive a IV-E subsidy and the survey was anonymous. The response rate was 44%: a total of 379 surveys were received. Of these 379 respondents, 34 (9%) people indicated that their child had been out of the home in the past year, and 27 (7%) indicated the number of days the child was out of the home. The median number of days children were out of home for the Maine Post-Legalization Adoption Services surveys was 21. Broken into percentages, the resulting data (N=27) is as follows:

• 30% of children were out of the home for less than 10 days • 50% of children were out of the home for less than 52 days • 85% of children were out of the home for 75 days or less


C. SERVICE CHARACTERISTICS 1. TYPES OF SERVICES PROVIDED The types of services that are provided by Adoption Guides social workers are outlined by service code in the discussion of Implementation Issues (Figure 4, pages 16-18). Social workers enter information into a database for every service they provide. Based on that data, we have the following information.

Table 69 Families and Services

As Reported by Caseworkers December 2002

Number of Families

Total Number of Services

Mean Number of Service Hours

Cohort One 34 7734 192.27 Cohort Two 49 6357 84.84 Cohort Three 32 923 22.59

The following page gives the breakdown of the types of services.


Table 70 Amounts of Each Type of Service Provided

As Reported by Caseworkers December 2002

Service Year 1

Count Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3 Percent

General Parent Education Support

2679 39.3 1730 30.9 156 20.5

Collateral Contacts 1047 15.4 903 16.1 164 21.6 Building/Maintaining Relationship*

390 5.7 906 16.2 156 20.5

Initial Assessment 291 4.3 576 10.3 120 15.8 Clinical Conversation* 232 3.4 201 3.6 25 3.3 Therapeutic: Adult Group 391 5.7 99 1.8 0 0 Therapeutic: Family 377 5.5 92 1.6 18 2.4 Non-Therapeutic Services 269 4.0 192 3.4 11 1.4 Case Plan 192 2.8 198 3.5 26 3.4 Therapeutic: Indiv. Child 189 2.8 237 4.2 6 .8 General Advocacy 161 2.4 108 1.9 10 1.3 Community Resources Referral 194 2.8 117 2.1 17 2.2 Concrete Services 129 1.9 97 1.7 1 .1 Therapeutic: Children Group 79 1.2 8 .1 4 .5 Educational Advocacy* 66 1.0 23 .4 8 1.1 Mental Health Referral 30 .4 79 1.4 14 1.8 Therapeutic: Indiv. Parent 38 .6 1 .01 0 0 Crisis Stabilization/Follow-up 47 .7 34 .6 21 2.8 Preparation/Placement 8 0.1 4 0.1 3 0.4 *These are newly created service codes as of May 2002. Building/Maintaining Relationship and Clinical Conversation were added to the list of service codes in an attempt to further refine the Parent Education and Support category. Educational Advocacy was added to clarify the Advocacy category. Non-Therapeutic services was added to quantify recreational activities. This table includes only results from actual services to families. In addition, social workers code “Case-Related Documentation,” and “No Contact This Month,” which is discussed below. The most common service provided is Parent Education/Support. Other services provided frequently are Collateral Contacts and Initial Assessments. At this point in the study, the average number of services provided to each family in Cohort I is 227 (n=34); in Cohort II is 130 (n=49); and in Cohort III is 29 (n=32). In addition to providing services to Guided children, caseworkers also spend time documenting their casework. Case-related documentation is recorded in the database, and represents 10 percent of Cohort I total services, 11 percent of Cohort II total services, and 16 percent of Cohort III total services. Caseworkers also record when families request “No Contact this Month.” This accounts for 2 percent of entries for Cohort I, 1 percent of entries for Cohort II, and 2 percent of Cohort III entries.


The number of services provided, however, does not reflect the amount of time spent on each service. The mean number of minutes spent on each service is shown in the table below.

Table 71 Mean Number of Minutes Provided for Each Service Type

December 2002 Service N Mean Minutes Standard

Deviation Therapy to Children’s Group 34 107.21 34.47 Non-Therapeutic Services 469 106.91 68.28 Therapeutic: Individual Parent 39 96.15 33.31 Therapeutic: Adult Group 490 90.83 18.91 Therapeutic: Family 349 73.84 27.02 Therapeutic: Individual Child 419 70.78 26.40 Initial Assessment 987 70.50 49.16 Educational Advocacy 97 66.96 41.76 Case Plan 414 59.93 39.29 Advocacy 279 55.86 45.89 Clinical Conversations 457 51.79 30.55 Crisis Stabilization/Follow-Up 102 46.32 35.64 Parent Education/Support 4561 36.51 47.48 Collateral Contacts 2081 26.9 21.33 Building/Maintaining Relationship 1445 26.23 24.85 Community Resources Referral 328 24.74 16.23 Preparation/Placement 15 24.00 7.61 Mental Health Referral 123 22.68 13.90 Concrete Services 227 18.24 10.86 The most minutes per service are spent doing therapeutic work—for children’s groups, and with individual parents, adult groups and individual children. Non-therapeutic services and initial assessments also take workers longer amounts of time. Workers spent a total of 6264 hours working with Cohort I families, a total of 4296 hours working with Cohort II families, and a total of 676 hours working with Cohort III families. The amount of time (minutes) spent working with each family differs—ranging from thirty minutes to 866 hours. Overall, the average number of hours spent with a family is 99.


Table 72 Mean Service Time Minutes Per Service by Cohort

December 2002

Report

Service Time in Minutes

48.65 7725 47.598 30.00 0 1200 37581040.58 6351 39.988 30.00 0 540 257730

44.01 921 46.167 30.00 0 480 40530

44.95 14997 44.609 30.00 0 1200 674070

CWaveCohort OneCohort TwoCohortThreeTotal

Mean NStd.

Deviation Median Minimum Maximum Sum

Until November 2000, there were four caseworkers providing services for Adoption Guides families and entering them into the database at Casey. A fifth worker began entering cases in November 2000, and then in March 2001, more workers were added month by month—until the current number of 13 workers entering services. Social workers record every service they provide including visits with clients, telephone calls or documenting notes in a file. The breakdown of recorded services is as follows:

Table 73 Contact Type For Services Provided

Reported by Caseworkers December 2002

Service Type Year 1 Count

Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3 Percent

Telephone Contact 3412 44% 3510 55% 456 49% In Person: Out of Office

1886 24% 1477 23% 152 17%

In Person: In Office 1199 16% 144 2% 36 4% Documentation 906 12% 928 15% 139 15% No Contact 226 3% 92 1% 19 2% Workers have frequent contact with clients over the telephone. Visits with families occur most often outside of the office.


When entering a service into the database, workers also identify to whom they provided the service. Results are as follows:

Table 74 To Whom Services Were Provided

Reported by Caseworkers December 2002

Service Provided To:

Year 1 Count

Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3 Percent

Parent 3676 48% 2786 44% 396 43% Family 2307 30% 2659 42% 436 47% Adopted Child

1581 20% 807 13% 79 9%

Other Sibling 41 0.5% 65 1.0% 1 0.1% Nearly half of all services provided in Year 1 were provided to the parent, and a third of all services provided to the family. In Year 2, the majority of services were provided to the family and to parents. In Year 3, the majority of services were also provided to families and parents—but the highest percentage was provided to families. The large number of services provided to parents can be expected due to the high number of telephone contacts recorded. High numbers of services provided to the family reflects the fact that social workers have reported they most often meet with the adopted child and his/her parents together, rather than meeting with the child alone. The amount of time spent on providing a service and on travel is recorded into the database. Sixty-two percent of all services take less than a half hour to provide, while 19 percent take between one and two hours. Less than three percent of services take more than two hours. Seventy-five percent of services do not require any travel time. Nine percent involve one or less hours of travel and 12% require between one and two hours of travel. Four percent require more than two hours of travel. The large number of entries with no travel time reflects the fact that the majority of services recorded are telephone contacts. In addition, no travel time is required for in-office visits or documentation. However, social workers often need to travel long distances across the state to meet with families.


2. TYPES OF SERVICES FAMILIES UTILIZE Families were asked about services they obtained pre- and post-legalization. Pre-Legalization Services When asked how often a DHS caseworker visited them, respondents answered with a range from once a year to three times per week. The mean number of visits was approximately 11 visits per year (Mean = 11.37; Standard Deviation = 17.27). Respondents were asked to rate how well the DHS adoption caseworker knew the respondent, the respondent’s family and the respondent’s adopted child. Answers are as follows:

Table 75

How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline By Assigned Group

December 2002 Guided (n=99) Standard (n=92)

Very Well Somewhat Well Not Very Well Caseworker Knew You

G = 41% S = 48%

G = 47% S = 45%

G = 12% S = 8%

Caseworker Knew Family

G = 30% S = 35%

G = 48% S = 47%

G = 21% S = 15%

Caseworker Knew Child

G = 39% S = 47%

G = 43% S = 39%

G = 17% S = 17%

G = Guided/S = Standard *Percentages are rounded.

