MAINE ADOPTION GUIDES PROJECTmuskie.usm.maine.edu/Publications/ipsi/maine_adopt_guide_04.pdf · DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine

Not to be used without author’s permission.

STATE OF MAINE

IV-E CHILD WELFARE DEMONSTRATION PROJECT

MAINE ADOPTION GUIDES PROJECT

INTERIM EVALUATION UPDATE

December 31, 2003

Submitted To: Virginia S. Marriner, Adoption Program Specialist Bureau of Child and Family Services Department of Human Services Prepared By: Michel Lahti, PhD, Principal Investigator Amy Detgen, MPA, Research Coordinator Institute for Public Sector Innovation Edmund S. Muskie School of Public Service University of Southern Maine

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project i

TABLE OF CONTENTS Research Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-28 Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i List of Figures, Tables and Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii-v Chapter I - Introduction A. Overview of the Demonstration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1. Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Adoption Guided Services Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

B. Research Design & Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1. Population Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2. Research Design & Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

a. Guided Services Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 b. Guided Services Model - Process Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 c. Outcome Evaluation - Guided Services Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 d. Outcome Evaluation - Research Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

C. Data Collection & Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1. Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2. Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter II - Process Analysis A. Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1. What Is the Maine Adoption Guides (MAGS) Model of Intervention . . . . . . . . . . . . . . 13 2. Types of Services Provided Through MAGS Intervention . . . . . . . . . . . . . . . . . . . . . . . 16 3. How is MAGS Implemented. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

a. Results of Referral . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 b. MAGS Implementation Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 c. Focus Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

B. Sample Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 1. Children Involved in MAGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Select Family Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3. Select Child Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

C. Service Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 1. Types of Services Provided . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2. Types of Services Families Utilize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 3. Families Access Natural Forms of Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 4. Barriers Families Experience In Responding to Child’s Needs . . . . . . . . . . . . . . . . . . . 92 5. Families Type of Medical Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Chapter III - Outcomes A. Description of Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 B. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

1. Family Level Variables – Mean Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 2. Child Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Chapter IV - Cost Neutrality Information, MaineCare & Guided Services

Title IV-E Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project ii

LIST OF FIGURES Figure 1: Post Legalization Program Model Differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Figure 2: Maine Adoption Guides – Guided Services Intervention Program Logic Model . . . . . 6-7 Figure 3: Outcomes Study Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 4: Casey Family Services: Maine Adoption Guides Service Codes & Definitions . . . . 16-19

LIST OF TABLES

Table 1: Social Worker Territories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2: Guided Services Population By Project Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 3: Non Participants by District – Year 4 to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 4: Adoptions: Adoption Finalizations by Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 5: Adoption Finalizations by Month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 6: Total Number of Children by Cohort and Assigned Group . . . . . . . . . . . . . . . . . . . . . . 24 Table 7: Total Number of Families by Cohort and Assigned Group. . . . . . . . . . . . . . . . . . . . . . 25 Table 8: Child Gender by Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 9: Child Age by Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 10: Average Child Age (mean score) at Entry in the Program. . . . . . . . . . . . . . . . . . . . . . . . 28 Table 11: Type of Adoption – Foster Parent and Non-Foster Parent . . . . . . . . . . . . . . . . . . . . . . 28 Table 12: Current Total Annual Income Before Taxes by Assigned Group. . . . . . . . . . . . . . . . . . 29 Table 13: Child Race by Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 14: Family Structure by Assigned Group. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 31 Table 15: Pre-Adoption Relationship to Child by Assigned Group .. . . . . . . . . . . . . . . . . . . . . . . 32 Table 16: Number of Children: Current or Previous Adoption Baseline by

Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 17: Average Number of Children’s Previous Foster Care Placements

by Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 18: Average Number of Years Child Has Been in a Foster Care by

Assigned Group. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 19: Average Time Child Has Lived in Home (Months) by Assigned Group . . . . . . . . . . . . 35 Table 20: Median # Days Child Out of Home Past Six Months by Assigned Group . . . . . . . . . . . 36 Table 21: Time in Study (months) by Cohort and Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 22: Percent of Children in Study Legally Adopted – 6-24 Months by Assigned Group . . . 37 Table 23: Child Behavior Problems Before Legalization - Baseline . . . . . . . . . . . . . . . . . . . . . . . 37 Table 24: Is the Child Currently Attending School by Assigned Group . . . . . . . . . . . . . . . . . . . .38 Table 25: Child’s Grade Level by Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 26: Child Has Individualized Education Plan (IEP) Children Age Five and Older by

Assigned Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 27: Clinically Diagnosed Disabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 40 Table 28: Child Taking Behavioral/Emotional Medication by Assigned Group . . . . . . . . . . . . . . 41 Table 29: Quality of Home Life in Past Six Months at Baseline In Study . . . . . . . . . . . . . . . . . . . 42 Table 30: Quality of Home Life in Past Six Months at 6-36 Months in Study . . . . . . . . . . . . . . 42 Table 31: Satisfaction with Marriage/Partnership at Baseline Only . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 32: Concerns about Adopting a Child – Baseline Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 33: Reasons for Adopting a Child – Baseline of Total Study Population . . . . . . . . . . . . . . 44 Table 34: Background of Adoptive Parents – Total Population. . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 35 : Spouse/Partner Attitude Toward Adoption – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 36 : Caregiver Rates Overall Level of Communication w/Adopted Child at Baseline . . . . . 47 Table 37 : Caregiver Rates Overall Level of Communication w/Adopted Child at 6-36 Months . .47 Table 38: Do You Trust Your Child at Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 39: Do You Trust Your Child at 6-36 Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 40: When Did You Feel Child was Permanently Yours at Baseline . . . . . . . . . . . . . . . . . . 49

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project iii

Table 41: Level of Agreement with: I Believe the Child is Permanently Mine at 6-36 Months . . 49 Table 42 Family Members Attachment to Child at Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 43: Family Members Attachment to Child at 6-36 Months . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 44: Overall Satisfaction with Adoption at Baseline . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 51 Table 45: Child Contact with Birth Family – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 46: Talk to Child About Birth Family – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 47: Talk to Child About Birth Family – 6-36 Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 48: Total Mean Scores of Parent Caregiving Behaviors – Baseline. . . . . . . . . . . . . . . . . . . . 53 Table 49: Total Mean Scores of Parent Caregiving Behaviors – 6-36 . . . . . . . . . . . . . . . . . . . . . . 54 Table 50: Total Mean Scores of Parent/Child Disagreements – Baseline . . . . . . . . . . . . . . . . . . . . 55 Table 51: Total Mean Scores of Parent/Child Disagreements – 6-36 Months. . . . . . . . . . . . . . . . . 55 Table 52: Health Status of Primary Caregiver – Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 53: Health Status of Primary Caregiver – Six Months in Study. . . . . . . . . . . . . . . . . . . . . . 57 Table 54: Health Status of Primary Caregiver – Twelve Months in Study. . . . . . . . . . . . . . . . . . . 58 Table 55: Health Status of Primary Caregiver – Eighteen Months in Study. . . . . . . . . . . . . . . . . . 59 Table 56: Health Status of Primary Caregiver – Twenty-Four Months in Study . . . . . . . . . . . . . . 60 Table 57: Health Status of Primary Caregiver – Thirty Months in Study . . . . . . . . . . . . . . . . . . . 61 Table 58: Health Status of Primary Caregiver – Thirty Six Months in Study . . . . . . . . . . . . . . . . 62 Table 59: Cohesion & Adaptability of Family FACES II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 60: Parenting Practices: Authoritarian or Authoritative – Cohort One - Baseline. . . . . . . 63 Table 61: Parenting Practices: Authoritarian or Authoritative – Baseline - 36 months . . . . . . . . 64 Table 62: Rating of Child’s Overall Health – Baseline - 36 Months . . . . . . . . . . . .. . . . . . . . . . . .66 Table 63: Rating of Child’s Physical Growth/Development Compared to Peers . . . . . . . . . . . . . . 67 Table 64: Frequency of Positive Behavior Child to Parent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 65: Frequency of Child Positive Traits/Moods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Table 66: Frequency of Child Negative Traits/Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 67: Child Attachment to Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 68: Child Satisfaction with Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 69: Child Functioning Measure – CBCL Scores: Clinical Needs Young / Old Child Scores at Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table 70: Median Number of Days Out of Home/Displacement Days Past Six Months. . .. . . . . 73 Table 71: Families and Services as Reported by Caseworkers . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 72: Amounts of Each Type of Service Provided As Reported by Caseworkers . . . . . . . . . 76 Table 73: Types of Services Provided to Families By Time In Study . . . . . . . . . . . . . . . . . . . . . . 77 Table 74: Mean Number of Minutes Provided for Each Service Type . . . . . . . . . . . . . . . . . . . . . 78 Table 75: Mean Service Time Minutes Per Service By Cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 76: Contact Type for Services Provided Reported by Caseworkers . . . . . . . . . . . . . . . . . . . 79 Table 77: To Whom Services Were Provided Reported by Caseworkers . . . . . . . . . . . . . . . . . . . 80 Table 78: How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 79: How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline by Type of Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 80: Satisfaction with Pre-Legalization Services to Family/Child at Baseline by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 81: Satisfaction with Pre-Legalization Services to Family/Child at Baseline by Type of Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 82: Percentage of Respondents Who Have Had Contact with a Case Worker in the

Past Six Months By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 83: Satisfaction with Post-Legalization Services to Family/Child by Assigned Group. . . . 83 Table 84: Satisfaction with Post-Legalization Services to Family/Child by Type of Adoption . . . 84 Table 85: Percent of Caregivers Obtaining Services – Types of Services at 6 - 30 Months

By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 86: Mean Number of Hours of Service Time Reported by Family at 6 – 30 Months into

Study by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 87: Mean Family Centeredness Scores by Assigned Group at 6 – 36 Months into Study

by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project iv

Table 88: Mean Family Centeredness Scores by Other Agencies at 6 – 36 Months . . . . . . . . . . . 88 Table 89: Types of Services Provided by Primary Caseworker at 6 – 30 Months By Assigned

Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 90 Type of Aid – Support Caregivers Rely On Most – Total Population . .. . . . . . . . . . . . . 89 Table 91: Percent of Respondents Who Routinely Access Natural Supports – Total Sample Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 92: Paying/Coverage for Child’s Medical Needs - Percentage of Each Method . . . . . . . . . 93 Table 93: Sample Characteristics Length of Time in Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 94: CRPR Results – Authoritarian / Authoritative Practices Cohort One – Baseline. . . . . . 106 Table 95: Median Number of Days Child Out of Home Past Six Months By Assigned Group . . 119 Table 96: Age Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Table 97: Cost Neutrality Total Difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Table 98: MaineCare Physician/Practitioner/Dental Costs Average per Child . . . . . . . . . . . . . . . 161 Table 99: MaineCare Prescription Drugs & Related Costs Average per Child . . . . . . . . . . . . . . . 163 Table 100: MaineCare Behavioral Health Services Average Costs per Child by Assigned Group . 166 Table 101: Long Term Care Costs Per Child By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table 102: Case Management Costs Per Child By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . 169 Table 103: General Inpatient Hospital By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Table 104: Psychiatric Facility Services By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table 105: Transportation Costs Per Child By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table 106: Ambulance Service By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table 107: Early Intervention Per Child By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table 108: Non-Traditional PHP/School Rehab by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . 173

LIST OF CHARTS Chart 1: Child’s Total Time in Foster Care – National Figures Compared to MAGS . . . . . . . . . 35 Chart 2: Parent Health: General Health . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Chart 3: Parent Health: Energy/Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Chart 4: Parent Health: Social Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Chart 5: Parent Health: Physical Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Chart 6: Parent Health: Physical Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Chart 7: Parent Health: Emotional Well Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Chart 8: Parent Health: Role Limitation Due to Physical Health . . . . . . . . . . . . . . . . . . . . . . . . . 103 Chart 9: Parent Health: Role Limitation Due to Emotional Problems. . . . . . . . . . . . . . . . . . . . . 104 Chart 10: Caregiver Satisfaction With Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Chart 11: Parenting Practices – Authoritarian . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 107 Chart 12: Parenting Practices – Authoritative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Chart 13: Family Cohesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Chart 14: Family Adaptability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Chart 15: Family Attached to Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Chart 16: Percent of Caregivers Who Trust Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Chart 17: Parent and Child Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Chart 18: Frequency of Parent and Child Disagreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Chart 19: Frequency of Parent Positive Caregiving Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Chart 20: Life Now Compared to Before Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Chart 21: Family Quality of Home Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Chart 22: Caseworker Family Centeredness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Chart 23: Child Attached to Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Chart 24: Somatic Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . . . . . . . . . . . . . 122 Chart 25: Somatic Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . 123 Chart 26: Withdrawn/Depressed Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . 124 Chart 27: Withdrawn/Depressed Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . 125 Chart 28: Anxious/Depressed Problems Child Behaviors – Younger Child Ages 1 ½-5 . . . . . . . 126

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project v

Chart 29: Anxious/Depressed Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . 127 Chart 30: Attention Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . 128 Chart 31: Attention Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . 129 Chart 32: Aggressive Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . 130 Chart 33: Aggressive Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . . . 131 Chart 34: Internalizing Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . 132 Chart 35: Internalizing Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . 133 Chart 36: Externalizing Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . .135 Chart 37: Externalizing Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . . 136 Chart 38: Total Problems Child Behaviors – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . . . . 138 Chart 39: Total Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Chart 40: Emotionally Reactive – Younger Child Ages 1 ½ -5 . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Chart 41: Sleep Problems – Younger Child Ages 1 ½ -5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Chart 42: Social Problems Child Behaviors – Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Chart 43: Thought Problems Child Behaviors - Child Ages 6-18 . . . . . . . . . . . . . . . . . . . . . . . . . 144 Chart 44: Rule Breaking Problems Child Behaviors – Child Ages 6-18. . . . . . . . . . . . . . . . . . . . 145 Chart 45: Competencies – Activities T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . 146 Chart 46: Competencies – Social T-Scores Child Behaviors - Child Ages 6-18 . . . . . . . . . . . . . 147 Chart 47: Competencies – School T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . . . . 148 Chart 48: Competencies – Total T-Scores Child Behaviors - Child Ages 6-18. . . . . . . . . . . . . . . 149 Chart 49: Child’s Overall Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Chart 50: Child Growth Development Compared to Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Chart 51: Frequency of Child Positive Traits / Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Chart 52: Frequency of Child Negative Traits / Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Chart 53: Child Satisfaction With Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Chart 54: Frequency of Child Positive Behaviors to Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Chart 55: Cost Neutrality Information for Title IV-E Waiver Program Total Cost . . . . . . . . . . . 156 Chart 56: Cost Neutrality Information for Title IV-E Waiver Program Total Cost Difference. . . 157 Chart 57: Total MaineCare Amounts – MAGS Study Population . . . . . . . . . . . . . . . . . . . . . . . . 158 Chart 58: Average Per Child MaineCare Amounts – MAGS Study Population . . . . . . . . . . . . . 159 Chart 59: Average MaineCare Costs – Foster and NonFoster . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Chart 60: Medicaid Physician/Practitioner/Dental Costs Average Per Child By Assigned Gp . . 161 Chart 61: MaineCare Prescription Drugs & Related Cost Average Per Child By Assigned Gp . . 162 Chart 62: Medicaid Behavioral Health Services Average Costs Per Child By Assigned Gp . . . . 165 Chart 63: Long Term Care Costs Per Child By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . 167 Chart 64: Care Management Costs Per Child by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . 168 Chart 65: General Outpatient Costs By Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Chart 66: Guided Services Families: IVE Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Chart 67: Average per Family IVE Expenditures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

LIST OF GRAPHS

Graph 1: Internalizing Problems Ages 1½ - 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Graph 2: Externalizing Problems Ages 1½ - 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Graph 3: Total Problems Child Behaviors 1½ - 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Graph 4: MaineCare Prescription Drug Costs by Assigned Group . . . . . . . . . . . . . . . . . . . . . . . . 164 Appendices are available upon request and include:

Copies of all measures/instruments Univariate analysis of all items (frequencies) Bivariate analysis on select items (cross-tabulations) Multivariate analysis on outcome variables (2x2 ANOVA)

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report - Maine Adoption Guides Project 1

MAINE ADOPTION GUIDES INTERIM EVALUATION REPORT:

RESEARCH SUMMARY - December 2003

This research summary was developed to provide information about the Maine Adoption Guides Project and its current research results. Six major research questions from the evaluation are:

• What is the Maine Adoption Guides post-adoption services model? • What issues do parents have before they legalize their adoption? • What are the characteristics of the children and families in the project? • What services do parents use the most, or least, and what types of services do they

prefer? • What difference does the MAGS model make in the lives of children and families? • What are the costs involved in caring for children after legalization?

The research design is a longitudinal control group design with random assignment and observations both before the intervention and then conducted every six months for the duration of the study. There will be four cohorts observed in the study. The outcome evaluation assesses the extent to which the children/families who received the Guided Services Model (experimental group) and the children/families who received Standard Services (control group) differ in regard to a number of outcome measures. The outcome measures include:

Rates of Adoption Dissolutions Number of Days Child in the Home / Displacement Rates Assessment of Family Functioning Assessment of Child Functioning/Well Being Assessment of Access to and Utilization of Services

This federal Department of Health and Human Services Child Welfare Demonstration Project is the result of planning on the part of the state DHS agency that originated in the mid 1990s. The guiding principles that drive this initiative are:

Adoption is a life-long process. Most adoptive families experience normal crisis in their development. Families need more support services post-legalization.


Following are the latest study results, from December 2003 or just over four years into the study, as they relate to each evaluation question. 1. What is the Maine Adoption Guides Post-Adoption Services Model? The core principle of this program is that adoption is different. The dynamics of a family created by adoption are different from the dynamics of a family created by birth. Adoption is lifelong and its impact creates unique opportunities and challenges for families and communities. Adoption is mutually beneficial to parent, child and society. Society is responsible for supporting and aiding integration and preservation of adoptive families. Participants are recruited from the overall population of families adopting children with special needs from the Foster Care system of the state Department of Human Services (DHS). Every year, for four years, 140 children and their families are recruited into the project. At the time that families meet with state DHS adoption caseworkers to plan for Title IVE subsidy arrangements, about three months prior to legalization, families are invited to participate in the project. Families are then randomly assigned to either the Standard Services (control) group or Guided Services (experimental) group. Standard Services families receive the adoption subsidy from the state DHS and whatever other supports are provided in their community. Guided Services families receive the adoption subsidies, may access other supports in their local community and have access to a Maine Adoption Guide social worker from Casey Family Services. All families who participate in the project commit to a set of interviews once every six months. Families in the Guided Services group commit to being contacted by their assigned social worker at least once every six months. This clinical case-management type of service delivery model is delivered statewide and is provided by a partnership of the state DHS and Casey Family Services. The Guided Services intervention is designed to be family driven. The adoptive parent(s) is viewed as the expert on their child. The social worker assigned to the family functions as a guide who consults with the family through the expected and normal crisis in the life of an adoptive family. The long-term plan, based on the positive outcomes of this study, is that these same guided services could be expanded to the general population of adopting families.


Figure 1 Post Legalization Program Model Differences

Program Standard Guided Supportive Attribute Services Services Target Population Children w/Special Needs, Children w/Special Needs, and their Families and their Families Program Goals - Provision of Adoption - Decrease Dissolutions Assistance Funds - Increase Family Strengths Funds - Maintain/Increase Child - Assistance with and Family Functioning process to Legalization - Provision of Adoption Assistance Funds Staffing D.H.S. Adoption Worker D.H.S. Adoption Worker and Casey Adoption Staff Services Provided - One time Assessment/ - Initial and ongoing Planning Session support based on family - Financial Support for needs identified in “Family Post Adoptive Services as Permanency Assessment”. per Entitlements - Scheduled check-ins with - Annual Financial Planning family and Casey staff at for Continuance of Adoption least once every six months. Assistance - Permanent assignment of Casey staff to family in an empowerment role; clinical case management. - Financial Support for Post Adoptive Services, not limited to services pre- defined in subsidy agreement. Access to Trained - Provided with List of - Provided with List of Providers Trained Providers Trained Providers

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides Project 4

Model Description - Focus Groups with MAGS Social Workers In addition to the implementation survey, focus groups with social workers provide valuable information on the project model and its process. Focus groups are held with Adoption Guides social workers and supervisors approximately every six months. Staff members are asked to define their roles in the project and provide general feedback on the project’s implementation—how the project model compares to their day-to-day work. In this, our final year of the project, we decided to postpone the scheduled November 2003 focus groups until January 2004, in order to conduct one final summary round of focus groups before the project officially ends in March 2004. Results from the final focus groups will be reported in the Final Report December 2004. Implementation of MAGS Model According to interviews with stakeholders and review of documents associated with project implementation, the model appears to be implemented as intended. Casey social workers are working to connect with DHS caseworkers and from there, establish relationships with the family. Services appear to be provided as needs in the family come forward in the form of a family-centered model of practice. Implementation issues will be evaluated in early 2004 to wrap up the results for the December 2004 Final Report. Results of Referral Process During the second year of the project, there was slow-down in referrals. DHS investigated the cause and it no longer is a problem. When DHS caseworkers invite families to participate in the project, they complete a brief questionnaire with families who decline to participate.

Non-Participants by District – Year 4 to Date December 2003

District

1 District

2 District

3 District

4 District

5 District

6 District

7 District

8 Total

11 4 8 10 5 13 11 9 71 Attrition from the Project The attrition of families from the project is a concern. Some families choose to drop out of the project and some are asked to leave due to not responding to surveys. The numbers of children dropped from the study are tracked each year by Cohort and Assigned Group, and are as follows:


Attrition from the Project Number of Children by Cohort and Assigned Group

December 2003

Guided Standard Total Cohort 1 25 42 67 Cohort 2 25 32 57 Cohort 3 19 24 43 Cohort 4 9 4 13

Total 78 102 180


2. What are the characteristics of the children and families in the project? Results listed below are from surveys parents complete at baseline, upon entering the study. A Pearson Chi-Square statistic was used to test for differences between groups for nominal/categorical data, and Independent t-tests were calculated for ordinal or continuous data. There was a significant difference between the Guided and Standard groups for “Is Child Attending School?” However, this is not a key variable in the research. There were no other significant differences found between groups. This result verifies the project’s randomization process. Children

• As of December 2003 there are a total of 117 children in Cohort I (Year One), 136 children in Cohort II (Year Two), 122 children in Cohort III (Year Three), and 89 children in Cohort IV (year Four); N = 464.

• Mean age of children in the study is 7 years of age.

o Guided Services Group Child Age = 7.19 o Standard Services Group Child Age = 7.21 o Children Currently Adopted – Total Sample = 6.69 years o Children Previously Adopted – Total Sample = 9.83 years

• Gender of Children: o 246 female (47%) and 218 male (53%)

• Racial Characteristics: o 91.2 % are White; this is in keeping with the general demographics of

Maine as a mostly White, non-Hispanic population. African-American is the next highest racial group with 19 out of 464 (4.1%) overall children identified in this category.

• Legally Adopted – By six months into the study, 87% of children were legally

adopted. By 12 months into the study, 95% of children were legally adopted. By 18 months, 100% were legally adopted.

• Type of Adoption:

o Approximately 89 percent of all children in the study are adopted by current foster parents; this is similar across all Cohorts.

• Previous versus Current Adoption: 84 percent of all children in the study are

current adoptions.

• Number of Previous Placements in Foster Care - Administrative data from state DHS records was available for 291 child study participants (63% of participants). The number of previous placements refers to permanent


placements—long-term placements in locations such as foster family homes, residential facilities and hospitals. As counted since the most recent removal from home, the mean overall is two placements per child (1.8 for both Guided and Standard).

• Length of Time in Foster Care - Administrative data from state DHS records

was available for 273 child study participants (59% of participants). The average (mean) number of years these children have been in Foster Care to entry to study is approximately 4 (3.93 for Guided and 3.86 for Standard).

• Time Child in Home Previous to Entry to Study – for the entire sample,

children are in this home on average for 35 months (35.4 months for Guided and 34.6 months for Standard children).

• School Age Children: 79 percent of children in the study are attending school (80 percent of Guided and 77 percent of Standard children).

• Receives Special Education Services at School – For children who are attending school, 50% overall have an Individualized Education Plan (50.3 percent of Guided; 48.4 percent of Standard).

• Clinical Diagnosis – Parents report that overall, 29% of Guided children and 26%

of Standard children have a clinically diagnosed disability. • Use of Psychotropic Medication –In the entire sample, 29 percent of children are

taking some type of psychotropic medication (29% of Guided children and 30% of Standard children)

Families

• Twenty six percent of families report an annual average income of more than $65,000. Eighteen percent earn between $35,000 - $45,000. Only 2% make less than $15,000.

• Family Structure:

o 88% are married couples and 10% are single female-headed households.

• Relationship to Child – As Reported by Parent: o 73 percent are Foster Parents

Sixty-eight percent are foster parents who were not related to the child—only 12 (5%) parents thus far in the study have been foster parents and relatives to the child. One percent of respondents were relatives of the child or friends of the family. Twenty-three percent were neither foster parents nor relatives to the child. 3. What issues do parents have before they legalize their adoption?


Results listed below are culled from surveys parents complete at baseline, upon entering the study.

• Reasons for Adopting a Child – Most common reasons cited by all caregivers were:

1) Wanted to Make Relationship Legal; 2) Felt Close to Child; 3) Wanted Child to Feel Secure; 4) Our Other Children Are Attached to Child.

• Concerns About Adoption – Most common concerns cited by all caregivers

were: 1) How to Meet Child’s Needs; 2) Child’s Acceptance of Me (caregiver); 3) Other Children’s (in family) Reactions; 4) Ability to Afford Additional Costs. 5) Ability to Continue to Work 6) Effect of Adoption on Marriage;

• Child Behavior Problems Before Legalization—Parents were asked to choose

from one or more of 11 problem type behaviors (including such problems as defiance of rules, destroying property, behavior problems in school, and emotional withdrawal). The scores for all 11 were summed and the mean score for Guided was 3.91, and for Standard was 3.79.

• Satisfaction with DHS Adoption Caseworkers Pre-Legalization:

o Majority of all Caregivers satisfied with DHS Caseworkers – on a scale

1=Very Satisfied to 4=Very Dissatisfied. Means are: Guided = 1.49 Standard = 1.50

o Majority of all Caregivers consistently felt that DHS Caseworkers knew

about them the most and about their family the least. (There is a statistically significant difference between the Foster and Non-foster parent groups – a larger percentage of Foster caregivers feel that their caseworker knows their family “very well” or “somewhat well.” )


4. What services do parents use the most or least, and what types of

services do they prefer? Results listed below are culled from surveys parents complete every six months after entering the study. Types of Services Families Access in the Community – As Reported by Respondents

• Contact with DHS: At six months, the majority of all caregivers in (Guided 76%; Standard 82%) reported ongoing contact with DHS adoption staff. At this point they were contacting DHS staff for assistance with monthly subsidy issues, adoption legalization questions and a child’s new emotional needs. At twelve months the overall number of those contacting the DHS offices drops slightly, but is still a majority (Guided 61%; Standard 54%); at 18 months, 50% of Guided and 50% of Standard contact DHS. The reasons for contact were the same.

• Services Sought and Received: Caregivers are asked which type of service

do they seek and the top four results are: (1) Individual Counseling Services, (2) Respite Care, (3) Adoption Support Groups, and (4) Other Services*. Caregivers were also asked to identify how many hours of service they received from a service provider. The top services by number of hours were: (1) Respite Care for Adopted Child, (2) *Other Services, and (3) Counseling for Adopted Child.

*The Other Services category includes services such as occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatments, neuropsychological evaluations, and homeopathic medicine. There are a few children in the study with very significant medical needs and these services require a large number of service hours. Some children have daily services.

One important part of this research is to try and understand if children who are in need of services are receiving services. To examine this, results from the Child Behavior Checklist measure of child functioning are used to estimate the number of children who are in need of mental health services – scoring in the clinical range on this measure. In addition information provided by the parent is used to describe the kinds of services the child and family is receiving. The table below displays the percentage of the “service gap” - children who are in the clinical range on their CBCL scores and are reportedly not receiving counseling.


Percentage of Children in CBCL Clinical Range who are Not Receiving Counseling (as reported by Parents)

Children Age 1 ½ - 18 December 2003

Time in Study:

Total Problems

Gap

Internalizing Problems

Gap

Externalizing Problems

Gap 6 Months 35%

(n=61) 34%

(n=70) 38%

(n=68)

12 Months 40% (n=55)

34% (n=54)

37% (n=34)

18 Months 31% (n=29)

29% (n=28)

28% (n=19)

24 Months 32% (n=23)

29% (n=20)

25% (n=14)

At 6 months in the study, 35% of children who score in the clinical range on the CBCL Total Problems Scale are not receiving counseling. At 12 months, 40% are not receiving counseling; at 18 months, 31% are not receiving counseling; and at 24 months, 32% are not receiving counseling. The percentages are high due to both the high number of children who score in the CBCL clinical range and the high number of families that do not seek counseling for their children.

• Natural and Professional Types of Supports/Services: Caregivers were asked which types of supports/services are most important and from where they are provided – either naturally through a friend, family or other social network, or paid for from a service provider. Caregivers stated that their most important source of support was professional (53%) in the forms of: (1) Case Management, (2) Counseling, (3) Respite, (4) Financial Supports. Forty-seven percent of the caregivers stated that their most important sources of support were natural and included: (1) Family Support, (2) Friends, (3) Support Groups. Overall, 78% of respondents state they “routinely” access natural forms of support. The most frequently accessed are: (1) Family Members other than Spouse (41%); (2) Friends (35%); (3) Church/Pastoral (14%); (4) Support Group (9%); and Other, which includes other adoptive parents, spouse, neighbors, co-workers, and other caregivers/parents (1%).

• Case-Manager/Worker: At six months into the study, 79% of all

respondents stated that they had a regular case manager; 82% of those in Guided Services and 76% in Standard Services. At twelve months, 58% reported having a case manager; 61% of Guided and 54% of Standard. At 18 months, 50% reported having a case manager; 50% of Guided and 50% of Standard. At 24 months, 43% reported having a case manager; 47% of Guided and 36% of Standard. At 30 months, 47% reported having a case manager; 39% of Guided and 55% of Standard.


• Number of Case Managers: At six months in the study, 80 percent of those

who were assigned a caseworker had one caseworker assigned to them; and 20 percent had two or more caseworkers (22% Guided, 16% Standard). At 12 months in the study, 76 percent had one caseworker; and 24 percent had two or more caseworkers (19% Guided, 40% Standard). At 18 months in the study, 66 percent had one caseworker; and 34 percent had two or more caseworkers (32% Guided, 43% Standard). By 24 months in the study, 74 percent had one caseworker; and 26 percent had two or more caseworkers (24% Guided, 30% Standard).

