Eric Bruns Mike Pullmann University of Washington School of Medicine
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Transcript of Eric Bruns Mike Pullmann University of Washington School of Medicine
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King County Family Treatment Court Evaluation
Grand Rounds—Division of Public Behavioral Health and Justice PolicyMarch 14, 2011
Eric BrunsMike Pullmann
University of Washington School of MedicineDivision of Public Behavioral Health and Justice
Policywww.uwhelpingfamilies.org
Jill MurphyMark Wirschem
King County Family Treatment CourtKing County Superior Court
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Specialty and Therapeutic Courts• Problem-solving courts that aim to address the root causes of
criminal activity• Generally multi-system, coordinated, collaborative process which
balances supervision with support• “Therapeutic Jurisprudence Theory” (Wexler & Winich, 1991): using
social science to inform legal policy and practice in order to promote individual and societal well-being.
• Examples include:– Adult and juvenile drug treatment courts; – Family drug treatment courts;– Mental health courts;– Homelessness courts; – Prostitution prevention courts;– DUI courts;– Habitual offender courts;– Prison re-entry courts.
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KCFTC PROCESSES AND FUNCTIONS•Comprehensive SB Assessment•High quality, appropriate CD Services•Timely/effective MH and other services•Effective care planning and management•Expanded and more frequent visitation•Consistent, timely incentives & sanctions•Random UA Screens•Effective pre-hearing case conferences•Effective judicial interaction
SHORT-TERM OUTCOMES•Eligibility/enrollment completed quickly•Enrollment in appropriate CD services•Parents compliant with/complete treatment•Parents ultimately able to remain sober•Parents/children more fully engaged in svcs•Parents/children receive needed services•Decreased placement disruptions•Parents compliant with court orders•Less negative effect on child well-being•Less disruption of child-parent bonds•Increased family reunification rates•Earlier determination. of alternate placement options
NATIONAL BEST PRACTICES•Communication bw Court and providers•Judge plays active role in Tx process•Judge responds to positive & noncompliant beh.•Mechanisms for shared decision making•Accountability for Tx services•Strategy for responding to noncompliance•MIS allow data to be assembled/reviewed•Enhancement of due process•Team members provided adeq resources
The King County Family Treatment Court
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Placement in Shelter Care
Dependency Petition Filed
Shelter Care Hearing(w/in 72 hours of place-ment or filing, whichever
occurs first)
Pre-TrialConference(21 days prior to
fact-finding)
Fact-Finding Hearing
(w/in 75 daysof filing)
Disposition Hearing
(same day as or w/in 14 days of dep finding)
Review Hearing(the sooner of 90 days from Dispo. or 6 mos.
from date of placement)
Permanency Planning Hearing(12 months from date of placement & every 12
months thereafter)
Review Hearing(w/in 6 months after
permanency planning hearing)
PetitionApproved
DependencyContinued
Exit System
Yes
PermanencyGoal Achieved?
Yes
PermanencyGoal Achieved?
Petition forParental Rights Termination?
No
No
Petition forParental Rights Termination?
No
No
Petition for Termination of Parental Rights
Filed
Yes
Yes
PetitionDismissed
PetitionDismissed
PetitionDismissed
PetitionDismissed
30-Day Shelter Care Review(w/in 30 days of
placement)
Shelter Care Case Conf.(30 days prior to
fact-finding)
PetitionDismissed
Dept. supervision
continues for 6 mos.
Childreturned
home
Review Hearing
PetitionDismissed
Dependency Stipulated
Enter FTC*(See separate
flow chart)
Enter FTC*(See separate
flow chart)
Exit FTC w/o Permanency Goal Achieved
Exit FTC w/o Permanency Goal Achieved
Original Chart prepared by Michael Curtis on January 12,
2006
*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.
*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.
