Using CANS Items to Define Child Well-Being and Study Child Welfare Outcomes
By: Dr. Amy Zimmerman, Casey Family Programs
Casey Family Programs (Casey) believes that every child deserves a safe, supportive, and permanent family. Casey works urgently and relentlessly with our target service population of older youth to achieve permanency so that no child will age out of Casey foster care. We believe building, or rebuilding, family is central in our practice and embodies our core values of Family-Centered Practice. Casey is also committed to becoming a learning organization and we regularly engage staff at all levels in the organization in the analysis and application of data so that we can improve the quality and consistency of our outcomes. From Data to Practice is a continuous quality improvement series that represents a learning opportunity driven by overarching questions from the field. We believe that:
- Every youth and family that walks in our doors is a test of our system.
- Those that exit teach us about the quality, effectiveness and efficiency of our system.
- Those who are yet to come represent an opportunity for us to improve.
The focus of From Data to Practice is the quality of practice and achieved outcomes across all of Casey’s Child and Family Services. It also seeks to connect front-line staff with their own data. Staff propose the question and then identify the next steps to be taken based on the evaluation’s results.
In volume 2 of our From Data to Practice series, we explored the impact of placement with relatives versus placement with non-relatives on youth safety, permanency, and well-being. The target population was 436 youth who entered Casey out-of-home care between July 1, 2014, and July 1, 2015. Data were analyzed in July 2017, allowing for two years of tracking outcomes.
More time placed with family while in out-of-home care is associated with better youth well-being, including school achievement, health, and optimism (at most recent assessment).
Child welfare does not use a standard, agreed-upon definition of youth well-being. Because there is no agreed upon definition, Casey staff and leadership were interviewed about how they defined youth well-being. Themes from these interviews fell into four categories: Education Physical and Mental Health, Social Development, and Culture. Within these categories, certain indicators were repeatedly mentioned. These indicators were then aligned with individual items on Casey’s CANS assessment.
We calculated the sum of actionable items (areas where help is needed to improve youth functioning) for the most recent assessment. Youth’s most recent CANS assessment corresponded to either their exit CANS, if they had exited Casey out-of-home care, or their most recent CANS as of July 1, 2017 (the end of the study period). Youth who spent more than half their time placed with family while in out-of-home care had fewer documented well-being challenges (an average of 1.25 actionable well-being items), compared to youth who spent less than half their time placed with family while in out-of-home care (an average of 1.94 actionable well-being items). More time placed with family indicated better youth well-being in school, mental and physical health, social development, and cultural identity.
The more time youth spend placed with family while in out-of-home care, the more likely they are to obtain legal permanency.
Youth who spent more time placed with family had higher legal permanency achievement rates, and the percent of youth who achieved legal permanency went up in a step-wise fashion as the amount of time placed with family while in care increased. For example, 38 percent of the youth who spent no time placed with family achieved legal permanency compared to 83 percent of the youth who spent all of their time placed with family.
Time to event analyses were completed to assess the time it took youth to exit to legal permanency. Comparisons were made base don the amount of time youth spent in out-of-home care placed with family. Results indicated that 1) Youth who spent 100% of their time placed with family while in Casey out-of-home care exited to legal permanency significantly faster and at a higher rate than those who spent less than 100% of their time placed with family while in care 2) Youth who spent 51-99% of their time with family in Casey out-of-home care exited to legal permanency significantly faster than youth who spent 50% or less of their time in care with family.
What we can do
This research provides important insights into how to approach practice in the future. This research furthers understanding of how our values affect outcomes among the children and families we serve and affirms Casey’s belief that families and cultural relevance play a central role in the decision-making process
- Persevering in engaging youth and caregivers in conversations about what well-being means to youth and families.
- Persisting in exploring youth identity and belonging, and their relationship to well-being.
- Examining licensing requirements for kinship caregivers and exploring ways to simplify and expedite the process.
- Persevering in engaging families, including advocating for and elevating the voice of birth parents.
- Persisting in challenging bias against birth families, including those who have previously had their parental rights terminated.
- Continuing to use and incorporate family group conferences or other family-centered teaming techniques as a practice strategy to elevate relatives’ voices, create a space for the relatives to develop their own plan, and break down power differentials.
Please visit: https://caseyfamilypro-wpengine.netdna-ssl.com/media/1896-CS-From-Data-to-Practice-2018.pdf for the full From Data to Practice vol. 2 report, which includes more detailed analyses and findings.
Note: Time with family is defined as the number of days in Casey out-of-home care spent residing in a trial home visit, relative placement, or placement with fictive kin. These days were divided by the total number of days in care for that youth (creating the percentage of time placed with family).