• Services Provided by Case Managers: All caregivers across both groups

report that case managers provide the following types of direct services/supports: (1) Assist to Develop and Broker for Services; (2) Provide General Supports/Education; (3) Advocates on Behalf of Child(ren); and (4) Provides Direct Therapeutic Services. The major difference between Guided and Standard Services groups was in the provision of direct therapeutic services by the caseworker—at six months, 25% of the Guided Services caregivers reported receiving therapeutic services as opposed to only 9% of the Standard Services; at twelve months, 23% of Guided as opposed to 5% of Standard; at 18 months, 35% of Guided and 0% of Standard; at 24 months, 33% of Guided and 4% of Standard; and at 30 months, 45% of Guided and 1% of Standard Services caregivers reported receiving therapeutic services from their caseworker. Statistically, there were significant differences between groups for three different questions:

-Case-Manager Develops/Brokers Services (at every point of data collection through 30 months) -Case-Manager Provides General Support/Educational Services (at every point of data collection through 30 months)

-Case Manager Advocates on Behalf of Family/Child (at 12 and 18 months) A higher percentage of Guided families report receiving the above services from their case manager than Standard families.

Services Provided through the Intervention – MAGS

• The most common service provided to families is Parent Education and Support: approximately 24 percent of all the types of services provided. The second most common type of activity is Building/Maintaining Relationships, which accounts for 21 percent of services. Collateral Contacts, sharing and/or gathering information with other professionals about the child and/or the family, accounts for 13 percent of all services.

• The amount of time spent providing services varies depending on the type of

service. Casey social workers apparently spend the largest amount of time (per service) providing group therapy to children (mean 137 minutes per service),


and providing non-therapeutic services, or recreational activities (mean 119 minutes per activity). The average minutes for all services in general was 47 minutes per service.

• Overall, Casey social workers have provided an average of 161 services per

family in Cohort One, an average of 72 services per family in Cohort Two, average of 50 services per family in Cohort Three, and an average of 26 services per family in Cohort Four. (Cohort One families have received the most services due to being in the project for the longest). The amount of time (minutes) spent working with each family differs—ranging from 15 minutes to 418 hours. Overall, the average number of hours spent with a family is 62.

Families are most frequently provided services through telephone contacts and then secondly through at-home visits.

• Parents are the primary recipients of a service (46% for Year One; 48% for

Year Two; 48% for Year Three; and 46% Year Four). Next is the family as a whole (27% for Year One; 41% for Year Two; 36% for Year Three; and 41% for Year Four), followed by a service to the adopted child (24% for Year One; 11% for Year Two; 14% for Year Three; and 14% for Year Four), and finally services to other siblings in the family.

• As this is a statewide model, there is an interest in the amount of time the

workers need to travel. Seventy-five percent of the services did not require any travel time, 6% required 1 hour or less of travel time, 13% involved between 1 and 2 hours of travel and 5% required more than two hours of travel.

Parent Support Groups One important service Casey Family Services also provides as part of the Adoption Guides project is support groups. Support groups offer adoptive families an opportunity to share parenting strategies and struggles with other parents in similar situations. Called “Parents of Challenging Children,” these groups help parents who are raising children with special needs, which may include learning disabilities, psychiatric disorders, socialization/behavioral difficulties, or children who are hospitalized, or have received day treatment or residential services. Facilitated by therapists, the groups offer adoptive parents a safe environment to discuss their problems, as well as the opportunity to meet and connect with other adoptive parents. In general, the groups meet once a week, or every other week and at this point in the project, most groups meet on an ongoing basis. Intended Outcomes: Goals of the parent support groups include:

• Parents feel more capable to meet the special needs of their child(ren) • Parents feel more supported • Parents feel more satisfied with their adoption(s) • Fewer dissolutions


Target Population: Parent support groups are open to any adoptive parent of children with special needs (support groups are available to adoptive parents in all agencies, private or DHS). For the purposes of these support groups, “special needs” are defined mostly as behavioral or psychiatric conditions—not special physical needs. Adoptive parents contact Casey if they are interested in joining a group and are then invited into Casey for an interview. Currently, Casey Family Services “Parents of Challenging Children” support groups are underway in Lewiston, Augusta , Ellsworth and two groups meet in Portland. The parent support group meetings are potluck dinners and include child-care and dinner for children. A Casey Family Services therapist leads each group. Many of the current groups have continued past their timeframe and members meet informally on their own. In addition to the parent groups, creative respite days are hosted for children on school holidays. Groups of children take part in such activities as horseback riding and rock climbing. Some difficulties occurred in organizing support groups in the northern part of the state. Families live further apart from each other and although social workers used central locations for group meetings, families would often have to travel an hour to and from meetings. With the added travel time, meetings required families to set aside four hours or more. Sparing four hours during the day was difficult for parents and four hours in the evening often interfered with children’s bedtimes. Therefore, attendance at meetings varied and some groups ended. Families however, expressed their interest in group meetings and social workers began to use a less structured form of groups—meeting at informal, recreational events, rather than weekly meetings. Picnics, outdoor events, or swimming parties offer parents and children the opportunity to gather together and share feelings and experiences in the same way that group meetings do—and families are able to plan for one day/evening at a time without having to commit to driving to meetings every week. In addition, two different 6-week movie groups were established as a recreational outing for parents.


5. What difference does the MAGS model make in the lives of children and families?

The following results are based on data collected at Baseline, 6 months, 12 months, 18 months, and in some cases up to 24 months into the study. Unless otherwise indicated, longitudinal results are analyzed through the use of a 2 x 2 ANOVA statistical procedure comparing outcomes between the Guided and Standard services groups. The number of study participants at each point in time is outlined in the table below.

Sample Characteristics Length of Time in Study

December 2003 TIME IN STUDY GUIDED SERVICES (E) STANDARD SERVICES (C)

Baseline Child: n = 226 Family: n = 123

Child: n = 177 Family: n = 103

6 Months Child: n = 193 Family: n = 99












A. Child Level Outcomes

At this point in the study, there are no statistical differences between groups for any of the child level outcomes that are measured. Therefore, according to the results on these outcomes, the Guided Services model is not having a positive effect on child functioning as compared to the Standard Services group.

In response to this interim finding, program officials have asked that the evaluators conduct analyses in order to better discern what, if any, differences may exist in consideration of levels of exposure to the intervention and or other types of services and supports. The following analyses will be conducted and reported on in the next interim evaluation report due January 1, 2005.

• Differences between children in Guided Services who receive all types of Guided

services on a regular basis – at least monthly – and all other children who do not receive regular, monthly services.

• Differences between children in Guided Services who receive all types of

services on a regular basis – at least monthly – and all children in the Standard Services group who do not receive regular, monthly services.


• Differences between children in the Guided and Standard Services groups who are receiving all types of regular, ongoing services and supports as reported by the parent.

• Differences between children in the Guided and Standard Services groups who

are not receiving all types of regular, ongoing services and supports as reported by the parent.

• Differences between children in Guided Services who receive primarily clinical

services on a regular basis – at least monthly – and all other children in the study; those receiving fewer services amongst both Guided and Standard Services.

• Differences between children in Guided Services who receive clinical services on

a regular basis – at least monthly – and all children in the Standard Services group.

The following is a summary report on a select number of the outcomes analyzed at this point in the study. Number of Days Child in Home – Displacement Days: At baseline, there were 12 children who were reported to be out of the home due to a problem—the median number of days was 13. At 6 months, there were 13 children out for a median number of 11 days. At twelve months, there were six children out for a median number of 15.5 days; at 18 months, four children were out for a median number of 29.5 days, at 24 months, six children were out for a median of 78 days. At 30 months and 36 months in the study, three children were out of the home for a median number of 14 and 9 days respectively.

Median Number of Days Child Has Been Out of the Home in Past Six Months by Assigned Group

December 2003 Median Number of Days Out of Home

Baseline 6 Months 12 Months 18 Months 24 Months 30 Months 36 Months Guided 20 (n=5) 12.5 (n=8) 20.5 (n=4) 8 (n=3) 95 (n=4) 20.5 (n=2) -- Standard 7 (n=7) 5 (n=5) 3 (n=2) 60 (n=1) 41 (n=2) 14 (n=1) 9 (n=3) Overall 13 (n=12) 11 (n=13) 15.5 (n=6) 29.5 (n=4) 78 (n=6) 14 (n=3) 9 (n=3)

This table indicates that there is a great deal of fluctuation in terms of displacement days – how often a child is out of the home due to a problem; not including respite services. Averaging the median scores over time results in the following:

o Guided Services group, at 36 months into the study, has an average of 25.21 days of displacement.

o Standard Services group, at 36 months into the study, has an average of 19.86 days of displacement.


o The overall total average at 36 months into the study is 24.29 days of displacement.

• Number of Adoption Dissolutions: There have been no dissolutions

reported by parents in either group. However, it is estimated that approximately four dissolutions have occurred within families that have dropped out of the study.

• Child Attached to Family: Caregivers from both groups rate levels of

attachment of child to family as high with no statistical difference between groups over time. At 6 months, Guided Services children rated at 1.92 and Standard Services children rated at 1.70; At 12 months, Guided Services children rated at 1.92 and Standard Services children rated at 1.70. At 18 months, Guided Services children rated at 1.75 and Standard Services children rated at 2.43; at 24 months, Guided Services children rated at 1.99 and Standard Services children rated at 2.33; at 30 months, Guided Services children rated at 1.73 and Standard Services children rated at 1.85 months; and at 36 months, Guided Services children rated at 1.92 and Standard Services children rated at 2.00. The scale is 1=Very Attached to 4=Not at All Attached.

• Children’s Mental Health – Child Functioning: Levels of child

functioning are measured once for children age 1.5 to 5 and once for children age 6 to 18. The following results are for measures at baseline only:

o Twenty-four percent of the younger children and 45% of older children score in the clinical range on the Internalizing Problem Behavior scale;

o Twenty-six percent of younger children and 62% of older children score in the clinical range on the Externalizing Problem Behavior scale;

o Twenty-four percent of younger children and 67% of older children score in the clinical range on the Total Problem Scale.

• Child’s Health and Development: For both groups, caregivers rate the

child’s overall health as positive. There are no statistical differences between groups. When caregivers rated their child’s growth and development to other children of the same age, both groups rated their child’s growth as being similar to other children.

• Child’s Satisfaction with Adoption: For both groups, caregivers rate that

the child is very satisfied with the process of adoption. There are no statistical differences between groups on these outcomes.

• Child’s Positive and Negative Traits: For both groups, caregivers rated

the frequency in which the child demonstrates positive traits as high and for


negative traits, the frequencies are low. There are no statistical differences between groups on these outcomes.

• Child Positive Behaviors to Parent: For both groups, caregivers rated the

frequency in which the child demonstrates positive behaviors to them as high.

B. Family Level Outcomes

Similar to findings from previous interim reports, the types of outcomes that do indicate a difference between groups, all in favor of the Guided Services model, are at the Family Level. These outcomes are considered important in support of a family’s ability to be successful in their adoption of a special needs child. The following is a summary report on those outcomes.

• Caregiver Health – Stress: Caregivers complete a health assessment rating themselves in eight areas. Using a scale of 0 - 100 with a higher score defining a more favorable health state, caregivers report on aspects of their overall physical and emotional health. There are two areas of statistical differences between groups on these outcomes. For the categories of Role Limitations Due to Physical Health and Emotional Health, parents in the Guided Services group report better physical and emotional health (physical and emotional issues are not interfering in their ability to function normally at home, work and or recreation). The other scales used in this measure did not result in any group differences.

• Caregiver Satisfaction with Adoption: For both groups, caregivers rate high levels of satisfaction with the adoption process. There are no statistical differences between groups on these outcomes. At 6 months, Guided caregivers = 1.28 and Standard = 1.26; At 12 months, Guided caregivers = 1.15 and Standard = 1.16; At 18 months, Guided caregivers = 1.15 and Standard = 1.12; At 24 months, Guided caregivers = 1.16 and Standard = 1.04; At 30 months, Guided caregivers = 1.19 and Standard = 1.12; and, at 36 months, Guided caregivers = 1.23 and Standard = 1.17. The scale is 1=Strongly Satisfied and 4=Not at All Satisfied

• Parenting Practices: Caregivers are asked to rate themselves on a set of

parenting behaviors that are classified as either Authoritarian or Authoritative. For both groups, parents tend to view themselves as more Authoritative than Authoritarian in their own parenting style. Authoritative practices include: display of affection towards child; sharing feelings and experiences with child; respect/encourage child’s independence; supervision


of child; and establishment of family rules and responsibilities. There are no statistical differences between groups on these outcomes.

• Family Adaptability and Cohesion: Family Cohesion is defined as the

emotional bonding that family members have towards one another. Family Adaptability is defined as the extent to which a family system is flexible and able to change. For Cohesion (scores in the range of 51 to 70 are considered balanced and healthy), at 6 months, Guided = 63.96 and Standard = 69.15; at 12 months, Guided = 68.44 and Standard = 68.37; at 18 months, Guided = 68.64 and Standard = 67.66, at 24 months, Guided=68.63 and Standard=66.69, and at 30 months, Guided=67.80 and Standard=63.60. For the Adaptability measure (scores in the range of 40 to 54 are considered balanced and healthy), at 6 months, Guided = 48.68 and Standard = 49.26; at 12 months, Guided = 48.13 and Standard = 47.96. At 18 months, Guided = 48.58 and Standard = 48.41, at 24 months, Guided=49.02 and Standard=47.86, and at 30 months Guided=48.60 and Standard=47.40. For both groups on both measures, their overall scores were within the moderate/normal ranges. There are no differences between groups on this outcome.

• Family Attachment to Child: Both groups of caregivers rate family

members attachment to the child as very attached. There is a statistically significant difference between groups for this family level outcome; Guided Services parents are reporting that family members are more attached to the child then those in the Standard Services group. At 6 months, the Guided Services mean score is 1.92 and Standard Services mean score is 1.70. At 12 months Guided Services mean score is 1.92 and Standard Services mean score is 1.70; At 18 months Guided Services mean score is 1.75 and Standard Services mean score is 2.43, at 24 months Guided Services mean score is 1.99 and Standard Services mean score is 2.33, at 30 months Guided Services mean score is 1.73 and Standard Services mean score is 1.85, and at 36 months Guided Services mean score is 1.92 and Standards Services mean score is 2.00. The scale used is 1=Very Attached and 4=Not at All Attached.

• Percent of Caregivers Who Trust Child: Caregivers are asked if they trust

their child, Yes or No. At Baseline, there were no statistical differences between groups. At 6 months, 72% of Guided and 62% of Standard report trusting their child. At 12 months, 69% of Guided and 63% of Standard report trusting their child. At 18 months, 66% of Guided and 49% of Standard report trusting their child. At 24 months, 66% of Guided and 56% of Standard report trusting their child. At 30 months, 73% of Guided and 54% of Standard report trusting their child. At 36 months 73% of Guided and 33% of Standard report trusting their child. For those in the study for at least 18 months and 36 months, there is a statistically significant difference between groups with parents in the Guided Services group reporting higher


levels of trust with their child than those parents in the Standard Services group.

• Parent and Child Communication: Both groups of caregivers rate their

overall level of communication with their child as very positive. At 6 months for Guided Services the rating = 1.70 and for Standard Services = 1.74; At 12 months for Guided Services the rating = 1.72 and for Standard Services = 1.89; At 18 months for Guided Services the rating = 1.81 and for Standard Services = 1.86. At 24 months for Guided Services the rating = 1.85 and for Standard Services = 1.79; At 30 months for Guided Services the rating = 1.96 and for Standard Services = 1.96; At 36 months for Guided Services the rating is 1.81 and for Standard Services = 1.89; The scale is 1=Excellent to 4=Poor.

• Frequency of Parent and Child Disagreements: Both groups of caregivers

appear to experience very low levels of parent-child disagreements. There are no statistical differences between groups on these outcomes.

• Frequency of Parent to Child Positive Care giving Behaviors: Both

groups of caregivers appear to demonstrate high levels of positive care giving behaviors. There are no statistical differences between groups on these outcomes.

• Overall Quality of Home Life: Both groups of caregivers rate their overall

quality of home life as positive. There is no statistical difference between groups on this outcome.

• Family Life Now Compared to Before Child Came to Live in Home:

Parents in the Guided Services group rate their Family Life better now in comparison to before the adopted child came to live with the family. This rating is statistically different from parents in the Standard Services group (at the 12 and 18 month points in time).

• Family Empowerment - Caseworker Family Centeredness: In families

that are receiving regular case management services, caregivers are asked to assess the family centeredness of those services. Supports are provided based on the family needs and not based solely on the adopted child’s needs or professional provider recommendations. Caregivers in both groups rate their caseworkers as functioning in a family-centered fashion.


6. What are the costs involved in caring for children after legalization?

The evaluator works cooperatively with D.H.S. and Casey Program staff in the design and implementation of the cost effectiveness/benefit analysis evaluation. DHS staff track overall IV-E costs associated with this Waiver project. Evaluation staff collect information about the costs to Casey Family Services for implementing the model, the IV-E dollars spent by the state DHS for MAGS families, and MaineCare costs for all children in the study. Cost data is provided by, and reviewed for accuracy by, agency administrators at Casey Family Services and at the state DHS.

The figures above show comparisons between total amounts spent by the state and federal government on children in the Guided Group (E) and the Standard Group (C). The bar furthest to the left displays the total costs spent on children. The other three bars show the total IV-E dollars spent on children. For each total, the amount spent on Guided children was less than the amount spent on Standard children.

Cost Neutrality Information for Title IV-E Waiver Program

Total Cost December 2003

$11,574,764.48

$5,495,038.33

$2,745,715.70

$8,240,754.03

$5,570,608.23

$8,363,086.30

$2,792,478.07

$11,941,002.33

$2,000,000.00

$4,000,000.00

$6,000,000.00

$8,000,000.00

$10,000,000.00

$12,000,000.00

State andFederal

State andFederal

StateParticipation

FederalParticipation

GuidedGroupControlGroup


The figures above shows the total difference in costs between the Guided and Standard Services groups. As of December 2002, the state and federal IVE costs for the Guided Services group are approximately $122,332.27 less than IVE costs for the Standard Services group. This information for this point in time appears to indicate that this project is demonstrating cost neutrality to the federal government and the intervention in fact is less costly than standard post-adoption services costs. The Table below provides summary details.

Cost Neutrality Total Difference December 2003

Total Costs Title IV-E Costs

GroupState and Federal

State and Federal

State Participation

Federal Participation

Guided Group $11,574,764.48 $8,240,754.03 $2,745,715.70 $5,495,038.33Control Group $11,941,002.33 $8,363,086.30 $2,792,478.07 $5,570,608.23Difference ($366,237.85) ($122,332.27) ($46,762.37) ($75,569.90)

Cost Neutrality Informationfor Title IV-E Waiver Program

Total Cost DifferenceDecember 2003

$366,237.85

$122,332.27

$46,762.37

$75,569.90

$0.00

$100,000.00

$200,000.00

$300,000.00

$400,000.00

State and FederalTotal

State and Federal IVE

State Participation IVE

Federal ParticipationIVE


The following charts provide information about MaineCare (Medicaid) total costs by category one year previous to study entry - baseline, first year in study, second year in study, and three-years in study. This information is provided to the evaluators from the state MaineCare office and is presented to Casey Family Services and state DHS program managers in order to assist them in their understanding of what may drive or inhibit costs in each area.

Total MaineCare AmountsMAGS Study Population

December 2003

$37,781

$56,076

$111,595

$82,045

$757,794

$211,125

$241,967

$712,489

$197,802

$211,921

$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000

Previous Year (g=166;s=144)

Year 1 (g=140; s=121)

Year 2 (g=113; s=86)

Year 3 (g=51; s=45)

Year 4 (g=26; s=31)

Total Dollars

Standard

Guided

The total amount of MaineCare dollars spent on this population (n=310) of children in foster care the year previous to study entry was $1,470,283. For those children (n=261) who are one year into the study, after approximately 90% are legally adopted, the total amount decreases to $408,927; a difference of nearly $1.1 million dollars. One reason given for this sharp decrease in this first year is the fact that therapeutic foster care costs are no longer accrued as these children are legally adopted. Total costs for those children (n = 199) in the study for two years are approximately $453,900. For those children in the study for three years (n = 96) the total MaineCare costs are $149,376. For those children in the study for four years (n=57), the total MaineCare costs are $138,121.


Average per Child MaineCare AmountsMAGS Study Population

December 2003

$741

$2,157

$2,480

$2,647

$4,565

$1,508

$2,141

$4,948

$1,635

$2,464

$0 $1,000 $2,000 $3,000 $4,000 $5,000


Year 1 (g=140; s=121)

Year 2 (g=113; s=86)

Year 3 (g=51; s=45)

Year 4 (g=26; s=31)

Average Dollars

Standard

Guided

This chart, and the one following, tracks costs that are Title IV-E dollars provided only to Guided Services (E) families. These funds are for services of various types that are not paid for from current options such as MaineCare and/or private insurance carriers. These services include such activities as respite, educational activities and/or special therapeutic


activities. The intent is for the family to share equally in the costs of these services. Requests are made to Casey social workers and then approved by the state DHS adoption program manager on a case-by-case basis.

Guided Services Families: IVE ExpendituresDecember 2003

$2,146$2,166

$38,878

$39,820

$10,312

$4,311

$18,196

$19,858

$5,125

$20,683

$19,962

$5,187

$0 $10,000 $20,000 $30,000 $40,000

Cohort 1 Families

Cohort 2 Families

Cohort 3 Families

Cohort 4 Families

Total Dollars

Total Expenditures

DHSReimbursementFamily Contribution

Cohort 1 (n=20) families are those families accessing these funds that entered the project in the first year, Cohort 2 (n=24) families entered in the second year and Cohort 3 (n=12) entered in third project year and Cohort 4 (n=6) entered in the fourth year. Approximately 66% of Cohort 1 families have accessed this funding, 53% of Cohort 2, 33% of Cohort 3 families, and 20% of Cohort 4 families. The types of activities paid for from these funds is varied; one arbitrary categorization of these activities is respite related services and all other.

• Cohort 1 Families: 22% Respite and 78% Other Types of Services • Cohort 2 Families: 38% Respite and 62% Other Types of Services • Cohort 3 Families: 20% Respite and 80% Other Types of Services


• Cohort 4 Families: 100% Other Types of Service

Average per Family IV E ExpendituresDecember 2003

$112

$144

$95

$128

$145

$96

$0 $50 $100 $150 $200 $250 $300

Cohort 1

Cohort 2

Cohort 3

Total Dollars

DHSReimbursement

Family Contribution

This chart depicts average overall expenses per family for Cohort 1, 2 and 3 families. This data indicates that the intent of co-equal contributions from families and the Title IVE dollars appears to be evident; there are no statistical differences to report. Looking closer at costs for types of expenses:

• There were a total of 361 requests for financial support from 62 families to date. • 99 requests for Respite type services, at an average total (family and DHS

combined) cost of $264.00 per request. • 261 requests for Other types of services, at an average total cost of $257.00. • Average costs per activity are:

o Family Contribution: $125.00 o DHS Contribution: $132.00 o Total Combined: $259.00

• Minimum Contribution by Family = $12.50 • Minimum Contribution by DHS = $12.50 • Maximum Contribution by Family = $1,550.00 • Maximum Contribution by DHS = $1,550.00


One of the goals of the intervention process was to create a shared approach to costs with families for services to meet their child’s unique needs. It appears that MAGS social workers are successful at creating this shared approach to paying for unique services. CONCLUSION A critical continued finding from this study is the level of need for mental health services for many of these children. Using the Child Behavior Checklist (Achenbach, 1991) as a measure of functioning, anywhere from 45% to 67% of the children (age 6 – 18 years old) in this study are considered in need of clinical mental health services. There remains strong and convincing evidence in favor of having post-adoption services and supports available to families for their children adopted from the state child welfare system.

In addition, it is clearly evident that a majority of the older children in the study are scoring in need of clinical services and parents are most often not seeking clinical services/supports for these children. This finding is critical in that these service gaps are evident within the first six months of children being in the study and therefore are likely to also be present at the time of legalization. Therefore, there is a concern in terms of whether or not the foster parent and or state agency adoption caseworker are identifying these needs and responding to these needs in support of the child. Given that the majority of children in this study have lived in their adoptive family for almost three years previous to the legalization, this apparent lack of identification and provision of supports points to a need for closer scrutiny of child well-being on the part of the state child welfare agency in cooperation with foster parents and parents who are in pre-adoptive placements. Caregivers appear to feel positive about the adoption process and rate the level of attachment of child to family and family to child as positive. Ratings of overall communication with the child and overall quality of home life are also positive. The parenting styles reported, Authoritative, and degree of family Cohesion and Adaptability are all results in favor of healthy family functioning.

For this report, there are only four outcome variables that indicate a difference between groups – all at the family level. The differences over time in favor of the Guided Services model and those are:

• Comparison of Family Life Now to Previous Before Adopted Child Came to Family

• Family Members Level of Attachment to Adopted Child • Parent Level of Physical Functioning • Parent Level of Pain – Interference with Routine Daily Tasks

Analyses for all other group differences over time were not statistically significant. Similar to what was reported in the previous December 2002 report, results to date provide reasons for concern and optimism. As these results are considered, it is very


important to remember that this intervention is being evaluated as it develops. Although the study design is strengthened by the use of random assignment and valid and reliable measures, the fact remains that this research is conducted in a live setting, not in a controlled setting. Questions that need to be explored while considering these results are:

• Fidelity of Implementation of the Intervention - Are all families receiving the same quality and quantity of service/support from their assigned social worker/case manager/Guide?

• Appropriateness of Outcomes – Are the outcomes chosen the best to measure success?

• Sensitivity of Measurement – Are the measures selected sensitive enough to pick up on changes over time?

• Group Differences – Are families/children in the control group (Standard Services) receiving services/supports in such a way that is similar to the experimental group (Guided Services) and therefore minimizes ability to detect between group differences?

• Amount of Intervention – Are children/families who are receiving the Guided Services intervention in fact getting the amount (dosage) of support that they need in order to improve?

• Length of Exposure to Intervention – Are children/families exposed to the Guided Services intervention for a long enough period of time in order to receive benefits?

• Limitations to Case Management Models – A core function of case management models is to refer and/or connect families to other services/supports in the community. What is the quality of the other services families receive and how does that influence outcomes?

At this point in time, there are few statistically significant differences to report that would lend support to the Guided Services intervention. Even with positive trends on a number of other child and family functioning outcomes, there is little evidence to support effectiveness based on differences between groups on these outcomes at this point in time. This is particularly troubling in terms of child functioning – there is no evidence that children in the Guided Services group are functioning better than those children not receiving the intervention. This finding needs further interpretation in order to decide how effective this type of case management model is at influencing change for children and families.

This intervention model appears to continue to be designed and implemented to meet needs expressed by these adoptive families, this is an important and positive finding. Statistical group differences at the family level are few and are consistently in favor of the Guided Services model. The philosophical intent of providing services in a family-driven framework appears to be evident. The partnership between the Casey Family Services agency and the state DHS adoption program appears to function in support of this project. Both agencies have demonstrated willingness to collaborate and work through a uniquely difficult process with families at various stages of engagement.


The Title IVE funds provided to Guided Services families appear to continue to be utilized in an equitable way amongst families and the state DHS funds are fairly matched by family contributions. This process may provide a model of how to increase flexibility of access to services for children/families in need.

Given the poor findings related to child functioning, additional analyses will be conducted to better describe what, if any, differences exist in consideration of the intensity or amount of intervention. Despite this lack of evidence in favor of the intervention with the current analyses, a focus needs to remain on the fact that these results continue to indicate a substantial need for behavioral health services and supports for the majority of children who are adopted from the state child welfare system.

The evidence from this study to date, from both parents and providers, continues to support the need for post-adoption services for a majority of the children entering into adoptive families. In the midst of caring for children with substantial needs, caregivers continue to report overall levels of satisfaction with the adoption, their services from state DHS staff, and with the supports they receive from the Guided Services social workers. These results are encouraging and are a testament to the grace exhibited by many of these families. For more information: Virginia Marriner Michel Lahti, Ph.D. Adoption Program Specialist Amy Detgen, M.P.A. Department of Human Services I.P.S.I./Muskie School 11 State House Station University of Southern Maine Augusta, ME 04333 295 Water Street P: 207.287.5060 Augusta, ME 04330 P: 207.626.5200


CHAPTER I – INTRODUCTION

A. OVERVIEW OF THE DEMONSTRATION 1. PURPOSE

The evaluation of the MAINE ADOPTION GUIDES PROJECT, Title IV-E Child Welfare Waiver is conducted for the Department of Human Services, Bureau of Child and Family Services (DHS). It is comprised of two parts: 1.) a process and an impact evaluation of the adoption competency-training program for public and private providers of adoption related services; and 2.) a process and outcome evaluation, and a cost effectiveness/benefit analysis, of the purchase and delivery of guided post legalization adoption support services to children and families. The design of the training evaluation was a nonrandomized pre-post design with follow up interviews to map the impacts of the training on knowledge and application of skills. The design of the post-legalization Adoption Guide support services evaluation is randomized. This interim report focuses on this model of supports to families adopting children with special needs.

The training evaluation component began on April 1, 1999 and continued through end of November 2000. The final training evaluation report is available upon request. Statewide implementation of the Guided Services model began on April 1, 2000 and will terminate on March 31, 2004. The entire evaluation will end no later than 9 months after the end date of the Waiver Demonstration Project, on or before December 31, 2004. The Maine Adoption Guides Project has both system level and program level intended outcomes. System Level - Permanency Related Outcomes:

Reduce Time in Foster Care to Adoption Legalization without Increasing the Number of Adopted Children whom Re-Enter Foster Care.

Increase Permanency for Special Needs Children These outcomes will be considered system level outcomes and will be tracked through current state Department of Human Services administrative data systems. Measures will be taken on an annual basis and comparisons made pre-Demonstration Project and over time. Program Intervention Level Outcomes:

DECREASED RATE OF ADOPTION DISSOLUTIONS SUPPORTED AND STRENGTHENED ADOPTIVE FAMILIES MAINTAINED OR ENHANCED THE WELL-BEING OF THE CHILD IN THE

ADOPTIVE FAMILY INCREASED ADOPTION RELATED AWARENESS, KNOWLEDGE, SKILLS AND

THE APPLICATION OF THOSE SKILLS AMONG PROVIDERS AND RELATED PROFESSSIONALS WHO SERVE ADOPTIVE FAMILIES.