Table 76 How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline

By Type of Adoption: Foster or Non-Foster December 2002

Foster (n=163) Non-Foster (n=28) Very Well Somewhat Well Not Very Well Caseworker Knew You

F = 44% N = 44%

F = 46% N = 44%

F = 10% N = 11%

Caseworker Knew Family

F = 32% N = 33%

F = 48% N = 44%

F = 19% N = 15%

Caseworker Knew Child

F = 40%* N = 63%

F = 44% N = 22%

F = 16% N = 15%

G = Guided/S = Standard. Percentages are rounded. *There is a statistically significant difference between the Foster and Non-foster parent groups – a larger percentage of Non-foster caregivers feel that their caseworker knows their child “very well” or “somewhat well.”


Respondents were asked how satisfied they were with pre-legalization services. Results are shown in the table below.

Table 77 Satisfaction with Pre-Legalization Services to Family/Child at Baseline

By Assigned Group December 2002

1 = Very Satisfied to 4 = Very Dissatisfied Responses are from caregiver rating state DHS Caseworker by each adopted child at time of entry to study.


N = 99

Mean = 1.44 SD = .688

N = 92

Mean = 1.49 SD = .777

Table 78 Satisfaction with Pre-Legalization Services to Family/Child at Baseline

By Type of Adoption December 2002

1 = Very Satisfied to 4 = Very Dissatisfied Responses are from caregiver rating state DHS Caseworker by each adopted child at time of entry to study.

Foster Non-Foster

N = 163 Mean = 1.5 SD = .757

N = 28

Mean = 1.29 SD = .535

Post Legalization Services Respondents were asked if they currently contact their DHS worker. At six months into the study, 75 percent of the Guided group and 79% of the Standard group had contact with their DHS worker; at 12 months into the study, 64% of Guided and 61% of Standard had contact with DHS workers; at 18 months 52% of Guided and 54% of Standard had contact and at 24 months, percentages decreased further to 41% of Guided and 27% of Standard. The reasons most often cited for contacting a DHS worker were monthly subsidy payments, adoption/legalization questions, and a child’s new emotional needs. Other reasons included subsidy re-certification, funding support services, birth family questions, Medicaid issues and a child’s new medical needs.


Using a four-point scale (1 = Very Satisfied, 2 = Somewhat Satisfied, 3 = Somewhat Dissatisfied, 4 = Very Dissatisfied) respondents were asked to rate their satisfaction with their DHS caseworker post-legalization. The mean scores are as follows:

Table 79 Satisfaction with Post-Legalization Services to Family/Child


1 = Very Satisfied to 4 = Very Dissatisfied

Responses are from caregiver rating state DHS Caseworker by each adopted child after entering study. Approximately 90% of all adoptions are finalized by this point in time; at least 6 months past baseline.


6 Months N = 58 Mean = 2.24

SD = 2.30

N = 55 Mean = 2.31

SD = 2.22 12 Months N = 36

Mean = 1.94 SD = 1.59

N = 26 Mean = 2.19

SD = 1.60 18 Months N = 15

Mean = 2.13 SD = 1.89

N = 14 Mean = 1.86

SD = .95 24 Months N = 9

Mean = 1.56 SD = 1.01

N = 4 Mean = 1.29

SD = 1.29

Table 80 Satisfaction with Post-Legalization Services to Family/Child

by Type of Adoption December 2002

Foster Non-Foster

6 Months N = 94 Mean = 2.26

SD = 2.22

N =19 Mean = 2.37

SD = 2.45 12 Months N = 51

Mean = 2.10 SD = 1.68

N = 11 Mean = 1.82

SD = .98 18 Months N = 24

Mean = 2.04 SD = .352

N = 5 Mean = 1.80

SD = .439 24 Months N = 10

Mean = 1.70 SD = 1.05

N = 3 Mean = 2.33

SD = 1.52


Services from the Community Families were asked about the kinds of services they obtained from their community in the past six months. Results are shown below:

Table 81 Percent of Caregivers Obtaining Services – Types of Service

at 6, 12, and 18 Months into Study By Assigned Group December 2002

Respondents can choose more than one service type. At 6 Months

Guided (N=77)

At 6 Months Standard (N=71)

At 12 Months Guided (N=56)

At 12 Months

Standard (N=43)

At 18 Months Guided (n=29)

At 18 Months

Standard (n=26)

Individual Counseling

55%

(n=42)

54%

(n=38)

52%

(n=29)

51%

(n=22) 52%

(n=15) 62%

(n=16)

Respite Care 17%

(n=13)

11% (n=8)

25%

(n=14)

28%

(n=12)

24% (n=7)

42%

(n=11)

Adoption Support Group

18%

(n=14)

11%

(n=8)

25%

(n=14)

19%

(n=8)

31% (n=9)

15% (n=4)

Other* 13%

(n=10)

10%

(n=7)

13%

(n=7)

21%

(n=9)

24%

(n=7)

27%

(n=7)

Family Therapy

11% (n=9)

11% (n=8)

11% (n=6)

12%

(n=5)

10% (n=3)

15%

(n=4)

Behavioral Specialist

6%

(n=5)

7%

(n=5)

20%

(n=11)

23%

(n=10)

34%

(n=10)

19% (n=5)

Marriage Counseling

3%

(n=2)

1%

(n=1)

2%

(n=1)

2%

(n=1)

4%

(n=1)

0

Residential Treatment 0 1%

(n=1) 7%

(n=4) 2%

(n=1) 0 4% (n=1)

Institutional Placement

0

1%

(n=1)

0 2% (n=1) 0 0

*Other services included occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatment, neuropsychological evaluations, and homeopathic medicine.


Caregivers were then asked the number of hours spent with a service provider within that same six month time period. The average (mean) in days for these services from the community are as follows:

Table 82 Mean Number of Days of Service Time Reported by Family

At 6, 12, and 18 Months into Study by Assigned Group December 2002

At 6

Months Guided

At 6 Months Standard

At 12 Months Guided


At 18 Months Guided


1. *Other

Service for Adopted Child

7.8 1.1 0.7 0.9 7.8 3.0

2. Respite

Care for Adopted Child

6.4 12.8 6.9 5.8 5.9 7.3

3. Counseling

for Adopted Child

1.0 3.4 1.0 1.3 1.1 1.0

4. Adoption

Support Group

0.6 0.5 0.8 0.3 0.6 0.7

5. Family

Therapy

0.5 0.4 0.9 0.3 0.4 0.4

6. Marriage

Counseling

0.1 0.3 0.2 0.1 0 0

Total Service Days: 16.4 18.5 10.5 8.7 15.8 12.4 *Other services included occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatment, neuropsychological evaluations, and homeopathic medicine.


Services From Case-manager/worker At six months into the study, 60 percent of all respondents stated that they had a regular case manager (83% of the Guided group and 32% of the Standard group). At twelve months, 64 percent of all respondents stated that they had a regular case manager (89% of Guided and 30% of Standard), and at 18 months, 67 percent reported having a case manager (97% of Guided and 35% of Standard). At six months in the study, 82 percent of those who were assigned a caseworker had one caseworker assigned to them; and 18 percent had two or more caseworkers (21% Guided, 13% Standard). At 12 months in the study, 72 percent had one caseworker; and 28 percent had two or more caseworkers (24% Guided, 39% Standard). At 18 months in the study, 64 percent had one caseworker; and 36 percent had two or more caseworkers (37% Guided, 33% Standard). Respondents were asked a series of questions about their caseworker’s actions and how their caseworker makes them feel. Questions ranged from whether or not their caseworker plans meetings at good times to whether or not their caseworker wants to hear what the family thinks. The mean score generated from all of these questions resulted in a “Family Centeredness” score, which is a score scaled from 1 (very low level of family centeredness) to 5 (very high degree of family centeredness). The higher the score, the more family-centered the program is. Lower scores—especially below 3.0 indicate that behavior needs improvement.

Table 83 Mean Family Centeredness Scores by Assigned Group

At 6, 12, and 18 Months Into Study December 2002

At 6

Months At 12

Months At 18

Months Guided Family Centeredness Score (E) 4.5

(N=62) 4.52

(N=49) 4.64

(N=28) Standard Family Centeredness Score (C) 4.52

(N=23) 4.56

(N=14) 4.57

(N=10) Respondents were asked about the services they receive directly from their primary caseworker. The table below categorizes families whose primary caseworker is from Casey Family Services apart from families whose primary caseworker works at an “Other” agency. The table below indicates, of those caregivers who have a case-manager, the type of service provided directly from the case-manager to the family/child.


Table 84 Types of Services Provided by Primary Caseworker

6, 12, 18 Months in Study by Assigned Group December 2002

Respondent can choose more than one service type.

