Ontario Looking After Children project: Overview of findings from research on implementation, outcomes, and costs
Bob Flynn ([email protected])Centre for Research on Community Services
University of Ottawa (Canada)ACWA Conference, Sydney, August 14, 2006
For more detailed information on the topic of this presentation, please see the following references:
Flynn, R. J., Dudding, P. M., & Barber, J. G. (Eds.) (2006). Promoting resilience in child welfare. Ottawa, ON: University of Ottawa Press. (http://www.utppublishing.com/pubstore/merchant.ihtml?pid=8652&step=4)
Flynn, R. J., & Byrne, B. (2005). Overview and findings to date of research in the Ontario Looking after Children project. OACAS Journal, vol. 49, no. 1 (April), pp. 12-21. (http://www.oacas.org/resources/OACASJournals/2005April/overview.pdf)
Flynn, R. J., Ghazal, H., Legault, L., Vandermeulen, G., & Petrick, S. (2004). Using general-population measures and norms to identify resilient outcomes among young people in care. Child and Family Social Work, 9, 65-79. (http://www.blackwell-synergy.com/toc/cfs/9/1)
Outline
Ontario Looking After Children (OnLAC) project (2000-present): Purpose Findings:
Implementation Outcomes Costs
Implications
OnLAC project: Purpose
Evaluation of: Implementation of LAC in 53 local
CASs Outcomes associated with LAC Costs of foster care
Milestones in implementing LAC in Ontario 2000-2006 & beyond
2000: OnLAC project begins; creation of AAR-C2 2001: LAC training & use of AAR-C2 begin 2002: First outcome reports & AAR-C2 revisions 2003: First review of provincial AAR-C2 data 2004: OACAS adopts LAC as official priority & establishes OnLAC
Council 2005: LAC becomes one of six priorities of Ontario CW
Transformation 2006: Definitive AAR-C2 version disseminated for use by all 53
CASs 2007: Plans of care (12,000 children) to be based on AAR-C2 2008: AAR-C2 to be part of new Single Information System 2009: Next revision of AAR-C2 planned
Study 1: How useful do child welfare staff find AAR-C2 in helping them in their work?* (% = “Very useful” or “Useful”; N = 126)
Understand child’s needs better: 77% Collaborate better with caregiver: 73% Prepare more useful plans of care: 70% Assist youth in planning future: 70% Perform service role more effectively: 66% Discuss more effectively with youth: 64%
Be more aware of youth’s progress: 64%
*Pantin & Flynn, 2006
Predictors of perceived utility of AAR-C2 among child welfare workers & supervisors (N = 125)
Frequency of discussion in supervision of information in AAR-C2 (+)
Quality of LAC training received (+) Amount of LAC training received (+) Amount of experience in using LAC (+)
Mean score (adjusted) on perceived utility of AAR-C2 scale, by frequency of discussion of information in AAR-C2 in supervision (N = 125)
17,47
13,86
11,52
7
9
11
13
15
17
19
21
Rarely or never From time to time Often or always
FREQUENCY OF DISCUSSION OF AAR-C2 IN SUPERVISION
PER
CEIV
ED
UTIL
ITY O
F AAR
-C2
Weakness in OnLAC implementation:information in AAR-C2 discussed too infrequently in supervision (N = 125)
Frequency of discussion of information contained in AAR-C2 in supervision: Among child welfare workers:
46% “Rarely or never” 46% “From time to time” 8% “Often or always”
Among supervisors: 7% “Rarely or never” 70% “From time to time” 23% “Often or always”
Study 2: How useful do foster parents find AAR-C2 in helping them in their work?* (% = “Very useful” or “Useful”; N = 93)
Make more useful suggestions to care plan: 84% Discuss more effectively with youth: 80% Understand child’s needs better: 79% Parent youth in care more effectively: 79% Collaborate better with child welfare staff: 79% Be more aware of youth’s progress: 79% Assist youth in planning future: 77% Clarify responsibility as foster parent: 73%
*Pantin & Flynn, unpublished manuscript
Predictors of perceived utility of AAR-C2 among foster parents (N = 93)
Quality of LAC training received (+) Amount of LAC training received (+)
Mean score on perceived utility of AAR-C2 scale, by foster parents’ perception of quality of LAC training (N = 93)
20,47
15,51
11,01
8
10
12
14
16
18
20
22
24
Poor Good Very good
PERCEIVED QUALITY OF LAC TRAINING
PER
CEIV
ED
UTIL
ITY O
F AAR
-C2
Study 3: Is greater success in achieving LAC goals with youth in care associated with more positive youth outcomes?* (N = 402)
Greater success in achieving goals of LAC was associated with: More positive relationship of youth with female
caregiver More positive relationship of youth with child welfare
worker Higher satisfaction of youth with current placement
*Pantin & Flynn, unpublished manuscript
Study 4: Placement satisfaction of young people living in foster or group homes*
*Flynn, Robitaille, & Ghazal, 2006
“Would you say that your current living situation meets your needs?”