The outcomes listed above are conceptualized in relationship to the proposed interventions by the following logic model.

INTERVENTIONS

Adoption Competency Training / Enhanced Supportive Services

SHORT TERM OUTCOMES

Increased adoption related awareness, knowledge, skills and the application of those skills by providers

and related professionals who serve adoptive families Decreased Rate of Adoption Dissolutions

Supported and Strengthened Families Maintained or Enhanced the Well-being of the Child in the Adoptive Family

LONGER TERM OUTCOMES

Reduce Time in Foster Care to Adoption Legalization without Increasing the Number of Adopted Children whom Re-Enter Foster Care

Increase Permanency for Special Needs Children


2. BACKGROUND

The evaluation of the MAINE ADOPTION GUIDES PROJECT, Title IV-E Child Welfare Waiver is conducted for the Department of Human Services, Bureau of Child and Family Services (DHS). It is comprised of two parts: 1.) a process and an impact evaluation of the adoption competency-training program for public and private providers of adoption related services; and 2.) a process and outcome evaluation, and a cost effectiveness/benefit analysis, of the purchase and delivery of guided post legalization adoption support services to children and families. The design of the training evaluation was a nonrandomized pre-post design with follow up interviews to map the impacts of the training on knowledge and application of skills. The design of the post-legalization Adoption Guide support services evaluation is randomized. This report will focus on the Guided Services evaluation results to date, for a full copy of the final training evaluation results please contact the evaluator.

The training evaluation component began on April 1, 1999 and continued through end of November 2000. Statewide implementation of the Guided Services model began on April 1, 2000. The entire evaluation will end no later than 9 months after the end date of the Waiver Demonstration Project, on or before December 31, 2004.

This Child Welfare Demonstration Project is the result of planning on the part of the state DHS agency since the mid 1990s. As a result of a series of interactions with parents, adoption agencies and other stakeholders the state DHS developed a specific focus on post-legalization services. This policy and program development was driven by two pressures on the adoption system: (1) increasing numbers of children requiring adoption services; and (2) pending implementation of the Adoption and Safe Families Act. In response to those pressures, state agency managers, parents and non-governmental adoption agencies undertook a process that resulted in this Child Welfare Demonstration Project - Maine Adoption Guides Project.

The guiding principles that drive this initiative are the following: Adoption is a life-long process. Most adoptive families experience normal crisis in their development. Families need more support services post-legalization.

In addition to realizing the need for a more concentrated effort to provide post-legalization services, the initiative also intends to impact the adoption competencies of clinicians providing services to adoptive families. Parents involved in the planning process were forceful in their concerns about an apparent lack of understanding of the dynamics of adoption on families on the part of mental health clinicians.


3. ADOPTION GUIDED SERVICES DESCRIPTION

The core principle of this program is that adoption is different. The dynamics of a family created by adoption are different from the dynamics of a family created by birth. Adoption is lifelong and its impact creates unique opportunities and challenges for families and communities. Adoption is mutually beneficial to parent, child and society. Society is responsible for supporting and aiding integration and preservation of adoptive families.

This program description will focus on the services to the guided supportive services (experimental) group. The standard services (control) group will get the same level of post legalization adoption assistance services that are presently in place, either through D.H.S. or generally available in the community. The guided service model is intended to differ from the standard practice in several ways, see Figure 1 below for a comparison. In addition, see Figure 2 following for a program logic model of the Guided Services intervention. We recruit the participants from the overall population of families adopting children with special needs, out of the Foster Care System of DHS. The families are selected at the time they are approved for adoption assistance. We will be covering the entire state of Maine, which includes all eight districts of the DHS. This service delivery will be provided by a partnership of DHS/BCFS and Casey Family Services. It may also include Casey Family Services subcontracting with other service providers to meet statewide needs. Families assigned to the standard services, adoption assistance group will not be eligible for the Guided post legalization adoption services. No family will receive any less service than is presently provided. The long-term plan, based on the positive outcomes of this study, is that these same guided services could be expanded to the general population of adopting families. This is a community-based delivery of service program designed to be child-centered and family focused. The adoptive parent(s) is viewed as the expert on their child. The adoption staff are guides who consult with the family through the expected and normal crisis in the life of an adoptive family. Therefore, the major hypothesis of the study is: Families and children who receive guided supportive services will be strengthened, have fewer dissolutions, and report higher levels of child and family well being than families and children that receive standard services.


Figure 1 Post Legalization Program Model Differences

Program Standard Guided Supportive Attribute Services Services Target Population Children w/Special Needs, Children w/Special Needs, and their Families and their Families Program Goals - Provision of Adoption - Decrease Dissolutions Assistance Funds - Increase Family Strengths Funds - Maintain/Increase Child - Assistance with and Family Functioning process to Legalization - Provision of Adoption Assistance Funds Staffing D.H.S. Adoption Worker D.H.S. Adoption Worker and Casey Adoption Staff Services Provided - One time Assessment/ - Initial and ongoing Planning Session support based on family - Financial Support for needs identified in “Family Post Adoptive Services as Permanency Assessment”. per Entitlements - Scheduled check-ins with - Annual Financial Planning family and Casey staff at for Continuance of Adoption least once every six months. Assistance - Permanent assignment of Casey staff to family in an empowerment role. - Financial Support for Post Adoptive Services, not limited to services pre- defined in subsidy agreement. - Annual Financial Planning for Continuance of Adoption Assistance Access to Trained - Provided with List of - Provided with List of Providers Trained Providers Trained Providers


Figure 2 - Maine Adoption Guides - Guided Services Intervention Program Logic Model

INPUTS ACTIVITIES OUTPUTS IMMEDIATE OUTCOMES 0 - 6 MONTHS

INTERMEDIATE OUTCOMES 7 - 18 MONTHS

LONG TERM OUTCOMES 19-48 MONTHS

• Social Worker Staff • Financial Supports

for Families • Formal and

Informal Supports for Families

• Initial Assessment with Family - Strength Based, Family Centered planning

• Case Management Activities

• Therapy Sessions • Resource

Brokerage • Regular Check-ins

with Family, at least once every 6 months

• Social Worker meets with family for initial strengths based, family centered assessment, with DHS/IASC Adoption worker; before legalization.

• Regular Check-Ins Occur; at least 2x per year.

• Social Worker available to family for case management - supportive services, therapy; ongoing.

• Family is supported and empowered as they respond to their child's needs.

• Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains.

• Families access needed resources, formal and informal supports.

• Family & Social Worker staff expresses satisfaction with Guided Services model.

• Adoption is maintained

• Few to No Displacements - Child Lives at Home


• Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains.


• Few to No Displacements - Child Lives at Home


• Family & Social Worker staff satisfied with Guided Services model given normal developmental crises.


• Selected Child(ren) maintains or improves functioning; school, social and emotional domains.


• Few to No Displacements- Child Lives at Home


• Family & Social Worker staff satisfied with Guided Services model given normal developmental crises.


Program Logic Model: Outcome Definitions

Family is supported and empowered as they respond to their child's needs. Parent - Child Communication Parent - Child Relationship Feelings about Adoption Attachment Satisfaction with Adoption Caregiver Health (Stress) Quality of Home Life Family Cohesion/Adaptability/Satisfaction (FACES II)

Selected Child(ren) maintains or improves functioning; family, school, social and emotional domains. Juvenile Justice Involvement Physical Status Emotional/Intellectual Status Relations with Peers Personality Traits Competencies and Problems - Functioning (CBCL, YSR, TRF-CRF) Academics/School (CBCL, YSR, TRF)

Families access needed resources, formal and informal supports. Formal Supports include: Case Management; Respite; Advocacy Support by Case Manager;

Counseling/Therapy; Family Therapy; Marriage Counseling; Adoption Support Group; Special Education services; Residential Treatment; and other Institutional Placement.

Informal Supports: identified by the family - documented. Family & Social Worker staff expresses satisfaction with Guided Services model given expected normal developmental crises. Family: Satisfaction with support and services as provided through their Adoption Guide social

worker. Adoption Guide Social Worker: Satisfaction with their role and performance in the Maine Adoption

Guides Program and how they are supported in their work with families. Adoption is Maintained The legalized adoption does not dissolve with the child returning to the state's custody and foster care

system. Few to No Displacements - Child Lives at Home The child/adolescent lives in her/his home on a permanent basis - number of days child is at home. A

displacement is when a child/adolescent is hospitalized or otherwise removed from the home in order to receive treatment so that the child may return home. Child is considered not at home when she runs away, is incarcerated, lives somewhere else against parents will or is hospitalized for other than a medical necessity.


B. RESEARCH DESIGN AND METHODOLOGY 1. POPULATION CHARACTERISTICS

This component of the project targets children who are in the state child welfare system who are classified as having special needs. The criteria for special needs in Maine results in nearly all children falling into this category. In April 1999, at the beginning of the Project, Maine had approximately 3,100 children in foster care. In January of 1999 there were 641 children requiring adoption services. As of January 2000, there were 806 children requiring adoption services. For the year 2000, 423 adoptions were legalized in Maine; for the year 2001, 304 adoptions were legalized in Maine; for the year 2002, 319 adoptions were legalized in Maine and, for 2003 through October, 223 adoptions were legalized. (See Table 4, page 21). All four years show an increase from 1999 when 240 children legalized. These figures represent the continuation of an upswing in adoptions in Maine, experienced after a four-year decrease from 1990 to 1994.

2. RESEARCH DESIGN AND METHODOLOGY

a. Guided Services Evaluation

As mentioned above, the Guided Services component of this initiative commenced in November 1999 through March 2000 with pilot implementation of the intervention. This pilot period was crucial for the evaluation as it provided an opportunity to design, test and implement the necessary procedures for random assignment, data collection, data entry and reporting. The pilot period resulted in the implementation of an evaluation process that is fairly well integrated with the two organizations that are part of this Demonstration project. The following is the basic evaluation plan developed for the Guided Services component of the project.

b. Guided Services Model - Process Evaluation

A process evaluation is critical in describing the program strengths and

weaknesses to guide implementation, and to understand the outcome data. For this project, the process evaluation will include the monitoring of:

DHS and Casey Family Program Organizational Aspects Staffing Structures and Profiles Financial Commitments Level of Acceptance by Field Staff Methods of Project Implementation - Fidelity of Guided Services Model Contextual Factors Demographic Profiles of Families and Children Served Utilization of Services and Unmet Needs Satisfaction with Services Differences in Experimental and Standard Groups Family Assessment of Long Term Permanency Needs


Results of Individual, Family Focused, Series of Regularly Scheduled “Maintenance” Checkups

c. Outcome Evaluation - Guided Services Model

The outcome evaluation began in Year 2 of the Demonstration Project on 4/1/2000

and will commence through March 2004. The selection or development of measures and data collection strategies, including a piloting process, was conducted during the Year One, 4/1/1999 - 3/31/2000. The outcome evaluation assesses to what extent the children/families who received the Guided Services Model (experimental group) and the children/families who received Standard Services (control group) differ in regard to a number of outcome measures. The outcome measures include:

Rates of Adoption Dissolutions Number of Days Child in the Home / Displacement Rates Assessment of Family Functioning Assessment of Child Functioning/Well Being Assessment of Access to and Utilization of Services Levels of Satisfaction with Services

d. Outcome Evaluation - Research Design

This study makes use of a randomized design with blocking on a few child and

family characteristics. The Figure 3 below outlines the proposed design which is a two-group randomized experimental design such that any family/child meeting the participation criteria will have an equal chance of being assigned to either of the two groups.

Figure 3 - Outcomes Study Design

This design intends for at least 60 children assigned to the Guided Services - experimental group and 60 children assigned to the Standard Services - control group each year. Actual recruitment will be for 70 children in each group to work against possible attrition. Sample size estimates are as follows:

Year 2, 2000-2001: 120 children (60E, 60C) Year 3, 2001-2002: 240 children (120E, 120C) Year 4, 2003-2004: 360 children (180E, 180C) Year 5, 2004-2005: 480 children (240E, 240C)

Guided Services: Group A Randomization --- (Baseline) O --- X --- O (Every 6 mos.) -- O Standard Services: Group B Randomization --- (Baseline) O ---------- O (Every 6 mos.) -- O


This design results in the following sample sizes for longitudinal study:

Four years in Project: 120 children Three years in Project: 240 children Two years in Project: 360 children One year in Project: 480 children


C. DATA COLLECTION & ANALYSIS

1. Data Collection

Data is collected from:

a. Self-selected primary caregivers to report on child level and family level variables;

b. Casey Family Services social workers to report on implementation of model and theory of change;

c. DHS state agency staff and administrators to report on implementation of overall program; and

d. Casey and DHS administrative records.

Data is collected by telephone interviews with parents, individual and group interviews with clinical staff and DHS staff, and data extraction forms with secondary data. Data is collected from primary caregivers at baseline upon entry to the study and every six months thereafter through the completion of the project. Both a written survey and a telephone survey are completed at baseline and at every six months. In general, telephone surveys are scheduled upon receipt of the written survey. The average time between the written survey and the telephone interview at baseline is 1.03 months. At six months the average amount of time is 0.8 months; at 12 months, 0.7 months; at 18 months, 0.5 months; at 24 months, 0.4 months; at 30 months, 0.5 months; and at 36 months, 0.6 months. Contact evaluator for:

a. a complete description of the measures selected/developed for this component of the evaluation; and

b. a description of the data collection schedule(s). 2. Data Analysis Plan

The estimated sample size is sufficient for both descriptive and inferential statistical analyses. Descriptive statistics, such as percentages, rates, frequency distributions and means, will be employed to describe the two groups. Descriptive statistics will be produced to answer each of the evaluation questions. Inferential statistics will be used to test the statistical significance of any differences within and or between groups as established in the research questions. Open-ended questions and results of focus group interviews are analyzed through coding for common themes emerging from the narrative data. For a complete data analysis plan, please contact the evaluator.


Information summarized in this report is primarily presented in two ways: at baseline (from surveys received upon a family’s entry into the study) and by six-month waves (corresponding to each wave of data collection from families). In addition, the data is analyzed by assigned group: Guided (experimental group) and Standard (control group). Until this point, information had also been presented by Cohort. However, at this time, with a sufficient number of families in each of four waves of data collection, and with no statistical differences between cohorts, we feel that our data would be more clearly understood if displayed simply by the amount of time in the study. In order to do this, we have combined all cohorts together and will describe the results by assigned group at baseline, and at every six months of data collection.


CHAPTER II – PROCESS ANALYSIS

A. IMPLEMENTATION 1. WHAT IS THE MAINE ADOPTION GUIDES (MAGS) MODEL OF

INTERVENTION?

A description of the Guided Services program is provided in Chapter I. Essentially this intervention appears to be a case management type of model. Casey Family Services social workers liaison with DHS Adoption Caseworkers and meet with the selected family approximately 3 months before legalization. This is the target point in time, however, this time period is somewhat arbitrary as the actual timeframe for legalization depends solely on the courts’ capacity to litigate these cases. During this initial meeting with the family, or sometimes over the course of two or three meetings, an assessment is conducted. Based on this assessment, driven by the needs of the family, services and supports are provided. Families are required to meet with the Casey Family Services social worker at least once every 6 months.

It is anticipated that this intervention model will evolve as the project develops.

The evaluator has and will meet with the clinical staff as they further refine this approach to post-legalization supports and services. The clinical staff, in consultation with the DHS program manager, has developed the following mission and standards statements (Casey Family Services, March 2000) that begin to define this intervention model.

Maine Adoption Guides Mission Statement and Case Practice Standards

Mission Statement: Adoption is a common and acceptable way to create a family. Still, a family formed by adoption has unique dynamics and issues. Bonding and attachment between an adoptive parent and child is not automatic, rather it is a process. And in this process of building a cohesive family, crises are predictable and normal. A child who is adopted brings to the family a unique history that includes the trauma of separating from his or her birth parents and often includes other life trauma. Adoptive parents also bring unique histories to the relationship. In addition, they have expectations about parenting that are sometimes not met by their adopted child. Siblings, by adoption, birth, or by fostering significantly contribute to the family dynamics. Communities are responsible for supporting and aiding integration and preservation of adoptive families. The process of building a cohesive family can be supported by community services and extended family, or it may be hindered if the community and/or extended family is not informed about adoption related issues, or is not supportive. Communities may need support in developing adoption competent resources. Consideration and respect is given to all triad members. The child’s birth family as well as adoptive family is vital to the child’s development and overall sense of well-being. The type of contact or the amount of information the child has regarding his or her birth family should be based on the child’s developmental


and therapeutic needs. Adoptive families may need encouragement to increase their comfort with birth family issues so that they can support their child’s integration of his or her history. A child’s family of origin may differ culturally from his or her adoptive families’. It is important for a child who is adopted to develop a positive understanding of his or her cultural heritage in order to form a healthy identity. Adoptive parents may need assistance finding ways to facilitate their child’s positive identity formation. Services delivered will be client-centered reflecting families’ interest, ability and desires. Parents will be supported in creating a safe and nurturing environment for their children. The Maine Adoption Guides will have the goal of empowering parents to claim their children and maintain hope. Case Practice Standards: Assessment The assessment of an adoptive family will take into account the normal struggles adoptive families are bound to have. Within this “normative crisis” framework, the interplay of the parent/child dynamics and the influence of the community will be assessed.

Child factors will include: • ability to attach; • history of trauma; • stages of normal child development; • educational, medical, social recreational and psychological needs.

Parent factors will include:

• parenting style; • the parent’s perspective and ability to respond to normative crises; • parent history; • the parent’s ability to seek and use support; • parent’s knowledge and understanding of their child’s cultural heritage; • parent’s medical and mental health needs will be assessed; • parent’s previous experience with service providers.

Resources:

• the availability of adoption competent providers; • the ability to meet the special needs of the child and family; • extended family support.

Service Plan

• service plans will be individualized and will reflect the assessment of the parent’s and child’s needs;

• service plans will be re-evaluated regularly to adapt to changing needs and abilities in a family;

• service plans will identify the current community supports; • service plans will support family connections regardless of whether a child is able to live in

the home at any given time; • service plans will recognize the importance of the adopted child’s birth and cultural heritage; • time frames identified in service plans will be realistic and reflect the family’s stage of

development; • barriers to achieving goals and services needed will be identified and documented.


Contact with Family:

• will occur minimally every six months; • will occur regularly and will coincide with the normative stages of family development; • will be driven by family needs.

Use of Community Resources:

• referrals will be made to adoption competent providers; • respite providers will have the knowledge and experience necessary to provide the level of

care necessary to meet the child’s needs; • communication between the agencies, providers and families will occur regularly to assure

that goals and treatment plans are agreed upon.

The Adoption Guides model is statewide. During the first year of the project, there were no social workers available in Aroostook County, the northern part of the state. Therefore, the program was not available to families in that county. In order to combat this problem, Casey Family Services developed a contract with Community Health Counseling Services, to provide social workers in Aroostook. Staffing Casey Family Services staff members working on the Adoption Guides project all have Master’s Degrees in Social Work and are licensed as LCSWs or LMSWs. Social workers provide intake and permanency planning services to special needs children, with birth, adoptive and foster families. They perform professional casework, group work and advocacy for children and families, function as clinical team members, and participate in individual and peer supervision. Responsibilities include providing ongoing education for families; gathering and presenting clinical information for disposition of referrals; providing ongoing assessment of each child or family’s needs; developing and administering case plans; and providing individual, family or group treatment. Social Workers’ territories are as follows:

Table 1 Social Worker Territories

December 2003 Region Number of Social

Workers Greater Portland/York County/Kennebec County 8 Lewiston/Auburn/Skowhegan/Waterville 1 Bangor/Ellsworth/Machias/Kingfield 5 Aroostook County 2 social workers cover

cases on as needed basis Two social workers are team leaders—one overseeing Augusta and southern Maine and the other covering the northern regions of the state.


Team leaders provide clinical supervision to staff delivering services to children and families referred to Casey Family Services. Team Leaders are members of the Divisional Management Team and participate in planning program development and other special projects. Responsibilities include planning, assigning, supervising and evaluating the work of social workers; assessing staff training needs; reviewing and monitoring case progress; and providing direct services to children and families when appropriate. Following are the Guided Services population total currently being served:

Table 2 Guided Services Population Served By Project Year (Cohort)

December 2003

April 2000 -March 2001

April 2001 -March 2002

April 2002 – March 2003

April 2003 – June 2003 Total

Children Served 50 74 59 65 248

Families Served 28 36 34 36 134

2. TYPES OF SERVICES PROVIDED THROUGH MAGS

INTERVENTION? Casey Family Services provides a wide variety of services to families as part of the Adoption Guides project. For further discussion of the amounts and types of services used, please see Section C: Service Characteristics (page 77). Service codes were developed with Casey Family Services in order to categorize the work they do with children and families. When a Casey social worker provides any of the following services to a child or family, the worker enters the corresponding code into the database.

Figure 4 Casey Family Services: Maine Adoption Guides Service Codes & Definitions

01 Initial Assessment

The Collection and assessment of information regarding the child, family and other relevant persons, to determine the nature of individual and family issues and the services needed to foster strengths and provide supportive services to a family. Activities consist of interviewing, making an assessment of need, assessing the availability and accessibility of services, making case recommendations and setting objectives. This activity includes conducting family assessment at time of referral to MAGS. Services Rendered to: Family


02 Case Plan (Initial and Subsequent Reviews)

Case plans are developed in accordance with overall MAGS program philosophy of family strengthening and empowerment. A case plan is developed in conjunction with the family and in consultation with a supervisor and other professionals as needed. The case plan identifies the client's needs, and delineates the objectives designed to meet those needs. The case plan is developed at completion of the intake process and is reviewed every six months or as needed. Services rendered to: Family

03a1 Building Relationship/Maintenance Contacts with the primary purpose to engage the client, build trust, or to maintain an existing relationship. Services rendered to: Parent

03a2 Clinical Conversation

Conversations focused on identifying, clarifying and addressing client's multiple needs. Social workers address interpersonal and intrapsychic issues that might be affecting the individual or family. These conversations are therapeutic in nature but are more global than traditional counseling. Services rendered to: Parent

03a3 General Parent Education and Support Providing information to parent to educate and support including preparation for PETs, assistance with parenting skills, information regarding such topics as birth family, normative developmental stages, attachment. Services rendered to: Parent 03b Crisis Stabilization/Follow-up Activities in response to a situation when a specific and urgent issue requires immediate attention from MAGS social worker or on-call staff member. Subsequent contacts may also be included to assess any additional services needed to insure ongoing stability. This requires that some action be done other than just supporting the parent by phone. Any situation requiring a critical incident report will be coded under this category.

03c Referral to Mental Health/Substance Abuse Services Coordinating information that results in a referral to an outpatient community based mental health and or substance abuse service agency. Referral can be for the child and or any member of the family who is recipient of services.

03d Referral to Community Resources (other than Mental Health, include Coordinating information that results in a referral to a community based resource and or support. Referral can be for the child and or any member of the family.

03e Provision of concrete services (include type in DOC) Activities that result in the purchase of concrete goods or services for the child and or family. Financial Assistance that is provided in addition to the Adoption Subsidy paid to the family through D.H.S. IV-E funding.


Figure 4 Continued:

03f Collateral Contacts Sharing with and gathering information from other parties associated with the child and or family.

03g Non-Therapeutic Services Informal social/recreational activities such as agency-sponsored picnics or attendance at legalization celebrations. These also may include recreational activities completed alone with children or with groups of children. Effective May 1, 2002, this code includes child care provided during parent support groups. 04a General Advocacy Contacts with others who have influence/power in the client's life with the goal of insuring that their needs are met. Negotiating and coordinating services on behalf of children and families to assist them to obtain otherwise inaccessible or unavailable services. Negotiating the development of new resources or services.

04b Educational Advocacy Similar to the general advocacy defined above but specifically related to the educational needs of the child. Includes attendance at PETS. Services rendered to: Child

05 Preparation and Placement Providing support to family/child when the child requires placement out of the home. Services Provided To: Child 06a Therapeutic Services: Child

Goal directed, therapy sessions for Individual child; may include therapeutic Life Book work.

06b Therapeutic Services: Parent

Goal directed, therapy sessions for Individual parent.

06c Therapeutic Services: Family

Goal directed, therapy sessions for the family; may include therapeutic Life Book work; Dan Hughes.

06d Therapeutic Services: Group Children

Goal directed, therapy sessions for children group.

06e Therapeutic Services: Group Adult

Goal directed, therapy sessions for adult group.

06f Therapeutic Services: Multiple Social Workers

Therapeutic services delivered to parent, family, group children or group adult by more than one clinician. (Effective 9-1-02)

07 Case Related Documentation

Reviewing of written materials and any written work including assessment reports, case plan, contact logs, critical incident reports, reading records, letters, reports, etc. Anything that requires 15 minutes or more is documented.


Figure 4 Continued:

08 Psychiatric Services

Psychiatric Consultation and/or medication monitoring provided by the Casey Family Services psychiatric consultant. (Effective 9-1-02)

88 No Contact This Month Per Family Request Support Groups One important service Casey Family Services also provides as part of the Adoption Guides project is support groups. Support groups offer adoptive families an opportunity to share parenting strategies and struggles with other parents in similar situations. Called “Parents of Challenging Children,” these groups help parents who are raising children with special needs, which may include learning disabilities, psychiatric disorders, socialization/behavioral difficulties, or children who are hospitalized, or have received day treatment or residential services. Facilitated by therapists, the groups offer adoptive parents a safe environment to discuss their problems, as well as the opportunity to meet and connect with other adoptive parents. In general, the groups meet once a week, or every other week and at this point in the project, most groups meet on an ongoing basis. Intended Outcomes: Goals of the parent support groups include:

• Parents feel more capable to meet the special needs of their child(ren) • Parents feel more supported • Parents feel more satisfied with their adoption(s) • Fewer dissolutions

Target Population: Parent support groups are open to any adoptive parent of children with special needs (support groups are available to adoptive parents in all agencies, private or DHS). For the purposes of these support groups, “special needs” are defined mostly as behavioral or psychiatric conditions—not special physical needs. Adoptive parents contact Casey if they are interested in joining a group and are then invited into Casey for an interview. Currently, Casey Family Services “Parents of Challenging Children” support groups are underway in Lewiston, Augusta and Ellsworth, and two groups meet in Portland. The parent support group meetings are potluck dinners and include child-care and dinner for children. A Casey Family Services therapist leads each group. Many of the current groups have continued past their timeframe and members meet informally on their own. In addition to the parent groups, creative respite days are hosted for children on school holidays. Groups of children take part in such activities as horseback riding and rock climbing.


Some difficulties occurred in organizing support groups in the northern part of the state. Families live further apart from each other and although social workers used central locations for group meetings, families would often have to travel an hour to and from meetings. With the added travel time, meetings required families to set aside four hours or more. Sparing four hours during the day was difficult for parents and four hours in the evening often interfered with children’s bedtimes. Therefore, attendance at meetings varied and some groups ended. Families however, expressed their interest in group meetings and social workers began to use a less structured form of groups—meeting at informal, recreational events, rather than weekly meetings. Picnics, outdoor events, or swimming parties offer parents and children the opportunity to gather together and share feelings and experiences in the same way that group meetings do—and families are able to plan for one day/evening at a time without having to commit to driving to meetings every week. In addition, two different 6-week movie groups were established as a recreational outing for parents.

3. HOW IS MAGS IMPLEMENTED? Every family who is adopting a child from the state DHS, unless the family is moving out of state, is invited to participate in the project. Based on random assignment, the family then receives the intervention. The protocol for referral and randomization is stated in Chapter 1, page 9.

a. Results of Referral Processes During the second year of the project, there was a slow down in referrals. DHS investigated why this was happening and it no longer is a problem. When DHS caseworkers invite families to participate in the project, they complete a brief questionnaire with families who refuse to participate in the project.

Table 3 Non-Participants by District – Year 4 to Date

December 2003

District 1

District 2

District 3

District 4

District 5

District 6

District 7

District 8

Total

11 4 8 10 5 13 11 9 71 b. MAGS Implementation Survey Results

In order to assess the project’s implementation, e-mail surveys are conducted each year with the DHS and Casey Family Services caseworkers and supervisors who are involved in the project. Surveys are conducted as each district reaches its quota of participants for the year. As districts close over the next few months, the final Implementation survey will be conducted and results will be reported in our Final Report December 2004.


c. Focus Groups

In addition to the implementation survey, focus groups with social workers provide valuable information on the project model and its process. Focus groups are held with Adoption Guides social workers and supervisors approximately every six months. Staff members are asked to define their roles in the project and provide general feedback on the project’s implementation—how the project model compares to their day-to-day work. In this, our final year of the project, we decided to postpone the scheduled November 2003 focus groups until January 2004, in order to conduct one final summary round of focus groups before the project officially ends in March 2004. Results from the final focus groups will be reported in the Final Report December 2004. j


B. SAMPLE CHARACTERISTICS 1. WHO ARE THE CHILDREN INVOLVED IN MAGS? Children entering this study are part of a historical event in terms of adoption legalizations in Maine. The increase in the number of these legalizations in the past few years, see Tables below, is part of the rationale for developing approaches such as Maine Guides to assist families.

