Measuring Well Being in Child Welfare Three Branch Institute July 2013

Most agency specific “outcomes” are actually

process measures –Outcomes limited to the

mandate or activities of a single agency and/or

external service providers

To truly measure an outcome (such as family

well-being, or child’s health status) we need to

take a multi-systems approach

Getting to Well-Being

• Assessment of Need• Access to Services• Quality of Services• Effectiveness of Services

Different data for different purposes: Child level vs. systems level

Getting to Well-Being– Descriptive: how many children have

diagnosed disabilities? (By age, gender, race, type of disabilities)

– Agency Specific Outcome: Do children receive assessment and treatment? Are children with disabilities achieving permanency?

– Integrated Functional Outcome: Are children experiencing limitations as a result of their medical condition? Is status improving?

Getting to Well Being

What screening tools are already in place? Many can be used over time to identify service needs, assess improvement and determine the need for changes in service delivery. Consider reporting capabilities before scaling up

What outcomes are already being measured by a partner agency? Can child welfare children be identified in the data?

And How Are the Children?

National Health Care Access Measures:• Insurance coverage• Having a “Usual Source” of healthcare• Immunizations• Oral Health – Dental Visits

Federal Interagency Forum on Child and Family Statistics. America’s Children: Key National Indicators of Well-Being, 2013.

And How Are the Children?Additional Data Needed• Adequacy of healthcare coverage• Quality and content of health care

In Child Welfare, physical health is monitored through qualitative case reviews. Some jurisdictions employ foster care health nurses and use Medicaid claims or other healthcare data to assess health care utilization

Getting to Well Being: Access to Healthcare

Getting to Well Being: Access to Healthcare

And How Are the Children?National Measures of Health Status• Preterm Birth and Low Birth weight• Infant Mortality• Emotional and Behavioral Difficulties• Adolescent Depression• Activity Limitation (due to chronic condition)• Diet Quality (Healthy Eating Index), Obesity• Asthma

Federal Interagency Forum on Child and Family Statistics. America’s Children: Key National Indicators of Well-Being, 2013.

And How Are the Children?Health – Data Needs• Improved measure of child disability based on

functional difficulties

In Child Welfare: we know very little about the health status of children and have traditionally focused on healthcare processes. Increased use of functional assessments and linkages to other data systems are key to improvement in this area

And How Are the Children?

Getting to Well Being: Descriptive Data/Assessing Need

Begin where you are: start small, show value, build relationships• Cluster Analysis • Trauma Assessment and Treatment –

collaborations with behavioral health• Access to Educational Data• Connections to Medicaid data• Primary prevention – connections to public

health and early learning

Resources for Action Planning

• Data sharing resources• America’s Children: Key National

Indicators of Well-Being, 2013• High level child welfare data – state fact

sheets• Descriptive Data “Who’s In Care”• Ongoing peer learning• Additional support and TA

There can be no keener revelation of a society's soul than the way in

which it treats its children.Nelson Mandela

Key Questions: Well-Being Processes• Are children and caregivers assessed for appropriate

service needs?• What interventions are currently in place to address

trauma and improve functioning and well-being? Are they achieving the desired results?

• How is program fidelity being assessed?• Are there services/interventions available in all areas?

Are they culturally sensitive? Targeted for the population?

• Evaluate capacity for data sharing and interagency collaboration (Medicaid, substance abuse, public health, early learning…)

Key Questions: Well-Being Outcomes

• Are children and caregivers assessed for appropriate service needs?

• Do children and youth have a positive relationship with a caring adult?

• Have children reached normative standards for growth and development?

• Are children and youth succeeding in school?• Are children and youth exhibiting a reduction in trauma

symptoms and/or improved social and emotional development?

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Guidance from ACF: Well-Being

• Explains ACYF’s priority to promote social and emotional well-being for children and youth receiving child welfare services,

• Encourages child welfare agencies to focus on improving the behavioral and social-emotional outcomes for children who have experienced abuse and/or neglect.

http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf

Guidance from ACF: Trauma

• Defines the issues surrounding psychotropic medication use by children in foster care,

• highlights available resources • encourages increasing access to clinically appropriate

screening, assessment, and evidence-based interventions for foster children with mental health and trauma-related needs.

http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1203.pdf

Guidance from ACF: Early Learning

• Provides information to State and local child welfare agencies to reinforce the Children's Bureau commitment to supporting child welfare agencies' investment in partnerships with Head Start and Early Head Start agencies in order to improve young children's access to and continuity of comprehensive, high quality early care and education services.

http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2011/im1101.htm

February 26, 2012 CWLA Pre-Conference Institute: Trauma

February 26, 2012 CWLA Pre-Conference Institute: Trauma

February 26, 2012 CWLA Pre-Conference Institute: Trauma

Common Outcomes

National Indicator

State Level (all children)

Child level – special

populations

Child level – special

populations

County or Agency Level

Child level – special

populations

And How Are the Children?Family and Social environment• Child care: access and quality• Adolescent birthsIn Child Welfare: Child maltreatment/victimization rates; Living situation, Placement stability, Maltreatment in foster care, achievement of permanency

Family and Social environment: Data Needs

• Social Connections and Engagement– The formation of close attachments to family,

peers, school and community have been linked to healthy youth development

In child welfare, connections are measured through the Child and Family Services Review additional measures include placement with siblings, relative placement, and relational and legal permanency.

And How Are the Children?Economic Circumstances• Child poverty, income distribution, parental employment• Food insecurityData needs:• Economic Well Being: Standard of Living• Long Term Poverty

In child welfare: • National Youth in Transition Database (NYTD) for older

youth• Family poverty as risk factor

And How Are the Children?Physical Environment and Safety• Outdoor Air and Drinking Water Quality• Environmental Tobacco Smoke• Lead in the Blood – declining, but higher in

African American and Latino children, higher for children living in poverty

• Housing and Homelessness• Victims of violent crimes• Injury and mortality

And How Are the Children?Physical Environment and Safety – Data Needs• Exposure to violence• Improved accuracy for measuring homelessness

In Child Welfare: • Child Fatalities/near fatalities• Homelessness as removal condition/risk factor• National Youth in Transition Database (NYTD)

for older youth

And How Are the Children?Behavior• Cigarette, Alcohol, and Illicit Drug Use• Sexual Activity• Youth Perpetrators of Violent Crime

Data Needed: Activities promoting health and development

In Child Welfare: Overlap with the Juvenile Justice System

And How Are the Children?Education• Family reading to young children• Mathematics and Reading Achievement• High School Academic Coursetaking• High School completion• College Enrollment• Youth Neither Enrolled in School nor Working

And How Are the Children?Education – Data Needs• Early child development; cognitive, emotional,

social skills of preschoolers (will be a special forum available at Childstats.gov)

In Child Welfare:Educational needs are monitored though the CFSR and NYTD (older youth). Some Jurisdictions employ educational specialists and have access to educational data.

Well Being is a Shared Responsibility

Courts

LegislaturePublic Agencies

Three Branches: Different processes

Outcome

OversightOversight

PolicyPolicyPracticePractice

• Child welfare process:

• Court process• Policy/Statute

Different processes, Common Outcomes

Child and Family

well being

Behavioral Health

Education

Public Health

Child Welfare