(N = 397)
81%
15%
4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A great deal Some Very little
“Would you say that, overall, you are satisfied with your current living situation here?” (N = 405)
78%
16%
6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A great deal Some Very little
Mean (average) score on 9-item placement satisfaction scale (OnLAC, longitudinal sample, yr 1, N = 223)
25,2
21,4
15
18
21
24
27
Pla
cem
ent
sati
sfact
ion
score
Foster home Group home
*Difference in means is statistically significant (p < .001)
,
Study 5: Young people’s suggestions for improving their current placements*
Suggested improvements were related to: Self Birth family Foster family Placement
Change in type or location Physical features or surroundings Social features or climate
*Robitaille, Ghazal, & Flynn, unpublished manuscript
Study 6: Positive life experiences that promote resilience in young people in care*(N = 641 aged 10+)
Major themes that emerged: Foster home (18%) Relationships (23%) Personal development (12%) Education (16%) Activities & events (24%) Family activities (4%) Life transitions (6%)
*Legault & Moffat, 2006
Study 7: Hope in young people in care* (N = 374)
Hope: “pathways thinking” + “agency” thinking Hope in young people in care:
As high as in other groups Higher hope associated with:
Active (vs. avoidant) coping (+) Living in foster (vs. group) home (+) Male gender (+) Relationship with female caregiver (+) Physical aggression (-) Age (-)
*Dumoulin & Flynn, 2006
Study 8: Participation by youth in care in structured voluntary
activities* (N = 442) Participation in structured voluntary activities:
Most frequent in sports Least frequent in art, drama, music More frequent participation associated with
psychological benefits But: psychological benefits of participation
depended on youth’s level of substance use: Low substance use: high benefits High substance use: low benefits
* Flynn, Beaulac, & Vinograd (2006)
Study 9: Foster parenting practices & foster youth outcomes* (N = 367)
Greater foster youth pro-social behaviour: Associated with higher foster-parent nurturance
Greater foster youth emotional distress: Associated with higher parent-youth conflict
Greater foster youth conduct disorder: Associated with lower foster-parent nurturance Associated with higher parent-youth conflict
Greater foster youth indirect aggression: Associated with lower foster-parent nurturance Associated with higher parent-youth conflict
*Perkins-Mangulabnan & Flynn, 2006
Study 10: Identifying resilient outcomes among youths in care*
Comparisons made between: Non-random sample of Ontario youths in
care, aged 10-15 years (N = 340), & Random sample from general Canadian
youth population, aged 10-15 years (N = 5,539)
*Flynn, Ghazal, Legault, Vandermeulen, & Petrick, 2004
Parental rating of youth’s academic achievement, in reading, math & overall
(Thirds based on Canadian [NLSCY] norms)
80
37
15
32
5
31
01020304050607080
%
Bot third (notresilient)
Mid third(resilient)
Top third(highly
resilient)
Ontario CAS (N = 319) NLSCY (N = 5539)
Note. Top third experience better academic achievement
General self-esteem(thirds based on Canadian [NLSCY] norms)
28 27
38 3734
37
05
10152025303540
%
Bot third (notresilient)
Mid third(resilient)
Top third(highly
resilient)
Ontario CAS (N = 326) NLSCY (N = 5325)
Note. Top third report higher levels of general self-esteem.
Peer relationships(thirds based on Canadian [NLSCY] norms)
49
33
19
2832
39
0
10
20
30
40
50
%
Bot third (notresilient)
Mid third(resilient)
Top third(highly
resilient)
Ontario CAS (N = 333) NLSCY (N = 4653)
Note: Top third experiences higher levels of positive relationships.
Pro-social behaviour(thirds based on Canadian [NLSCY] norms)
3327
35 35 35 38
05
10152025303540
%
Bot third (notresilient)
Mid third(resilient)
Top third(highly
resilient)
Ontario CAS (N = 463) NLSCY (N = 4879)
Note: Top third report higher levels of pro-social behaviour.
Anxiety/emotional distress (thirds based on Canadian [NLSCY] norms)
65
33
20
32
15
35
010
2030
4050
6070
%
Bot third (notresilient)
Mid third(resilient)
Top third(highly
resilient)
Ontario CAS (N = 475) NLSCY (N = 4847)
Note: Top third report lower levels of anxiety/emotional distress
Study 11: Costs of foster care*(N = 119)
Data on 119 young people in foster care, aged 10 and over, from 3 Ontario CASs
111 youths in foster care, 8 in kinship care Sources of data:
Longitudinal data on needs & outcomes taken from AAR-C2 in 2001-2002 & 2002-2003
Costing data taken mainly from CAS accounting departments, supplemented by data on services from AAR-C2
*MacDonald, Flynn, Aubry, & Angus, unpublished manuscript
Three key questions
Q1: What is average cost of individual packages of care?
Q2: Do greater needs predict higher costs?
Q3: Are higher costs related to changes in child’s functioning over 12-month study period?
“Package of Care”
Complete set or “package” of services received by an individual child in care, from: CAS: board rates, clothing allowances, spending
allowances, reimbursed expenses for recreation, camp, dental services, therapy, etc.
Other government ministries: OHIP & Ministry of Health: doctor’s visits; hospital stays Education: classroom costs Court costs
Foster parents: Out-of pocket expenses not reimbursed by CAS
Volunteers (e.g., cost of services provided by volunteer driver)
Results for question 1: Annual average costs of total package of care (N = 119, including 3 “outliers”)
CAS Other agenciesCaregivers Volunteers
Total: $35,286.91 CAS: 65%
M = $22,892.73 Agencies: 28%
M = $9,854.47 Caregivers: 7%
M = $2,468.72 Volunteers: .02%
M = $70.86
Results for question 2:Needs & costs
Higher health needs predicted higher costs, suggesting equitable allocation of resources
Kinship care was less costly than foster care (but only 8 of the 119 youths were in kinship care)
Results for question 3:Costs & outcomes
Over 12-month study period, higher costs: Were not associated with changes on outcomes
of: Self-esteem Pro-social behaviour Emotional distress.
Were associated with increases on outcomes of: Conduct disorder Indirect aggression Ill-health
Implications of OnLAC project findings
For practice For policy For research