Table 4 ADOPTIONS

Adoption Finalizations by Years AS OF 12-1-03

Office 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Pending Biddeford/ Sanford

63

32

49

40

10

Portland

13

21

34

27

19

32

46

57

31

42

29

14

Lewiston

15

5

18

9

17

30

49

70

28

40

27

24

Augusta

22

10

29

26

32

17

50

92

80

56

39

25

Rockland

12

8

3

Bangor

16

14

18

35

21

26

30

64

54

53

44

13

Ellsworth/ Machias

10

29

31

47

60

43

29

12

Houlton

9

16

15

25

15

15

17

30

19

24

13

15

TOTAL

75

66

114

122

114

149

223

423

304

319

229

116


Table 5

Adoption Finalizations by Month AS OF 12/1/03

Month

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003 as of 12/1/03

January 1 0 9 5 4 6 9 31 26 25 12 February 9 4 7 15 5 8 17 17 23 12 16 March 7 4 2 18 10 8 17 31 23 23 12 First Quarter 17 8 18 38 19 22 43 79 72 60 40 April 3 15 7 5 9 8 12 36 15 23 19 May 2 12 8 12 6 16 14 44 31 33 22 June 1 8 20 11 10 5 27 22 34 35 32 Second Quarter 6 35 35 28 25 29 53 102 80 91 73 July 10 1 8 13 8 16 28 35 18 28 33 August 6 5 5 13 16 15 13 34 24 19 25 September 10 4 6 10 8 11 11 35 30 31 30 Third Quarter 26 10 19 36 32 42 52 104 72 78 88 October 11 1 17 7 20 15 15 33 25 25 22 November 8 1 12 4 2 18 9 43 22 25 6 December 7 11 13 9 16 23 51 62 33 40 Fourth Quarter 26 13 42 20 38 56 75 138 80 90 28 TOTAL

75

66

114

122

114

149

223

423

304

319


NOTE: Data used for analysis differs slightly from the actual study data (number of children and families currently served) due to attrition from the project. The MAGS research team asks families who drop out of the study for permission to keep their data. Therefore, the data from participants who agree remains in the analysis databases. The number of children and families in the following tables reflects that total (actual plus attrition combined) unless the table refers to actual number of children or families served. As mentioned in Chapter I, all children entering this study are coming into adoption from the state child welfare system. The following are a set of selected variables that are being investigated for change between groups and over time. Most Tables display the data (from all Cohorts combined) by Assigned Group. The figures represent data collected through November 2003. A Pearson Chi-Square statistic was used to test for differences between groups for nominal - categorical data and Independent T-tests were calculated for ordinal -continuous type data. There was a significant difference between assigned groups at Baseline for one variable: Is Child Attending School. However, this is not a key variable in the research. There were no significant differences found between assigned groups for any major outcome variables at Baseline. This result verifies the randomization process.

Table 6 Total Number of Children

by Cohort and Assigned Group December 2003

Number of Children

AssignedGroup Total

Guided (E) Standard (C) CWave Cohort One Baseline Count 56 61 117 Expected Count 65.6 51.4 117.0 % within CWave 47.9% 52.1% 100.0% % within AssignedGroup 21.5% 29.9% 25.2% Residual -9.6 9.6 Cohort Two Baseline Count 88 48 136 Expected Count 76.2 59.8 136.0 % within CWave 64.7% 35.3% 100.0% % within AssignedGroup 33.8% 23.5% 29.3% Residual 11.8 -11.8 Cohort Three Baseline Count 63 59 122 Expected Count 68.4 53.6 122.0 % within CWave 51.6% 48.4% 100.0% % within AssignedGroup 24.2% 28.9% 26.3% Residual -5.4 5.4 Cohort Four Baseline Count 53 36 89 Expected Count 49.9 39.1 89.0 % within CWave 59.6% 40.4% 100.0% % within AssignedGroup 20.4% 17.6% 19.2% Residual 3.1 -3.1 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within CWave 56.0% 44.0% 100.0% % within AssignedGroup 100.0% 100.0% 100.0%


Table 7 Total Number of Families

by Cohort and Assigned Group December 2003

Assigned Group Guided

(E) Standard

(C)

Total

CWave Cohort One Baseline Count 30 34 64 Expected Count 35.3 28.8 64.0 % within CWave 46.9% 53.1% 100.0% % within Assigned Group 21.3% 29.6% 25.0% % of Total 11.7% 13.3% 25.0 Residual -5.3 5.3 Cohort Two Baseline Count 45 30 75 Expected Count 41.3 33.7 75.0 % within CWave 60.0% 40.0% 100.0% % within Assigned Group 31.9% 26.1% 29.3% % of Total 17.6% 11.7% 29.3% Residual 3.7 -3.7 Cohort Three Baseline Count 36 34 70 Expected Count 38.6 31.4 70.0 % within CWave 51.4% 48.6% 100.0% % within Assigned Group 25.5% 29.6% 27.3% % of Total 14.1% 13.3% 27.3% Residual -2.6 2.6 Cohort Four Baseline Count 30 17 47 Expected Count 25.9 21.1 47.0 % within CWave 63.8% 36.2% 100.0% % within Assigned Group 21.3% 14.8% 18.4% % of Total 11.7% 6.6% 18.4% Residual 4.1 -4.1 Total Count 141 115 256 Expected Count 141.0 115.0 256.0 % within CWave 55.1% 44.9% 100.0% % within Assigned Group 100.0% 100.0% 100.0% % of Total 55.1% 44.9% 100.0%


Table 8 Child Gender

by Assigned Group December 2003


(E) Standard

(C)

Total

Gender Male Count 113 105 218 Expected Count 122.2 95.8 218.0 % within Gender 51.8% 48.2% 100.0% % within Assigned Group 43.5% 51.5% 47.0% Residual -9.2 9.2 Female Count 147 99 246 Expected Count 137.8 108.2 246.0 % within Gender 59.8% 40.2% 100.0% % within Assigned Group 56.5% 48.5% 53.0% Residual 9.2 -9.2 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within Gender 56.0% 44.0% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Table 9

Child Age by Assigned Group

December 2003

Current Age Categories * AssignedGroup Crosstabulation

61 57 11866.1 51.9 118.0

51.7% 48.3% 100.0%23.5% 27.9% 25.4%13.1% 12.3% 25.4%

-5.1 5.1121 77 198

110.9 87.1 198.061.1% 38.9% 100.0%46.5% 37.7% 42.7%26.1% 16.6% 42.7%

10.1 -10.172 67 139

77.9 61.1 139.051.8% 48.2% 100.0%27.7% 32.8% 30.0%15.5% 14.4% 30.0%

-5.9 5.96 3 9

5.0 4.0 9.066.7% 33.3% 100.0%

2.3% 1.5% 1.9%1.3% .6% 1.9%

1.0 -1.0260 204 464

260.0 204.0 464.056.0% 44.0% 100.0%

100.0% 100.0% 100.0%56.0% 44.0% 100.0%

CountExpected Count% within Current Age% within AssignedGroup% of TotalResidualCountExpected Count% within Current Age% within AssignedGroup% of TotalResidualCountExpected Count% within Current Age% within AssignedGroup% of TotalResidualCountExpected Count% within Current Age% within AssignedGroup% of TotalResidualCountExpected Count% within Current Age% within AssignedGroup% of Total

0 - 5 years old

6 - 10 years old

11 - 17 years old

18 + years old

Total

Guided (E) Standard (C)AssignedGroup

Total


Table 10

Average Child Age (Mean Scores) at Entry in the Program


An important part of our analysis is to compare the differences between adoptive parents who were originally foster parents and those that were not foster parents. Currently, 89 percent of the parents in the study were identified as foster parents. The actual numbers are as follows:

Table 11 Type of Adoption – Foster Parent and Non-Foster Parent


Assigned Group

Guided (E)

Standard (C)

Total

Type of Foster Parent Count 234 178 412 Adoption Expected Count 230.9 181.1 412.0 % within Type of Adoption 56.8% 43.2% 100.0% % within Assigned Group 90.0% 87.3% 88.8% Residual 3.1 -3.1 Non-Foster Parent Count 26 26 52 Expected Count 29.1 22.9 52.0 % within Type of Adoption 50.0% 50.0% 100.0% % within Assigned Group 10.0% 12.7% 11.2% Residual -3.1 3.1 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within Type of Adoption 56.0% 44.0% 100.0% % within Assigned Group 100.0% 100.0% 100.0%

Age at Intake by Years Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 7.19 260 4.028 6.33 Standard (C) 7.21 204 4.220 6.38 Total 7.20 464 4.109 6.33


Twenty-six percent of families have a total family annual income of more than $65,000. The next largest group (20%) earns between $45,000 and $55, 000 per year. Annual income varied fairly evenly over the different categories, with a small percentage earning less than $15, 000.

Table 12 Current Total Annual Income Before Taxes


Current Total Annual Income Before Taxes * Assigned Group Crosstabulation

2 2 42.2 1.8 4.0

50.0% 50.0% 100.0%1.6% 1.9% 1.7%.9% .9% 1.7%

11 10 2111.3 9.7 21.0

52.4% 47.6% 100.0%8.7% 9.3% 8.9%4.7% 4.3% 8.9%

13 15 2815.1 12.9 28.0

46.4% 53.6% 100.0%10.2% 13.9% 11.9%5.5% 6.4% 11.9%

24 18 4222.7 19.3 42.0

57.1% 42.9% 100.0%18.9% 16.7% 17.9%10.2% 7.7% 17.9%

25 21 4624.9 21.1 46.0

54.3% 45.7% 100.0%19.7% 19.4% 19.6%10.6% 8.9% 19.6%

21 11 3217.3 14.7 32.0

65.6% 34.4% 100.0%16.5% 10.2% 13.6%8.9% 4.7% 13.6%

30 30 6032.4 27.6 60.0

50.0% 50.0% 100.0%23.6% 27.8% 25.5%12.8% 12.8% 25.5%

1 1 21.1 .9 2.0

50.0% 50.0% 100.0%.8% .9% .9%.4% .4% .9%127 108 235

127.0 108.0 235.054.0% 46.0% 100.0%

100.0% 100.0% 100.0%54.0% 46.0% 100.0%

CountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of TotalCountExpected Count% within Annual Income% within Assigned Group% of Total

Less than $15,000

$15,000 - $25,000

$25,000 - $35,000

$35,000 - $45,000

$45,000 - $55,000

$55,000 - $65,000

Over $65,000

Don't Know

Total

Guided (E) Standard (C)Assigned Group

Total


The race of adopted children is also predominant in one category—91 percent of all children in the study are White. Roughly four percent are Black, and a small percentage are American Indian/Alaskan Native, Asian & Pacific Islander, and Unable to Determine.

Table 13

Child Race by Assigned Group

December 2003


(E) Standard

(C)

Total

Race White Count 244 179 423 Expected Count 237.0 186.0 423.0 % within Race 57.7% 42.3% 100.0% % within Assigned Group 93.8% 87.7% 91.2% Residual 7.0 -7.0 Black Count 7 12 19 Expected Count 10.6 8.4 19.0 % within Race 36.8% 63.2% 100.0% % within Assigned Group 2.7% 5.9% 4.1% Residual -3.6 3.6 American Indian / Count 2 5 7 Alaskan Native Expected Count 3.9 3.1 7.0 % within Race 28.6% 71.4% 100.0% % within Assigned Group .8% 2.5% 1.5% Residual -1.9 1.9 Asian & Pacific Count 1 4 5 Islander Expected Count 2.8 2.2 5.0 % within Race 20.0% 80.0% 100.0% % within Assigned Group .4% 2.0% 1.1% Residual -1.8 1.8 Unable to Determine Count 6 4 10 Expected Count 5.6 4.4 10.0 % within Race 60.0% 40.0% 100.0% % within Assigned Group 2.3% 2.0% 2.2% Residual .4 -.4 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within Race 56.0% 44.0% 100.0% % within Assigned Group 100.0% 100.0% 100.0% When parents were asked if they are the same race as the child, the majority said yes. Of the 11 percent who said no (41 parents), 15 percent (six parents) said this racial difference made a difference in their relationship with the child. Some parents mentioned that the race difference is a positive, enriching experience. Others mentioned noticing reactions from the community. Two parents mentioned their efforts in trying to learn about the child’s culture and background


Adopted children in the study live with families that largely are married couples. Eighty-eight percent of families are married couples, 2 percent are unmarried couples, ten percent are single mothers, and less than 1 percent are single fathers.

Table 14

Family Structure by Assigned Group

December 2003

Assigned Group

Guided (E)

Standard (C)

Total

FamStruc Married Couple Count 277 233 510 Expected Count 272.5 237.5 510.0 % within FamStruc 54.3% 45.7% 100.0% % within Assigned Group 89.1% 86.0% 87.6% % of Total 47.6% 40.0% 87.6% Residual 4.5 -4.5 Unmarried Couple Count 6 6 12 Expected Count 6.4 5.6 12.0 % within FamStruc 50.0% 50.0% 100.0% % within Assigned Group 1.9% 2.2% 2.1% % of Total 1.0% 1.0% 2.1% Residual -.4 .4 Single Female Count 26 29 55 Expected Count 29.4 25.6 55.0 % within FamStruc 47.3% 52.7% 100.0% % within Assigned Group 8.4% 10.7% 9.5% % of Total 4.5% 5.0% 9.5% Residual -3.4 3.4 Single Male Count 2 3 5 Expected Count 2.7 2.3 5.0 % within FamStruc 40.0% 60.0% 100.0% % within Assigned Group .6% 1.1% .9% % of Total .3% .5% .9% Residual -.7 .7 Total Count 311 271 582 Expected Count 311.0 271.0 582.0 % within FamStruc 53.4% 46.6% 100.0% % within Assigned Group 100.0% 100.0% 100.0% % of Total 53.4% 46.6% 100.0%


Table 15

Pre-Adoption Relationship to Child by Assigned Group

December 2003

As mentioned earlier, the majority of families were first foster parents to the child. Sixty-eight percent identify themselves as foster parents who are not related to the child—only 12 (less than 5%) parents thus far in the study have been foster parents and relatives to the child. Four percent of respondents are relatives of the child or friends of the family. Twenty-three percent were neither foster parents nor relatives to the child.


(E) Standard

(C)

Total

Pre-Adoption Foster Parent and Count 9 3 12 Relationship Relative Expected Count 6.6 5.4 12.0 to Child % within Relationship to Child 75.0% 25.0% 100.0% % within Assigned Group 6.4% 2.6% 4.7% Residual 2.4 -2.4 Foster Parent Count 95 79 174 Non-relative Expected Count 95.8 78.2 174.0 % within Relationship to Child 54.6% 45.4% 100.0% % within Assigned Group 67.4% 68.7% 68.0% Residual -.8 .8 Relative Count 7 3 10 Expected Count 5.5 4.5 10.0 % within Relationship to Child 70.0% 30.0% 100.0% % within Assigned Group 5.0% 2.6% 3.9% Residual 1.5 -1.5 Friend of Biological Count 1 1 2 Family Expected Count 1.1 .9 2.0 % within Relationship to Child 50.0% 50.0% 100.0% % within Assigned Group .7% .9% .8% Residual -.1 .1 None of the Above Count 29 29 58 Expected Count 31.9 26.1 58.0 % within Relationship to Child 50.0% 50.0% 100.0% % within Assigned Group 20.6% 25.2% 22.7 Residual -2.9 2.9 Total Count 141 115 256 Expected Count 141.0 115.0 256.0 % within Relationship to Child 55.1% 44.9% 100.0% % within Assigned Group 100.0% 100.0% 100.0%


Sometimes children who are newly adopted join a family with a child(ren) who has previously been adopted and is receiving federal Title IVE subsidy. This then qualifies both the current and previously adopted child(ren) to be in the study sample. However, the fact that some children in the study are part of the same family could potentially be a limitation to the research. Most inferential statistical techniques assume that members of a population are randomly and independently drawn—that the fact that one child became a member of the sample should not have any relationship to the probability of another child becoming a member of the sample. Lack of independence of observations can compromise the significance and power of certain statistical tests. Therefore, we plan to closely monitor the percentages of the two groups (Current and Previous) as well as any differences between them. Overall, 84 percent of children are current adoptions (85% of Guided; 83% of Standard) and 16 percent (16% of Guided; 17% of Standard) are previous adoptions.

Table 16

Number of Children: Current or Previous Adoption Baseline by Assigned Group

December 2003


(E) Standard

(C)

Total

Is Child Current Adoption Count 219 169 388 Current or Expected Count 217.4 170.6 388.0 Previous Adoption?

% within is Child Current or Previous Adoption? 56.4% 43.6% 100.0%

% within Assigned Group 84.2% 82.8% 83.6% Residual 1.6 -1.6 Previous Adoption Count 41 35 76 Expected Count 42.6 33.4 76.0 % within is Child Current

or Previous Adoption? 53.9% 46.1% 100.0%

% within Assigned Group 15.8% 17.2% 16.4% Residual -1.6 1.6 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within is Child Current

or Previous Adoption? 56.0% 44.0% 100.0%

% within Assigned Group 100.0% 100.0% 100.0%


We receive state data on children from the Maine Automated Child Welfare Information System (MACWIS). This data provides us information on the number of a child’s previous placements in foster care and how long he/she has been in the foster care system. The overall average number of previous placements is two (1.8 for both Guided and Standard). The number of placements ranged from zero to eight. The average number of years a child has been in foster care is 4 (3.93 for Guided and 3.86 for Standard).

Table 17 Average Number of Child's Previous Foster Care Placements


Table 18 Average Number of Years Child Has Been in Foster Care


Number of Previous Placements Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 1.82 162 1.405 1.00 Standard (C) 1.80 129 .995 2.00 Total 1.81 291 1.238 2.00

Total Years in Foster Care Assigned Group

Mean

N

Std. Deviation

Median

Guided (E) 3.93 149 2.22758 3.75 Standard (C) 3.86 .124 2.55797 3.333 Total 3.90 273 2.37906 3.667


The General Accounting Office issued a report in June 2002, “Foster Care: Recent Legislation Helps States Focus on Finding Permanent Homes for Children but Long-Standing Barriers Remain.” Based on national child welfare data sets, statistical reports, and state surveys, the report examined foster care and adoption trends since the 1997 Adoption and Safe Families Act (AFSA). One of the variables analyzed was children’s average length of stay in foster care. Specifically, the GAO examined length of stay for children who were adopted from foster care (FY 1998-2000). The graph below displays how length of stay compares between the Adoption Guides study children and the GAO national sample.

Chart 1 National Data Compared to Adoption Guides

Table 19 Average Time Child Has Lived in the Home (mean amounts -- in months)


Assigned Group

N

Mean

Std. Deviation

Median Time in Home Guided (E) 254 35.36 28.929 28.50 Standard (C) 195 34.60 31.000 25.00 Total 449 35.03 29.815 27.00

On average, children have lived in their present home for just under four years (35.4 months for Guided children and 34.6 months for Standard children).

Child's Total Time In Foster Care

0 20 40 60 80 100

0 - 12 Months

13 - 24 Months

25 - 36 Months

37 - 48 Months

More than 4 years

Tim

e in

Fos

ter C

are

Percent of Children

Federal Report

Adoption Guides

MAGS June 2002


Table 20


December 2003

Median Number of Days Out of Home Baseline 6 Months 12 Months 18 Months 24 Months 30 Months 36 Months Guided 20 (n=5) 12.5 (n=8) 20.5 (n=4) 8 (n=3) 95 (n=4) 20.5 (n=2) -- Standard 7 (n=7) 5 (n=5) 3 (n=2) 60 (n=1) 41 (n=2) 14 (n=1) 9 (n=3) Overall 13 (n=12) 11 (n=13) 15.5 (n=6) 29.5 (n=4) 78 (n=6) 14 (n=3) 9 (n=3) At baseline, there were 12 children who were reported to be out of the home due to a problem—the median number of days was 13. At 6 months, there were 13 children out for a median number of 11 days. At twelve months, there were six children out for a median number of 15.5 days; at 18 months, four children were out for a median number of 29.5 days, at 24 months, six children were out for a median of 78 days. At 30 months and 36 months in the study, three children were out of the home for a median number of 14 and 9 days respectively.

Table 21 Time in Study (mean amounts -- in months)

By Cohort and Assigned Group December 2003

CWave

Assigned Group

N

Mean

Std.

Deviation

Std. Error Mean

Cohort One Guided (E) 56 42.16 3.324 .444 Standard (C) 61 41.25 5.790 .741 Cohort Two Guided (E) 88 26.55 4.088 .436 Standard (C) 48 25.73 4.574 .660 Cohort Three Guided (E) 63 15.78 3.850 .485 Standard (C) 59 15.53 3.481 .453 Cohort Four Guided (E) 53 5.30 2.591 .356 Standard (C) 36 4.89 2.135 .356


Table 22 Percent of Children in Study Legally Adopted – At 6 – 24 Months In Study


Table 23 Child Behavior Problems Before Legalization – Baseline

December 2003

Respondents answered per child and chose from one or more of 11 problem type behaviors. Means represent the sum of the total behavior problems.

Guided Services Standard Services

N = 240

Mean = 3.91 SD = 2.937

N= 190

Mean = 3.79 SD = 2.965

6 Months 12 Months 18 Months 24 Months

Guided Services

87% 94%

99% 100%

Standard Services

87%

96%

100% 100%


Table 24 Is the Child Currently Attending School

by Assigned Group

December 2003


(E) Standard

(C)

Total

Is Child Yes Count 209 156 365 Attending Expected Count 204.5 160.5 365.0 School? % within is Child Attending

School? 57.3% 42.7% 100.0%

% within Assigned Group 80.4% 76.5% 78.7% Residual 4.5 -4.5 No Count 51 48 99 Expected Count 55.5 43.5 99.0 % within is Child Attending

School? 51.5% 48.5% 100.0%

% within Assigned Group 19.6% 23.5% 21.3% Residual -4.5 4.5 Total Count 260 204 464 Expected Count 260.0 204.0 464.0 % within is Child Attending

School? 56.0% 44.0% 100.0%

% within Assigned Group 100.0% 100.0% 100.0%

Table 25 Child's Grade Level by Assigned Group

December 2003

Assigned Group Group Total Guided (E) Standard (C)

Count Col% Count Col%

Count

Col% Child’s Not in School 89 34.2% 79 38.7% 168 36.2% Grade 1 22 8.5% 17 8.3% 39 8.4% Level 10 2 .8% 3 1.5% 5 1.1% 11 3 1.2% 2 1.0% 5 1.1% 12 3 1.2% 3 1.5% 6 1.3% 2 18 6.9% 13 6.4% 31 6.7% 3 21 8.1% 13 6.4% 34 7.3% 4 15 5.8% 13 6.4% 28 6.0% 5 14 5.4% 13 6.4% 27 5.8% 6 14 5.4% 6 2.9% 20 4.3% 7 7 2.7% 7 3.4% 14 3.0% 8 6 2.3% 9 4.4% 15 3.2% 9 9 3.5% 2 1.0% 11 2.4% K 33 12.7% 24 11.8% 57 12.3% Pre K 4 1.5% 4 .9% Group Total 260 100.0% 204 100.0% 464 100.0%�


Table 26 Child Has Individualized Education Plan (IEP)

Children Age Five and Older by Assigned Group

December 2003


(E) Standard

(C)

Total

Child has Yes Count 75 60 135 Expected Count 73.7 61.3 135.0 Individualized % within Child has IEP? 55.6% 44.4% 100.0% Education Plan? % within Assigned Group 50.3% 48.4% 49.5% Residual 27.5% 22.0% 49.5% No Count 1.3 -1.3 Expected Count 73 62 135 % within Child has IEP? 73.7 61.3 135.0 % within Assigned Group 54.1% 45.9% 100.0% Residual 49.0% 50.0% 49.5% Don’t Know Count 0 1 1 Expected Count .5 .5 1.0 % within Child has IEP? .0% 100.0% 100.0% % within Assigned Group .0% .8% .4% Residual .0% .4% .4% NA/Refused Count -.5 .5 Expected count 1 1 2 % within Child has IEP? 1.1 .9 2.0 % within Assigned Group 50.0% 50.0% 100.0% Residual .7% .8% .7% Total Count .4% .4% .7% Expected Count -.1 .1 % within Child has IEP? 149 124 273 % within Assigned Group 149.0 124.0 273.0


Less than one-third of children in the study have clinically diagnosed disabilities—29 percent of Guided children and 26 percent of Standard children. The most common diagnoses are emotionally disturbed, ADHD, and “other” conditions such as post-traumatic stress disorder, attachment disorder, asthma, ODD, developmental delays, Fetal Alcohol Syndrome, and speech problems. Percentages of diagnoses are in the following table.

Table 27 Clinically Diagnosed Disabilities

December 2003

69 29.0% 169 71.0%21 8.8% 217 91.2%37 15.5% 201 84.5%20 8.4% 218 91.6%66 27.7% 172 72.3%54 22.7% 184 77.3%

123 51.7% 115 48.3%49 25.8% 141 74.2%10 5.3% 180 94.7%28 14.7% 162 85.3%

9 4.7% 181 95.3%61 32.1% 129 67.9%57 30.2% 132 69.8%

114 60.0% 76 40.0%

Clinically Diagnosed DisabilityMental RetardationVisual or Hearing ImpairmentPhysically DisabledEmotionally DisturbedADHDOther Diagnosed Condition

Guided(E)

Clinically Diagnosed DisabilityMental RetardationVisual or Hearing ImpairmentPhysically DisabledEmotionally DisturbedADHDOther Diagnosed Condition

Standard(C)

Count %Yes

Count %No


Table 28 Child Taking Behavioral/Emotional Medication


68 58 12670.2 55.8 126.0

54.0% 46.0% 100.0%28.5% 30.5% 29.4%15.9% 13.5% 29.4%

-2.2 2.2 171 132 303

168.8 134.2 303.056.4% 43.6% 100.0%71.5% 69.5% 70.6%39.9% 30.8% 70.6%

2.2 -2.2 239 190 429

239.0 190.0 429.055.7% 44.3% 100.0%

100.0% 100.0% 100.0%55.7% 44.3% 100.0%

Count Expected Count % within Taking Medication?% within AssignedGroup% of Total Residual Count Expected Count % within Taking Medication?% within AssignedGroup% of Total Residual Count Expected Count % within Taking Medication?% within AssignedGroup% of Total

Yes

No

Total

Guided (E) Standard (C) AssignedGroup

Total


2. SELECT FAMILY LEVEL VARIABLES The following are a set of results on some of the key family level variables for this study. Unless otherwise noted, the between group comparisons are not statistically significant.

Table 29 Quality of Home Life in Past Six Months at Baseline

December 2003 1 = Excellent to 5 = Poor


N=141 Mean = 1.41

SD = .568

N=115 Mean = 1.52

SD = .549

Table 30 Quality of Home Life in Past Six Months at 6 - 36 Months in Study



Six Months N = 99 Mean = 1.95

SD = .838

N=83 Mean = 1.94

SD = .738 12 Months N=82

Mean = 2.04 SD = .793

N=69 Mean = 2.07

SD = .846 18 Months* N = 60

Mean = 1.98 SD = .965

N=41 Mean = 2.29

SD = .814 24 Months N = 41

Mean = 2.12 SD = .921

N=30 Mean = 2.27

SD = .834 30 Months N = 22

Mean = 2.09 SD = 1.029

N = 16 Mean = 2.19

SD = .834 36 Months N = 13

Mean = 2.38 SD = 1.044

N = 11 Mean = 2.55

SD = .820


Table 31 Satisfaction with Marriage/Partnership at Baseline Only

December 2003 1 = Very High to 5 = Very Low

Guided Services Standard Services N=128

Mean = 1.46 SD = .675

N=101 Mean = 1.48

SD = .593

Table 32 Concerns about Adopting a Child - Baseline Only

December 2003 Respondents could indicate more than one concern.

GUIDED

SERVICES (n=123)

STANDARD SERVICES

(n=103)

TOTAL (n=226)

HOW TO MEET CHILD’S NEEDS

68% 68% 68%

CHILD ACCEPTING ME 49% 47% 48% OTHER CHILDREN’S

REACTION 52% 42% 47%

ABLE TO AFFORD ADDITIONAL COSTS

40% 34% 37%

ABILITY TO CONTINUE TO WORK

38% 32% 35%

EFFECT ON MARRIAGE 36% 28% 32% HOW

RELATIVES/FRIENDS WOULD FEEL

28% 30% 29%

BEING QUALIFIED ENOUGH TO DEAL

WITH CHILD NEEDS

28% 25% 27%

OTHER CONCERNS1 18% 19% 19% MEETING LEGAL

OBLIGATIONS 13% 11% 12%


Table 33 Reasons for Adopting a Child – Baseline of Total Study Population

December 2003 Respondents could indicate more than one reason to adopt. Respondents were asked different questions

depending on relationship to child. Reasons are in order of most to least common.

GUIDED SERVICES STANDARD SERVICES TOTAL WANTED TO MAKE IT

LEGAL 106 80 186

(n = 198) FELT CLOSE TO CHILD 105 81 186

(n = 198) WANTED CHILD TO

FEEL SECURE 109 7 186

(n = 198) OUR CHILDREN WERE ATTACHED TO CHILD

59 52 111 (n = 196)

DID NOT WANT TO LOSE CONTACT WITH

CHILD

60 37 97 (n = 198)

WANTED TO PREVENT

STRANGERS FROM RAISING CHILD

48 42 90 (n = 195)

COULD NOT HAVE ANY BIRTH CHILDREN

48 42 90 (n = 243)

PREFERRED ADOPTION TO FOSTER CARE

52 30 82 (n = 196)

CHILD WOULD FEEL REJECTED IF WE DID

NOT ADOPT

41 29 70 (n = 196)

ALWAYS WANTED A BOY/GIRL

33 30 63 (n = 255)

HAD SUCCESS WITH OTHER ADOPTIONS

28 30 58 (n = 256)

CHILD WOULD BE GOOD COMPANION

FOR OTHER CHILD(REN)

22 29 51 (n = 252)

OTHER CONCERN 24 21 45 (n = 243)

OUR OTHER CHILDREN ARE GROWN

24 17 41 (n = 255)

TO PREVENT OTHER RELATIVE FROM RAISING CHILD

7 4 11 (n = 24)

HAD A CHILD WHO DIED

7

3 10 (n = 256)

FELT OBLIGATION TO CHILD

6 3 9 (n = 24)

FAMILY MEMBERS URGED US TO ADOPT

5 0 5 (n = 196)

AGENCY PRESSURED US TO ADOPT

1 1 2 (n = 82)


Table 34 Background of Adoptive Parents - Total Population

December 2003 Respondents could indicate more than one characteristic.

