Fostering Innovation through Title IV-E Waiver Demonstrations
Testa, Mark, Policy & Practice
How many times as a child welfare practitioner or administrator have you thought: I could do much better by this child if only I could use the Title IV-E dollars my state receives differently than to spend them solely on child placement administration and foster care maintenance? Now you have the opportunity to act on your inclinations and evaluate the impact.
Whether you want to offer evidence-based services that are not reimbursable under Title IV-E, such as drug-recovery coaches or parent-management training, or test promising practices that lack solid scientific proof of effectiveness, such as kinship navigator programs, the restoration of IV-E waiver authority by the Child and Family Services Improvement and Innovation Act (P.L. 21-118) once again gives states a powerful tool for testing innovative service-delivery strategies and contributing to the evidence base of what works to ensure the safety, permanency, and well-being of vulnerable children and their families.
Guidance from the U.S. Department of Health and Human Services (HHS) on the new waiver program was not published when this article went to press, but there is sufficient similarity with the old program and enough details in the Federal Register (FR) to outline the key ingredients that go into a waiver application. Even though a letter of intent is not strictly required, it is good practice to identify the four components that the FR encourages Title IV-E agencies to describe in a letter: the target population, the intervention the agency proposes to implement, the comparison group, and the outcomes the agency expects to change.
Conveniently, these four components align closely with the four elements of a well-built PICO question that evaluators use to guide intervention research: Population, Intervention, Comparison, and Outcome. For example, the subsidized guardianship demonstrations that Illinois, Tennessee, and Wisconsin conducted can be summed up as answering the following PICO question: Does the availability of guardianship assistance (I) for children who have been in foster care for a year or more and resided continuously with a related foster parent (P) increase overall permanency rates at no extra cost (0) compared to children in similar circumstances who receive permanency planning services as usual without the guardianship assistance option (C)? The affirmative answer that all three demonstrations gave to this question is generally credited with helping to pave the way for the creation of the kinship Guardianship Assistance Program (GAP) in 2008.
Permanency, Prevention, and Well-Being Outcomes
As is true with PICO questions, it is usually best to begin with the 0 when preparing a waiver application. States like Delaware, Maryland, and Virginia, that have already turned the corner on caseload growth but face challenges finding permanent homes for children who enter foster care after age 12, may best improve outcomes by prioritizing permanency for older youth and promoting their successful transition to adulthood. States like Iowa, Nebraska, and Wyoming that register foster care placement and entry rates well above the U.S. average may best improve outcomes by preventing child abuse and neglect and re-entry into care. The federal statute identifies a third goal: increasing well-being and other positive outcomes for infants, children, and families in their homes and communities, including tribal communities.
When justifying the reasons for a waiver demonstration project, it is advisable to couple well-being outcomes with either permanency or prevention. This is because funding for any new services must come from the "savings" generated by holding costs in the intervention group below the cost-neutrality limit set by the control group. Improvements in well-being, such as educational success or emotional health, are vital but don't always translate directly into cost savings. …