The RAND Approach to Child Welfare: Cutting Cost, Improving Outcomes

This week, the RAND Corporation issued a report describing how federal child welfare policy could be changed to improve outcomes for children and youth while saving $12.3 billion.

To reach its conclusions, the Santa Monica, Calif.-based nonprofit research firm developed a model that points to the value of increased spending on child maltreatment prevention while also expanding and improving supports for kin caregivers, relatives who care for foster youth.

“Our study suggests that one need not choose between prevention and treatment,” the report reads. “This is not an either-or issue.”

The report, entitled “Improving Children’s Lives: Balancing Prevention and Treatment in the Child Welfare System,” was presented to lawmakers and congressional staff on Capitol Hill on Tuesday.

CREDIT: The RAND Corporation. This chart describes how children flow into foster care, and the different intervention points along the way.

The research’s findings relied on the development of a “transition state probability model,” which focused on the nearly 24 million children born in the United States between 2010 and 2014. The research team, led by senior RAND economist Jeanne Ringel, created what is best described as a flow chart that takes into account the probability of several different outcomes, ranging from instances of child maltreatment early in life to challenges in early adulthood.

The researchers then studied the effect of different interventions on children at three seminal stages in their life trajectory: before maltreatment occurred; after a report of maltreatment had been lodged, but before entering foster care; and after a child had been placed into foster care. The policies and programs they focused on were child maltreatment prevention, family preservation and support for kin as foster youth caregivers.

The analysis included the estimated cost of delivering these three types of services, and the savings that could be expected based on altering a child’s trajectory through the system.

For example, increasing both the quality and quantity of prevention strategies like the Nurse Family Partnership or the Positive Parenting Program, known as “Triple P,” would cost $4.3 billion over the lifetime of the children studied. This would be partially offset by a $2.5 billion reduction in costs associated with “screenings, investigations, services and temporary placements.”

The model also measured the impact of the programs on outcomes later in life, including substance abuse, underemployment, homelessness and criminal conviction. In the scenario where both the quantity and quality of child maltreatment prevention services were increased, these adverse outcomes were reduced by six to seven percent in every category.

The RAND team didn’t stop at prevention. The main thrust of the report is focused on the interplay of child maltreatment prevention and interventions once children are deep in the system.

When prevention is coupled with increased supports for relative caregivers, the RAND report found that maltreatment episodes were reduced by 10 percent, driving down referrals, substantiations and out-of-home placements.

Because of an estimated $16.6 billion reduction in costs associated with less expensive placements with kin, the overall savings reached by combining these services with child maltreatment prevention was $12.3 billion. In addition, the deleterious outcomes in young adulthood described earlier were also reduced by seven percent across the board.

“The big takeaway from this work is that balanced approaches to improving the child welfare system that expand both prevention and treatment can improve outcomes and ultimately reduce system costs for a cohort of children,” Ringel wrote in an email. “There is no need to choose between prevention and treatment; one doesn’t come at the expense of the other. In fact, pursuing both together can lead to better results.”

While the research shows promise, Ringel also pointed to the project’s limitations. These include the complexity of how children flow into and through the child welfare system and the nature of the existing data and research, which is rarely national in scale.

For example, the RAND model estimated extremely low numbers of child maltreatment investigations and substantiations when compared with other recent peer-reviewed studies that work with administrative data. RAND estimated that 4.6 percent of the 24 million children in its cohort would be subject to a child abuse investigation by age 18, and that 0.9 percent would be substantiated victims of abuse.

CREDIT: The RAND Corporation. This model shows how children flow into and through the foster care system, with rates per thousand included.

Ringel and her team used the Fourth National Incidence Studies on Child Abuse and Neglect (NIS-4), which was published in 2010, as its basis for child maltreatment rates. That study, which relies on reports from agencies – including but not limited to child protection – estimated that 1.7 percent of U.S. children “experienced maltreatment” in the study year (2005-06). NIS-4 also uses a separate rate to include those children who were not confirmed victims of abuse, but were thought to be in harm of maltreatment. In the study year, the report estimated that 4 percent of all children would meet this standard.

But since the publication of NIS-4, a series of studies have calculated the cumulative, multi-year rate for abuse, which, understandably, dwarfs the one-year rates caught by NIS-4 and reports issued by federal agencies.

In 2011, researchers from U.C. Berkeley linked birth records of the nearly two million California babies born between 1999 and 2002 with child welfare administrative data and death records. By age 5, 5.1 percent of those babies had been substantiated victims of abuse.

A few years later, Yale’s Christopher Wildeman was part of a group of researchers who analyzed of the National Child Abuse and Neglect Data System furnished by the federal government. A 2014 paper found that 12.5 percent of all U.S. children would be confirmed victims of child abuse by age 18. The subsequent 2017 analysis led by Washington University’s Hyunil Kim – and included Wildemam – found that more than 37 percent of all U.S. children would be investigated as potential victims of child abuse by age 18.

Despite the wide variance between these numbers and what the RAND model estimated child maltreatment rates would be, Ringel was confident that inputting those higher numbers would not affect the RAND model’s cost estimates.

“While the levels of maltreatment and all of the subsequent steps in the pathway through the system would be higher in the status quo, we expect that the percentage changes associated with implementing the different policies would be similar,” Ringel said in an email. “Certainly within the same order of magnitude and direction.”

On May 25, Ringel will present RAND’s findings during a webinar hosted by Fostering Media Connections, the parent organization to The Chronicle of Social Change.

The Los Angeles-based Pritzker Foster Care Initiative funded the RAND Report.

NOTE: This article was changed to reflect that Washington University’s Hyunil Kim was the lead author on the 2017 study showing that more than 37 percent of all U.S. children would be investigated for maltreatment by age 18. 

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New York wants to use a fund for #FamilyFirst Act prep to prevent youth from aging out of #fostercare, but some counties say the money is already spent or earmarked #childwelfare