This study (N = 384) presents results from outcome measurement in a services network providing specialized foster care (SFC) to children in child protective service custody. A majority of participants improved on most outcomes. Global improvement was associated with increased length of stay up to two years, five months, and with younger age, fewer problems, and, paradoxically, the presence of a trauma history. Results suggest the value of SFC within managed services and of research using outcome measurement systems.
In the past decade, spurred by philosophical changes in children's services (see, for example, Stroul & Friedman, 1994, 1996) as well as concerns for cost, innovative, moderately intensive community-based services have increasingly replaced residential care as the intervention of choice for children with serious disturbances in the child welfare system. One of the most popular community-based interventions is specialized foster care (SFC), an intensive form of foster care that provides specially trained and supported foster parents to children with serious emotional disturbances. SFC is also referred to as specialist, therapeutic, or treatment foster care.
Not long after intervention philosophies changed, child welfare services began to move to a managed care model (casey Outcomes and Decision-Making Project, 1999; Scallet, Brach, & Steel, 1996; Winterfeld & Alsop, 1997a, 1997b, 1998). This model responded to increased demands for services, increased costs, diminished resources, and the perception that better quality services could be provided through greater planning and oversight. Not surprisingly, agencies now offer SFC and other communitybased services within managed care models. Yet research on this application of SFC is only in its early stages (see Armsden, Pecora, Payne, & Szatkiewicz, 2000; Davis et al., 1997). This study examines outcomes of SFC in a managed child welfare services network through use of an ongoing outcome measurement system. It also examines the relationship between client and service characteristics and outcomes.
SFC provides intensive, therapeutic services while maintaining youth in a community setting and avoiding the restrictiveness of psychiatric hospitalization and residential treatment. In this study, SFC differed from standard foster care in the following ways: (a) only one foster child was in the home, (b) one foster parent was at home full-time, (c) that foster parent received special training in behavior management (d) caseworkers provided ample support and supervision to foster parents, and (e) the provider agency was vigilant in reviewing and overseeing children's and families' service plans (see, for example, Bates, English, & Kouidou-Giles, 1997). The behavior management model in this study engages children in their strengths, uses positive reinforcements, includes children and birthfamilies in planning and decisionmaking, and promotes collaboration between foster parents and birth-parents on parenting. caseworker support includes home visits ranging from twice a month to twice a week, 24-hour crisis intervention, and monthly support group meetings.
Like other foster care, SFC is temporary, with the goal of preparing children for the most appropriate permanent life situation, whether that is reunification with parents, adoption, or independent living. SFC can also lead to a step-down program, such as regular foster care, when children no longer need the intensity of SFC but permanent placement is not indicated, or to more intensive programs, like residential or hospital treatment, if children need more than SFC. One risk of SFC, however, is that youth may run away from their foster home. In a previous study of part of this study's sample (Fasulo, Cross, Mosley, & Leavey, 2002), 44% of adolescents ran away from SFC at least temporarily and 22% ran permanently. Data on a subsample suggested that most ran back to their birthfamily or home community. …