Policy & Practice June 2015

for both groups for a five-year period or imputed for a five-year period. The first year cohort will be observed for five years, the second for four years, and the third for three years. The evaluation will calculate the total number of foster care days avoided by comparing the total number of days in the treatment group compared with the control group. A statistically adjusted estimate of the difference between the two groups will be used to calculate the number of foster care days prevented by the PFS program. The success payment will be equal to the product of the total number of foster care days avoided multiplied by $75.00, an amount determined by the county to be the total daily cost of main- taining a child in foster care. While Cuyahoga County has safely reduced the number of children in foster care and the number of homeless people, families who experience both homelessness and foster care repre- sent an especially difficult challenge. Through PFS, we have new tools to meet the unique needs of this popula- tion as well as explicit expectations that the government will only pay for suc- cessful outcomes. The combination of innovative financing and program inte- gration allows us to address the needs of some of our most vulnerable children and families. Karen J. Anderson is the Pay for Success coordinator at the Cuyahoga County Division of Children and Family Services. David Crampton is an associate professor of Social Work and the associate director of the Center on Urban Poverty and Community Development at the Jack, Joseph, and Morton Mandel School of Applied Social Sciences at CaseWestern Reserve University in Cleveland, Ohio. Trista Piccola is the deputy administrator of the Cuyahoga County Division of Children and Family Services. Reference Note 1. See “ACYF/Recent Demographic Trends in Foster Care” September 2013. http:// www.acf.hhs.gov/sites/default/files/cb/ data_brief_foster_care_trends1.pdf

Initially all participants receive Critical Time Intervention (CTI), an intensive case management model aimed at building skills that help individuals transition to and live suc- cessfully in their own community-based housing. CTI has been evidenced to reduce homelessness in vulnerable populations although it has not been used with child welfare families. The six- to nine-month intervention focuses on the transition from homelessness to housing, development of life skills, and linkages to community resources. The FLS team implements Trauma- Adapted Family Connections at the time of parent-child reunification. This intensive in-home manualized practice, for families with children between 5 and 17 years of age, focuses on meeting families’ basic needs, building protec- tive factors, and enhancing family relationships. This program has demon- strated success in working with urban families who live in poverty. Initially, workers engage with families through the assessment of unmet basic needs such as health care, emergency food, household furniture, and supplies. The program has resources to assist the families in meeting these basic needs. Workers then teach parents to build and enhance physical and emotional safety and to identify, express, and regulate feelings. Parents learn skills to commu- nicate more effectively, establish family roles and boundaries, and problem solve. Child-Parent Psychotherapy (CPP) is an in-home therapeutic model for parents with children ages birth to six. CPP focuses on trauma in the family system and its impact on the parent- child relationship. The model is based on attachment theory but also inte- grates developmental, social learning, and cognitive behavioral theories. The Center on Urban Poverty and Community Development is conducting an evaluation that will determine if the PFS intervention reduces the number of days children are in out-of-home placement using a randomized con- trolled trial. Over a three-year period, eligible families will be identified and then randomly assigned to a treatment or control group. Once enrolled in the study, the children’s days in out-of-home placement will be counted or “tracked”

the children’s length of stay in care by providing immediate housing/re- housing services, as well as intensive case management and trauma-based clinical interventions. To begin to identify the target population for this project, Integrated Data Systems (IDS) at the Case Western Reserve University’s Center on Urban Poverty and Community Development, the PFS independent evaluator, were used to quantify the number of homeless families who also receive child welfare services. The analysis examined 6,061 women who entered homeless services in 2010, 2011, and 2012. The center found that nearly 30 percent of these women had an open case with the county child welfare agency. Only 7 percent of these women, representing 411 households, had children placed in foster care. However, the 739 children placed in foster care from these households rep- resented 18 percent of all the children in foster care over this three-year period. The cost of care for this subset of child welfare-involved children exceeded $18 million dollars for the county, amounting to a government expenditure of nearly $25,000 per child. While small in numbers, this group merits special attention because children in these dually involved families spend at least 30 percent more time in foster care compared with children from families who are not receiving homeless services. These extensive foster care experiences are not only related to the families’ home- lessness, but also to high rates of mental illness, substance abuse, and trauma among both parents and children. The PFS program is a 12–15 month intervention designed to meet a range of client issues. The FrontLine Service (FLS) case manager and the DCFS case- worker become a team and together build a comprehensive support network for program participants. The DCFS worker remains responsible for child safety, well-being, and permanency and for coordinating the parent’s child welfare case plan. The FLS case manager implements the program interventions, supports the parent with child visitation, and attends all child welfare-related meetings and court hearings.

June 2015   Policy&Practice 21