Primary

Caregiver Spouse/

Partner TOTAL Number

CAME FROM LARGE FAMILY

140 (55%) 105 (46%) 245

IS A RELATIVE/FRIEND OF FOSTER/ADOPTIVE PARENT

98 (38%) 55 (24%) 153

WORKED WITH HANDICAPPED CHILDREN

96 (38%) 26 (11%) 122

IS A RELATIVE/FRIEND OF ADOPTED/FOSTER CHILD

66 (26%) 38 (17%) 104

WAS ABUSED AS A CHILD 33 (13%) 12 (5%) 45

HAD ADOPTED/FOSTER SIBLINGS

27 (11%) 11 (5%) 38

PARENT DIED IN CHILDHOOD

21 (8%) 11 (5%) 32

WAS SERIOUSLY NEGLECTED AS A CHILD

14 (6%) 12 (5%) 26

WAS AN ADOPTED CHILD 11 (4%) 6 (3%) 17 WAS A FOSTER CHILD 8 (3%) 6 (3%) 14

ABANDONED BY PARENTS 5 (2%) 3 (1%) 8 RAISED BY NON-RELATIVES 4 (2%) 4 (2%) 8

LIVED IN/OUT OF FOSTER HOMES/INSTITUTIONS AS A

CHILD

4 (2%) 3 (1%) 7

LIVED IN AN INSTITUTION AS A CHILD

1 (.5%) 0 1


Table 35 Spouse/Partner Attitude Toward Adoption – Baseline

December 2003

Partner's Attitude Towards Adoption * AssignedGroup Crosstabulation

84 77 161

52.2% 47.8% 100.0%

66.1% 76.2% 70.6%9 5 14

64.3% 35.7% 100.0%

7.1% 5.0% 6.1%29 18 47

61.7% 38.3% 100.0%

22.8% 17.8% 20.6%

3 0 3

100.0% .0% 100.0%

2.4% .0% 1.3%1 1 2

50.0% 50.0% 100.0%

.8% 1.0% .9%1 0 1

100.0% .0% 100.0%

.8% .0% .4%127 101 228

55.7% 44.3% 100.0%

100.0% 100.0% 100.0%

Count% within Partner'sAttitude TowardsAdoption% within AssignedGroupCount% within Partner'sAttitude TowardsAdoption% within AssignedGroupCount% within Partner'sAttitude TowardsAdoption% within AssignedGroup

Count% within Partner'sAttitude TowardsAdoption% within AssignedGroupCount% within Partner'sAttitude TowardsAdoption% within AssignedGroupCount% within Partner'sAttitude TowardsAdoption% within AssignedGroupCount% within Partner'sAttitude TowardsAdoption% within AssignedGroup

Felt the SameWay You Did

Was More Eagerto Adopt

Had MoreConcerns thanYou

Was IndifferentTo It

Was Against It

NA/Refused

Total

Guided(E)

Standard(C)

AssignedGroup

Total


Table 36 Caregiver Rates Overall Level of Communication w/Adopted Child – Baseline

December 2003 Respondent answers for each adopted child.

1 = Excellent to 4 = Poor


Mean = 1.70 SD = .673

N=183 Mean = 1.69

SD = .667

Table 37 Caregiver Rates Overall Level of Communication w/Adopted Child

At 6 – 36 Months December 2003

Respondent answers for each adopted child. 1 = Excellent to 4 = Poor


6 Months N = 174 Mean = 1.70

SD = .731

N=129 Mean = 1.74

SD = .710 12 Months N=147

Mean = 1.72 SD = .738

N=111 Mean = 1.89

SD = .994 18 Months* N = 110

Mean = 1.81 SD = .765

N=73 Mean = 1.86

SD = .729 24 Months N = 80

Mean = 1.85 SD = .765

N=48 Mean = 1.79

SD = .898 30 Months N = 48

Mean = 1.96 SD = .899

N=26 Mean = 1.96

SD = .900 36 Months N = 26

Mean = 1.81 SD = .694

N=18 Mean = 1.89

SD = .900


Table 38 Do you trust your child? at Baseline

December 2003 1 = Yes 2 = No


77% state YES N=183

70% state YES

Table 39 Do you trust your child at 6 - 36 Months

December 2003 1 = Yes 2 = No

Guided Services Standard Services 6 Months 72% state YES 62% state YES 12 Months 69% state YES 63% state YES 18 Months* 66% state YES 49% state YES 24 Months 66% state YES 56% state YES

30 Months 73% state YES 54% state YES

36 Months** 73% state YES 33% state YES

*There is a statistically significant difference between groups at this wave of data collection (.030). **There is a statistically significant difference between groups at this wave of data collection (.009).


Table 40 When Did You Feel Child was Permanently Yours -- at Baseline

December 2003 Caregiver answered for each adopted child.

When Child Was Permanently Yours * AssignedGroup Crosstabulation

65 58 12352.8% 47.2% 100.0%27.9% 34.1% 30.5%

34 11 4575.6% 24.4% 100.0%14.6% 6.5% 11.2%

125 94 21957.1% 42.9% 100.0%

53.6% 55.3% 54.3%

1 1 250.0% 50.0% 100.0%

.4% .6% .5%8 6 14

57.1% 42.9% 100.0%3.4% 3.5% 3.5%

233 170 40357.8% 42.2% 100.0%

100.0% 100.0% 100.0%

Count% When Permanent% within AssignedGroupCount% When Permanent% within AssignedGroupCount% When Permanent% within AssignedGroup

Count% When Permanent% within AssignedGroupCount% When Permanent% within AssignedGroupCount% When Permanent% within AssignedGroup

When He/She FirstCame to Live With You

When the AdoptionWas Finalized

At Some Other Point inTime

Don't Know

NA/Refused

Total


Total

Table 41 Level of Agreement with: I Believe the Child is Permanently Mine

at 6 – 36 Months December 2003

Caregiver answered for each adopted child.

172 89.1% 15 7.8% 5 2.6% 1 .5%135 91.2% 6 4.1% 5 3.4% 1 .7% 1 .7%142 91.0% 12 7.7% 1 .6% 1 .6%

111 94.9% 2 1.7% 2 1.7% 2 1.7%

107 93.0% 8 7.0% 70 93.3% 4 5.3% 1 1.3%79 97.5% 2 2.5%46 95.8% 2 4.2%45 93.8% 2 4.2% 1 2.1%26 100.0% 25 96.2% 1 3.8%18 100.0%

Guided (E)Standard (C)Guided (E)Standard (C)

Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)

Time inStudy6Months12Months

18Months24Months30Months36Months

Strongly Agree Agree Undecided Disagree Strongly Disagree


Table 42 Family Members Attachment to Child - Baseline

December 2003

Respondent answers for each adopted child. 1 = Very Attached to 4 = Not at All Attached


N=233 Mean = 1.24

SD = .823

N=180 Mean = 1.22

SD = .829

Table 43 Family Members Attachment to Child at 6 – 36 Months


1 = Very Attached to 4 = Not at All Attached

Guided Services Standard Services 6 Months N = 193

Mean = 1.92 SD = 1.541

N=148 Mean = 1.70 SD = 1.549

12 Months N = 156 Mean = 1.92 SD = 1.475

N=117 Mean = 1.70

SD = .922 18 Months* N = 115

Mean = 1.75 SD = 1.302

N=75 Mean = 2.43 SD = 2.348

24 Months N = 81 Mean = 1.99 SD = 1.654

N=48 Mean = 2.33 SD = 2.177

30 Months N = 48 Mean = 1.73 SD = 1.125

N=26 Mean = 1.85 SD = 1.515

36 Months N = 26 Mean = 1.92 SD = 1.129

N=16 Mean = 2.00 SD = 1.085

*There is a statistically significant difference between groups at this wave of data collection (.008).


Table 44 Overall Satisfaction with Adoption – Baseline


1 = Strongly Satisfied to 4 = Not at All Satisfied

169 72% 50 21% 9 4% 6 3%

152 65% 40 17% 12 5% 9 4%

142 60% 35 15% 8 3% 10 4%

178 76% 23 9.8% 7 3% 5 2%

139 77% 26 14% 7 4% 8 4%

122 69% 24 14% 8 5% 8 5%

105 59% 26 15% 9 5% 6 3%

132 74% 14 7.8% 5 3% 5 3%

Satisfaction withAdoption ProcessSpouse's Satisfactionwith AdoptionOther Children'sSatisfaction withAdoptionChild's Satisfactionwith Adoption

Guided(E)

Satisfaction withAdoption ProcessSpouse's Satisfactionwith AdoptionOther Children'sSatisfaction withAdoptionChild's Satisfactionwith Adoption

Standard(C)

Very Strongly Moderately Slightly Not at All


Table 45 Child Contact with Birth Family - Baseline

December 2003

Birth Family Contact Since Living With You? * AssignedGroupCrosstabulation

189 132 32158.9% 41.1% 100.0%80.4% 73.3% 77.3%

46 48 9448.9% 51.1% 100.0%19.6% 26.7% 22.7%

235 180 41556.6% 43.4% 100.0%

100.0% 100.0% 100.0%

Count% Birth Family Contact% within AssignedGroupCount% Birth Family Contact% within AssignedGroupCount% Birth Family Contact% within AssignedGroup

Yes

No

Total


Total

Table 46 Talk to Child About Birth Family – Baseline

December 2003 Caregiver answer for each adopted child.

Discuss Child's Birth Family With Him/Her * AssignedGroup Crosstabulation

181 136 317

57.1% 42.9% 100.0%

77.0% 75.6% 76.4%54 44 98

55.1% 44.9% 100.0%

23.0% 24.4% 23.6%235 180 415

56.6% 43.4% 100.0%

100.0% 100.0% 100.0%

Count% within Discuss Child'sBirth Family With Him/Her% within AssignedGroupCount% within Discuss Child'sBirth Family With Him/Her% within AssignedGroupCount% within Discuss Child'sBirth Family With Him/Her% within AssignedGroup

Yes

No

Total


Total


Table 47

Talk to Child About Birth Family at 6 – 36 Months December 2003

Caregiver answer for each adopted child.

154 79.8% 113 76.4%39 20.2% 35 23.6%

124 80.0% 88 75.2%31 20.0% 29 24.8%94 81.7% 60 80.0%21 18.3% 15 20.0%66 81.5% 39 81.3%15 18.5% 9 18.8%41 85.4% 22 84.6%

7 14.6% 4 15.4%24 92.3% 15 83.3%

2 7.7% 3 16.7%

YesNoYesNoYesNoYesNoYesNoYesNo

Time in Study6 Months in Study

12 Months in Study

18 Months in Study

24 Months in Study

30 Months in Study

36 Months in Study

Guided (E) Standard (C)

Assigned Group

Table 48 Total Mean Scores of Parent Caregiving Behaviors – Baseline


Mean overall scores for how often parent provided seven positive care-giving behaviors to child. Rating is 1=Never to 4=Everyday.


N=229 Mean = 3.72

SD = .311

N=176 Mean = 3.68

SD = .378


Table 49 Total Mean Scores of Parent Caregiving Behaviors at 6 - 36 Months


Mean overall scores for how often parent provided seven positive care-giving behaviors to child. Rating is 1=Never to 4=Everyday.


6 Months N = 174 Mean = 3.63

SD = .370

N= 128 Mean = 3.63

SD = .370 12 Months N = 147

Mean = 3.57 SD = .448

N= 111 Mean = 3.62

SD = .378 18 Months N = 110

Mean = 3.64 SD = .358

N= 72 Mean = 3.55

SD = .433 24 Months N = 80

Mean = 3.57 SD = .399

N= 48 Mean = 3.57

SD = .347 30 Months N = 48

Mean = 3.50 SD = .399

N= 26 Mean = 3.63

SD = .347 36 Months N = 26

Mean = 3.44 SD = .398

N= 18 Mean = 3.57

SD = .539


Table 50 Total Mean Scores of Parent/Child Disagreements – Baseline

December 2003

Respondent answers for each adopted child. Mean overall scores for how often parent experiences eight disagreement type behavior with child.

Rating is 1=Never to 4=Everyday.


Mean = 1.62 SD = .418

N=170 Mean = 1.61

SD = .431

Table 51

Total Mean Scores of Parent/Child Disagreements at 6 – 36 Months December 2003

Respondent answers for each adopted child. Mean overall scores for how often parent experiences eight disagreement type behavior with child.

Rating is 1=Never to 4=Everyday.

Guided Services Standard Services 6 Months N = 174

Mean = 1.65 SD = .392

N=129 Mean = 1.67

SD = .424 12 Months N = 147

Mean = 1.63 SD = .406

N=111 Mean = 1.65

SD = .415 18 Months N = 110

Mean = 1.67 SD = .409

N=73 Mean = 1.71

SD = .470 24 Months N = 80

Mean = 1.65 SD = .371

N=48 Mean = 1.75

SD = .437 30 Months N = 48

Mean = 1.67 SD = .399

N=26 Mean = 1.78

SD = .427 36 Months* N = 26

Mean = 1.69 SD = .464

N=18 Mean = 2.01

SD = .515 *There is a statistically significant difference between groups at this wave of data collection (.041).


Table 52 Health Status of Primary Caregiver – Baseline

December 2003 (Rand 36-Item Health Survey, 1992)

A high score (top score = 100) defines a more favorable health state.

Group Statistics

128 87.7886 13.07536 1.15571110 87.3737 13.95482 1.33054128 93.8477 16.22584 1.43417

110 91.9318 18.74705 1.78746

128 93.4896 16.23245 1.43476109 95.7187 12.08757 1.15778127 63.2021 17.55516 1.55777109 61.4832 16.05568 1.53786127 80.0945 11.89867 1.05584109 81.8716 10.23529 .98036128 92.7734 15.73412 1.39071109 95.2982 10.45673 1.00157127 84.8425 14.76586 1.31026109 87.8440 13.99598 1.34057128 77.3828 10.18582 .90031110 77.2727 10.12845 .96571

AssignedGroupGuided (E)Standard (C)Guided (E)Standard (C)

Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)Guided (E)Standard (C)

Physical Functioning

Role Limitations Dueto Physical Health

Role Limitations Dueto Emotional HealthEnergy/Fatigue

Emotional Well-being

Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean


Table 53 Health Status of Primary Caregiver – Six Months in Study



Group Statisticsa

99 86.9192 13.38132 1.3448783 84.3842 17.23533 1.8918299 92.4242 18.71324 1.88075

83 91.1145 19.27913 2.11616

99 90.5724 20.22571 2.0327683 94.7791 15.16122 1.6641699 61.1616 16.74887 1.6833283 61.8675 15.63125 1.7157599 78.9495 11.29328 1.1350283 81.3012 11.82157 1.2975999 91.1616 17.96863 1.8059283 92.0181 17.52375 1.9234899 87.5505 14.10592 1.4177083 85.4518 16.76208 1.8398899 75.6313 10.86409 1.0918883 76.3253 11.84463 1.30012







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean

Time by Wave = 6 Months in Studya.


Table 54 Health Status of Primary Caregiver – Twelve Months in Study



Group Statisticsa

81 87.4417 10.96763 1.2186369 85.2456 15.71988 1.8924581 93.8272 14.93782 1.65976

69 90.2174 20.98993 2.52689

81 91.7695 18.65689 2.0729969 92.7536 16.03669 1.9305982 63.1098 16.36090 1.8067669 63.4783 15.88804 1.9126982 80.3415 13.06699 1.4430169 82.2609 11.46818 1.3806181 89.3519 17.12900 1.9032269 89.4928 19.48595 2.3458381 84.8765 16.02196 1.7802269 85.5072 14.83723 1.7861982 76.5091 10.36513 1.1446469 76.7391 11.10862 1.33732







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean



Table 55 Health Status of Primary Caregiver – 18 Months in Study


A high score (top score = 100) defines a more favorable health state. Group Statisticsa

60 86.9815 11.89968 1.5362441 80.2439 27.06361 4.2266360 95.0000 15.64300 2.01950

41 85.0610 28.53445 4.45633

60 93.3333 18.20577 2.3503541 90.2439 22.66164 3.5391560 64.3333 14.45234 1.8657941 60.4878 21.02989 3.2843260 81.7333 12.19873 1.5748541 81.0732 14.45059 2.2568060 91.2500 17.57249 2.2686041 88.4146 23.28328 3.6362460 86.7083 15.19988 1.9623041 81.1585 21.43375 3.3473960 77.4167 10.51600 1.3576141 73.6890 14.61472 2.28244




Role Limitations Dueto Physical Health*



Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean


*statistically significant difference at 18 months in study (.027)





Group Statisticsa

41 88.7195 10.72558 1.6750530 81.7500 20.84580 3.8059141 94.2073 18.13525 2.83225

30 83.7500 28.07587 5.12593

41 95.1220 14.06528 2.1966330 80.0000 32.28228 5.8939141 63.6585 15.00102 2.3427730 57.1667 17.50287 3.1955741 81.4634 9.82878 1.5350030 78.4000 14.42603 2.6338241 94.5122 14.80308 2.3118530 91.6667 15.16196 2.7681841 85.3659 14.83831 2.3173530 81.1667 19.25032 3.5146141 78.0488 9.73897 1.5209730 72.8333 14.42480 2.63360





Role Limitations Dueto Emotional Health*Energy/Fatigue


Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean


*statistically significant difference at 24 months in study (.009)





Group Statisticsa

22 81.8182 21.98730 4.6877116 84.0625 24.23625 6.0590622 92.0455 22.34252 4.76344

16 91.4063 22.69304 5.67326

22 87.8788 21.93172 4.6758616 87.5000 26.87419 6.7185522 64.7727 16.29178 3.4734216 59.6875 14.88498 3.7212422 80.3636 13.00017 2.7716416 77.7500 13.30413 3.3260322 88.0682 19.84961 4.2319516 78.9063 28.03225 7.0080622 86.3636 14.44875 3.0804816 77.1875 24.23625 6.0590622 80.2273 7.93984 1.6927816 72.5000 14.14214 3.53553







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean




December 2003

Group Statistics a

13 80.7692 21.49090 5.9605011 84.7727 18.42059 5.5540213 94.2308 14.97862 4.15432

11 87.5000 24.36699 7.34692

13 97.4359 9.24500 2.5641011 78.7879 34.23035 10.3208413 61.5385 16.12253 4.4715811 50.9091 22.11540 6.6680413 79.6923 11.82782 3.2804511 69.4545 18.95449 5.7149913 90.3846 19.19869 5.3247611 77.2727 31.03334 9.3569013 87.8846 14.31950 3.9715111 78.8636 18.38354 5.5428513 78.0769 10.51556 2.9164911 75.0000 10.48809 3.16228







Social Functioning

Pain

General Health

N MeanStd.

DeviationStd. Error

Mean


Table 59

Cohesion and Adaptability of Family FACES II December 2003

GUIDED SERVICES STANDARD SERVICES

COHESION

A score of 80 reflects a family system that is Very Connected or Enmeshed. A score of 15 reflects

a family system in which members are Disengaged from

each other. Scores in the range of 51 to 70 are considered reflective

of balanced, healthy family systems.

Baseline = 70.06 6 Months = 69.37 12 Months = 68.44 18 Months = 68.64 24 Months = 68.63 30 Months = 67.80 36 Months = 70.47


ADAPTABILITY

A score of 70 reflects a family

system that is Very Flexible. A score of 15 reflects a family that is Rigid. Scores in the 40 to 54

range are considered reflective of balanced, healthy family systems.




Table 60

Parenting Practices: Authoritarian or Authoritative – Cohort One Baseline Only (Adapted from Block, 1965; Kochanska, Kuczynski & Radke-Yarrow, 1989)

December 2003

Mean scores for how parent rates self on parenting practices; Authoritative and Authoritarian scales reported on. Two questionnaires were used – in the first year of the study a questionnaire was used that was an adaptation from Block (1965); a 90-item forced choice instrument asking parent to agree with statements about parenting, 1=Strongly Agree to 5=Strongly Disagree. In the second year and continuing, a shorter further adapted revised version of the Block CRPR was chosen (Kochanska, Kuczynski & Radke-Yarrow, 1989). Many parents expressed difficulty with completing the 90-item questionnaire. The shorter version is 29 items also asking for level of agreement with statements; 1=Not at All Like Me to 6=Highly Descriptive of Me. This shorter version is demonstrated to measure similar dimensions as the original Block CRPR (Kaufman, Gesten, Lucia, Salcedo, Rendina-Gobioff and Gadd, 2000).

Authoritarian Score

( 1 = More Authoritarian to 5 = Less Authoritarian )

Authoritative Score ( 1 = More Authoritative to 5 =

Less Authoritative) Guided Services ( n = 31)

Mean = 3.58

SD = .27

Mean = 2.17

SD = .30

Standard Services ( n= 42)

Mean = 3.52

SD = .29

Mean = 2.04*

SD = .21

Total for Cohort One at Baseline ( n = 73)

Mean = 3.55

SD = .28

Mean = 2.09

SD = .26

*These results indicate that this group of parents view themselves as more Authoritative than Authoritarian in their parenting style. Standard Services parents reporting that they are significantly less Authoritative than Guided Services parents at baseline ( p = .041).


Table 61

Parenting Practices: Authoritarian or Authoritative – Baseline - 36 Months (Adapted from Block, 1965; Kochanska, Kuczynski & Radke-Yarrow, 1989)

December 2003

GUIDED SERVICES STANDARD SERVICES AUTHORITATIVE

PRACTICES

Higher scores indicate a more authoritative approach to parenting. Means are against a 1 – 6 scale. *Note: Baseline for Cohort 2 & 3 only

*Baseline = 4.87 (n = 108) 12 Months = 4.73 (n = 85) 24 Months = 4.65 (n = 45) 36 Months = 4.83 (n = 14)

*Baseline = 4.83 (n = 82) 12 Months = 4.72 (n = 73)24 Months = 4.66 (n =33) 36 Months = 4.61 (n = 12)

AUTHORITARIAN PRACTICES

Higher scores indicate a more authoritarian approach to parenting. Means are against a 1 – 6 scale. *Note: Baseline for Cohort 2 & 3 only

*Baseline = 2.83 (n=108) 12 Months = 2.77 (n=85) 24 Months = 2.76 (n=45) 36 Months = 2.84 (n = 14)

*Baseline = 2.74 (n=82) 12 Months = 2.81 (n=73) 24 Months = 2.75 (n=33) 36 Months = 2.67 (n = 12)


3. SELECT CHILD LEVEL VARIABLES

This section provides additional information intended to describe the sample of children in this study based on a select set of variables. Most of this information is collected through questionnaires that the self-selected caregiver completes, or is collected through a telephone interview with that same caregiver. Information is collected approximately once every 6 months.

Child Needs – Most Difficult

As part of the regular telephone interviews, caregivers are asked an open ended question: “In the last six months, if you had to list two or three things about your adopted child/ren’s particular needs that have been the most difficult for you and your family to deal with, what would they be?” The following is a compilation of responses collected at Baseline. The responses were coded into common thematic categories and then categories were counted. There were a total of 471 responses to the First most difficult need; 46 responses to the Second most difficult need; and 14 responses to the Third most difficult need—a total of 531 responses (all Cohorts combined). Parents’ identification of the most difficult types of needs are:

1. Behavioral Problems: 69% of all comments mentioned some type of specific behavior that was of a primary concern to a parent. Behaviors mentioned were numerous and included violent tantrums, not listening, difficulties in school, and sexual acting out behaviors.

2. Aggression/Hyperactivity: 36% of all comments mentioned aggressive and hyperactive behavior specifically as difficult to deal with.

3. Emotional Problems: 33% of all comments mentioned some type of emotional problem that a child was experiencing as a primary need to be addressed. Most often mentioned were problems with attachment or connection to family members.

4. Attention/Needy Behavior: 28% of all responses concerned the attention needs or needy behavior of the child.

5. Learning Disabilities: 27% of all comments mentioned a learning disability as a concern of the parent.

6. Medical Needs: 25% of the responses focused on specific type of medical need that parents were having difficulty responding to: either through their own efforts or having difficulty finding appropriate professional services.

7. Other Issues: Approximately 24% of the responses covered other areas such as lack of services, lack of social skills, internal family issues, and respondent’s own frustrations.


Table 62 Rating of Child’s Overall Health


Guided Services (E) Standard Services (C)

Baseline

N=239 Mean = 1.44 SD = .742

N = 190

Mean = 1.43 SD = .602

6 Months in Study

N = 192

Mean = 1.43 SD = .618

N = 147

Mean = 1.47 SD = .686

12 Months in Study

N = 156

Mean = 1.49 SD = .799

N = 117

Mean = 1.49 SD = .610

18 Months in Study

N = 115

Mean = 1.49 SD = .598

N = 75

Mean = 1.55 SD = .684

24 Months in Study

N = 81

Mean = 1.38 SD = .561

N = 48

Mean = 1.60 SD = .818

30 Months in Study

N = 48 Mean = 1.46 SD = .582

N = 26

Mean = 1.62 SD = .697

36 Months in Study

N = 26 Mean = 1.46 SD = .859

N = 18

Mean = 1.61 SD = .698


Table 63 Rating of Child’s Physical Growth/Development Compared to Peers

December 2003 1 = More Advanced to 3 = Less Advanced


Baseline

N = 237 Mean = 2.05 SD = .636

N = 190

Mean = 2.13 SD = .663

6 Months in Study

N = 193

Mean = 2.05 SD = .589

N = 147

Mean = 2.10 SD = .774

12 Months in Study

N = 156

Mean = 2.06 SD = .784

N = 117

Mean = 2.09 SD = .601

18 Months in Study

N = 115

Mean = 2.02 SD = .562

N = 75

Mean = 2.13 SD = .704

24 Months in Study

N = 81

Mean = 2.07 SD = .565

N = 48

Mean = 2.23 SD = .592

30 Months in Study

N = 48

Mean = 2.08 SD = .539

N = 26

Mean = 2.15 SD = .613

36 Months in Study

N = 26

Mean = 2.00 SD = .400

N = 18

Mean = 2.06 SD = .639


Table 64 Frequency of Positive Behavior Child to Parent

December 2003 Frequency of instances of traits/moods that child exhibits as reported by caregiver;

1 = Never to 4 = Everyday


Baseline

N = 232 Mean = 3.30 SD = .570

N = 182

Mean = 3.29 SD = .438

6 Months in Study

N = 173

Mean = 3.22 SD = .493

N = 128

Mean = 3.29 SD = .483

12 Months in Study

N = 146

Mean = 3.27 SD = .456

N = 111

Mean = 3.25 SD = .473

18 Months in Study

N = 110

Mean = 3.28 SD = .490

N = 72

Mean = 3.19 SD = .555

24 Months in Study

N = 80

Mean = 3.28 SD = .426

N = 48

Mean = 3.18 SD = .592

30 Months in Study

N = 48

Mean = 3.07 SD = .546

N = 26

Mean = 3.23 SD = .570

36 Months in Study

N = 26

Mean = 3.24 SD = .492

N = 18

Mean = 3.17 SD = .541


Table 65 Frequency of Child Positive Traits/Moods

December 2003 Frequency of instances of traits/moods that child exhibits as reported by caregiver;

1 = Never to 4= Everyday


Baseline

N = 238 Mean = 3.54

SD = .541

N = 189

Mean = 3.50 SD = .497

6 Months in Study

N = 192

Mean = 3.50 SD = .541

N = 148

Mean = 3.48 SD = .555

12 Months in Study

N = 155

Mean = 3.47 SD = .564

N = 117

Mean = 3.50 SD = .527

18 Months in Study

N = 115

Mean = 3.49 SD = .521

N = 75

Mean = 3.35 SD = .607

24 Months in Study

N = 81

Mean = 3.44 SD = .529

N = 48

Mean = 3.36 SD = .621

30 Months in Study

N = 47

Mean = 3.26 SD = .659

N = 26

Mean = 3.43 SD = .493

36 Months in Study

N = 26

Mean = 3.44 SD = .571

N = 18

Mean = 3.28 SD = .606


Table 66 Frequency of Child Negative Traits/Moods

December 2003

Frequency of instances of traits/moods that child exhibits as reported by caregiver; 1 = Never to 4= Everyday


Baseline

N = 238 Mean = 2.26

SD = .722

N = 189

Mean = 2.27 SD = .710

6 Months in Study

N = 192

Mean = 2.26 SD = .716

N = 148

Mean = 2.31 SD = .742

12 Months in Study*

N = 155

Mean = 2.18 SD = .643

N = 117

Mean = 2.37 SD = .757

18 Months in Study

N = 115

Mean = 2.29 SD = .725

N = 75

Mean = 2.37 SD = .758

24 Months in Study

N = 81

Mean = 2.32 SD = .756

N = 48

Mean = 2.38 SD = .758

30 Months in Study

N = 48

Mean = 2.31 SD = .706

N = 26

Mean = 2.47 SD = .733

36 Months in Study

N = 26

Mean = 2.21 SD = .734

N = 18

Mean = 2.51 SD = .715

*There is a statistically significant difference between groups at this wave of data collection (.026).


Table 67 Child Attachment to Family

December 2003

Respondent rates level of attachment for each child: 1 = Very Attached to 4 = Not at All Attached


Baseline

N = 235 Mean = 1.38 SD = 1.041

N = 180

Mean = 1.27 SD = .555

6 Months in Study

N = 193

Mean = 1.18 SD = .421

N = 148

Mean = 1.13 SD = .355

12 Months in Study

N = 156

Mean = 1.15 SD = .412

N = 117

Mean = 1.12 SD = .351

18 Months in Study

N = 115

Mean = 1.18 SD = .470

N = 75

Mean = 1.13 SD = .414

24 Months in Study

N = 81

Mean = 1.11 SD = .354

N = 48

Mean = 1.08 SD = .347

30 Months in Study

N = 48

Mean = 1.10 SD = .309

N = 26

Mean = 1.00 SD = .000

36 Months in Study

N = 26

Mean = 1.00 SD = .000

N = 18

Mean = 1.00 SD = .000


Table 68 Child Satisfaction with Adoption

December 2003

Respondent answers for each child: 1= Very Strongly Satisfied to 4 = Not at All Satisfied


Baseline

N = 234 Mean = 1.89 SD = 2.148

N = 179

Mean = 2.17 SD = 2.497

6 Months in Study

N = 188

Mean = 1.39 SD = 1.350

N = 144

Mean = 1.48 SD = 1.546

12 Months in Study

N = 153

Mean = 1.16 SD = .479

N = 113

Mean = 1.17 SD = .441

18 Months in Study

N = 114

Mean = 1.14 SD = .373

N = 73

Mean = 1.18 SD = .452

24 Months in Study

N = 79

Mean = 1.09 SD = .286

N = 47

Mean = 1.38 SD = 1.311

30 Months in Study

N = 48

Mean = 1.46 SD = 1.237

N = 26

Mean = 1.54 SD = 1.630

36 Months in Study

N = 26

Mean = 1.08 SD = .272

N = 15

Mean = 1.07 SD = .258


Table 69 Child Functioning Measure CBCL: Scores in Clinical Need

Young/Old Child Scores at Baseline December 2003

Internalizing Scores Externalizing Scores Total Problem Scores

Young Children Total: n = 138 Mean Age: 4 yrs. Male = 52% Female = 48%

Within Clinical Range = 24%

Within Clinical Range = 26%*


Older Children

Total: n = 306 Mean Age: 11 yrs. Male = 63% Female = 37%




Guided 19%/Standard 35% in Clinical range: statistical difference (.030) Levels of child functioning are being measured through the use of the Child Behavior Checklist (Achenbach et al, 1991). This is an important outcome variable and more information is provided in the next chapter. The table above illustrates the level of need of these children as they exit foster care and join families through adoption. Within clinical range means that those children are functioning at a level where they would need a referral to mental health services. Older children are scoring at higher levels of clinical need at the time of adoption.