Guided at 6

Months (N=69)

Standard at 6

Months (N=47)

Guided at 12 Months

(N=46)

Standard at 12 Months

(N=38)

Guided at 18 Months

(N=27)

Standard at 18 Months

(N=22)

Case-Manager Develops/Brokers Services

73% (n=50)

51% (n=24)

74%* (n=34)

37%* (n=14)

78% (n=21)

41% (n=9)

Case-Manager Provides General Support/Educational Services

60% (n=40)

35% (n=16)

57%* (n=26)

24%* (n=9)

74%* (n=20)

14%* (n=3)

Case-Manager Advocates on Behalf of Family/Child

36% (n=24)

30% (n=14)

47% (n=18)

53% (n=7)

48% (n=13)

18% (n=4)

Case-Manager Provides Therapeutic Services

26% (n=17)

11% (n=5)

22% (n=10)

3% (n=1)

44% (n=12) 0

Case-Manager Assists with Preparation/ Placement to Residential Setting

5% (n=3)

7% (n=3) 0 3%

(n=1) 4%

(n=1) 0

*Statistically significant differences between Guided and Standard Groups at these points in time.


3. FAMILIES ACCESS NATURAL FORMS OF SUPPORT Caregivers indicated that they seek support from a paid professional slightly more so than from a natural source of support. Caregivers are asked the following open-ended question every six months: “ What would you identify as the top three most important sources of aid or support available to you in helping care for your adopted child/ren? This may include natural as well as professional supports.” The following results are totals from caregivers in at 6, 12, 18, and 24 months into study.

Table 85 Type of Aid – Support Caregivers Rely On Most

Total Population December 2002

First Most Important Aid -Support

54% Rely On Professional Type Supports: 1. Social Workers/Case

Management 2. Counseling/Therapy 3. School/School Services 4. Financial Supports 5. Doctor – Medical

46% Rely On Natural, Non-Professional Type Supports:

1. Family Support 2. Friends 3. Spousal Support 4. Support Groups

Second Most Important Aid – Support

56% Rely On Professional Type Supports 1. Social Workers/Case Managers 2. Counseling/Therapy 3. School/School Services 4. Doctor – Medical Services 5. Financial Supports

44% Rely On Natural, Non-Professional Type Supports

1. Family 2. Support Groups 3. Friends

Third Most Important Aid – Support

54% Rely On Professional Type Supports 1. Social Workers/Case Manager 2. School/School Services 3. Counseling/Therapy

46% Rely On Natural, Non-Professional Type Supports

1. Family 2. Friends 3. Support Groups

In order to find out more about the kinds of natural supports caregivers may be seeking, they were asked the following open-ended question as part of the regular 6-month telephone interview: “Sometimes when a family experiences stress or problems,


family members receive important natural supports from friends, other family members/relatives and or others in the community. Natural supports are types of support that you receive on a regular basis that are not provided by a professional person or agency. In the past six months, have you had the need to seek natural supports from friends, other family members/relatives and or others in your community?”

Table 86 Percent of Respondents Who Routinely Access Natural Supports

Total Sample Results December 2002

6 Months in Study

78%

(n=139)

12 Months in Study

76%

(n=91)

18 Months in Study

79%

(n=53)

24 Months in Study

82%

(n=33)

A majority of caregivers report that they access natural supports. In order to find out which types of natural supports were used primarily, a total of 255 responses were analyzed and types of supports were coded and counted.

1. Family Members: 44% of the respondents identified a family member, other than the spouse or partner, from which the caregiver routinely received support.

2. Friends: 37% of the respondents identified a friend from whom the caregiver routinely received support.

3. Support Group: 6% of the responses identified either a foster parent or adoptive parent support group as their natural source of support.

4. Church/Pastoral: 5% of the respondents identified the church as a source of support

5. Other Supports: The remainder of the responses, approximately 10% of all responses, included the following sources of support: other foster parents, spouse, neighbors, co-workers, other caregiver/parent.


4. BARRIERS FAMILIES EXPERIENCE IN RESPONDING TO CHILD’S NEEDS

Caregivers are asked the following question as part of the regular telephone interview: “In the last six months, what would you say has been the biggest barrier to you in your attempts to deal with your child’s needs?” The following results are from an analysis of all respondents from Cohort 1, 2 and 3. This initial analysis consisted of coding and simply counting similar responses across all four points in time. There were a total of 331 comments that were analyzed and coded. There were 71 comments that indicated that there were no barriers, while noted barriers related to: 1. Child’s Own Need: 26% of all barriers were about the child’s own issues as a barrier – not something external to the child of family. 2. Lack of Services/Support in the Community: 16% of all the barriers were about a lack of services and supports in the community 3. Lack of Accurate Information: 10 % of all barriers concerned a parent lacking sufficient information to respond effectively to the child’s need. 4. Other Issues: 10% of the indicated barriers included e.g. lack of energy, lack of timely responsiveness from the state adoption agency, dealing with insurance agencies and difficulties in contacts with birth family. 5. Time: 8% of respondents described the lack of time due to full-time employment as a barrier in dealing with the child’s needs. 6. Self-Doubt – Inadequacy: 7% of all barriers described what appeared to be concerns from the parent about their own ability to deal effectively with the child’s needs. 7. School-Related Issues: 7% of all barriers centered on concerns with how school personnel and programs were a barrier to the child’s needs getting met. 8. Medical Support: 6% of all barriers related to difficulties obtaining support for the child’s medical needs. 9. Communication: 6% of all barriers concerned the lack of accurate communication skills for working with the child, as well as with agencies and service providers. 10. Financial Difficulties: 4% of all barriers were financial.


CHAPTER III – OUTCOMES

A. DESCRIPTION OF ANALYSES

The changes in outcome variables over time are compared between treatment and control groups using a two by three mixed analysis of variance (ANOVA) or repeated measures design. In these models, the two levels of treatment versus control, Guided versus Standard Services, constitute the between subjects effect with the difference over time serving as the within subjects, or repeated measures effect. The periods of time are; baseline, 6 months into study, 12 months into study, 18 months into study, 24 months into study and continuing every six month period of observation until the end of study. Of particular interest in these models are the F tests for the interaction of treatment group and time as these will answer the question of whether the change in the outcome variable over time, if any, differed between treatment (Guided) and control (Standard) groups. For all models, the nature of any significant interactions are characterized as ordinal versus disordinal through plotting techniques. Examination of these plots allow conclusions to be drawn regarding whether or not a significant interaction indicates a beneficial effect of the Guided Services model.

For this report, between group differences are considered for all cohorts for up to

24 months in study. This differs from the analysis reported in the evaluation report of July 2002 when only Cohort I children and families were considered for outcome analysis. At that time, not enough observations were available to consider Cohort II children and families beyond baseline and the initial six-month periods. To conduct the analysis in this way may lessen the effects of attrition to any one cohort over time. In addition, preliminary analyses indicates that there is no significant difference over time in terms of the quality of the intervention; participants in Cohort I are getting a similar type or quality of intervention compared to participants in Cohort II and III. Therefore, these results are measuring changes to outcome variables based on length of time in study irrespective of membership to cohort. The following tables provide approximate sample sizes for the analyses. There are slight differences in actual sample size depending upon how missing data is handled; for repeated measures analysis conducted with SPSS, any missing data for a single period of observation excludes that entire case for the analysis.

Table 87

Sample Characteristics Length of Time in Study December 2002

TIME IN STUDY GUIDED SERVICES (E) STANDARD SERVICES (C) Baseline Child: n = 198

Family: n = 107 Child: n = 161 Family: n = 96










B. RESULTS

The select child and family level outcome variables are also described in the previous chapter and more complete statistical data is available by contacting the evaluator. Graphs display mean scores or total scores between groups over time. The purpose of these graphs/charts is to provide the reader with information comparing both groups. For each instance of statistical significance, an explanation will be provided. At this time, there are no statistically significant differences at baseline between the two groups. This finding supports the function of the randomization process in establishing the intervention and control groups.

The reader is asked to consider the following as they interpret the meaning of these study results. Achenbach et al (p. 56, 1991) in their scoring manual describe how to interpret the syndrome scales in their Child Behavior Checklist. “…there is no well-validated criterion for categorically distinguishing between children who are “normal” and those who are “abnormal” with respect to each syndrome. Because children are continually changing and because all assessment procedures are subject to errors of measurement and other limitations, no single score precisely indicates a child’s status. Instead, a child’s score on a syndrome scale should be interpreted as an approximation of the child’s status as seen by a particular informant at the time the informant completes the CBCL.”

For most all of the variables presented in the following results, the rating is from a

single caregiver at one point in time – and then repeated approximately six months later. No single one of these results precisely indicates the status of a family or child, they are approximations at best. The intent is that taken together, these results help to build is a mosaic of understanding the lives of children and families after adoption.

1. FAMILY LEVEL VARIABLES – MEAN GRAPHS

What is the Health Status of the Primary Caregiver? The Rand 36 – Item Health Survey 1.0 (1993) is used to measure this outcome. This instrument measures eight aspects of health concepts: physical functioning, bodily pain, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. The following results display total mean scores for the two groups on these eight domains. There are no significant statistical differences between groups over time.