Juvenile Dependency Case Flow (noting FTC)
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FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART
Check In Hearing: Set for following week after positive/missed UA or noncompliance w/ tx
Compliance Clock Hearing: Can be applied
after 5th response and set 60 days out from
current hearing
Motion Hearing: Can be set anytime there is a contested issue. Not
heard during regular FTC calendar
Discharge/Opt Out Hearing: Dependency
dismissed or discharged
to regular dependency
Other FTC Hearings:
Box Color Legend:
Red: Not a hearing
Green: Beginning and end of FTC Process
Blue: FTC Review Hearings
Graduated Blue: Does not occur on every case
Orange: Not unique to FTC
Purple: Unique to FTC and can occur throughout FTC process
Summary of the FTDC Literature(ca. 2008)
• Now three studies of FTDC model (Green et al., Boles, NPC Research)
• All three studies show positive outcomes:– Less reliance on foster care– Greater reunification rates (e.g., 42% vs. 27%; 70% vs. 45%)– Higher rates of treatment engagement and completion
• No study found between-group differences in future abuse/neglect reports
• NPC Research, the most active evaluators of FTCs and drug treatment courts, has completed several cost-benefit analyses at sites across the nation. The table below summarizes their findings:
Location Cost savings per participant
Return on investment
Areas of savings[1]
Harford Co., MD $12,000 over 1 year 350% Foster care days, Criminal justice, Court Cases
Jackson Co., OR $5,593 over 4 years 106% Foster care days, Probation/Parole, Court Cases
CA "Court 1" $1,657 over 4 years 130% Not provided
CA "Court 2" $2,141 over 5 years Not provided Not provided
Baltimore, MD $5,022 over 1 year Not provided Foster care days (did not examine other areas)
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Components of the KCFTC Evaluation
• Process evaluation– Interviews with team members and
stakeholders, 2006 and 2008– Parent interviews, 2007-2009
• Outcomes evaluation– Analysis of child placement data from Children’s
Administration and adult treatment data from the Division of Behavioral Health and Recovery
• Cost-benefit analysis– Currently underway
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What we learned from process evaluation
• Strengths– Strong opinions about the positive impact of KCFTC– Most processes and functions viewed as successfully being
accomplished by 2008• Relative Weaknesses
– Respondents less confident that goal of serving a representative population was being met
– Respondents believed client load was less than optimal (serving too few families)
– Mixed opinions on the amount of shared vision among team members
– Certain processes and functions:• Efficiency of eligibility determination and intake• Consistency and effectiveness of incentives and sanctions• Resources and training for KCFTC staff and team members
0%
5%
10%
15%
20%
25%
30%
35%
40%
Overall Success compared to regular dependency court"Compared to the regular dependency court process, how succesful do you
think KCFTC is in accomplishing these overall goals for participating families?"
2006-2008 (n=37, 36)
2006 0% 5% 11% 19% 27% 24% 14%
2008 0% 3% 11% 6% 19% 39% 22%
Much less successful
Somewhat less
successful
About the same
A little bit more
successful
Somewhat more
successful
A good deal more successful
Much more
successful
2006: Mean= 5 Std. Dev= 1.4
2008: Mean= 5.47 Std. Dev= 1.36
Summary of Process and Function Questions
Means
2 2.5 3 3.5 4 4.5 5
Effective judicial interaction
Training and education for FTC staff
Effective pre-hearing case conferences
Random UA screens
Consistent, timely incentives and sanctions
Expanded and more frequent visitation
Care planning and management
Timely/ effective other services (children)
Timely/ effective other services (parents)
High quality, appropriate CD services
Comprehensive SB Assessment
2006
2008
A little bit
successful
Somewhat
Successful
Moderately
successful
Extremely
successful
Summary of Outcome QuestionsMeans
3 3.5 4 4.5 5 5.5 6
Early determination of alternate placement options
Increased family reunification rates
Less disruption of child/ parent bonds
Parents compliant with court orders
Decreased placement disruptions
Parents/ children receive services they need
Parents/ children more fully engaged in services
Ultimately able to be and remain sober
Parents compliant with/ complete treatment
Enrollment in appropriate CD services
2006
2008
About the same A little bit more successful
Somewhat more successful
A good deal more successful
What we learned from parent interviews
• High overall satisfaction with the process• Overall perception that court process and
treatment services are helpful• Some confusion among parents about
requirements of court, completing treatment plan, and regaining custody– Parents of color more likely to voice confusion
• Certain types of needed services to be available were difficult to access– Housing, child care, employment
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Treatment Program is Helpful (n=28)“This treatment program can really help you.”
