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Outcomes for Child Welfare

Outcomes for Child Welfare. Fred Wulczyn Research Fellow, Chapin Hall for Children University of Chicago. Overview. Historical context Domains versus measures Process, quality, capacity, outcomes CFSR, Braam Risk adjustment Standards and Baselines Linking outcomes to finance.

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Outcomes for Child Welfare

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  1. Outcomes for Child Welfare Fred Wulczyn Research Fellow, Chapin Hall for Children University of Chicago

  2. Overview • Historical context • Domains versus measures • Process, quality, capacity, outcomes • CFSR, Braam • Risk adjustment • Standards and Baselines • Linking outcomes to finance

  3. Historical Context • Adoption Assistance and Child Welfare Act (1980) • Data collection • Adoption and Safe Families Act (1997) • CFSR • State and Local Initiatives • EQUIP • AB 636 • BRAAM • Brian A.

  4. Domains and Measures • Domains • Broad categories of interest related to the core mission of the system • Measures • Numerators and denominators • How many? • How long? • How likely? • Measures are used to determine whether there are meaningful changes in the domains of interest

  5. Domains • Safety • Are children safe from abuse, neglect, and other forms maltreatment? • Permanency • Are children living with a forever family? • Well-being • Education • Health • Mental health

  6. Domains (cont.) Safety, Permanency, Well-Being Well-Being Safety, Permanency, Health, Education, Mental Health

  7. Safety Outcomes • Incidence • How often does it happen? • Incidence rates per 1000 • Recurrence • Does it happen again? • What proportion is re-reported? Re-substantiated? • What is the timing? • Setting • Where was the child when it happened? • At home? • In placement?

  8. Permanency • How often are children placed? • Incidence rate per 1,000 children • As a fraction of children with a substantiated maltreatment • How likely is permanency? • How long does it take to achieve? • How often do children return to foster care (aka reentry)? • How often do children move? • What is the timing of the moves?

  9. Health, Education, Mental Health • Are children healthy? • Are children doing well in school? • Are children well-adjusted? • Are children/youth prepared for the next transition?

  10. Outcome Measures • Measures typically have three dimensions • The numerator: who experienced the outcome • The denominator: who was at ‘risk’ • Time • These dimension are used to measure: • The likelihood that something will happen • The timing of an outcome • Put another way: • How likely is it the a child will achieve permanency? • How long does it take?

  11. Likelihood and Timing • Keep these two ideas separate

  12. In Addition to Outcomes, What Else? • Process - • Refers to what you do to influence outcomes • Quality • Refers to how well you do what you do • Capacity • Refers to whether you have resources needed to meet process and quality req. Often thought of as ‘outcomes’ but one has to be careful

  13. Process • Referral, Assessment • Treatment planning • Service delivery • Clinical follow-up • Etc.

  14. Quality • Culturally competent • Properly trained • Properly resourced

  15. The Connection • Organizations invest in process and quality to improve outcomes • The link between process, quality, and outcomes has to be established. • Fidelity (compliance) to practice protocols is critical

  16. CFSR and Braam - Where Do They Fit? • Outcome measurement issues • Process and quality vs. outcomes • Standards vs. baselines

  17. Risk Adjustment • Differences in what happens that are tied to practice or organizational variation

  18. Standards and Baselines • Standards • Of practice • Of performance • Baselines • Status prior to intervention • Measuring change relative to the baseline

  19. Finance and Outcomes • Creating an unambiguous link between outcomes and finance . . .

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