Chart 2

Parent Health: General HealthDecember 2002

A higher (top score equals 100) score defines a more favorable health state

77.86

78.25

73.32

71.54

76.77

75.50

76.84

76.83

76.02

75.00

40 60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A high score defines a more favorable health state and the general health scale consists of responses to the following items:

! Rating of overall general health ! Get sick more/less than others ! As healthy as others ! Expect health to get worse ! Rate health as excellent


Chart 3

Parent Health: Energy/FatigueDecember 2002

A higher score (top score equals 100) defines a more favorable health state

63.04

64.25

55.38

51.54

61.95

60.26

63.47

61.14

59.22

61.43

40 60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state. This scale consists of the following types of items:

! Feeling “full of pep” ! Having lots of energy ! Feeling worn out ! Feeling tired


Chart 4

Parent Health: Social FunctioningDecember 2002


88.83

95.63

83.65

92.31

90.91

90.67

88.52

94.84

90.23

86.90

60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and this scale consists of the following types of items:

! Extent to which health/emotional problems interfered with normal social activities


Chart 5

Parent Health: Physical FunctioningDecember 2002


84.60

89.12

79.42

82.88

87.87

88.20

88.69

87.13

82.25

84.63

60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


! Vigorous Activities ! Moderate Activities ! Carrying Groceries ! Climbing Stairs ! Bending, Kneeling, Stooping ! Walking ! Bathing/Dressing Self


Chart 6

Parent Health: Physical Pain December 2002


85.89

86.00

76.25

77.69

84.97

86.60

86.43

88.10

82.97

84.11

60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


! Amount of bodily pain in past month ! Degree to which pain interfered with normal work


Chart 7

Parent Health: Emotional Well-BeingDecember 2002


77.57

81.80

78.92

74.15

78.59

77.23

79.92

81.61

79.25

79.71

40 60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


! Frequency of feeling nervous ! Feeling “down in the dumps” ! Feeling “calm and peaceful” ! Feeling “downhearted and blue” ! Feeling happy


Chart 8

Parent Health: Role Limitation Due to Physical HealthDecember 2002


92.86

96.25

82.21

78.85

91.79

94.00

94.90

91.26

87.89

88.10

60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and this scale consists of items such as:

! Health problems – had to cut down on time on activities ! Health problems – have accomplished less than would like ! Health problems – were limited in kind of work ! Health problems – had difficulty performing tasks


Chart 9

Parent Health: Role Limitation Due to Emotional ProblemsDecember 2002


89.29

95.00

85.90

71.80

92.26

89.33

91.16

94.20

91.67

89.68

60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and items that make up this scale include:

! Emotional problems – have had to cut down on activities ! Emotional problems – have accomplished less than would like ! Emotional problems – didn’t do work/activities as carefully as usual


How Satisfied is the Parent with the Adoption?

Chart 10

Caregiver Satisfaction With AdoptionDecember 2002

1 = Strongly Satisfied 4 = Not at All Satisfied

1.15

1.18

1.18

1.05

1.41

1.23

1.18

1.45

1.17

1.34

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Approximately every six months, caregivers are asked how satisfied they are with the adoption or adoption process to date. There is no statistically significant difference between groups over time for this outcome variable. Both groups state feeling strongly satisfied with the adoption process.


What are Parenting Styles of Adoptive Parents – Authoritarian or Authoritative ?

Previous research with caregivers post-legalization (Sedlak & Broadhurst, 1993) found that parenting styles or practices were the strongest predictors of adoption outcomes. For this study, two aspects of parenting style are being considered, authoritative and authoritarian. Kaufman, Gesten et al (2000) define these concepts as follows: Authoritative parenting style is characterized by the display of affection toward the child, sharing feelings and experiences with the child, respect for and encouragement of the child’s independence, as well as supervision of the child, and the establishment of family rules and responsibilities. The Authoritarian scale includes items endorsing restriction of the child’s emotional expression, limited involvement of the child in family decisions and the establishment of rules, as well as an emphasis on physical and verbal punishment as a consequence of disobedience.

Cohort One – Baseline Results For the first year of the study, researchers selected a CRPR instrument that proved

to be very cumbersome for parents to complete. The following results are only for Cohort One at baseline; those parents who entered the study in the first year.

Table 88

CRPR Results – Authoritarian / Authoritative Practices Cohort One - Baseline

December 2002

Authoritarian Score ( 1 = More Authoritarian to 5 =

Less Authoritarian )

Authoritative Score ( 1 = More Authoritative to 5 =

Less Authoritative) Guided Services ( n = 31)

Mean = 3.58

SD = .27

Mean = 2.17

SD = .30

Standard Services ( n= 42)

Mean = 3.52

SD = .29

Mean = *2.04

SD = .21

Total for Cohort One at Baseline ( n = 73)

Mean = 3.55

SD = .28

Mean = 2.09

SD = .26

*These results indicate that this group of parents view themselves as more

Authoritative than Authoritarian in their parenting style. Standard Services parents reporting that they are significantly less Authoritative than Guided Services parents at baseline ( p = .041).


Chart 11

Parenting Practices: AuthoritarianDecember 2002

1 = Not Authoritarian 6 = Highly Authoritarian

2.71

3.00

2.93

2.78

2.81

2.82

1.0 2.0 3.0 4.0

Baseline

12 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

The Authoritarian scale includes items endorsing restriction of the child’s emotional expression, limited involvement of the child in family decisions and the establishment of rules, as well as an emphasis on physical and verbal punishment as a consequence of disobedience. This chart displays data from the revised CRPR instrument that will be used from Year Two forward in the study; therefore there are no baseline results for Cohort One, see previous page. These results indicate that parents view themselves as mid-range in terms of Authoritarian approaches to parenting practices.


Chart 12

Parenting Practices: AuthoritativeDecember 2002

1= Not Authoritative 6 = Highly Authoritative

4.53

4.81

4.87

4.72

4.30

4.88

1.0 2.0 3.0 4.0 5.0 6.0

Baseline

12 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Authoritative parenting style is characterized by the display of affection toward the child, sharing feelings and experiences with the child, respect for and encouragement of the child’s independence, as well as supervision of the child, and the establishment of family rules and responsibilities. This chart displays data from the revised CRPR instrument that will be used from Year Two forward in the study; therefore there are no baseline results for Cohort One, see previous page. These results indicate that parents view themselves as predominantly Authoritative in their approaches to parenting practices.


How Cohesive and Adaptable is the Family ?

Chart 13

Family Cohesion December 2002

Moderate/Balanced family system scores range from 51 to 70.Scores over 70 are considered enmeshed and not optimal.

67.16

67.08

68.12

67.38

69.28

68.80

67.63

68.90

68.97

67.44

40 60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

The concepts of Family Adaptability and Cohesiveness are considered important

in how families function, and especially in how families integrate a new member – the adopted child. To measure this family system process, the FACES II (Olson et al, 1992) Family Adaptability and Cohesion Scale is used in the study. For this measure, as for all others, the informant was the self-selected primary caregiver to the child. There was no attempt made to get the other spouse/partners assessment of family functioning as is recommended in the use of this measure. This was due to a concern with data collection burden to the family. Family Cohesion is defined as the emotional bonding that family members have toward one another. There are no group differences over time through 24 months in the study.


Chart 14

Family AdaptabilityDecember 2002

Moderate/Balanced family system scores range from 40 to 54.Scores over 54 are considered "chaotic" family type and not optimal.

47.59

47.22

47.96

46.76

49.39

48.59

48.04

51.22

53.68

45.87

20 40 60 80

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Family Adaptability is defined as the extent to which a family system is flexible

and able to change. There are no group differences over time through 24 months in the study.


How Attached is the Family to the Child?

Chart 15

Family Attached to ChildDecember 2002

1 = Very Attached 4 = Not at All Attached

2.20

1.86

1.97

1.92

1.79

2.01

1.70

2.31

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked, “At the present time, how would you assess household or family members overall attachment to the adopted child(ren)? To what degree are they attached to the child?” These results are not statistically significant in terms of group differences over time. Both sets of caregivers appear to feel that family members are very attached to the adopted child.


Does caregiver trust adopted child?

Chart 16

Percent of Caregivers Who Trust Child December 2002

71%

70%

41%

55%

78%

73%

69%

69%

61%

52%

0% 20% 40% 60% 80% 100%

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Percent Who Answered "YES"

Standard

Guided

At entry to the study and every six months, caregivers are asked if they trust their adopted child(ren). At entry to study, at six months, and at 12 months, there were no significant statistical differences between groups for this variable. However, at 18 months there is a statistically significant difference between groups. The Pearson’s Chi Square value for 18 months is 8.947, df=1 and p=.003. More Guided Services caregivers stated that they trust their child than those caregivers in the Standard Services group at this point in time.


How do the caregiver and child communicate?

Chart 17

Parent and Child CommunicationDecember 2002

1 = Excellent 4 = Poor

2.00

1.82

1.73

1.71

1.71

1.77

1.96

1.96

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this outcome variable, caregivers are asked “During the last six months, how would you rate your overall level of communication with your child?” There are no statistically significant between group differences over time for this outcome. Both groups of caregivers appear to rate their overall levels of communication between excellent and good.