0%
10%
20%
30%
40%
50%
60%
70%
80%
All Parents 4% 0% 21% 75%
Strongly disagree Disagree Agree Strongly agree
Mean= 3.68 Std. Dev= .670
Court System Helps with Recovery (n=28)“There are people involved in the court system who help me in my recovery.”
0%
10%
20%
30%
40%
50%
60%
70%
All Parents 4% 0% 29% 68%
Strongly Disagree
Disagree AgreeStrongly
Agree
Mean= 3.61 Std. Dev= .685
nn YesYes NoNo nn YesYes NoNo nn HelpfulHelpful(Mean Rating)(Mean Rating)
TransportationTransportation 227770%70% 30%30% 1919 90%90% 10%10% 1616 4.444.44
HousingHousing 227767%67% 33%33% 1818 50%50% 50%50% 99 4.674.67
Health insuranceHealth insurance 227752%52% 48%48% 1414 86%86% 14%14% 1212 4.584.58
Services for your children Services for your children (i.e. medical or counseling services)(i.e. medical or counseling services)
227741%41% 59%59% 1111 82%82% 18%18% 99 4.444.44
Parenting classesParenting classes 227748%48% 52%52% 1313 77%77% 23%23% 99 4.444.44
ChildcareChildcare 227726%26% 74%74% 77 57%57% 43%43% 44 3.753.75
Help finding employmentHelp finding employment 227722%22% 78%78% 66 67%67% 33%33% 44 2.252.25
Financial assistanceFinancial assistance 227756%56% 44%44% 1515 73%73% 27%27% 1010 3.503.50
Mental health servicesMental health services 227737%37% 63%63% 1010 80%80% 20%20% 77 4.004.00
Substance abuse assessmentSubstance abuse assessment 227726%26% 74%74% 77 100%100% 0%0% 66 4.504.50
Substance abuse treatment servicesSubstance abuse treatment services 227756%56% 44%44% 1515 100%100% 0%0% 1313 4.544.54
Medical services/medicationMedical services/medication 227730%30% 70%70% 88 75%75% 25%25% 55 4.004.00
In the past 30 days, have you needed any of the following services?If yes, did you obtain the service?If service was obtained, how helpful was it?1=Not at all helpful -- 2=A little helpful -- 3=Somewhat helpful -- 4=Very helpful --5=Extremely helpful
Needed Received
Clear Understanding About Regaining Custody (n=23)
“I have a clear understanding about what I need to do to have my child[ren] returned to me.”
0%
10%
20%
30%
40%
50%
60%
All Parents 9% 17% 17% 57%
Strongly Disagree
Disagree AgreeStrongly
Agree
Mean= 3.22 Std. Dev= 1.043
Confused About What is Happening with my Child (n=26)
“I am confused about what is happening with my child[ren].”
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
All Parents 31% 46% 15% 8%
Strongly Disagree
Disagree AgreeStrongly
Agree
Mean= 2.00 Std. Dev= .894
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Outcome Evaluation:Research Questions