Table 70


December 2003

Median Number of Days Out of Home Baseline 6 Months 12 Months 18 Months 24 Months 30 Months 36 Months Guided 20 (n=5) 12.5 (n=8) 20.5 (n=4) 8 (n=3) 95 (n=4) 20.5 (n=2) -- Standard 7 (n=7) 5 (n=5) 3 (n=2) 60 (n=1) 41 (n=2) 14 (n=1) 9 (n=3) Overall 13 (n=12) 11 (n=13) 15.5 (n=6) 29.5 (n=4) 78 (n=6) 14 (n=3) 9 (n=3)

At baseline, there were 12 children who were reported to be out of the home due to a problem—the median number of days was 13. At 6 months, there were 13 children out for a median number of 11 days. At twelve months, there were six children out for a median number of 15.5 days; at 18 months, four children were out for a median number of 29.5 days, at 24 months, six children were out for a median of 78 days. At 30 months


and 36 months in the study, three children were out of the home for a median number of 14 and 9 days respectively. In November 2001, 867 Maine Post-Legalization Adoption Services surveys were mailed to DHS adoptive parents. This was a statewide sample of adoptive parents who receive a IV-E subsidy and the survey was anonymous. The response rate was 44%: a total of 379 surveys were received. Of these 379 respondents, 34 (9%) people indicated that their child had been out of the home in the past year, and 27 (7%) indicated the number of days the child was out of the home. The median number of days children were out of home for the Maine Post-Legalization Adoption Services surveys was 21. Broken into percentages, the resulting data (N=27) is as follows:

• 30% of children were out of the home for less than 10 days • 50% of children were out of the home for less than 52 days • 85% of children were out of the home for 75 days or less


C. SERVICE CHARACTERISTICS 1. TYPES OF SERVICES PROVIDED The types of services that are provided by Adoption Guides social workers are outlined by service code in the discussion of Implementation Issues (Figure 4, pages 16-19). Social workers enter information into a database for every service they provide. Based on that data, we have the following information.

Table 71

Families and Services As Reported by Caseworkers

December 2003

Number of Families

Total Number of Services

Mean Number of Service Hours

by Family Cohort One 26 3836 135.52 Cohort Two 43 3079 48 Cohort Three 32 1602 43.16 Cohort Four 32 819 18.54

The following page gives the breakdown of the types of services.


Table 72 Amounts of Each Type of Service Provided

As Reported by Caseworkers December 2003

Service Year 1

Count Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3 Percent

Year 4 Count

Year 4 Percent

General Parent Education Support

1102 28.7 717 23.3 246 15.3 170 20.8

Collateral Contacts 436 11.4 366 11.9 227 14.2 141 17.2 Building/Maintaining Relationship*

416 10.8 920 29.9 462 28.8 186 22.7

Therapeutic: Adult Group

253 6.6 57 1.9 26 1.6 2 0.2

Therapeutic: Family 228 5.9 98 3.2 43 2.7 20 2.4 Non-Therapeutic Services

218 5.7 83 2.7 79 4.9 39 4.8

Therapeutic: Indiv. Child

291 7.6 72 2.3 44 2.7 42 5.1

Clinical Conversation* 182 4.7 149 4.8 87 5.4 17 2.1 Initial Assessment 79 2.1 202 6.6 106 6.6 104 12.7 Case Plan 100 2.6 143 4.6 50 3.1 20 2.4 Community Resources Referral

93 2.4 39 1.3 24 1.5 10 1.2

Therapeutic: Multiple Social Workers 91 2.4 26 0.8 52 3.2 18 2.2

General Advocacy 63 1.6 44 1.4 16 1.0 11 1.3 Concrete Services 38 1.0 65 2.1 17 1.1 10 1.2 Crisis Stabilization/Follow-up

33 0.9 27 0.9 46 2.9 7 0.9

Educational Advocacy* 36 0.9 14 0.5 13 0.8 5 0.6 Therapeutic: Indiv. Parent

59 1.5 8 0.3 38 2.4 3 0.4

Psychiatric Services 36 0.9 6 0.2 13 0.8 0 0.0 Therapeutic: Children Group

65 1.7 12 0.4 0 0.0 2 0.2

Mental Health Referral 18 0.5 32 1.0 13 0.8 12 1.5 Preparation/Placement 3 0.1 0 0.0 1 0.1 0 0.0

*These service codes have been in place since May 2002. Building/Maintaining Relationship and Clinical Conversation were added to the list of service codes in an attempt to further refine the Parent Education and Support category. Educational Advocacy was added to clarify the Advocacy category. Non-Therapeutic services was added to quantify recreational activities. This table includes only results from actual services to families. In addition, social workers code “Case-Related Documentation,” and “No Contact This Month,” which is discussed below.


The most common service provided is General Parent Education/Support. Other services provided frequently are Building/Maintaining Relationships, Adult Group Therapy, and Family Therapy. Types of services were also analyzed by the amount of time families were in the study.

Table 73 Types of Services Provided To Families

By Time in Study December 2003

Time in Study

First Most Common Service

Second Most Common Service

Third Most Common Service

Fourth Most Common Service

0 – 6 months Parent Education/Support

Initial Assessments Collateral Contacts Building/Maintaining Relationship

7-12 Months Parent Education/Support

Building/Maintaining Relationship

Collateral Contacts Non-therapeutic Services

13 – 18 months

Parent Education/Support


Collateral Contacts Individual Child Therapy

19 – 24 months



Collateral Contacts Family Therapy

25 – 30 months



Collateral Contacts Family Therapy

31 – 36 months



Individual Child Therapy

Therapy: Multiple Social Workers

37 or more months


Individual Child Therapy


Clinical Conversations

At this point in the study, the average number of services provided to each family in Cohort I is 161 (n=26); in Cohort II is 71.6 (n=43); in Cohort III is 50.1 (n=32) and in Cohort IV is 25.6 (n=32). In addition to providing services to Guided children, caseworkers also spend time documenting their casework. Case-related documentation is recorded in the database, and represents seven percent of Cohort I total services, 12 percent of Cohort II total services, 19 percent of Cohort III services and 5 percent of Cohort IV total services. Caseworkers also record when families request “No Contact this Month.” This accounts for two percent of entries for Cohort I, two percent of entries for Cohort II, three percent of Cohort III entries, and one percent of Cohort IV entries. The number of services provided, however, does not reflect the amount of time spent on each service. The mean number of minutes spent on each service is shown in the table below.


Table 74 Mean Number of Minutes Provided for Each Service Type

December 2003

Service N Mean Minutes Standard Deviation

Therapy to Children’s Group 79 136.90 34.75 Non-Therapeutic Services 417 119.21 81.01 Therapeutic: Adult Group 338 90.80 12.89 Therapeutic: Individual Parent 108 90.69 33.91 Therapeutic: Multiple Social Workers 187 89.84 28.04 Educational Advocacy 68 78.31 39.80 Therapeutic: Family 389 77.81 29.64 Therapeutic: Individual Child 449 73.70 28.87 Initial Assessment 491 70.42 58.98 Case Plan 313 62.49 36.48 Clinical Conversations 435 59.83 34.82 Advocacy 134 53.40 46.33 Crisis Stabilization/Follow-Up 113 52.17 57.96 Parent Education/Support 2233 36.81 44.70 Collateral Contacts 1168 26.52 21.81 Community Resources Referral 166 25.66 16.52 Building/Maintaining Relationship 1984 25.21 26.71 Mental Health Referral 75 22.80 15.67 Preparation/Placement 4 22.50 8.66 Concrete Services 130 17.08 7.87 The most minutes per service are spent doing therapeutic work—for children’s groups, adult groups, with individual parents and when clinicians team to work together with a family—and Non-therapeutic services, such as recreational activities and informal get-togethers including picnics and pool parties. Workers spent a total of 3757 hours working with Cohort I families, a total of 2375 hours working with Cohort II families, a total of 1523 hours working with Cohort III families, and a total of 632 hours working with Cohort IV families. The amount of time (minutes) spent working with each family differs—ranging from 15 minutes to 418 hours. Overall, the average number of hours spent with a family is 62.


Table 75 Mean Service Time Minutes Per Service by Cohort

December 2003

Report

Service Time in Minutes

55.1043 3836 46.80247 45.0000 .00 1200.00 211380.0040.3085 3079 41.18121 15.0000 .00 540.00 124110.0051.7509 1602 56.96802 30.0000 .00 570.00 82905.0043.1319 819 46.15062 15.0000 .00 360.00 35325.0048.5990 9336 47.39923 30.0000 .00 1200.00 453720.00

CWave10203040Total

Mean N Std. Deviation Median Minimum Maximum Sum

Until November 2000, there were four caseworkers providing services for Adoption Guides families and entering them into the database at Casey. A fifth worker began entering cases in November 2000, and then in March 2001, more workers were added month by month—until the current number of 13 workers and two team leaders entering services. Social workers record every service they provide including visits with clients, telephone calls or documenting notes in a file. The breakdown of recorded services is as follows:

Table 76 Contact Type For Services Provided

Reported by Caseworkers December 2003

Service Type Year 1

Count Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3 Percent

Year 4 Count

Year 4 Percent

Telephone Contact 1611 39% 1904 56% 927 52% 479 56% In Person: Out of Office 1225 30% 702 20% 359 20% 230 27%

In Person: In Office 838 20% 174 5% 226 13% 36 4%

Documentation 354 9% 525 15% 189 10% 75 9% No Contact 99 2% 77 2% 54 3% 8 1% E-mail* 32 0.8% 102 3% 24 1% 29 3%

*New category as of May 2002. Workers have frequent contact with clients over the telephone. Visits with families occur most often outside of the office.


When entering a service into the database, workers also identify to whom they provided the service. Results are as follows:

Table 77 To Whom Services Were Provided

Reported by Caseworkers December 2003

Service Provided To:

Year 1

Count

Year 1 Percent

Year 2 Count

Year 2 Percent

Year 3 Count

Year 3

Percent

Year 4 Count

Year 4

Percent Parent 1922 46% 1697 48% 888 48% 360 42% Family 1100 27% 1433 41% 652 36% 357 41% Adopted Child 1012 24% 385 11% 259 14% 123 14%

Other Sibling 106 3% 9 0.3% 7 0.4% 23 3%

Nearly half of all services provided in Year 1 were provided to the parent, and a third of all services provided to the family. In Years 2 - 4, the majority of services were provided to the parents and to the family. The large number of services provided to parents can be expected due to the high number of telephone contacts recorded. High numbers of services provided to the family reflects the fact that social workers have reported they most often meet with the adopted child and his/her parents together, rather than meeting with the child alone. The amount of time spent on providing a service and on travel is recorded into the database. Forty-two percent of all services take less than a half hour to provide, while 22 percent take between one and two hours. Four percent of services take more than two hours. Seventy-five percent of services do not require any travel time. Six percent involve between 15 – 60 minutes of travel and 13% require between one and two hours of travel. Five percent require more than two hours of travel. The large number of entries with no travel time reflects the fact that the majority of services recorded are telephone contacts. In addition, no travel time is required for in-office visits or documentation. However, social workers often need to travel long distances across the state to meet with families.


2. TYPES OF SERVICES FAMILIES UTILIZE Families were asked about services they obtained pre- and post-legalization. Pre-Legalization Services When asked how often a DHS caseworker visited them, respondents answered with a range from once a year to three times per week. The mean number of visits was approximately 11 visits per year (Mean = 10.92; Standard Deviation = 14.218). Respondents were asked to rate how well the DHS adoption caseworker knew the respondent, the respondent’s family and the respondent’s adopted child. Answers are as follows:

Table 78 How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline

December 2003

Guided=134; Standard=111 Very Well Somewhat Well Not Very Well Caseworker Knew You

G = 44% S = 45%

G = 41% S = 45%

G = 16% S = 10%

Caseworker Knew Family

G = 33% S = 34%

G = 43% S = 49%

G = 23% S = 15%

Caseworker Knew Child

G = 39% S = 46%

G = 43% S = 37%

G = 18% S = 17%

G = Guided/S = Standard *Percentages are rounded.

Table 79 How Well DHS Caseworker Knew Family Members – Pre-Legalization Baseline

By Type of Adoption: Foster or Non-Foster December 2003

Foster=210; Non-Foster=34 Very Well Somewhat Well Not Very Well Caseworker Knew You

F = 44% N = 47%

F = 43% N = 38%

F = 13% N = 15%

Caseworker Knew Family

F = 33% N = 35%

F = 47% N = 38%

F = 20% N = 18%

Caseworker Knew Child

F = 40% N = 56%

F = 42% N = 27%

F = 18% N = 18%

F = Foster/N = Non-Foster *Percentages are rounded. *There is a statistically significant difference (.005) between the Foster and Non-foster parent groups – a larger percentage of Foster caregivers feel that their caseworker knows their family “very well” or “somewhat well.”


Respondents were asked how satisfied they were with pre-legalization services. Results are shown in the table below.

Table 80 Satisfaction with Pre-Legalization Services to Family/Child at Baseline

By Assigned Group December 2003

1 = Very Satisfied to 4 = Very Dissatisfied Responses are from caregiver rating state DHS Caseworker by each adopted child at time of entry to study.


N= 134 Mean = 1.49

SD = .743

N=111 Mean = 1.50

SD = .796

Table 81 Satisfaction with Pre-Legalization Services to Family/Child at Baseline

By Type of Adoption December 2003

1 = Very Satisfied to 4 = Very Dissatisfied Responses are from caregiver rating state DHS Caseworker by each adopted child at time of entry to study.

Foster Non-Foster N= 211

Mean = 1.51 SD = .771

N=34 Mean = 1.41

SD = .743 Respondents were asked about the kinds of things a caseworker did before legalization that were helpful. The most cited activities were; provided a continuous flow of information, gave assistance with adoption papers, life book, and financing/subsidies, provided background information on the child, and made courtesy calls and visits.


Post Legalization Services Respondents were asked if they currently contact their DHS worker.

Table 82 Percentage of Respondents Who Have Had Contact with

a Case Worker in the Past Six Months By Assigned Group

December 2003 6

Months 12

Months 18

Months 24

Months 30

Months Guided 76% 61% 50% 47% 39% Standard 82% 54% 50% 36% 55%

The reasons most often cited for contacting a DHS worker were monthly subsidy payments, adoption/legalization questions, a child’s new emotional needs, MaineCare coverage questions, or questions concerning the child’s birth family. Using a four-point scale (1 = Very Satisfied, 2 = Somewhat Satisfied, 3 = Somewhat Dissatisfied, 4 = Very Dissatisfied) respondents were asked to rate their satisfaction with their DHS caseworker post-legalization. The mean scores are as follows:

Table 83 Satisfaction with Post-Legalization Services to Family/Child


1 = Very Satisfied to 4 = Very Dissatisfied

Responses are from caregiver rating state DHS Caseworker by each adopted child after entering study. Approximately 90% of all adoptions are finalized by this point in time; at least 6 months past baseline.


Six Months in Study N= 84 Mean = 2.27

SD = 2.30

N=71 Mean = 2.24

SD = 1.95 12 Months in Study N=52

Mean = 1.87 SD = 1.34

N=38 Mean = 1.95


Mean = 2.19 SD = 1.40

N=22 Mean = 2.05


Mean = 1.70 SD = .923

N=12 Mean = 2.00 SD = 1.128

30 Months in Study N=10 Mean = 1.70

SD = .675

N=11 Mean = 1.91 SD = 1.221


Table 84 Satisfaction with Post-Legalization Services to Family/Child

by Type of Adoption December 2003

Foster Non-Foster

Six Months in Study N= 128 Mean = 2.29

SD = 2.17

N=27 Mean = 2.11


Mean = 1.95 SD = 1.43

N=15 Mean = 1.67

SD = .900 18 Months in Study N=45

Mean = 2.04 SD = 1.31

N=9 Mean = 2.56


Mean = 1.69 SD = .928

N=6 Mean = 2.33


Mean = 1.78 SD = .878

N=3 Mean = 2.00

SD = 1.73 While the majority of respondents reported being very satisfied with post-legalization services, a few respondents indicated that they were dissatisfied with the services. The reason most cited for dissatisfaction with post-legalization services were: the legalization time frame was too long, case workers are overloaded and don’t have time; it was difficult to access the case worker; not all background information on the child was provided, and there is a lack of support network for parents.


Services from the Community Families were asked about the kinds of services they obtained from their community in the past six months. Results are shown below:

Table 85 Percent of Caregivers Obtaining Services – Types of Service

at 6 - 30 Months into Study By Assigned Group December 2003

Respondents can choose more than one service type. 6 Mos

Guided N=110

6 Mos Stdard N=88

12Mos Guided

N=85

12Mos Stdard N=72

18 Mos Guided N=64

18 Mos Stdard N=44

24 Mos Guided

N=43

24Mos Stdard N=33

30 Mos Guided

N=26

30Mos Stdard N=21

Individual Counseling

53%

(n=58)

55%

(n=48)

53%

(n=45)

46%

(n=33)

45%

(n=29)

50%

(n=22)

53%

(n=23)

52%

(n=17)

46%

(n=12)

52%

(n=11)

Respite Care 14%

(n=15)

14%

(n=12)

22%

(n=19)

18%

(n=13)

22%

(n=14)

30%

(n=13)

23%

(n=10)

24%

(n=8)

31% (n=8)

33%

(n=7)

Adoption Support Group

18% (n=20)

14%

(n=12)

19% (n=16)

14% (n=10)

23% (n=15)

16% (n=7)

28% (n=12)

21% (n=7)

46% (n=12)

19% (n=4)

Other* 16%

(n=18)

16%

(n=14)

13%

(n=11)

21%

(n=15)

22%

(n=14)

23%

(n=10)

23%

(n=10)

18% (n=6)

31%

(n=8)

19%

(n=4)

Behavioral Specialist

8%

(n=9)

9%

(n=8)

20%

(n=17)

21%

(n=15)

25%

(n=16)

18%

(n=8)

30%

(n=13)

12% (n=4)

27%** (n=7)

0**

Family Therapy

13%

(n=14)

26% (n=8)

11% (n=9)

7%

(n=5)

11% (n=7)

16%

(n=7)

16% (n=7)

15% (n=5)

8%

(n=2)

14%

(n=3)

Marriage Counseling

4%

(n=4)

2%

(n=2)

7%

(n=1)

1%

(n=1)

2%

(n=1)

2%

(n=1)

2%

(n=1)

0

0

0

Residential Treatment

1%

(n=1)

1%

(n=1)

6%

(n=5)

0

3%

(n=2)

2%

(n=1)

9%

(n=4)

3%

(n=1)

4%

(n=1)

9%

(n=2) Institutional Placement

0

1%

(n=1)

1%

(n=1)

0

3%

(n=2)

0

0

6%

(n=2)

0

0

*Other services included psychiatrists, caseworker consultation, occupational therapy, speech therapy, physical therapy, and other medical services. **There is a statistically significant difference between groups at this point of data collection (.005). A higher number of Guided families obtained services from a behavioral specialist.


Caregivers were then asked the number of hours spent with a service provider within that same six month time period. The average (mean) in days for these services from the community are as follows: Note: A small number of families use a very high amount of services (counseling, therapy, etc); more than 600 hours of any one type of service in the past six months, or 25 hours per week. In order to calculate averages that represent the majority of families, the extraordinarily high amounts were eliminated from the analysis.

Table 86 Mean Number of Hours of Service Time Reported by Family

At 6 - 30 Months into Study by Assigned Group December 2003

At 6

Months Guided

At 6 Months

Standard

At 12 Months Guided

At 12 Months Standard

At 18 Months Guided

At 18 Months

Standard

At 24 Months Guided

At 24 Months Standard

At 30 Months Guided

At 30 Months Guided

Respite Care for Adopted Child

152.5 107.0 141.3 133.2 148.0 161.3 118.2 116.8 105.1 126.3

*Other Service for Adopted Child

49.4 22.7 12.4 56.7 47.6 94.4 44.6 115.2 19.4** 81.5**

Counseling for Adopted Child

33.9 21.0 25.2 27.4 38.9 22.9 23.0 24.3 24.9 23.4

Adoption Support Group

13.8 13.0 19.8** 8.9** 13.9 13.1 14.0 24.7 15.2 13.8

Behavioral Specialist

9.6 15.5 15.1 25.7 14.8 23.7 31.7 22.4 36.7 0

Family Therapy

9.6 9.1 16.8 7.8 20.9 10.4 17.3 11.2 16.0 11.0

Marriage Counseling

6.3 5.0 5.0 2.0 1.0 3.0 3.0 0.0 0.0 0.0

Total Service Hours:

72.4 108.3 82.3 85.3 117.4 125.9 111.4 150.0 100.5 79.1

*Other services included occupational therapy, speech therapy, physical therapy, caseworker consultation, psychiatrists, substance abuse treatment, neuropsychological evaluations, and homeopathic medicine. **There is a statistically significant difference between groups at this point of data collection.


Services From Case-manager/worker At six months into the study, 62% of all respondents stated that they had a regular case manager (86% of the Guided group and 32% of the Standard group). At twelve months, 62% of all respondents stated that they had a regular case manager (92% of Guided and 26% of Standard). At 18 months 70% reported having a case manager assigned to them (95% of Guided and 34% of Standard); at 24 months, 71% (98% of Guided and 36% of Standard) said they had a case-manager assigned to them, and at 30 months, 65% (92% of Guided and 30% of Standard) reported having a case manager. At six months in the study, 80 percent of those who were assigned a caseworker had one caseworker assigned to them; and 20 percent had two or more caseworkers (22% Guided, 16% Standard). At 12 months in the study, 76 percent had one caseworker; and 24 percent had two or more caseworkers (19% Guided, 40% Standard). At 18 months in the study, 66 percent had one caseworker; and 34 percent had two or more caseworkers (32% Guided, 43% Standard). By 24 months in the study, 74 percent had one caseworker; and 26 percent had two or more caseworkers (24% Guided, 30% Standard). Respondents were asked a series of questions about their caseworker’s actions and how their caseworker makes them feel. Questions ranged from whether or not their caseworker plans meetings at good times to whether or not their caseworker wants to hear what the family thinks. The mean score generated from all of these questions resulted in a “Family Centeredness” score, which is a score scaled from 1 (very low level of family centeredness) to 5 (very high degree of family centeredness). The higher the score, the more family-centered the program is. Lower scores—especially below 3.0 indicate that behavior needs improvement.

Table 87 Mean Family Centeredness Scores by Assigned Group

At 6 - 36 Months Into Study December 2003

At 6

Months At 12

Months At 18

Months At 24

Months* At 30

Months At 36

Months Guided Family Centeredness Score (E)

4.71 (N=91)

4.70 (N=77)

4.70 (N=61)

4.76 (N=42)

4.83 (N=24)

4.85 (N=14)

Standard Family Centeredness Score (C)

4.72 (N=28)

4.49 (N=20)

4.61 (N=16)

4.61 (N=12)

4.77 (N=6)

4.75 (N=4)

Respondents were asked about the services they receive directly from their primary caseworker. The table below categorizes families whose primary caseworker is from Casey Family Services apart from families whose primary caseworker works at an “Other” agency.


Table 88 Mean Family Centeredness Scores by Agency

Families working with Casey Family Services compared to All Other Agencies At 6 - 36 Months In Study

December 2003

At 6 Months*

At 12 Months*

At 18 Months

At 24 Months

At 30 Months

At 36 Months

Casey Family Centeredness Score 4.82 (N=71)

4.77 (N=66)

4.68 (N=56)

4.76 (N=42)

4.83 (N=24)

4.85 (N=14)

“Other” Family Centeredness Score 4.55 (N=48)

4.42 (N=31)

4.67 (N=21)

4.62 (N=12)

4.77 (N=6)

4.75 (N=4)

* There are significant differences between groups at 6 and 12 months in the study, families working primarily with Casey Family Services workers have higher family centeredness scores than families working with other agencies. The table below indicates, of those caregivers who have a case-manager, the type of service provided directly from the case-manager to the family/child.

Table 89 Types of Services Provided by Primary Caseworker

6 – 30 Months in Study by Assigned Group December 2003

Respondent can choose more than one service type.

Case Manager: Guided 6 Mos (N=80)

Standard 6 Mos (N=58)

Guided 12 Mos (N=79)


Guided 18 mos (N=56)






Develops/Brokers Services

78%* (n=71)

53%* (n=31)

77%* (n=61)

35%* (n=20)

79%* (n=44)

42%* (n=14)

85%* (n=33)

48%* (n=11)

86%* (n=18)

22%* (n=2)

Provides General Support/Educational Services

60%* (n=53)

33%* (n=19)

60%* (n=47)

25%* (n=14)

66%* (n=37)

18%* (n=6)

68%* (n=26)

35%* (n=8)

70%* (n=14)

11%* (n=1)

Advocates on Behalf of Family/Child

41% (n=36)

26% (n=15)

39%* (n=31)

19%* (n=11)

39%* (n=22)

15%* (n=5)

50% (n=19)

35% (n=8)

50% (n=10)

11% (n=1)

Provides Therapeutic Services

25% (n=22)

9% (n=5)

23% (n=18)

5% (n=3)

35% (n=15)

0% (n=0)

33% (n=13)

4% (n=11)

45% (n=9)

1% (n=11)

Assists with Preparation/ Placement to Residential Setting

5% (n=4)

5% (n=3)

5% (n=4) 0* 6%

(n=3) 0* 5% (n=2)

9% (n=2) 0* 11%

(n=1)

*Statistically significant differences between Guided and Standard Groups at these points in time.


3. FAMILIES ACCESS NATURAL FORMS OF SUPPORT Caregivers indicated that they seek support from a paid professional slightly more so than from a natural source of support. Caregivers are asked the following open-ended question every six months: “ What would you identify as the top three most important sources of aid or support available to you in helping care for your adopted child/ren? This may include natural as well as professional supports.” The following results are totals from caregivers in at 6 - 36 months into study.

Table 90 Type of Aid – Support Caregivers Rely On Most

Total Population December 2003

First Most Important Aid –Support

Note: A higher percentage of Guided families rely first on professional supports: Guided = 59% professional; 47% natural Standard = 41% professional; 53% natural Significance (p=.005)

53% Rely On Professional Type Supports: 1. Social Workers/Case

Management 2. Counseling/Therapy 3. Respite 4. Financial Supports/Subsidy

47% Rely On Natural, Non-Professional Type Supports:

1. Family Support 2. Friends 3. Support Groups

Second Most Important Aid – Support

Note: A higher percentage of Guided families rely first on professional supports: Guided = 61% professional; 45% natural Standard = 39% professional; 55% natural Significance (p=.001)

55% Rely On Professional Type Supports 1. Social Workers/Case

Managers 2. Counseling/Therapy 3. School/School Services 4. Respite 5. Financial Supports/Subsidy

45% Rely On Natural, Non-Professional Type Supports

1. Family 2. Friends 3. Support Groups

Third Most Important Aid – Support

Guided = 57% professional; 50% natural Standard = 43% professional; 50% natural

56% Rely On Professional Type Supports 1. Social Workers/Case

Manager 2. Counseling/Therapy 3. Financial Supports/Subsidy

44% Rely On Natural, Non-Professional Type Supports

1. Family 2. Friends 3. Support Groups


In order to find out more about the kinds of natural supports caregivers may be seeking, they were asked the following open-ended question as part of the regular 6-month telephone interview: “Sometimes when a family experiences stress or problems, family members receive important natural supports from friends, other family members/relatives and or others in the community. Natural supports are types of support that you receive on a regular basis that are not provided by a professional person or agency. In the past six months, have you had the need to seek natural supports from friends, other family members/relatives and or others in your community?”

Table 91 Percent of Respondents Who Routinely Access Natural Supports

Total Sample Results December 2003

6 Months in Study

78%

(n=142)

12 Months in Study

74%

(n=112)

18 Months in Study

78%

(n=78)

24 Months in Study

79%

(n=56)

30 Months in Study

84%

(n=32)

36 Months in Study

79%

(n=19)

A majority of caregivers report that they access natural supports. In order to find out which types of natural supports were used primarily, a total of 831 responses were analyzed and types of supports were coded and counted.

1. Family Members: 41% of the respondents identified a family member, other than the spouse or partner, from which the caregiver routinely received support.

2. Friends: 35% of the respondents identified a friend from whom the caregiver

routinely received support.


3. Church/Pastoral: 14% of the respondents identified the church as a source of support.

4. Support Group: 9% of the responses identified either a foster parent or adoptive parent support group as their natural source of support.

5. Other Supports: The remainder of the responses, approximately 1% of all responses, included the following sources of support: neighbors, school, other foster parents, spouse, co-workers, other caregiver/parent.


4. BARRIERS FAMILIES EXPERIENCE IN RESPONDING TO CHILD’S

NEEDS Caregivers are asked the following question as part of the regular telephone interview: “In the last six month, what would you say has been the biggest barrier to you in your attempts to deal with these things (child’s needs)?” The following results are from an analysis of the respondents from all Cohorts. This initial analysis consisted of coding and simply counting similar responses across all four points in time. There were a total of 586 comments that were analyzed and coded, 292 from Cohort 1, 200 from Cohort 2, and 94 from Cohort 3. There were 109 respondents (19%) who indicated that there were no barriers. The most common barriers noted related to: 1. Child’s Behavior: 20% of all barriers were about the child’s own issues as a barrier – not something external to the child of family. 2. Time: 11% of all barriers concerned the lack of time parents have to deal with the child’s needs due to full-time employment 3. Lack of Accurate Information: 11% of all barriers concerned a parent lacking sufficient information to respond effectively to the child’s need. 4. School Related Issues: 10% of parents noted that school personnel and programs were a barrier to meeting the child’s needs. 5. Self-Doubt – Inadequacy: 7% of all barriers described what appear to be concerns from the parents about their own ability to deal effectively with the child’s needs. 6. Contacting Agencies: 6% of parents mentioned difficulties contacting or obtaining information from the agencies involved. Other barriers mentioned included: money issues, lack of energy, lack of timely responsiveness from the state adoption agency, dealing with insurance agencies and difficulties in contacts with birth family.