Chart 18

Frequency of Parent and Child Disagreements December 2002

1 = Never 4 = Everyday

1.65

1.64

1.82

1.82

1.66

1.66

1.64

1.68

1.68

1.75

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked, “Now I would like to ask you about some of the areas where it is most common for parents and children to have disagreements. Choosing from the following answers, please tell me how often you and the child disagree on each issue.” The items are: Spending money; Television; Friendships; Use of Drugs-Alcohol; Sexual behavior; Personal Appearance; Schoolwork and Respect to Parents. For this outcome variable, there are no statistically significant differences between groups over time. Both groups of caregivers appear to experience low levels of frequencies of disagreements with their child(ren).


Chart 19

Frequency of Parent Positive Caregiving Behaviors December 2002

1 = Never 4 = Everyday

3.55

3.66

3.49

3.47

3.77

3.36

3.58

3.70

3.61

3.59

2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers were also asked in the past month how often they demonstrated certain positive behaviors to their child(ren). Those behaviors are: Helped with homework; Said nice things to child; Showed that you liked to have child around; Were thoughtful when child was tired; Kissed or hugged child; Comforted child when child had problems and Made child feel loved.

For this outcome variable, there are no statistically significant differences between groups over time. Both groups of caregivers appear to demonstrate high levels of frequencies of positive care-giving behaviors to their child(ren).


What is the overall quality of home life?

Chart 20

Family Quality of Home Life December 2002

1 = Excellent 4 = Poor

2.07

1.90

2.42

2.46

1.53

2.03

2.00

1.57

2.05

2.21

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked to rate their overall quality of home life during the past six months. There are no significant differences between groups. Both groups of caregivers appear to rate their home life between excellent (1) to good (3).


How Empowered Does the Family Feel as a Result of Case Management Services?

Chart 21

Caseworker Family CenterednessDecember 2002

1 = Very Low Level Family Centeredness5 = Very High Level Family Centeredness

4.50

4.52

4.64

4.52

4.56

4.57

2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0

6 Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

As described earlier in the report, the Guided Services model is implemented with the intent that it be family centered. The proposition is that the more family-centered the support, the more empowered the family (caregiver) will feel and perhaps be better able to function in support of the family and child. The intent is that the case-management, family support intervention be done in such a way that it is neither driven solely by the needs of the child nor is it provided from a professional-centered model with the social worker viewed as sole expert on the family. Family-centered models emphasize that children – and adults – grow and develop within family systems. Family-centered service delivery recognizes the centrality of the family in the lives of individuals. For those caregivers who reported receiving regular services from a case-manager, there were no statistically significant differences between groups over time. According to Allen, Petr & Brown (1995) any score of 3 or below indicates practice that is not family centered. Apparently, both groups are reporting that the case-management related services that they are receiving are family-centered.


2. CHILD LEVEL VARIABLES

The following results are presented in order to display group differences over time. These are initial results on the key child level variables identified for the study.

Number of Days Child in Home – No Displacements

One of the most important outcomes of this initiative is the intent of the MAGS model to enable families to stay together. That is, that adopted children do not leave the home due to some sort of problem. This may include running away from home, being incarcerated and/or leaving home for a short-term hospitalization due to a behavioral health problem. The following initial results indicate that there are few displacements occurring in both groups. This information was also provided in Chapter II.





At baseline, there were there were seven children who were reported to be out of the home due to a problem—the median number of days was 20. At 6 months, there were ten children out for a median number of 10.5 days. At twelve months, there were nine children out for a median number of nine days; at 18 months, three children were out for a median number of 51 days, and at 24 months, one child was out for five days.

In November 2001, 867 Maine Post-Legalization Adoption Services surveys were mailed to DHS adoptive parents. This was a statewide sample of adoptive parents who receive a IV-E subsidy and the survey was anonymous. The response rate was 44%: a total of 379 surveys were received. Of these 379 respondents, 34 (9%) people indicated that their child had been out of the home in the past year, and 27 (7%) indicated the number of days the child was out of the home. The median number of days children were out of home for the Maine Post-Legalization Adoption Services surveys was 21. Broken into percentages, the resulting data (N=27) is as follows:

• 30% of children were out of the home for less than 10 days • 50% of children were out of the home for less than 52 days • 85% of children were out of the home for 75 days or less

Number of Adoption Dissolutions

As of this point in the study, there are no adoption dissolutions to report from

either group.


What is the child’s level of attachment to the family?

Chart 22

Child Attached to FamilyDecember 2002

1 = Very Attached 4 = Not at All Attached

1.50

1.10

1.16

1.09

1.43

1.15

1.10

1.25

1.09

1.15

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

There is no statistical difference between groups over time. Caregivers in the both groups report a high level attachment of child to family.


What is the Child’s Level of Mental Health Needs?

(CBCL Syndrome & Scale Scores) The sample considered for the analysis of the child functioning variables are in two age categories, younger children age 1 ½ to 5 years and older children age 6 and above. The following table provides approximate totals for each age category used in the analysis. Specific sample sizes vary depending upon age of child at point of data collection.

Table 90 Age Categories December 2002

Time in Study Guided Services Standard Services

Baseline

0 – 5 : 52 6 – 18+ : 146

0 – 5 : 55 6 – 18+: 106

6 Months in Study

0 – 5 : 36 6 – 18+ : 111

0 – 5 : 37 6 – 18+ : 86

12 Months in Study

0 – 5 : 19 6 – 18+ : 80

0 – 5 : 16 6 – 18+ : 58

18 Months in Study

0 – 5 : 8 6 – 18+ : 46

0 – 5 : 7 6 – 18+ : 46


Chart 23

Somatic Problems Child Behaviors Younger Child Ages 1 1/2 - 5 Years

December 2002T-scores from the CBCL; a score of 65 represents the bottom of the clinical range.

Scores of 65 discriminate between referred and nonreferred children.

52.44

52.83

53.87

50.88

55.50

52.67

53.25

55.56

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

Somatic problems include: Aches; Can’t stand things out of place; Constipated, Diarrhea, Doesn’t eat well; Headaches; Nausea; Painful bowel movements; Stomach problems; Too concerned with neatness/cleanliness; and Vomiting. All syndrome score results are below the clinical range.


Chart 24

Somatic Problems Child Behaviors Child Ages 6 - 18 Years

December 2002T-scores from the CBCL; a score of 65 represents the bottom of the clinical range.

Scores of 65 discriminate between referred and nonreferred children.

56.95

57.69

57.26

56.13

56.78

57.01

56.76

56.95

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

Somatic problems include: dizziness, tiredness, aches, headaches, nausea, eye problems, skin problems, stomach problems, and or vomiting. For all results these syndrome scores are below the clinical range.


Chart 25

Withdrawn/Depressed Problems Child BehaviorsYounger Child Ages 1 1/2 - 5 Years

December 2002

56.56

64.83

56.69

55.90

56.13

56.50

56.64

55.08

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between

referred and nonreferred children.

Items for the Withdrawn construct include: Acts too young for age; Avoids eye contact; Doesn’t answer; Refuses active games; Unresponsive to affection; Little affection; Little interest; and Withdrawn. All scores are below the clinical range, with the Standard group at 18 months just below the clinical range.


Chart 26

Withdrawn/Depressed Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

59.48

57.69

58.56

58.65

58.34

57.79

56.93

57.14

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between


For this syndrome score, Withdrawn Behaviors, these scores are all below the clinical range. Items for this construct from the CBCL are: Rather be Alone; Won’t Talk; Secretive; Shy; Stares; Sulks; Under-active; Sad; and Withdrawn.


Chart 27

Anxious/Depressed Problems Child BehaviorsYounger Child Ages 1 1/2 - 5 Years

December 2002

51.78

61.67

54.36

52.97

51.88

52.16

54.56

58.38

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred children.

For this syndrome score, all scores are below the clinical range. The Anxious/Depressed construct includes such items as: Clings; Feelings hurt; Upset by separation; Looks unhappy; Nervous; Self-conscious; Fearful; and Sad.


Chart 28

Anxious/Depressed Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

59.55

57.38

59.00

59.11

59.25

57.94

57.95

57.79

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Anxious/Depressed, these scores are below the clinical range. Items for this construct from the CBCL are: Complains of Loneliness; Cries a lot; Fears might think or do something bad; Feels has to be Perfect; Feels or complains no one loves her/him; Feels other are out to get him/her; Feels Worthless; Nervous, highstrung, or tense; Feels too guilty; Too fearful; Self-conscious/Easily embarrassed; Suspicious; Unhappy, sad, depressed; and Worries.


Chart 29

Attention Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2002

55.67

63.67

59.19

56.48

54.98

57.00

57.81

55.67

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred

hild

All scores for the Attention Problems scale are below the clinical range. Items included in this construct are: Can’t concentrate; Can’t sit still; Clumsy; Quickly shifts; and Wanders away.