1. Do FTC participants have more positive substance abuse treatment outcomes than comparable non-FTC parents?
2. Do FTC families have more positive child welfare outcomes compared to comparable non-FTC families?
3. Do families of color have outcomes similar to families not of color?
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Outcome Evaluation
• Administrative data: – Treatment data from Division of Behavioral Health and Recovery – Child welfare data from Children’s Administration– Data collected September 2010
• Family Treatment Court group:– Selected all parents admitted to the FTC between March 2006
and October 2009
• Comparison group:– Eligible parents referred but not admitted to the Family
Treatment Court– Randomly selected a reasonable number– Statistically matched on demographics, historical treatment use,
and historical child welfare referrals
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Reasons why parent is in comparison group
Percent
Attorney not responding 42%
Over 6 months without referral 18%
Chose not to participate 8%
No known address/can’t locate/on run 7%
Other 8%
Reason missing 17%
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44%
1%
6%
1%3%
1%
7%
1%
14%
23%
56%
15%
40%
59%
18%
Parentwhite
Parent ofcolor
AfricanAmerican
AmericanIndian
Asian Hispanic PacificIslander
Missing
Comparison
FTC
Parent mean age• Comparison = 31• KCFTC = 31
Mean # of children per participant• Comparison=1.39• KCFTC = 1.46
Detail: specific race/ethnicity
Total # of parents = 268• Comparison = 182• KCFTC = 76
Parent demographics
Note: no significant differences
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Prior Investigations
Comparison %or Mean (SD)
KCFTC %or Mean (SD)
Any investigation completed prior to petition 83% 79%
Type of Allegation (index petition)
Neglect 83% 77%
Abuse 36% 36%
Prenatal Injury 8% 9%
Medical Neglect 8% 7%
Abandonment 2% 3%
Number of investigations prior to petition 2.1 (2.1) 1.8 (2.3)
Note: No statistically significant differences
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50%
4%
10%
2%
26%
6%
1%
17%
50%
35%32%
38%
54%
46%
28%
Female Male White AfricanAmerican
Asian/PI NativeAmerican
Hispanic Unknown
Comparison
FTC
Child Mean Age• Comparison = 4.2• KCFTC = 3.5
Number of children• Comparison = 235• KCFTC = 89
Child demographics
Note: Statistically significant difference for Native American
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Status of FTC parent at time of data collection
FTC(n=76)
Discharged 33%
Graduated 26%
Currently enrolled 22%
Opted out of program 11%
Certificate of participation 7%
Dismissed 1%
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Note on Analytic Approach…• 1). “Intent to treat”
– All parents who were admitted to FTC were included in all analyses, even if they opted out or had an unsuccessful outcome.
• No parent who was ever in FTC was ever included in the comparison group
• 2). Index Petition Date– “Time Zero” or comparable start point for both groups
was the petition date, not date of entry into FTC (comparison group had no date of entry)
These decisions likely result in more conservative findings
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• Question 1: Do FTC participants have more positive substance abuse treatment outcomes than comparable non-FTC parents?– Are they more likely to enter treatment?– Do they enter treatment more quickly?– Are they more likely to attend treatment?– Do they remain in treatment longer?– Are they more likely to be successfully
discharged from treatment?
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FTC parents are more likely to enter treatment
40%
20%
53% 52%59%
32%
88%84%
Admittedprior topetition
In treatmentat petition
Admittedafter
petition
Received txafter
petition
Comparison
FTC
Note: All differences statistically significant
FTC parents were 63% more likely to be admitted to treatment.
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FTC parents enter treatment twice as fast
(Of those entering treatment, n=165)
Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:
• Comparison: 115
• KCFTC: 51
Note: Statistically significant difference, p < .05
Pro
por
tion
not
adm
itted
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FTC parents received broader service array
Of those admitted to any treatment
Comparison(n=94)
KCFTC(n=66)
Long term Residential* 40% 65%
Intensive Outpatient 52% 56%
Outpatient 43% 50%
Intensive Inpatient 40% 35%
Methadone 17% 27%
Recovery House* 1% 9%
Housing Support 8% 3%
* Statistically significant difference, p < .05
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FTC parents received broader service array
Of those who received any treatment
Comparison(n=94)
KCFTC(n=64)
Individual therapy* 89% 100%
Group therapy 90% 97%
Case management 81% 89%
Urinalysis 43% 52%
Methadone/opiate subst. 15% 25%
Childcare* 11% 25%
* Statistically significant difference, p < .05
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FTC parents receive more treatment and are
more likely to attend treatment (Of all treatment events)
Comparisonn=6,188
FTCn=8,357
Attended treatment episode 87% 90%
Excused by provider 6% 4%
No show, unexcused 8% 6%
Note: Statistically significant difference, p < .05
Avg. # of treatment events per person who received treatment:
• KCFTC = 145
• Comparison = 65
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Success in treatment
• FTC parents remained in treatment twice as long (median of 109 days compared to 53)
• FTC parents 37% more likely to be successfully discharged from treatment (74% compared to 54%)
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• Question 2: Do FTC families, compared to similar families who did not receive FTC services, have more positive child welfare outcomes? Specifically:– Do the children of FTC participants spend less time in
out of home placement?– Are the children of FTC participants placed in
permanent living situations more quickly overall?– Are FTC children more likely to have a permanent
placement?– Are FTC participants less likely to have subsequent
CPS referrals?