5. FAMILIES TYPE OF MEDICAL COVERAGE At baseline, families were asked how the costs for their adoptive children's medical physical health needs, and medical mental/psychological health needs are covered. The following table outlines the percentage of families that rely on each type of coverage. Note: Percentages total more than 100% because some families use a combination of coverage methods.

Table 92 Paying/Coverage for Child’s Medical Needs Percentage of Families Using Each Method

Type of Coverage Physical

Needs Mental Health Needs

MaineCare 93%* 87%* Employer insurance/Union 11% 11% Out-of-pocket 11% 0% Private insurance 2% 2% Other Method 2% 8%

Of families who report receiving MaineCare coverage, approximately 79% receive full coverage for their children’s medical needs. The remaining 21% must use another form of payment/coverage in addition to MaineCare.


CHAPTER III – OUTCOMES

A. DESCRIPTION OF ANALYSES

The changes in outcome variables over time are compared between treatment and control groups using a two by three mixed analysis of variance (ANOVA) or repeated measures design. In these models, the two levels of treatment versus control, Guided versus Standard Services, constitute the between subjects effect with the difference over time serving as the within subjects, or repeated measures effect. The periods of time are; baseline, 6 months into study, 12 months into study, 18 months into study, 24 months into study and continuing every six month period of observation until the end of study. Of particular interest in these models are the F tests for the interaction of treatment group and time as these will answer the question of whether the change in the outcome variable over time, if any, differed between treatment (Guided) and control (Standard) groups. For all models, the nature of any significant interactions are characterized as ordinal versus disordinal through plotting techniques. Examination of these plots allow conclusions to be drawn regarding whether or not a significant interaction indicates a beneficial effect of the Guided Services model.

For this report, between group differences are considered for all cohorts for up to

24 months in study, dependent upon group sample size. This differs from the analysis reported in the evaluation report of July 2002 when only Cohort I children and families were considered for outcome analysis. At that time, not enough observations were available to consider Cohort II children and families beyond baseline and the initial six-month periods. To conduct the analysis in this way may lessen the effects of attrition to any one cohort over time. In addition, preliminary analyses indicates that there is no significant difference over time in terms of the quality of the intervention; participants in Cohort I are getting a similar type or quality of intervention compared to participants in Cohort II, III and IV. Therefore, these results are measuring changes to outcome variables based on length of time in study irrespective of membership to cohort. The following tables provide approximate sample sizes for the analyses. There are slight differences in actual sample size depending upon how missing data is handled; for repeated measures analysis conducted with SPSS, any missing data for a single period of observation excludes that entire case for the analysis.


Table 93

Sample Characteristics Length of Time in Study December 2003

TIME IN STUDY GUIDED SERVICES (E) STANDARD SERVICES (C) Baseline Child: n = 226

Family: n = 123 Child: n = 177 Family: n = 103












B. RESULTS

The select child and family level outcome variables are also described in the previous chapter and more complete statistical data is available by contacting the evaluator. Graphs display mean scores or total scores between groups over time. The purpose of these graphs/charts is to provide the reader with information comparing both groups. For each instance of statistical significance, an explanation will be provided. At this time, there are no statistically significant differences at baseline between the two groups. This finding supports the function of the randomization process in establishing the intervention and control groups.

The reader is asked to consider the following as they interpret the meaning of these study results. Achenbach et al (p. 56, 1991) in their scoring manual describe how to interpret the syndrome scales in their Child Behavior Checklist. “…there is no well-validated criterion for categorically distinguishing between children who are “normal” and those who are “abnormal” with respect to each syndrome. Because children are continually changing and because all assessment procedures are subject to errors of measurement and other limitations, no single score precisely indicates a child’s status. Instead, a child’s score on a syndrome scale should be interpreted as an approximation of the child’s status as seen by a particular informant at the time the informant completes the CBCL.”

For most all of the variables presented in the following results, the rating is from a

single caregiver at one point in time – and then repeated approximately six months later. No single one of these results precisely indicates the status of a family or child, they are approximations at best. The intent is that taken together, these results help to build is a mosaic of understanding the lives of children and families after adoption.

1. FAMILY LEVEL VARIABLES – MEAN GRAPHS

What is the Health Status of the Primary Caregiver? The Rand 36 – Item Health Survey 1.0 (1993) is used to measure this outcome. This instrument measures eight aspects of health concepts: physical functioning, bodily pain, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. The following results display total mean scores for the two groups on these eight domains. There are no significant statistical differences between groups over time.


Chart 2

Parent Health: General HealthDecember 2003

A higher (top score equals 100) score defines a more favorable health state

77.42

78.04

80.23

73.69

72.93

71.67

74.00

78.08

77.38

75.80

76.34

77.27

76.42

76.74

40 60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

StandardGuided

A high score defines a more favorable health state and the general health scale consists of responses to the following items:

Rating of overall general health Get sick more/less than others As healthy as others Expect health to get worse Rate health as excellent

There is no statistical difference over time between the two groups on this outcome.


Chart 3

Parent Health: Energy/FatigueDecember 2003

A higher score (top score equals 100) defines a more favorable health state

64.33

63.66

64.77

61.54

60.49

57.07

58.33

47.50

63.20

61.55

62.96

61.48

62.04

63.48

40 60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state. This scale consists of the following types of items:

Feeling “full of pep” Having lots of energy Feeling worn out Feeling tired



Chart 4

Parent Health: Social FunctioningDecember 2003


91.25

94.51

88.07

90.38

88.41

91.38

77.50

75.00

92.77

92.27

89.22

95.30

91.98

89.49

60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and this scale consists of the following types of items:

Extent to which health/emotional problems interfered with normal social activities There is no statistical difference over time between the two groups on this outcome.


Chart 5

Parent Health: Physical FunctioningDecember 2003


86.98

88.72

81.82

80.77

80.24

81.64

84.00

86.25

87.79

87.65

87.35

87.37

84.49

85.25

60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


Vigorous Activities Moderate Activities Carrying Groceries Climbing Stairs Bending, Kneeling, Stooping Walking Bathing/Dressing Self

For this outcome, there is a statistical difference between groups over time considering the period from baseline to twelve months. Guided Services parents are reporting better physical functioning that Standard Service group parents (F=4.129, df=2, p=.017).


Chart 6

Parent Health: Physical Pain December 2003


86.71

85.37

86.37

87.88

81.16

80.52

75.67

79.75

84.84

88.40

84.81

87.84

85.46

85.51

60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


Amount of bodily pain in past month Degree to which pain interfered with normal work

For this outcome there is a statistically significant difference between the groups over time from baseline to twelve months. Parents in the Guided Services group report a lesser amount of bodily pain and a lesser amount to which that pain interferes with normal work than parents in the Standard Services group (F=3.843, df=2, p=.023).


Chart 7

Parent Health: Emotional Well-Being

December 2003A higher score (top score equals 100) defines a more favorable health state

81.73

81.46

80.36

79.69

81.07

77.93

76.53

68.80

80.10

79.05

80.25

81.87

81.43

82.26

40 60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided


Frequency of feeling nervous Feeling “down in the dumps” Feeling “calm and peaceful” Feeling “downhearted and blue” Feeling happy



Chart 8

Parent Health: Role Limitation Due to Physical HealthDecember 2003


95.00

94.21

92.05

94.23

85.06

83.19

90.83

86.25

93.85

93.81

93.75

91.93

91.20

90.22

60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and this scale consists of items such as:

Health problems – had to cut down on time on activities Health problems – have accomplished less than would like Health problems – were limited in kind of work Health problems – had difficulty performing tasks



Chart 9

Parent Health: Role Limitation Due to Emotional ProblemsDecember 2003


93.33

95.12

87.88

97.44

90.24

79.31

86.67

76.67

91.67

91.75

93.49

92.75

94.65

95.72

60 80 100

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

A higher score defines a more favorable health state and items that make up this scale include:

Emotional problems – have had to cut down on activities Emotional problems – have accomplished less than would like Emotional problems – didn’t do work/activities as carefully as usual



Chart 10

Caregiver Satisfaction With AdoptionDecember 2003

1 = Strongly Satisfied 4 = Not at All Satisfied

1.13

1.17

1.20

1.23

1.10

1.02

1.14

1.14

1.40

1.30

1.15

1.36

1.27

1.15

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Approximately every six months, caregivers are asked how satisfied they are with the adoption or adoption process to date. There is no statistically significant difference between groups over time for this outcome variable. Both groups state feeling strongly satisfied with the adoption process.


What are Parenting Styles of Adoptive Parents – Authoritarian or Authoritative ?

Previous research with caregivers post-legalization (Sedlak & Broadhurst, 1993) found that parenting styles or practices were the strongest predictors of adoption outcomes. For this study, two aspects of parenting style are being considered, authoritative and authoritarian. Kaufman, Gesten et al (2000) define these concepts as follows: Authoritative parenting style is characterized by the display of affection toward the child, sharing feelings and experiences with the child, respect for and encouragement of the child’s independence, as well as supervision of the child, and the establishment of family rules and responsibilities. The Authoritarian scale includes items endorsing restriction of the child’s emotional expression, limited involvement of the child in family decisions and the establishment of rules, as well as an emphasis on physical and verbal punishment as a consequence of disobedience.

Cohort One – Baseline Results For the first year of the study, researchers selected a CRPR instrument that proved to be very cumbersome for parents to complete. The following results are only for Cohort One at baseline; those parents who entered the study in the first year.

Table 94

CRPR Results – Authoritarian / Authoritative Practices Cohort One - Baseline

December 2003

Authoritarian Score ( 1 = More Authoritarian to 5 =

Less Authoritarian )

Authoritative Score ( 1 = More Authoritative to 5 =

Less Authoritative) Guided Services ( n = 31)

Mean = 3.58

SD = .27

Mean = 2.17

SD = .30

Standard Services ( n= 42)

Mean = 3.52

SD = .29

Mean = *2.04

SD = .21

Total for Cohort One at Baseline ( n = 73)

Mean = 3.55

SD = .28

Mean = 2.09

SD = .26

*These results indicate that this group of parents view themselves as more

Authoritative than Authoritarian in their parenting style. Standard Services parents reporting that they are significantly less Authoritative than Guided Services parents at baseline ( p = .041).


Chart 11

Parenting Practices: AuthoritarianDecember 2003

1 = Not Authoritarian 6 = Highly Authoritarian

2.84

2.67

2.76

2.77

2.83

2.75

2.81

2.74

1.0 2.0 3.0 4.0

Baseline

12 Months

24 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

The Authoritarian scale includes items endorsing restriction of the child’s emotional expression, limited involvement of the child in family decisions and the establishment of rules, as well as an emphasis on physical and verbal punishment as a consequence of disobedience. This chart displays data from the revised CRPR instrument that has been used from Year Two forward in the study; therefore there are no baseline results for Cohort One, see previous page. These results indicate that parents view themselves as just below mid-range in terms of Authoritarian approaches to parenting practices. There is no statistical difference over time between the two groups on this outcome.


Chart 12

Parenting Practices: AuthoritativeDecember 2003

1= Not Authoritative 6 = Highly Authoritative

4.83

4.61

4.65

4.73

4.87

4.66

4.72

4.83

1.0 2.0 3.0 4.0 5.0 6.0

Baseline

12 Months

24 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Authoritative parenting style is characterized by the display of affection toward the child, sharing feelings and experiences with the child, respect for and encouragement of the child’s independence, as well as supervision of the child, and the establishment of family rules and responsibilities. This chart displays data from the revised CRPR instrument that will be used from Year Two forward in the study; therefore there are no baseline results for Cohort One, see previous page. These results indicate that parents view themselves as predominantly Authoritative in their approaches to parenting practices.



Chart 13

Family Cohesion December 2003

Moderate/Balanced family system scores range from 51 to 70.Scores over 70 are considered enmeshed and not optimal.

68.64

68.63

67.80

70.47

67.66

66.69

63.60

64.00

70.06

69.37

68.44

69.65

69.15

68.37

40 60 80 100

Baseline

Six Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

The concepts of Family Adaptability and Cohesiveness are considered important in how families function, and especially in how families integrate a new member – the adopted child. To measure this family system process, the FACES II (Olson et al, 1992) Family Adaptability and Cohesion Scale is used in the study. For this measure, as for all others, the informant was the self-selected primary caregiver to the child. There was no attempt made to get the other spouse/partners assessment of family functioning as is recommended in the use of this measure. This was due to a concern with data collection burden to the family. Family Cohesion is defined as the emotional bonding that family members have toward one another. There is no statistical difference over time between the two groups on this outcome.


Chart 14

Family AdaptabilityDecember 2003

Moderate/Balanced family system scores range from 40 to 54.Scores over 54 are considered "chaotic" family type and not optimal.

48.58

49.02

48.60

48.93

48.41

47.88

47.40

47.92

48.82

48.68

13.00

49.23

49.26

47.96

20 40 60 80

Baseline

Six Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Family Adaptability is defined as the extent to which a family system is flexible and able to change. There is no statistical difference over time between the two groups on this outcome.

Chart 15


Family Attached to ChildDecember 2003

1 = Very Attached 4 = Not at All Attached

1.74

2.01

1.76

1.92

2.46

2.33

1.95

2.21

1.24

1.96

1.94

1.22

1.88

1.69

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked, “At the present time, how would you assess household or family members overall attachment to the adopted child(ren)? To what degree are they attached to the child?” Both sets of caregivers appear to feel that family members are very attached to the adopted child. However, there is a statistically significant difference between groups when analyzed over time—Guided families report being more attached to their child (F=5.817, df=3, p=.001).

Chart 16


Percent of Caregivers Who Trust Child December 2003

67%

68%

74%

73%

50%

56%

55%

29%

77%

71%

69%

70%

63%

64%

0% 20% 40% 60% 80% 100%

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Percent Who Answered "YES"

Standard

Guided

At entry to the study and every six months, caregivers are asked if they trust their adopted child(ren). At entry to study, at six months, and at 12 months, there were no significant statistical differences between groups for this variable. However, at 18 months there is a statistically significant difference between groups. More Guided Services caregivers stated that they trust their child than those caregivers in the Standard Services group at this point in time (chi-square = 5.204, df=1,p=.023).


Chart 17

Parent and Child CommunicationDecember 2003

1 = Excellent 4 = Poor

1.79

1.84

1.98

1.81

1.82

1.74

2.00

2.00

1.70

1.72

1.74

1.70

1.73

1.87

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this outcome variable, caregivers are asked “During the last six months, how would you rate your overall level of communication with your child?” There are no statistically significant between group differences over time for this outcome. The majority of both groups appear to rate their overall levels of communication between excellent and good.



Chart 18

Frequency of Parent and Child Disagreements December 2003

1 = Never 4 = Everyday

1.68

1.65

1.66

1.69

1.68

1.70

1.72

1.97

1.62

1.66

1.64

1.60

1.66

1.63

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked, “Now I would like to ask you about some of the areas where it is most common for parents and children to have disagreements. Choosing from the following answers, please tell me how often you and the child disagree on each issue.” The items are: Spending money; Television; Friendships; Use of Drugs-Alcohol; Sexual behavior; Personal Appearance; Schoolwork and Respect to Parents. For this outcome variable, there are no statistically significant differences between groups over time. Both groups of caregivers appear to experience low levels of frequencies of disagreements with their child(ren).


Chart 19

Frequency of Parent Positive Caregiving Behaviors December 2003

1 = Never 4 = Everyday

3.64

3.58

3.52

3.44

3.56

3.61

3.57

3.47

3.72

3.64

3.56

3.68

3.64

3.62

2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers were also asked in the past month how often they demonstrated certain positive behaviors to their child(ren). Those behaviors are: Helped with homework; Said nice things to child; Showed that you liked to have child around; Were thoughtful when child was tired; Kissed or hugged child; Comforted child when child had problems and Made child feel loved. For this outcome variable, there are no statistically significant differences between groups over time. Both groups of caregivers appear to demonstrate high levels of frequencies of positive care-giving behaviors to their child(ren).


Chart 20

Life Now Compared to Before Child December 2003

1 = Better 2 = Same 3 = Not as Good

1.59

1.64

1.74

1.54

2.16

1.93

2.23

1.50

1.73

1.56

1.66

1.67

1.74

2.07

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked, “Comparing how things are now in terms of your family life, to how things were before [select child] came to your home, would you say that overall, things are now…?” For this question, there is a significant difference between groups when analyzed over time. A higher number of Guided families rate their family life as better compared to the Standard group (F=2.701, df=3, p=.045).


Chart 21

What is the overall quality of home life?December 2003


1.98

2.12

2.09

2.38

2.29

2.31

2.27

2.70

1.88

1.96

2.05

1.84

1.94

2.07

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers are asked to rate their overall quality of home life during the past six months. There are no significant differences between groups. Both groups of caregivers appear to rate their home life between excellent (1) to good (3).


Chart 22

Caseworker Family CenterednessJune 2003

1 = Very Low Level Family Centeredness5 = Very High Level Family Centeredness

4.87

4.87

4.48

4.77

4.67

4.67

4.72

4.74

4.50

4.65

2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0

6 Months

12 Months

18 Months

24 Months

30 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

As described earlier in the report, the Guided Services model is implemented with the intent that it be family centered. The proposition is that the more family-centered the support, the more empowered the family (caregiver) will feel and perhaps be better able to function in support of the family and child. The intent is that the case-management, family support intervention be done in such a way that it is neither driven solely by the needs of the child nor is it provided from a professional-centered model with the social worker viewed as sole expert on the family. Family-centered models emphasize that children – and adults – grow and develop within family systems. Family-centered service delivery recognizes the centrality of the family in the lives of individuals. For those caregivers who reported receiving regular services from a case-manager, there were no statistically significant differences between groups over time. According to Allen, Petr & Brown (1995) any score of 3 or below indicates practice that is not family centered. Apparently, both groups are reporting that the case-management related services that they are receiving are family-centered. There is no statistical difference over time between the two groups on this outcome.


2. CHILD LEVEL VARIABLES

The following results are presented in order to display group differences over time. These are interim results on the key child level variables identified for the study.

Number of Days Child in Home – No Displacements

One of the most important outcomes of this initiative is the intent of the MAGS model to enable families to stay together. That is, that adopted children do not leave the home due to some sort of problem. This may include running away from home, being incarcerated and/or leaving home for a short-term hospitalization due to a behavioral health problem. The following initial results indicate that there are few displacements occurring in both groups. This information was also provided in Chapter II.

Table 95


December 2003

Median Number of Days Out of Home Baseline 6 Months 12 Months 18 Months 24 Months 30 Months 36 Months Guided 20 (n=5) 12.5 (n=8) 20.5 (n=4) 8 (n=3) 95 (n=4) 20.5 (n=2) -- Standard 7 (n=7) 5 (n=5) 3 (n=2) 60 (n=1) 41 (n=2) 14 (n=1) 9 (n=3) Overall 13 (n=12) 11 (n=13) 15.5 (n=6) 29.5 (n=4) 78 (n=6) 14 (n=3) 9 (n=3)

At baseline, there were 12 children who were reported to be out of the home due to a problem—the median number of days was 13. At 6 months, there were 13 children out for a median number of 11 days. At twelve months, there were six children out for a median number of 15.5 days; at 18 months, four children were out for a median number of 29.5 days, at 24 months, six children were out for a median of 78 days. At 30 months and 36 months in the study, three children were out of the home for a median number of 14 and 9 days respectively. In November 2001, 867 Maine Post-Legalization Adoption Services surveys were mailed to DHS adoptive parents. This was a statewide sample of adoptive parents who receive a IV-E subsidy and the survey was anonymous. The response rate was 44%: a total of 379 surveys were received. Of these 379 respondents, 34 (9%) people indicated that their child had been out of the home in the past year, and 27 (7%) indicated the number of days the child was out of the home. The median number of days children were out of home for the Maine Post-Legalization Adoption Services surveys was 21. Broken into percentages, the resulting data (N=27) is as follows:

• 30% of children were out of the home for less than 10 days • 50% of children were out of the home for less than 52 days • 85% of children were out of the home for 75 days or less


Number of Adoption Dissolutions

As of this point in the study, there have been no reported adoption dissolutions. However, we estimate that approximately three of the families who have dropped out of the study left due to adoption dissolutions (one Guided family and two Standard families).

Chart 23

Child Attached to FamilyDecember 2003

1 = Very Attached 4 = Not at All Attached

1.16

1.10

1.09

1.00

1.11

1.05

1.00

1.00

1.38

1.18

1.15

1.27

1.13

1.11

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

There is no statistical difference between groups over time. Caregivers in the both groups report a high level attachment of child to family.


What is the Child’s Level of Mental Health Needs?

(CBCL Syndrome & Scale Scores) The sample considered for the analysis of the child functioning variables are in two age categories, younger children age 1 ½ to 5 years and older children age 6 and above. The following table provides approximate totals for each age category used in the analysis. Specific sample sizes vary depending upon age of child at point of data collection. For charts 23-47, the number of children appears next to the time of data collection (g=Guided group; s=Standard group).

Table 96 Age Categories December 2003

Time in Study Guided Services Standard Services

Baseline

0 – 5 : 76 6 – 18+ : 174

0 – 5 : 63 6 – 18+: 131

6 Months in Study

0 – 5 : 56 6 – 18+ : 142

0 – 5 : 54 6 – 18+ : 97

12 Months in Study

0 – 5 : 41 6 – 18+ : 116

0 – 5 : 42 6 – 18+ : 81

18 Months in Study

0 – 5 : 30 6 – 18+ : 95

0 – 5 : 22 6 – 18+ : 57

24 Months in Study

0 – 5 : 13 6 – 18+ : 66

0 – 5 : 12 6 – 18+ : 38

30 Months in Study

0 – 5 : 7 6 – 18+ : 40

0 – 5 : 4 6 – 18+ : 27

36 Months in Study

0 – 5 : 2 6 – 18+ : 25

0 – 5 : 2 6 – 18+ : 18


Chart 24

Somatic Problems Child Behaviors Younger Child Ages 1 1/2 - 5 Years

December 2003T-scores from the CBCL; a score of 65 represents the bottom of the clinical range.

Scores of 65 discriminate between referred and nonreferred children.

52.70

53.08

54.86

55.67

54.75

51.44

52.53

52.80

52.93

52.89

53.06

53.73

40 50 60 70 80

Baseline (g = 76; s = 63)

6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g =13; s = 12)

30 Months (g =7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

Somatic problems include: Aches; Can’t stand things out of place; Constipated, Diarrhea, Doesn’t eat well; Headaches; Nausea; Painful bowel movements; Stomach problems; Too concerned with neatness/cleanliness; and Vomiting. All syndrome score results are below the clinical range; except for the Standard group at 24 months (a mean score based on 6 children).



Chart 25

Somatic Problems Child Behaviors Child Ages 6 - 18 Years

December 2003T-scores from the CBCL; a score of 65 represents the bottom of the clinical range.

Scores of 65 discriminate between referred and nonreferred children.

56.33

56.54

55.73

57.08

57.29

57.56

59.33

58.11

56.82

56.13

56.53

56.83

56.73

56.95

40 50 60 70 80

Baseline (g = 174; s =131)

6 Months (g = 142; s =97)

12 Months (g = 116; s =81)

18 Months (g = 95; s =57)

24 Months (g = 66; s =38)

30 Months (g = 40; s =27)

36 Months (g = 25; s =18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

Somatic problems include: dizziness, tiredness, aches, headaches, nausea, eye problems, skin problems, stomach problems, and or vomiting. For all results these syndrome scores are below the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 26

Withdrawn/Depressed Problems Child BehaviorsYounger Child Ages 1 1/2 - 5 Years

December 2003

56.30

54.62

57.86

59.91

61.17

65.50

55.05

54.80

54.97

54.62

55.61

56.56

40 50 60 70 80


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = s12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred

children.

Items for the Withdrawn construct include: Acts too young for age; Avoids eye contact; Doesn’t answer; Refuses active games; Unresponsive to affection; Little affection; Little interest; and Withdrawn. All scores are below the clinical range, with the Standard group at 24 months just above the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 27

Withdrawn/Depressed Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

59.52

60.64

59.90

59.56

57.65

59.29

59.89

60.28

57.91

58.33

59.10

57.53

56.81

57.57

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and

nonreferred children.

For this syndrome score, Withdrawn Behaviors, these scores are all below the clinical range. Items for this construct from the CBCL are: Rather be Alone; Won’t Talk; Secretive; Shy; Stares; Sulks; Under-active; Sad; and Withdrawn.



Chart 28

Anxious/Depressed Problems Child BehaviorsYounger Child Ages 1 1/2 - 5 Years

December 2003

52.57

54.85

53.43

56.59

58.17

63.50

53.51

52.54

51.88

53.57

53.39

54.31

40 50 60 70 80


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred children.

The Anxious/Depressed construct includes such items as: Clings; Feelings hurt; Upset by separation; Looks unhappy; Nervous; Self-conscious; Fearful; and Sad. All scores are below the clinical range, with the Standard group at 30 months just reaching the clinical range (a mean score based on 3 children). There is no statistical difference over time between the two groups on this outcome.


Chart 29

Anxious/Depressed Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

59.35

60.24

60.65

59.16

57.95

56.71

58.07

59.17

59.33

58.87

58.66

57.91

58.21

58.27

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Anxious/Depressed, these scores are below the clinical range. Items for this construct from the CBCL are: Complains of Loneliness; Cries a lot; Fears might think or do something bad; Feels has to be Perfect; Feels or complains no one loves her/him; Feels other are out to get him/her; Feels Worthless; Nervous, highstrung, or tense; Feels too guilty; Too fearful; Self-conscious/Easily embarrassed; Suspicious; Unhappy, sad, depressed; and Worries. There is no statistical difference over time between the two groups on this outcome.


Chart 30

Attention Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2003

56.07

57.92

59.00

57.09

58.50

66.50

55.76

55.75

54.72

56.02

57.94

56.41

40 50 60 70 80


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


All scores for the Attention Problems scale are below the clinical range. Items included in this construct are: Can’t concentrate; Can’t sit still; Clumsy; Quickly shifts; and Wanders away. There is no statistical difference over time between the two groups on this outcome.


Chart 31

Attention Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

63.85

65.64

64.45

64.76

62.72

66.45

67.26

68.44

61.89

61.13

62.17

62.93

61.76

62.30

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


Items for the Attention Problems construct from the CBCL are: Acts too young for age; Can’t concentrate, pay attention for long; Can’t sit still, restless, or hyperactive; Confused or seems to be in a fog; Day-dreams or gets lost in thoughts; Impulsive or acts w/out thinking; Nervous, highstrung, or tense; Nervous movements or twitching; Poor school work; Poorly coordinated, clumsy; and Stares blankly. Average scores for both Guided and Standard groups score in the clinical range at 24 and 30 months. There is no statistical difference over time between the two groups on this outcome.


Chart 32

Aggressive Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2003

54.10

59.38

52.86

61.77

61.58

53.68

54.64

54.57

67.75

56.12

58.07

58.06

40 50 60 70 80


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred

Aggressive Behavior items include: Can’t stand waiting; Defiant; Demands met; Destroys others’ things; Disobedient; Lacks guilt; Easily frustrated; Fights; Hits others; Hurts accidentally; Angry moods; Attacks people; Punishment doesn’t change behavior; Screams; Selfish; Stubborn; Temper; Uncooperative; and Wants attention. Average scores for children in the Standard group are in the clinical range at 24 and 30 months (based on 6 and 3 children respectively). There is no statistical difference over time between the two groups on this outcome.


Chart 33

Aggressive Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

64.52

65.53

63.50

63.80

63.75

65.16

65.56

69.39

63.31

63.15

64.68

66.21

65.32

64.42

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66 ; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Aggressive Problems, a few group scores are close to or past the borderline clinical range, which means that this group of children scores just in the deviant range of behavior for this syndrome. Items for this construct from the CBCL are: Argues a lot; Bragging, boasting; Cruelty, bullying or meanness to others; Demands a lot of attention; Destroys own things; Destroys others things; Disobedient at home; Disobedient at school; Easily Jealous; Gets in many fights; Physically attacks people; Screams a lot; Showing off or clowning; Stubborn, sullen or irritable; Sudden changes in mood or feelings; Talks too much; Teases a lot; Temper tantrums or hot temper; Threatens people; and Unusually loud. Overall, these results show all kids to be in or close to the clinical range. Averages for Guided children at 18 months, and for Standard children at 12 and 24 months, are in the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 34

Internalizing Problems Child Behaviors Younger Child Ages 1&1/2 - 5 Years

December 2003

48.67

48.33

40.50

51.72

55.14

66.00

45.65

46.10

43.71

47.88

46.74

46.14

40 50 60 70 80


6 Months (g = 40; s = 42)

12 Months (g = 28; s =35)

18 Months (g = 21; s =18)

24 Months (g = 9; s = 7)

30 Months (g =4; s = 1)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between

referred and nonreferred children

The Internalizing scale is developed from the Emotionally Reactive, Anxious/Depressed, Somatic Complaints, and Withdrawn syndrome scores. All internalizing scores are below the clinical range except for the Standard group scores at 24 and 30 months in the study (based on 6 and 3 children respectively). There is no statistical difference over time between the two groups on this outcome.


Chart 35

Internalizing Problems Child Behaviors Child Ages 6 - 18 Years

December2003

56.36

57.71

57.23

56.28

55.88

56.03

57.63

59.00

57.89

56.44

55.19

56.43

56.18

56.36

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

These are T-scores from the CBCL; the score of 60 represents the bottom ofthe clinical range for syndrome scales. T-Scores of 60 discriminate between referred and nonreferred children.

For this scale score, Internalizing Problems, these scores are just below the clinical range. This scale is developed from the Withdrawn, Somatic Complaints and Anxious/Depressed syndrome scores. There is no statistical difference over time between the two groups on this outcome.


Graph 1

Internalizing Problems Ages 1 ½ - 18 December 2003

The graph above outlines the average scores of children over time, when data is combined from the 1.5 – 5 year-old, and the 6 – 18 year-old tables. For this scale score, Internalizing Problems, these scores are below the clinical range. There is no statistical difference over time between the two groups on this outcome.

Internalizing 1 1/2 - 18

57.15 57.07

54.84

57.05

56.71

56.2956.42

55.98

57.93

57.00

54.5

55.0

55.5

56.0

56.5

57.0

57.5

58.0

58.5

B 6 12 18 24

Months

Guided(n=75)

Standard(n=49)


Chart 36

Externalizing Problems Child Behaviors Younger Child Ages 1 & 1/2 - 5 Years

December 2003

50.47

54.38

48.00

57.75

69.25

48.93

48.89

47.85

57.45

54.14

53.39

50.90

40 50 60 70 80


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


The Externalizing Problems scale is developed from the Attention Problems and Aggressive Behavior syndrome scores. Averages for Standard children are in the clinical range at 24 and 30 months (based on 6 and 3 children respectively).