Chart 30

Attention Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

62.29

61.84

61.00

60.06

60.69

62.14

60.20

60.57

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred

hild

For this syndrome score, Attention Problems, scores are primarily just below the clinical range. Items for this construct from the CBCL are: Acts too young for age; Can’t concentrate, pay attention for long; Can’t sit still, restless, or hyperactive; Confused or seems to be in a fog; Day-dreams or gets lost in thoughts; Impulsive or acts w/out thinking; Nervous, highstrung, or tense; Nervous movements or twitching; Poor school work; Poorly coordinated, clumsy; and Stares blankly.


Chart 31

Aggressive Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2002

52.78

71.67

55.13

56.03

55.98

59.25

58.14

56.43

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and

f d hild

At 18 months, the Standard group scores fall in the clinical range. All scores for both groups at the other points in time are below the clinical range. Aggressive Behavior items include: Can’t stand waiting; Defiant; Demands met; Destroys others’ things; Disobedient; Lacks guilt; Easily frustrated; Fights; Hits others; Hurts accidentally; Angry moods; Attacks people; Punishment doesn’t change behavior; Screams; Selfish; Stubborn; Temper; Uncooperative; and Wants attention.


Chart 32

Aggressive Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

65.14

64.27

64.35

63.37

63.79

67.60

65.27

64.72

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and

For this syndrome score, Aggressive Problems, a few group scores are close to or past the borderline clinical range, which means that this group of children scores just in the deviant range of behavior for this syndrome. Items for this construct from the CBCL are: Argues a lot; Bragging, boasting; Cruelty, bullying or meanness to others; Demands a lot of attention; Destroys own things; Destroys others things; Disobedient at home; Disobedient at school; Easily Jealous; Gets in many fights; Physically attacks people; Screams a lot; Showing off or clowning; Stubborn, sullen or irritable; Sudden changes in mood or feelings; Talks too much; Teases a lot; Temper tantrums or hot temper; Threatens people; and Unusually loud.


Chart 33

Internalizing Problems Child Behaviors Younger Child Ages 1&1/2 - 5 Years

December 2002

48.00

65.17

48.87

48.65

45.19

48.06

49.61

55.13

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred

and nonreferred children.

All internalizing scores are below the clinical range except for the Standard group scores at 18 months in the study. The Internalizing scale is developed from the Emotionally Reactive, Anxious/Depressed, Somatic Complaints, and Withdrawn syndrome scores.


Chart 34

Internalizing Problems Child Behaviors Child Ages 6 - 18 Years

December 2002

57.52

55.40

57.33

56.47

55.83

56.15

55.87

56.31

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred


For this scale score, Internalizing Problems, these scores are just below the clinical range. This scale is developed from the Withdrawn, Somatic Complaints and Anxious/Depressed syndrome scores.


Chart 35

Externalizing Problems Child Behaviors Younger Child Ages 1 & 1/2 - 5 Years

December 2002

48.67

50.02

51.00

52.19

70.17

51.67

52.67

55.25

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred and nonreferred children.

At 18 months in the study, the Standard group scores are well into the clinical range. All other scores for both groups are below the clinical range. The Externalizing Problems scale is developed from the Attention Problems and Aggressive Behavior syndrome scores.


Chart 36

Externalizing Problems Child Behaviors Child Ages 6 - 18 Years

December 2002

62.31

61.48

60.80

61.23

62.56

61.64

62.06

64.95

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred and nonreferred children.

For this scale score, Externalizing Problems, these scores are at or just above the clinical range, which means children in these groups are considered deviant according to this scale score. This scale is developed from the Delinquent and Aggressive Behaviors syndrome scores.


Chart 37

Total Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2002

48.44

70.00

50.02

50.97

50.19

50.43

51.94

56.38

20 40 60 80 100

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Guided Standard

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred and nonreferred

All scores for both groups are below the clinical range except for the Standard group at 18 months into the study. According to Achenbach et al (1991) the Total Problem score can be used as a basis for comparing problems in different groups and for assessing change as a function of time or intervention. The Total Problem score is computed by summing all problem items except for Sleep Problems. If a parent rated more than one problem for item 100 (Other Problems), only the item with the highest score is counted. There are 100 problem items on this section of the CBCL.


Chart 38

Total Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

62.31

61.93

61.76

60.82

60.57

61.40

61.16

63.93

20 40 60 80 100

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Guided Standard

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred and nonreferred

For the Total Problems scale, these scores are close and or over the clinical cut point meaning both groups are close to being considered deviant according to this scale score. According to Achenbach et al (1991) the total problem score can be used as a basis for comparing problems in different groups and for assessing change as a function of time or intervention. The Total Problem score is computed by summing all problem items except items 2 (Allergy) and 4 (Asthma). If a parent rated more than one problem for item 113 (Other problems), only the item with highest score is counted. There are 113 problem items on this section of the CBCL.


Chart 39

Emotionally ReactiveYounger Child Ages 1 1/2- 5 Years

December 2002These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between


55.33

69.67

52.25

55.16

54.64

60.94

57.00

53.92

20 30 40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

This syndrome scale is only asked of caregivers of children age 1 ½ to 5 years. For this syndrome scale, only the Standard group at 18 months is in the clinical range; all other scores for both groups fall below the clinical range. Items that make up this scale are: Disturbed by change; Twitches; Moody; Sulks; Upset by New Things; Whining; Worries; Panics; and Shifts between sadness and excitement.


Chart 40

Sleep ProblemsYounger Child Ages 1 1/2 - 5 Years

December 2002These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred


53.67

68.67

55.31

58.00

55.96

59.81

58.33

55.53

20 30 40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

This syndrome scale is only asked of caregivers of children age 1 ½ to 5 years. For the Sleep Problems scale, all scores for both groups fall below the clinical range except for the Standard group at 18 months in the study. Items for this construct are: Doesn’t want to sleep; Trouble sleeping; nightmares; Resists bed; Sleeps little; Talks/Cries in sleep; and Wakes often.


Chart 41

Social Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

63.21

60.53

62.07

63.10

62.18

61.56

61.31

62.74

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Social Problems, the majority of the scores are just below the clinical range. Items for this construct from the CBCL are: Acts too young for age; Clings to adults or too dependent; Not get along with other kids; Gets teased a lot; Not liked by other kids; Overweight; Clumsy; and Prefers being with younger kids.


Chart 42

Thought Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

62.29

61.84

60.66

60.32

60.82

62.17

60.64

61.61

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Thought Problems, these scores are just below the clinical range. Items for this construct from the CBCL are: Can’t get mind off certain thoughts; Hears sounds/voices that aren’t there; Repeats certain acts over and over, compulsions; Sees things that aren’t there; Stares blankly; Strange behavior; and Strange ideas.


Chart 43

Rule Breaking Problems Child BehaviorsChild Ages 6 - 18 Years

December 2002

58.33

60.33

58.27

59.46

59.32

61.33

59.53

59.92

40 50 60 70 80

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Guided Standard


For this syndrome score, Rule Breaking, all scores are below the clinical range. Items for this construct from the CBCL are: Doesn’t seem to feel guilty after misbehaving; Hangs around with others who get in trouble; Lying or cheating; Prefers being with older kids; Runs away from home; Sets fires; Steals at home; Steals outside of home; Swearing or obscene language; Thinks about sex too much; Truancy, skips school; Uses alcohol or drugs for non-medical purposes; and Vandalism.


Chart 44

Competencies - Activities T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2002T-Scores below 31 are scores in the clinical range.

43.60

46.93

46.57

45.59

44.74

45.63

46.95

46.69

0 10 20 30 40 50 60

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Activities scale includes items such as:

! Level of involvement in sports, work and other activities ! Perception of skill level in activities – quality of involvement

The T-Score cut point for the competency scales is 31, scores below 31 deemed in the clinical range. For this measure children in both groups are not deviant with scores above the clinical range.


Chart 45

Competencies - Social T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2002T-Scores below 31 represent scores in the clinical range.

40.60

36.24

38.12

39.21

40.01

41.05

39.23

39.88

0 10 20 30 40 50 60

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Social scale includes items such as:

! Involvement in organizations or clubs ! Number of friends and frequency of contact with friends ! Behavior with others and alone

The T-Score cut point for the competency scale is 31, scores below 31 deemed in the clinical range. For this measure children in all groups are above the clinical range.


Chart 46

Competencies - School T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2002T-Scores below 31 represents scores in the clinical range

34.54

36.55

35.60

36.90

35.91

34.67

35.57

36.47

0 10 20 30 40 50 60

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The School scale includes items such as:

! Academic Performance ! Instances of repeating grades ! Involvement in special classes/education ! Other school problems

The T-Score cut point for the competency scales is 31, scores below 31 deemed in the clinical range. For this measure all children are just above the clinical range. For all the individual competency measures, this scale displays the area of most detriment in terms of competencies.


Chart 47

Competencies - Total T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2002T-Scores below 37 represent scores in the clinical range.