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Child welfare outcomes
• FTC children spent 30% less time in out-of-home placements (median of 481 days, compared to 689 for comparison group)
• FTC children spent 20% less time in the child welfare system (median of 729 days, compared 819 for comparison group)
• FTC children 43% more likely to have a permanent placement (60% compared to 42%)
• FTC children 70% more likely to return to the care of their parent (58% compared to 34%)
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Comparisonn=235
KCFTCn=89
Trial home visit 10% 17%
Reunification 9% 11%
Dependency dismissed 15% 30%
Adoption 14% 18%
Guardianship 4% 1%
Other 3% 1%
In out-of-home placement 46% 21%
34% 58%
Return home
42% 60%
Permanent placement
Permanent placements & returns home more likely for FTC children
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Question 3: Do families of color have outcomes similar to families
not of color?
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52%
87%
56%
90%
Comparison FTC
Parent white
Parent white
Parent of
color
Parent of
color
Parents of color did not differ from white parents in their likelihood to:
• Be in treatment when petition was filed
• Be admitted to treatment after petition
• Schedule treatment episode after petition is filed
Note: No statistically significant differences
Admitted to treatment through DBHR after petition
All parents
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Note: White-white, p < .05
POC-POC, p < .10
81
5149
152
Comparison FTC
Parent white
Parent of color
Parent white
Parent of color
Median days until treatment entry
Of those not in treatment at petition
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Median days in first treatment
Note: White-white, p < .05
POC-POC, p < .10
FTC: POC-White mixed
43
77
151
53
Comparison FTC
Parent white Parent
of color
Parent white
Parent of color
40
Length of time in first treatment episode
Of those parents entering treatment, the median days in first treatment episode:
• Comparison, parent of color: 43
• Comparison, white: 53
• KCFTC, parent of color: 77
• KCFTC, white: 151
Note: No statistically significant differences
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Percentage successfully completing a treatment episode
Of those receiving treatment
Note: POC-POC p < .05
No other significant differences
52%
68%
55%
82%
Comparison FTC
Parent white
Parent white
Parent of
color
Parent of
color
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Percentage of children with permanent placements
Note:
All: Comp-FTC p < .05
No other significant differences
45%
66%
41%
57%
Comparison FTC
Child white
Child of color
Child white
Child of color
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Percentage of children remaining in out of home placement
Note:
All: Comp-FTC p < .05
FTC: COC – Child white, p < .10
No other significant differences
45%
11%
47%
28%
Comparison FTC
Child white
Child of color
Child white
Child of color
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Comparing FTC to regular court for families of color
• Generally indicate that families of color in FTC had more positive outcomes than families of color in the comparison group– 61% more likely to enter treatment– Enter treatment 63% faster– Remain in treatment nearly twice as long– 49% more likely to complete treatment– Children 39% more likely to be permanently placed– Children 54% more likely to be returned home
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Comparisons by race in FTC
• Parents of color in the FTC were not significantly different than white parents on:– Percentage admitted to treatment– Speed of admission to treatment– Percentage successfully completing treatment
• Parents of color spent less time than white parents in treatment
• Children of color might be more likely to remain in out-of-home placements (borderline significance)
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Summary and conclusions• The King County Family Treatment Court is one of a
variety of problem-solving courts• Staff from several disciplines and agencies collaborate
