Effective and Affordable Treatment for Foster Children; One-and-the-Same

By Nora Bacher

In the wake of the Great Recession, child welfare administrators and policymakers have to make tough choices about where to invest in foster children.

A study published in the January issue of Children and Youth Services Review found that a program for foster preschoolers may double their chances of finding a permanent home while also saving money for cash-strapped counties. Two sites in California are already implementing the reform.

Stewart Holzman is Program Manager at the San Diego Center for Children, and oversees one of the two sites using the program in the state.

“You find the upfront costs are higher, but outcomes are better,” Holzman said.

The program, called Multidimensional Treatment Foster Care for Preschoolers, or MTFC-P for short, is being used and tested world-wide. The combination of highly-standardized services provided to preschoolers, foster parents, and birth or adoptive parents over the course of 9 to 12 months are part of the program’s success, according to the recent study.

These services include individual skills training for preschoolers and family therapy for birth parents. But the bulk of the treatment happens within the foster family.  MTFC-P foster parents are carefully selected and trained, and receive 24/7 on-call support. MTFC-P is commonly referred to as a “group home for one” in that it provides intensive treatment in a family setting, rather than an institution where kids may otherwise receive these services.

A randomized clinical trial (RCT) looked at 117 kids and showed that for the preschoolers who have already had four or more foster placements, MTFC-P helped land them in a permanent home. In this study, children who received MTFC-P had an 83 percent success rate in adoption or reunification attempts, versus a 39 percent success rate for the kids in regular foster care.

Though it’s a relatively small sample, the findings are significant:  RCT’s are considered the “gold standard” for research because they randomly assign alike participants to one of two groups—the treatment (in this case MTFC-P) or non-treatment group—and compare results. Randomization allows researchers to more confidently attribute differences seen between the groups to the intervention.

In San Diego, Holzman has seen the program in action. They typically have five to eight children in the MTFC-P program at any given time, all of whom have been through multiple placements.

“Sometimes we’re getting five year olds with 10 to 12 placement disruptions already,” Holzman said. After MTFC-P, he said “kids are less stressed, build skills, and are better able to regulate their emotions. You see better outcomes in the long-range and quicker reunification.”

Finding a permanent home for children who enter foster care is critical and one of the top priorities of child welfare institutions across the country. Children and youth who are either adopted or successfully reunited with their birth family tend to do better in school, be healthier, and more emotionally well compared to children who spend their childhood in the foster system, according to a large body of research.

Children who never find permanency may move foster homes multiple times in a year—an experience that can be highly disruptive to school, friendships, and relationships with caregivers. In 2012, 14 percent of foster children in California had three or more placements, according to Kidsdata.org.

The intensive services don’t come cheap, but this latest research conducted by Dr. Frances Lynch, a health economist with Kaiser Permanente, and colleagues indicates that the benefits of MTFC-P outweigh the costs. Researchers first compared the cost of regular foster care to MTFC-P. Then they looked at money saved over 24 months from children who left the foster system through adoption or reunification. Finally, they examined agency’s willingness to pay for permanency (a research method use to put a dollar value on results).

Even when agencies put a $0 value on permanency, using MTFC-P still made financial sense.

“Even if they don’t value the program very highly, it’s still going to be a pretty good deal for them,” Lynch said in an interview.

The results could affect how we help the approximately 55,000 children currently in foster care in California. Children’s Institute, Inc. (CII), a multiservice organization serving children in Los Angeles County, has been using a version of MTFC for adolescents for roughly six years and selected the program based on the evidence that showed it worked.

“There is a difference between gaining access to services and gaining access to effective services,” said Dr. Todd Sosna, Senior Vice President for Program Evaluation and Improvement at CII. According to Dr. Sosna, this new research is among a growing body of work that indicates paying for high-quality services upfront can save in the long run.

“The more we can show how these programs work, the more policymakers can insist that public funding take advantage of this accumulated knowledge,” Sosna said.

Nora Bacher is a graduate student at UC Berkeley’s School of Social Welfare. She wrote this story as part of her coursework for a class called Journalism for Social Change, offered at the Goldman School of Public Policy. 

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Legislative leaders in California have produced an initial plan to achieve Gov. Gavin Newsom's call for the closure of the state's Department of #JuvenileJustice, which once housed more than 10,000 youth and young adults and now holds fewer than 1,000. https://j.mp/3fSYElu