34.54

38.79

37.53

38.67

39.55

39.22

38.92

39.44

0 10 20 30 40 50 60

Baseline

Six Months

12 Months

18 Months

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Total Competency Scale is the sum of the raw Activities, School and Social scale scores. The T-Score cut point for the Total Competency scale is 37, scores below 37 deemed in the clinical range. For this measure, children in both groups are just at or below the clinical range. The Guided group at 18 months scores in the clinical range.


How is Child’s Overall Health?

Chart 48 Child Overall Health

December 20021 = Excellent 4 = Poor

1.38

1.38

1.63

1.50

1.48

1.41

1.54

1.42

1.54

1.59

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

There is no statistically significant difference between groups on this item. Caregivers in both groups rate their child’s overall health as excellent to very good.


How is Child’s Overall Growth and Development?

Chart 49 Child Growth/Development Compared to Others

December 20021 = More Advanced 3 = Less Advanced

2.06

2.05

2.18

2.18

2.12

2.04

2.13

2.08

2.13

2.13

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers from both groups report that their child’s overall growth and development is similar to other children of the same age. There are no significant differences between groups.


Child Traits and Moods?

Chart 50

Frequency of Child Positive Traits/Moods December 2002

1 = Never 4 = Every Day

3.37

3.39

3.31

3.31

3.54

3.49

3.46

3.55

3.45

3.39

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has demonstrated a particular trait/mood or behavior. Caregivers in both groups report often to daily demonstrations of positive traits/moods. Positive traits/moods are: Pleasant to have around; Loving; Well-adjusted; and Cheerful.


Chart 51

Frequency of Child Negative Traits/Moods December 2002


2.30

2.51

2.74

2.39

2.23

2.25

2.27

2.28

2.34

2.52

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has demonstrated a particular trait/mood or behavior. Caregivers in both groups report often to seldom demonstrations of negative traits/moods. Negative traits/moods are: Moody; Hostile or Aggressive; Jealous; and Destructive.


Chart 52

Child Satisfaction With AdoptionDecember 2002

1 = Very Satisfied 4 = Not at All Satisfied

1.29

1.13

1.55

1.59

1.79

1.49

1.29

2.36

1.58

1.58

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers from both groups report that they believe that their child(ren) are very satisfied with the adoption. For this result, there is no statistically significant difference between groups over time. However, there is a statistically significant difference between groups at Baseline.


Chart 53

Frequency of Child Positive Behaviors to ParentDecember 2002


3.27

3.22

3.18

3.10

3.31

3.19

3.26

3.33

3.26

3.21

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Baseline

Six Months

12 Months

18 Months

24 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has acted a certain way toward the parent. Caregivers in both groups report often to daily demonstrations of positive behaviors exhibited to them from their child(ren). Positive behaviors are: Said nice things; Helped you with housework; Showed that s/he liked having you around; Did things with you; Was thoughtful when you were tired; Kissed/hugged you; Comforted you; Made you feel loved; and Showed you that s/he needed you.

DHHS IVE Child Welfare Demonstration Project December 2002 Interim Report – Maine Adoption Guides 145

CHAPTER IV – MEDICAID AND GUIDED SERVICES TITLE IV-E COSTS

The evaluator works cooperatively with D.H.S. and Casey Program staff in the

design and implementation of the cost effectiveness/benefit analysis evaluation. DHS staff track overall IV-E costs associated with this Waiver project. Evaluation staff collect information about the costs to Casey Family Services for implementing the model, the IV-E dollars spent by the state DHS for MAGS families, and Medicaid costs for all children in the study. Cost data is provided by, and reviewed for accuracy by, agency administrators at Casey Family Services and at the state DHS. The following charts provide information about total costs by category one year previous to study entry - baseline, first year in study, second year in study, and three-years in study. This information is presented to Casey Family Services and state DHS program managers in order to assist them in their understanding of what may drive or inhibit costs in each area.

Chart 54

Total Medicaid AmountsMAGS Study Population

December 2002

$1,190,427$2,039,354

$7,378,497

$5,906,420

$8,502,200

$6,775,558

$3,785,949

$3,228,144

$0 $2,500,000 $5,000,000 $7,500,000

Previous Year

Year 1

Year 2

Year 3

Total Dollars

Standard

Guided

The total amount of Medicaid dollars spent on this population (n=340) of children in foster care the year previous to study entry was $14, 154, 055. For those children (n=338) who are one year into the study, after approximately 90% are legally adopted, the total amount decreases to $9, 692, 369; a difference of nearly $4.5 million dollars. One reason given for this sharp decrease in this first year is the fact that therapeutic foster care costs are no longer accrued as these children are legally adopted. Total costs for those children (n = 233) in the study for two years are approximately $11, 730, 344. For Year 2, there were three children with a total of $7, 011, 618 in costs. Removing costs associated for these three provides a revised Year 2 total of approximately $4, 718, 726. For those children in the study for three years (n = 110) the total Medicaid costs are $3, 229, 871.


Chart 55

Average per Child Medicaid AmountsMAGS Study Population

December 2002

$19,515

$41,620

$39,040

$31,086

$65,909

$44,871

$25,581

$31,040

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000

Previous Year

Year 1

Year 2

Year 3

Average Dollars

Standard

Guided

*$20,516

For these results a t-test was performed and there are no differences between groups at baseline, Medicaid costs for the previous year prior to study entry. At baseline the Guided Services results are; n=189, mean = $39, 040 and SD = $41, 123. At baseline Standard Services n=151, mean = $44, 871 and SD = $61, 408. As mentioned above, just three children in the Guided Services group account for almost 60% of the total costs for all children in Year 2. * Results for the Guided Group for Year 2 without these three children included yields an average of approximately $20, 516 per child. Using this revised average amount, note line on bar, there is a decrease in average costs per child over time for both the Guided and Standard Services groups.


Chart 56

Average Medicaid Costs - Foster and NonFoster December 2002

$39,730

$30,608

$53,432

$57,669

$12,953

$20,733

$0 $15,000 $30,000 $45,000 $60,000

1 Yr. Prior to Study

1 Year in Study

2 Years in Study

Total Dollars

Foster Non-Foster

*$38, 850

Comparing Medicaid costs by type of adoption indicates that during the year previous to entry to study, while these children were still in the foster care system not yet adopted, average costs for those children who would be adopted by non-foster parents was higher than those who would be adopted by foster parents; $57, 669 to $39, 730 comparatively. However, after legalization, that pattern changes and then foster parent adoptions have higher average costs than non-foster parent adoptions. For Year 1 results only, these differences are found to be statistically significant; Mann Whitney independent samples test result of p = .001. *When removing the previously mentioned three children with unusually high costs in Year 2, the average for foster parent adoptions at $38, 850 is still higher than non-foster average at $20, 733; although this difference is not statistically significant. The following table does not include these three high cost children in the results.


Table 91 Average Medicaid Costs – Foster and Non-Foster



Foster Parents: N

Mean SD

207

$34, 962 $42, 957

204

$31, 372 $78, 087

208

$38,850 $71, 523

NonFoster Parents:

N Mean SD

22

$45, 501 $35, 468

22

$15, 648 $20, 697

22

$20, 733 $64, 884


Chart 57

Medicaid Hospital Spending Average per Child MAGS Study Population by Assigned Group

December 2002

$2,043

$2,237

$18,744

$6,227

$3,694

$11,654

$0 $3,000 $6,000 $9,000 $12,000 $15,000 $18,000 $21,000

Hos

ptia

l Spe

ndin

g

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided

Previous Year - Standard

Previous Year - Guided

This and the following charts break down average per child Medicaid costs by specific categories of service. A table is provided with each chart in order to provide more descriptive detail for each result.

Table 91

Medicaid Hospital Spending Average Per Child By Assigned Group December 2002

Previous Year –



N Mean SD

154 $3,694 $7,855

70 $2,043 $7,163

31 $18,744 $57,962


N

Mean SD

122 $11,654 $38,726

55 $2,237 $7,193

32 $6,227 $22,897


Chart 58

Medicaid Physician / Practitioner / Dental Costs Average per Child MAGS Study Population by Assigned Group

December 2002

$561

$613

$550

$694

$1,907

$2,778

$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000

Phy

sici

an/P

ract

ition

er/D

enta

l

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 93

Medicaid Physician / Practitioner / Dental Costs Average per Child By Assigned Group




N Mean SD

190 $1,907 $2,194

150 $561 $836

59 $550 $893


N

Mean SD

152 $2,778 $3593

134 $613 $963

62 $694 $838


Chart 59

Medicaid Prescription Drugs and Related Costs Average per Child MAGS Study Population by Assigned Group

December 2002

$203

$221

$303

$165

$178

$241

$0 $50 $100 $150 $200 $250 $300 $350 $400

Pre

scrip

tion

Dru

gs &

Rel

ated

Cos

ts

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 94 Medicaid Prescription Drugs and Related Costs Average per Child