on supervision and support• Stakeholders generally have positive opinions about the
development and functioning of the court• Parents have more successful substance use treatment
outcomes• Children are more likely to exit the child welfare system
and be returned to the care of their parents
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Please contact us with any questionsEric Bruns
Mike Pullmann
Jill Murphy
Mark Wirschem
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Extra slides
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Median days until treatment entryAll parents
Note: White-white, p < .05
POC-POC, p < .05
Comp White – Comp POC, p < .05
No differences for FTC groups
215
2843
487
Comparison FTC
Parent white
Parent of color
Parent white
Parent of color
50
Median days until end of child’s out of home placement
Note: White-white, p < .05
POC-POC, p < .10
792 764
630651
Comparison FTC
Child white
Child of color
Child white
Child of color
51
Percentage of children returning home
Note:
All: Comp-FTC p < .05
No other significant differences
31%
66%
35%
54%
Comparison FTC
Child white
Child of color
Child white
Child of color
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Parent Primary Drug of Choice
Comparison % KCFTC %
None listed/not in DBHR dataset 54% 30%
Alcohol 8% 15%
Cocaine 12% 16%
Heroin 7% 16%
Marijuana/Cannabis 7% 3%
Methamphetamines/amphetamines 7% 13%
Other 6% 8%
Note: Groups significantly differed, p < .05
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Statistical controls
• Because the groups differed slightly at petition date, in many analyses we controlled for:– Caregiver age– Caregiver race– Child age– Number of prior investigations– Whether parent was in treatment at admission– Number of prior treatment episodes– Primary drug of choice
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FTC parents enter treatment more quickly
Note: Statistically significant difference, p < .05
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FTC parents remain in treatment longer
Note: Statistically significant difference, p < .05
56
FTC children spend less time in out-of-home placements
Note: Statistically significant difference, p < .05
57
FTC children are placed in permanent situations more quickly
Note: Statistically significant difference, p < .05
58
Parents of color differ on speed at admission to services
Of all parents, the median days until treatment entry were:
• Comparison, parent of color: 215
• Comparison, white: 487
• KCFTC, parent of color: 28
• KCFTC, white: 43
Note: White-white, p < .05
POC-POC, p < .05
59
Parents of color differ on speed at admission to services
Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:
• Comparison, parent of color: 81
• Comparison, white: 152
• KCFTC, parent of color: 51
• KCFTC, white: 49
Note: White-white, p < .05
POC-POC, p < .10
60
Children of color do not differ in length of time in out of home
placementMedian days until end of out of home placement were:
• Comparison, youth of color: 792
• Comparison, white: 651
• KCFTC, youth of color: 764
• KCFTC, white: 630
Note: White-White p < .05
No other significant differences
61
Children of color differ on permanent placement type
Comparisonyouth of
color n=150
Comparisonwhite
n=85
FTCyouth of
colorn=54
FTC, white
n=35
Trial home visit 12% 6% 13% 23%
Reunification 11% 7% 15% 6%
Dependency dismissed
13% 18% 26% 37%
Adoption 13% 15% 17% 20%
Guardianship 6% 5% 0% 3%
Other 1% 5% 2% 0%
In out-of-home placement
47% 45% 28% 11%
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Children of color differ on permanent placement type
Comparisonyouth of
color n=150
Comparisonwhite
n=85
FTCyouth of
colorn=54
FTC, white
n=35
Permanent placement 41% 45% 57% 66%
Returned home 35% 31% 54% 66%
In out-of-home placement
47% 45% 28% 11%
Note: White-White p < .05
YOC-YOC p < .05
No other significant differences
63
Children of color differ slightly in length of time until permanent
placementMedian days until permanent placement were:
• Comparison, youth of color: 866
• Comparison, white: 688
• KCFTC, youth of color: 763
• KCFTC, white: 632
Note: White-White p < .10
YOC-YOC p < .10
No other significant differences