Chart 37

Externalizing Problems Child Behaviors Child Ages 6 - 18 Years

December 2003

61.21

62.08

60.13

59.64

63.45

64.78

68.17

62.25

61.11

60.00

62.42

62.03

63.13

64.21

40 50 60 70 80

Baseline (g = 174; s = 131)

Six Months (g = 142; s =97)

12 Months (g = 116; s =81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this scale score, Externalizing Problems, these scores are all above the clinical range, which means children in these groups are considered deviant according to this scale score. This scale is developed from the Delinquent and Aggressive Behaviors syndrome scores. There is no statistical difference over time between the two groups on this outcome.


Graph 2

Externalizing Problems Ages 1 ½ - 18

December 2003

The graph above outlines the average scores of children over time, when data is combined from the 1.5 – 5 year-old, and the 6 – 18 year-old tables. For this scale score, Externalizing Problems, these scores are just below the clinical range.


Externalizing 1 1/2 - 18

61.32

60.4760.37 60.31

60.65

61.43

62.43

63.16

62.47 62.47

60.0

60.5

61.0

61.5

62.0

62.5

63.0

63.5

64.0

B 6 12 18 24

Months

Guided(n=75)

Standard(n=49)


Chart 38

Total Problems Child BehaviorsYounger Child Ages 1 & 1/2 - 5 Years

December 2003

49.97

52.92

48.86

56.68

59.33

70.75

48.99

48.63

47.27

53.16

51.46

50.31

20 40 60 80 100


Six Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g = 13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Guided Standard


According to Achenbach et al (1991) the Total Problem score can be used as a basis for comparing problems in different groups and for assessing change as a function of time or intervention. The Total Problem score is computed by summing all problem items except for Sleep Problems. If a parent rated more than one problem for item 100 (Other Problems , only the item with the highest score is counted. There are 100 problem items on this section of the CBCL. Averages for children in the Standard group at 24 and 30 months in the study (based on 6 and 3 children respectively) are in the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 39

Total Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

61.23

62.59

61.42

61.12

62.07

63.11

64.44

66.50

62.55

61.04

60.22

62.06

62.24

63.35

20 40 60 80 100

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Guided Standard


For the Total Problems scale, these scores are close and/or over the clinical cut point meaning both groups are close to being considered deviant according to this scale score. According to Achenbach et al (1991) the total problem score can be used as a basis for comparing problems in different groups and for assessing change as a function of time or intervention. The Total Problem score is computed by summing all problem items except items 2 (Allergy) and 4 (Asthma). If a parent rated more than one problem for item 113 (Other problems), only the item with highest score is counted. There are 113 problem items on this section of the CBCL. There is no statistical difference over time between the two groups on this outcome.


Graph 3 Total Problems Child Behaviors 1 ½ - 18

December 2003

The graph above outlines the average scores of children over time, when data is combined from the 1.5 – 5 year-old, and the 6 – 18 year-old tables. For this scale score, Total Problems, these scores are just below the clinical range. There is no statistical difference over time between the two groups on this outcome.

Total Problems 1 1/2 - 18

61.32

60.67

59.71

60.40

61.23

61.02

61.67

62.37

62.69

62.47

59.5

60.0

60.5

61.0

61.5

62.0

62.5

63.0

B 6 12 18 24

Months

Guided(n=75)Standard(n=49)


Chart 40

Emotionally ReactiveYounger Child Ages 1 1/2- 5 Years

December 2003These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical range for syndrome scales. T-Scores of 65 discriminate between referred

and nonreferred children.

55.27

56.62

55.29

60.27

64.42

78.50

53.07

54.75

54.45

56.38

56.07

56.00

20 30 40 50 60 70 80 90 100


6 Months (g = 56; s = 54)

12 Months (g = 41; s = 42)

18 Months (g = 30; s = 22)

24 Months (g =13; s = 12)

30 Months (g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

This syndrome scale is only asked of caregivers of children age 1 ½ to 5 years. For this syndrome scale, averages for Standard children at 24 and 30 months are in the clinical range (based on 6 and 3 children respectively); all other scores for both groups fall below the clinical range. Items that make up this scale are: Disturbed by change; Twitches; Moody; Sulks; Upset by New Things; Whining; Worries; Panics; and Shifts between sadness and excitement. There is no statistical difference over time between the two groups on this outcome.


Chart 41

Sleep ProblemsYounger Child Ages 1 1/2 - 5 Years

December 2003These are T-scores from the CBCL; the score of 65 represents the bottom of the clinical

range for syndrome scales. T-Scores of 65 discriminate between referred and nonreferred children.

55.27

55.54

54.71

58.86

62.92

74.75

54.70

55.43

55.71

56.19

57.41

56.24

20 30 40 50 60 70 80


6 Months (g = 56; s =54)

12 Months (g = 41; s =42)

18 Months (g = 30; s =22)

24 Months (g = 13; s =12)

30 Months g = 7; s = 4)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

This syndrome scale is only asked of caregivers of children age 1 ½ to 5 years. For the Sleep Problems scale, averages for Standard children at 24 and 30 months are in the clinical range (based on ) . Items for this construct are: Doesn’t want to sleep; Trouble sleeping; nightmares; Resists bed; Sleeps little; Talks/Cries in sleep; and Wakes often. There is no statistical difference over time between the two groups on this outcome.


Chart 42

Social Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

63.35

62.82

62.40

63.88

60.74

61.87

63.30

62.11

62.78

62.96

62.56

62.32

61.73

62.47

20 30 40 50 60 70 80

Baseline (g = 174, s =131)

6 Months (g = 142, s =97)

12 Months (g = 116, s =81)

18 Months (g = 95, s =57)

24 Months (g = 66, s =38)

30 Months (g = 40, s =27)

36 Months (g = 25; s =18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Social Problems, all scores for both groups are below the clinical range. Items for this construct from the CBCL are: Acts too young for age; Clings to adults or too dependent; Not get along with other kids; Gets teased a lot; Not liked by other kids; Overweight; Clumsy; and Prefers being with younger kids. There is no statistical difference over time between the two groups on this outcome.


Chart 43

Thought Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

61.88

61.36

60.36

62.28

61.18

60.79

62.44

64.44

61.01

60.34

61.67

62.46

61.48

61.40

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 66; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided


For this syndrome score, Thought Problems, these scores are just below the clinical range. Items for this construct from the CBCL are: Can’t get mind off certain thoughts; Hears sounds/voices that aren’t there; Repeats certain acts over and over, compulsions; Sees things that aren’t there; Stares blankly; Strange behavior; and Strange ideas.



Chart 44

Rule Breaking Problems Child BehaviorsChild Ages 6 - 18 Years

December 2003

59.96

60.21

60.79

57.72

60.77

60.63

62.39

65.56

59.29

60.07

60.36

61.07

60.71

60.12

40 50 60 70 80

Baseline (g = 174; s = 131)

6 Months (g = 142; s = 97)

12 Months (g = 116; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 44; s = 27)

30 Months (g = 66; s = 38)

36 Months (g 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Guided Standard


For this syndrome score, Rule Breaking, all scores are below the clinical range. Items for this construct from the CBCL are: Doesn’t seem to feel guilty after misbehaving; Hangs around with others who get in trouble; Lying or cheating; Prefers being with older kids; Runs away from home; Sets fires; Steals at home; Steals outside of home; Swearing or obscene language; Thinks about sex too much; Truancy, skips school; Uses alcohol or drugs for non-medical purposes; and Vandalism.



Chart 45 Competencies - Activities T-Scores Child Behaviors

Child Ages 6 - 18 YearsDecember 2003

T-Scores below 31 are scores in the clinical range.

47.39

44.63

45.25

44.4

47.33

47.19

47.11

46.00

47.29

46.18

46.98

45.59

47.50

46.75

0 10 20 30 40 50 60

Baseline (g = 172; s =132)

6 Months (g = 140; s = 96)

12 Months (g = 115; s =80)

18 Months (g = 95; s = 57)

24 Months (g = 65; s = 37)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Activities scale includes items such as:

Level of involvement in sports, work and other activities Perception of skill level in activities – quality of involvement

The T-Score cut point for the competency scales is 31, scores below 31 deemed in the clinical range. For this measure children in both groups are not deviant with scores above the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 46

Competencies - Social T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2003T-Scores below 31 represent scores in the clinical range.

37.82

36.68

37.6

40.19

41.84

40.74

39.89

40.66

39.6

39.26

39.1141.03

39.05

38.79

0 10 20 30 40 50 60

Baseline (g = 163; s = 128)

6 Months (g = 139; s = 95)

12 Months (g = 113; s = 81)

18 Months (g = 95; s = 57)

24 Months (g = 65; s = 38)

30 Months (g = 40; s = 27)

36 Months (g = 25; s = 18)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Social scale includes items such as:

Involvement in organizations or clubs Number of friends and frequency of contact with friends Behavior with others and alone

The T-Score cut point for the competency scale is 31, scores below 31 deemed in the clinical range. For this measure children in all groups are above the clinical range. There is no statistical difference over time between the two groups on this outcome.


Chart 47

Competencies - School T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2003T-Scores below 31 represents scores in the clinical range

36.67

35.14

33.80

35.68

35.12

36.18

36.16

35.35

36.76

35.94

35.5334.29

35.20

35.20

0 10 20 30 40 50 60

Baseline (g = 143; s =107)

6 Months (g = 123; s =82)

12 Months (g = 100; s =69)

18 Months (g = 90; s =49)

24 Months (g = 65; s =38)

30 Months (g = 40; s =25)

36 Months (g = 25; s =17)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The School scale includes items such as:

Academic Performance Instances of repeating grades Involvement in special classes/education Other school problems

The T-Score cut point for the competency scales is 31, scores below 31 deemed in the clinical range. For this measure all children are just above the clinical range. For all the individual competency measures, this scale displays the area of most detriment in terms of competencies. There is no statistical difference over time between the two groups on this outcome.


Chart 48

Competencies - Total T-Scores Child BehaviorsChild Ages 6 - 18 Years

December 2003T-Scores below 37 represent scores in the clinical range.

39.42

36.14

35.50

36.24

38.57

40.30

40.48

38.76

39.54

38.55

39.16

38.90

38.63

37.78

0 10 20 30 40 50 60

Baseline (g = 134; s =105)

6 Months (g = 119; s = 80)

12 Months (g = 97; s = 69)

18 Months (g = 90; s = 49)

24 Months (g = 64; s = 37)

30 Months (g = 40; s = 25)

36 Months (g = 25; s = 17)

Tim

e in

Stu

dy

Mean T-Score

Standard

Guided

It is widely recognized that children and adolescents need to develop competencies in all areas for healthy overall growth and development. The CBCL measures competencies in four ways; activities, social, school and total competencies. The Total Competency Scale is the sum of the raw Activities, School and Social scale scores. The T-Score cut point for the Total Competency scale is 37, scores below 37 deemed in the clinical range. For this measure, Guided children fall in the clinical range at 18, 24, and 30 months. There is no statistical difference over time between the two groups on this outcome.


Chart 49

Child Overall HealthDecember 2003


1.50

1.40

1.48

1.46

1.53

1.60

1.64

1.64

1.44

1.45

1.51

1.43

1.47

1.46

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

There is no statistically significant difference between groups on this item. Caregivers in both groups rate their child’s overall health as excellent to very good.


Chart 50

Child Growth/Development Compared to Others December 2003

1 = More Advanced 3 = Less Advanced

2.02

2.08

2.09

2.00

2.13

2.26

2.18

2.14

2.05

2.07

2.08

2.12

2.08

2.09

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers from both groups report that their child’s overall growth and development is similar to other children of the same age. There are no significant differences between groups.


Chart 51

Frequency of Child Positive Traits/Moods December 2003

1 = Never 4 = Every Day

3.50

3.45

3.28

3.44

3.35

3.37

3.34

3.11

3.53

3.50

3.47

3.50

3.48

3.51

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has demonstrated a particular trait/mood or behavior. Caregivers in both groups report often to daily demonstrations of positive traits/moods. Positive traits/moods are: Pleasant to have around; Loving; Well-adjusted; and Cheerful.


Chart 52

Frequency of Child Negative Traits/MoodsDecember 2003


2.29

2.33

2.32

2.21

2.37

2.40

2.52

2.52

2.26

2.26

2.18

2.27

2.29

2.37

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has demonstrated a particular trait/mood or behavior. Caregivers in both groups report often to seldom demonstrations of negative traits/moods. Negative traits/moods are: Moody; Hostile or Aggressive; Jealous; and Destructive.


Chart 53

Child Satisfaction With AdoptionDecember 2003

1 = Very Satisfied 4 = Not at All Satisfied

1.13

1.09

1.46

1.08

1.16

1.17

1.18

1.08

1.89

1.40

1.17

2.18

1.44

1.14

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

Caregivers from both groups report that they believe that their child(ren) are very satisfied with the adoption. For this result, there is no statistically significant difference between groups over time.


Chart 54

Frequency of Child Positive Behaviors to ParentDecember 2003


3.30

3.30

3.10

3.24

3.22

3.20

3.19

3.02

3.30

3.21

3.26

3.29

3.30

3.27

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Baseline

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

Tim

e in

Stu

dy

Mean Score

Standard

Guided

For this score there is no statistically significant difference between groups over time. Caregivers are asked to estimate how often their child has acted a certain way toward the parent. Caregivers in both groups report often to daily demonstrations of positive behaviors exhibited to them from their child(ren). Positive behaviors are: Said nice things; Helped you with housework; Showed that s/he liked having you around; Did things with you; Was thoughtful when you were tired; Kissed/hugged you; Comforted you; Made you feel loved; and Showed you that s/he needed you.

DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine Adoption Guides 156

CHAPTER IV – COST NEUTRALITY INFORMATION, MAINECARE AND GUIDED SERVICES TITLE IV-E

COSTS The evaluator works cooperatively with D.H.S. and Casey Program staff in the design and implementation of the cost effectiveness/benefit analysis evaluation. DHS staff track overall IV-E costs associated with this Waiver project. Evaluation staff collect information about the costs to Casey Family Services for implementing the model, the IV-E dollars spent by the state DHS for MAGS families, and MaineCare costs for all children in the study. Cost data is provided by, and reviewed for accuracy by, agency administrators at Casey Family Services and at the state DHS.

Chart 55

The figures above show comparisons between total amounts spent by the state and federal government on children in the Guided Group (E) and the Standard Group (C). The bar furthest to the left displays the total costs spent on children. The other three bars

Cost Neutrality Information for Title IV-E Waiver Program

Total Cost December 2003

$11,574,764.48

$5,495,038.33

$2,745,715.70

$8,240,754.03

$5,570,608.23

$8,363,086.30

$2,792,478.07

$11,941,002.33

$2,000,000.00

$4,000,000.00

$6,000,000.00

$8,000,000.00

$10,000,000.00

$12,000,000.00

State andFederal

State andFederal

StateParticipation

FederalParticipation

GuidedGroupControlGroup


show the total IV-E dollars spent on children. For each total, the amount spent on Guided children was less than the amount spent on Standard children.

Chart 56

The figures above shows the total difference in costs between the Guided and Standard Services groups. As of December 2002, the state and federal IVE costs for the Guided Services group are approximately $122,332.27 less than IVE costs for the Standard Services group. This information for this point in time appears to indicate that this project is demonstrating cost neutrality to the federal government and the intervention in fact is less costly than standard post-adoption services costs. The Table below provides summary details.

Cost Neutrality Informationfor Title IV-E Waiver Program

Total Cost DifferenceDecember 2003

$366,237.85

$122,332.27

$46,762.37

$75,569.90

$0.00

$100,000.00

$200,000.00

$300,000.00

$400,000.00

State and FederalTotal

State and Federal IVE

State Participation IVE

Federal ParticipationIVE


Table 97 Cost Neutrality Total Difference

December 2003

The following charts provide information about MaineCare (Medicaid) total costs by category one year previous to study entry - baseline, first year in study, second year in study, and three-years in study. This information is provided to the evaluators from the state MaineCare office and is presented to Casey Family Services and state DHS program managers in order to assist them in their understanding of what may drive or inhibit costs in each area.

Chart 57

Total MaineCare AmountsMAGS Study Population

December 2003

$37,781

$56,076

$111,595

$82,045

$757,794

$211,125

$241,967

$712,489

$197,802

$211,921

$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000


Year 1 (g=140; s=121)

Year 2 (g=113; s=86)

Year 3 (g=51; s=45)

Year 4 (g=26; s=31)

Total Dollars

Standard

Guided

Total Costs Title IV-E Costs

GroupState and Federal

State and Federal

State Participation

Federal Participation

Guided Group $11,574,764.48 $8,240,754.03 $2,745,715.70 $5,495,038.33Control Group $11,941,002.33 $8,363,086.30 $2,792,478.07 $5,570,608.23Difference ($366,237.85) ($122,332.27) ($46,762.37) ($75,569.90)


The total amount of MaineCare dollars spent on this population (n=310) of children in foster care the year previous to study entry was $1,470,283. For those children (n=261) who are one year into the study, after approximately 90% are legally adopted, the total amount decreases to $408,927; a difference of nearly $1.1 million dollars. One reason given for this sharp decrease in this first year is the fact that therapeutic foster care costs are no longer accrued as these children are legally adopted. Total costs for those children (n = 199) in the study for two years are approximately $453,900. For those children in the study for three years (n = 96) the total MaineCare costs are $149,376. For those children in the study for four years (n=57), the total MaineCare costs are $138,121.

Chart 58

Average per Child MaineCare AmountsMAGS Study Population

December 2003

$741

$2,157

$2,480

$2,647

$4,565

$1,508

$2,141

$4,948

$1,635

$2,464

$0 $1,000 $2,000 $3,000 $4,000 $5,000


Year 1 (g=140; s=121)

Year 2 (g=113; s=86)

Year 3 (g=51; s=45)

Year 4 (g=26; s=31)

Average Dollars

Standard

Guided

For these results a t-test was performed and there are no differences between groups at baseline, MaineCare costs for the previous year prior to study entry. At baseline for the Guided Services (n=166) group the mean per child cost is approximately $4, 565. At


baseline for the Standard Services (n=144) group the mean per child cost is approximately $4, 948. These average per child costs appear less than the baseline, which is the previous year pre-legalization status, at all points in time Years 1 through 4.

Chart 59

Average MaineCare Costs - Foster and NonFoster December 2003

$1,492

$2,438

$2,262

$2,332

$4,622

$1,628

$2,242

$5,608

$1,165

$2,613

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000

1 Yr. Prior to Study (F=272; NF=38)

1 Year in Study (F=226; NF=35)

2 Years in Study (F=178; NF=21)



Total Dollars

Non-Foster

Foster

Comparing MaineCare costs by type of adoption indicates that during the year previous to entry to study, while these children were still in the foster care system not yet adopted, average costs for those children who would be adopted by non-foster parents were higher than those who would be adopted by foster parents; $5,608 to $4,622 comparatively.

MAINECARE COSTS BY CATEGORY The following charts and tables present MaineCare (Medicaid) costs by category of type of service. This information is important as they provide a type of description of the kinds of services children and families are accessing pre and post legalization. Of particular interest are the costs related to case management and behavioral health services as those types of services are most often thought to be associated with this particular post-adoption intervention. In fact, the social workers time working in the Guided Services model is paid for by a family based rate charged to MaineCare under Targeted Case Management.


Chart 60

Medicaid Physician / Practitioner / Dental Costs Average per Child

MAGS Study Population by Assigned GroupDecember 2003

$360$426

$405$266

$247$358

$142$570

$538$557

$0 $100 $200 $300 $400 $500 $600 $700 $800

Phys

icia

n/Pr

actit

ione

r/Den

tal

Average DollarsPrevious Year - Guided Previous Year - Standard Year 1 - GuidedYear 1 - Standard Year 2 - Guided Year 2 - StandardYear 3- Guided Year 3 - Standard Year 4 - GuidedYear 4 - Standard

Table 98 MaineCare Physician / Practitioner / Dental Costs Average per Child

By Assigned Group December 2003

Previous Year – Baseline

Year1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study

Guided Services (E):

N Mean SD

37 $538 $707

51 $360 $539

59 $405 $691

31 $247 $403

34 $142 $130

Standard

Services (C): N

Mean SD

34 $557 $610

51 $426 $706

64 $266 $429

27 $358 $873

41 $569

$1,789


Chart 61

MaineCare Prescription Drugs and Related Costs Average per Child MAGS Study Population by Assigned Group

December 2003

$565

$1,011

$871

$1,254

$605

$3,207

$526

$1,887

$505

$779

$0 $300 $600 $900 $1,200 $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 $3,300

Pres

crip

tion

Dru

gs &

Rel

ated

Cos

ts

Average Dollars

Previous Year - Guided Previous Year - Standard Year 1 - GuidedYear 1 - Standard Year 2 - Guided Year 2 - StandardYear 3 - Guided Year 3 - Standard Year 4 - GuidedYear 4 - Standard


Table 99 MaineCare Prescription Drugs and Related Costs Average per Child


Previous

Year – Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study

Guided Services (E): N

Mean SD

161 $505

$1,155

151 $565

$1,089

118 $871

$1,962

73 $605 $965

34 $526 $482

Standard

Services (C): N

Mean SD

133 $779

$1,713

129 $1,011 $2,484

106 $1,254 $2,695

54 $3,207 $11,723

40 $1,887 $3,884


Graph 4

MaineCare Prescription Drug CostsMAGS Study Population by Assigned Group

December 2003

$929

$1,397

$1,542

$629$695

$870

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Aver

age

Dol

lars

Guided (n = 100)

Standard (n = 84)

Prev. Year Year 1 Year 2

This graph displays cost differences over time for the two groups and indicates an average difference in cost over time which is not statistically significant; p=.125. However, this is an interesting finding and needs to be discussed as the average per child costs for prescription drugs has only increased slightly for the Guided Services group, approximately $200 dollars per child. However, in the Standard Services group, per child costs have increased over $600 per child. Given the thousands of children who are currently receiving post-adoption subsidy and MaineCare coverage, it seems imperative to analyze further this particular finding.


Chart 62

Medicaid Behavioral Health Services Average Costs per Child MAGS Study Population by Assigned Group

December 2003

$1,428

$4,436

$2,403

$3,925

$2,403

$4,059

$2,790

$5,480

$3,034

$2,738

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000

Beha

vior

al H

ealth

Ser

vice

s

Average Dollars



Table 100 MaineCare Behavioral Health Services Average costs per Child by Assigned Group

December 2003 Previous Year

– Baseline Year 1

In Study Year 2

In Study Year 3

In Study Year 4

In Study Guided

Services (E): N

Mean SD

14 $3,034 $5,010

16 $1,428 $1,805

26 $2,403 $3,790

14 $2,403 $2,471

16 $2,790 $3,611

Standard

Services (C): N

Mean SD

20 $2,738 $5,034

25 $4,436 $6,875

27 $3,926 $5,070

12 $4,059 $5,711

12 $5,480 $7,302


Chart 63

Long Term Care Costs per Child MAGS Study Population by Assigned Group

December 2003

$7,124

$8,346

$24,077

$19,674

$0 $10,000 $20,000 $30,000 $40,000 $50,000

Long

-Ter

m C

are

& R

elat

ed

Average Dollars

Year 1 - Standard

Year 1 - Guided

Previous Year -StandardPrevious Year -Guided

Table 101 Long Term Care Costs per Child by Assigned Group

December 2003

Previous Year – Baseline

Year 1 in Study


N Mean SD

14 $24,077 $19,842

7

$7,124 $8,980

Standard

Services (C): N

Mean SD

14 $19,674 $12,694

5

$8,346 $3,586


Chart 64

Case Management Costs per Child MAGS Study Population by Assigned Group

December 2003

$4,736

$2,569

$2,345

$1,249

$2,350

$1,056

$3,142

$2,279

$5,828

$7,293

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000

Cas

e M

anag

emen

t

Average Dollars


Case Management costs are significantly different at time period Year 1, chi-square 10.275 and p=.001, and Year 2, chi-square 10.962 and p=.001. This analysis is done with a nonparametric statistic, the Kruskal-Wallis test of mean ranks. Use of the median also confirmed statistical differences at Year 1 and Year 2. These results indicate that the Guided Services model is more costly in terms of case management than the Standard Services model. The primary way in which the social worker is compensated in the Guided Services intervention is MaineCare - Targeted Case Management.


Table 102 Case Management Costs per Child By Assigned Group

December 2003 Previous Year

– Baseline Year 1 in

Study Year 2 in

Study Year 3 in

Study Year 4 in

Study Guided

Services (E): N

Mean SD

30 $5,828 $3,668

39 $4,736 $3,435

54 $2,345 $1,597

29 $2,350 $1,498

22 $3,142 $1,342

Standard

Services (C): N

Mean SD

28 $7,293 $3,273

34 $2,569 $2,957

30 $1,248 $1,216

9

$1,056 $889

9

$2,279 $1,338

Table 103 General Inpatient Hospital By Assigned Group

December 2003

Previous Year –

Baseline

Year 1 in Study

Year 4 in Study


N Mean SD

0

2

$9,181 $6,334

0

Standard

Services (C): N

Mean SD

1

$7,291 $

0

1

$238,226


Table 104 Psychiatric Facility Services By Assigned Group

December 2003

Table 105

Transportation Costs per Child By Assigned Group December 2003

Previous

Year – Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study


N Mean SD

3

$2,006 $1,047

5

$949 $1,236

2

$1,460 $1,428

3

$545 $490

6

$111 $157

Standard

Services (C): N

Mean SD

2

$2,167 $2,947

3

$2,398 $1,713

5

$568 $567

2

$820 $758

4

$492 $268

Previous Year –

Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study


N Mean SD

1

$46,486 --

0

2

$36,075 $17,316

2

$23,385 $16,454

1

$41,932 --

Standard

Services (C): N

Mean SD

1

$26,013 --

0

0

0

0


Table 106 Ambulance Service By Assigned Group

December 2003

Previous Year –

Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study


N Mean

SD

2

$2,380 $2,322

0

0

1

$ 99 --

0

Standard

Services (C): N

Mean SD

1

$101 --

0

0

1

$ 129 --

0


Chart 65

General Outpatient MAGS Study Population by Assigned Group

December 2003

$1,836

$822

$438

$459

$162

$1,025

$737

$619

$1,034

$761

$0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $1,800 $2,000

Cas

e M

anag

emen

t

Average Dollars



Table 107 Early Intervention per Child By Assigned Group

December 2003 Previous

Year – Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study


N Mean SD

10 $2,004 $3,729

7

$3,305 $2,611

4

$1,644 $2,158

3

$3,886 $4,363

1

$2,290 --

Standard

Services (C): N

Mean SD

3

$1,360 $2,137

4

$2,969 $3,225

6

$4,331 $7,199

3

$1,458 $1,415

1

$2,130 --

Table 108 Non Traditional PHP/School Rehab By Assigned Group

December 2003 Previous

Year – Baseline

Year 1 in Study

Year 2 in Study

Year 3 in Study

Year 4 in Study


N Mean SD

5

$1,066 $424

6

$1,016 $ 941

12 $ 330 $ 156

11 $ 451 $ 435

12 $ 321 $ 256

Standard

Services (C): N

Mean SD

11 $1,514 $ 983

12 $ 707 $ 751

7

$ 263 $ 90

10 $ 280 $ 103

12 $ 293 $ 101


Chart 66

Guided Services Families: IVE ExpendituresDecember 2003

$2,146$2,166

$38,878

$39,820

$10,312

$4,311

$18,196

$19,858

$5,125

$20,683

$19,962

$5,187

$0 $10,000 $20,000 $30,000 $40,000

Cohort 1 Families

Cohort 2 Families

Cohort 3 Families

Cohort 4 Families

Total Dollars

Total Expenditures

DHSReimbursementFamily Contribution

This chart, and the one following, tracks costs that are Title IV-E dollars provided only to Guided Services (E) families. These funds are for services of various types that are not paid for from current options such as MaineCare and/or private insurance carriers. These services include such activities as respite, educational activities and/or special therapeutic activities. The intent is for the family to share equally in the costs of these services. Requests are made to Casey social workers and then approved by the state DHS adoption program manager on a case-by-case basis. Cohort 1 (n=20) families are those families accessing these funds that entered the project in the first year, Cohort 2 (n=24) families entered in the second year and Cohort 3 (n=12) entered in third project year and Cohort 4 (n=6) entered in the fourth year. Approximately 66% of Cohort 1 families have accessed this funding, 53% of Cohort 2, 33% of Cohort 3 families, and 20% of Cohort 4 families.


The types of activities paid for from these funds is varied; one arbitrary categorization of these activities is respite related services and all other.

• Cohort 1 Families: 22% Respite and 78% Other Types of Services • Cohort 2 Families: 38% Respite and 62% Other Types of Services • Cohort 3 Families: 20% Respite and 80% Other Types of Services • Cohort 4 Families: 100% Other Types of Service

Chart 67

Average per Family IV E ExpendituresDecember 2003

$112

$144

$95

$128

$145

$96

$0 $50 $100 $150 $200 $250 $300

Cohort 1

Cohort 2

Cohort 3

Total Dollars

DHSReimbursement

Family Contribution

This chart depicts average overall expenses per family for Cohort 1, 2 and 3 families. This data indicates that the intent of co-equal contributions from families and the Title IVE dollars appears to be evident; there are no statistical differences to report. Looking closer at costs for types of expenses:

• There were a total of 361 requests for financial support from 62 families to date. • 99 requests for Respite type services, at an average total (family and DHS

combined) cost of $264.00 per request. • 261 requests for Other types of services, at an average total cost of $257.00. • Average costs per activity are:

o Family Contribution: $125.00


o DHS Contribution: $132.00 o Total Combined: $259.00

• Minimum Contribution by Family = $12.50 • Minimum Contribution by DHS = $12.50 • Maximum Contribution by Family = $1,550.00 • Maximum Contribution by DHS = $1,550.00

Documents

MAINE ADOPTION GUIDES PROJECTmuskie.usm.maine.edu/Publications/ipsi/maine_adopt_guide_04.pdf · DHHS IVE Child Welfare Demonstration Project December 2003 Interim Report – Maine