Previous Year –



N Mean SD

80 $178 $304

26 $203 $373

15 $303 $565


N

Mean SD

78 $241 $436

25 $221 $396

19 $165 $339


Chart 60

Medicaid Behavioral Health Services Average Costs per Child MAGS Study Population by Assigned Group

December 2002

$4,093

$2,673

$6,559

$2,662

$5,149

$5,774

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000

Beh

avio

ral H

ealth

Ser

vice

s

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 95 Medicaid Behavioral Health Services Average costs per Child by Assigned Group

December 2002

Previous Year –



N Mean SD

128 $5,149 $6,360

57 $4,093 $9,242

21 $6,559 $10,192


N

Mean SD

77 $5,774 $11,654

39 $2,673 $4,761

17 $2,662 $2,728


Chart 61

Medicaid Other Services Average Costs per Child MAGS Study Population by Assigned Group

December 2002

$5,175

$2,870

$6,731

$2,870

$14,211

$14,213

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000

Tran

spor

tion

/ Cas

e M

anag

emen

t / E

arly

Inte

rven

tion

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 96

Medicaid Other Services Average Costs per Child December 2002

Previous Year –



N Mean SD

182 $14,211 $13,332

138 $5,175 $5,763

56 $6,731 $5,819


N

Mean SD

141 $14,213 $10,954

96 $2,870 $2,618

38 $2,870 $3,367


Chart 62

Long Term Care Costs per Child MAGS Study Population by Assigned Group

December 2002

$3,429

$8,574

$1,694

$5,672

$40,060

$40,679

$0 $10,000 $20,000 $30,000 $40,000 $50,000

Long

-Ter

m C

are

& R

elat

ed

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 97

Long Term Care Costs per Child by Assigned Group December 2002

Previous Year –



N Mean SD

74 $40,060 $38,139

20 $3,429 $3,011

2

$1,694 $1,555


N

Mean SD

62 $40,679 $42,075

19 $8,574 $9,984

3

$5,672 $4,406


Chart 63

Case Management Costs per Child MAGS Study Population by Assigned Group

December 2002

$4,170

$2,591

$5,979

$1,928

$11,699

$11,994

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000

Cas

e M

anag

emen

t

Average Dollars

Year 2 - Standard

Year 2 - Guided

Year 1 - Standard

Year 1 - Guided



Table 98

Case Management Costs per Child By Assigned Group December 2002

Previous Year –



N Mean SD

173 $11,699 $8,588

130 $4,170 $3,087

43 $5,979 $3,514


N

Mean SD

136 $11,994 $8,042

77 $2,591 $2,354

21 $1,928 $1,130


Chart 64

Guided Services Families: IVE ExpendituresDecember 2002

$25,431

$19,092

$360

$12,283

$10,466

$180

$13,148

$8,626

$180

$0 $10,000 $20,000 $30,000

Cohort 1 Families

Cohort 2 Families

Cohort 3 Families

Total Dollars

Total Expenditures

DHS Reimbursement

Family Contribution

This chart, and the one following, tracks costs that are Title IV-E dollars provided only to Guided Services (E) families. These funds are for services of various types that are not paid for from current options such as Medicaid and/or private insurance carriers. These services include such activities as respite, educational activities and/or special therapeutic activities. The intent is for the family to share equally in the costs of these services. Requests are made to Casey social workers and then approved by the state DHS adoption program manager on a case-by-case basis. Cohort 1 (n=18) families are those families accessing these funds that entered the project in the first year, Cohort 2 (n=14) families entered in the second year and Cohort 3 (n=3) in the current or third project year. Therefore, Cohort 1 families have had more time to accumulate costs as they have been in the project longer. Approximately 56% of Cohort 1 families have accessed this funding, 30% of Cohort 2 families and only 11% of Cohort 3 families. The types of activities paid for from these funds is varied; one arbitrary categorization of these activities is respite related services and all other.

• Cohort 1 Families: 31% Respite and 69% Other Types of Services • Cohort 2 Families: 38% Respite and 62% Other Types of Services • Cohort 3 Families: 67% Respite and 33% Other Types of Services


Chart 65

Average per Family IV E ExpendituresDecember 2002

$118

$209

$126

$173

$0 $50 $100 $150 $200 $250 $300

Cohort 1

Cohort 2

Total Dollars

DHS Reimbursement

Family Contribution

This chart depicts average overall expenses per family for Cohort 1 and Cohort 2 families. This data indicates that the intent of co-equal contributions from families and the Title IVE dollars appears to be evident; there are no statistical differences to report. Looking closer at costs for types of expenses:

• There were a total of 157 requests for financial support from 35 families to date. • 54 requests for Respite type services, at an average total (family and DHS

combined) cost of $276.00 per request. • 103 requests for Other types of services, at an average total cost of $289.00. • Average costs per activity are:

o Family Contribution: $145.00 o DHS Contribution: $139.00 o Total Combined: $284.00

• Minimum Contribution by Family = $12.50 • Minimum Contribution by DHS = $12.50 • Maximum Contribution by Family = $1,800.00 • Maximum Contribution by DHS = $600.00.


CHAPTER V – SUMMARY AND CHALLENGES A. EVALUATION IMPLEMENTATION

The evaluation for the Maine Adoption Guides Project – DHHS Child Welfare Demonstration Project continues to be on target according to established timelines. Products and services are being provided to the state Department of Human Services program manager in a timely fashion. The following are the major accomplishments and ongoing challenges at this halfway point, two and one-half years, of the Project. 1. ACCOMPLISHMENTS

• Designed and implemented a process and impact evaluation of the training program. Provided a final report to Program Manager and trainers for use in their training program planning.

• Implemented a set of procedures for random assignment and process / outcome level data collection for the Guided Services model. Process resulted in statewide referrals to project in a timely fashion with notification of assignment within 24 hours.

• Data base design, data entry and cleaning procedures finalized for the Guided Services implementation. Data analysis plan implemented.

• Institutional Review Board protocol submitted for review and approved. Developed an outline to document steps taken to ensure adherence to data collection procedures.

• Developed and continue with a Parent Advisory Group to the evaluation. This group of 12 parents who have all adopted children with special needs has been extremely valuable in all aspects of the evaluation for the Guided Services component. Group members reviewed and pilot tested instruments, suggested specific outcome indicators and assisted with the design of the invitational process to families. The Parent Advisory Group will continue to meet regularly to review evaluation results and provide advice on the progress of the study.

• Ongoing involvement as a member of the Project leadership group. Participation in this process has enabled the evaluation to be well integrated as the project has evolved. Monthly project meetings and additional meetings with other project staff have provided numerous opportunities for collecting information about the context of the project and the processes of it’s implementation.

• Participated in dissemination of preliminary study results at three national adoption and research conferences.

• Developed and currently conducting an evaluation of the Guided Services parent education/support groups.

• Provided research findings to state DHS managers to assist them with project management.


2. CHALLENGES

! Study Participant Attrition – A serious concern is how to maintain participants in the study over time. The hope is that the compensation rates will be sufficient, along with a person’s general desire to provide information for the improvement of adoption services in the future. However, this may become a serious concern as the study goes forward.

! Referral to Project – In year two of the study, there was a slower rate of referrals to the Project from DHS agency adoption caseworkers. Upon further investigation, it was discovered that at least 25-30 families had never been contacted, contrary to the established referral process. Procedures have since been implemented, with the cooperation of DHS administrators, to insure that all families are invited to participate. However, referrals still remain an issue at this point in time.

! Data Collection Processes – Just as noted in the last report, this study relies on managing a data collection process across three different agencies; state child welfare system data, Casey Family Services data and the University data entry system. As much as possible, the data collection and entry process is designed to be electronic in order to alleviate duplicative data entry procedures. However, it is inherently difficult to manage a consistent process across three systems. There has been data base design difficulties with the telephone survey instrument, difficulty in receiving and analyzing administrative data in a timely fashion and this will be an ongoing challenge.

! Data Analysis and Use of Findings – Due to the scope of the study, there is a great deal of information generated from the study. Data cleaning and initial analysis work is tedious and very time consuming. It is also difficult to judge how best to engage DHS adoption staff and the Casey Services social work staff in exploring the results of the study in a way that is meaningful. Project members agreed that results would be presented for in-person discussion in an ongoing manner once per quarter for frontline staff. In addition, the evaluation staff disseminates a monthly newsletter electronically to all DHS adoption staff in order to provide Project evaluation updates.

! Cost-Effectiveness/Benefit Study: Despite having begun to develop a proposal for this work, it has not gone forward as quickly as intended. The state agency is tracking overall IVE costs and Casey Family Services has provided basic cost information related to implementing the services model. However, the evaluator has not moved forward on the final research design for this study. This work will have to commence quickly within the next 3-4 months as outcome data is now becoming available.

It is expected that as the study commences and the population doubles each year,

many more challenges will emerge. Thus far, based largely on a supportive environment and dedication to success, the project and evaluation plan are commencing as intended. It is exciting to be part of an effort that holds so much promise for informing policy and practice on behalf of families adopting children with special needs.

state of maine iv-e child welfare demonstration...

Documents