Two studies are useful for understanding the development and implementation of the HomeTies Program: a study by the Tennessee Department of Finance and Administration, Division of Budget, of children in state care in Tennessee in 1989; and the evaluation of the HomeTies program by the University of Tennessee Social Work Office of Research and Public Service (SWORPS).
In 1989, during the pilot phase of the HomeTies program, the State of Tennessee conducted the Assessment of Children and Youth Committed to State Care. This report was compiled with the hope of locating inefficiencies in the current placement, tracking, and management process in child welfare. It explored the kinds of children committed to state care and the types of placements and services provided and needed by those children. Teams of professionals reviewed a random sample of 247 children (out of a total of 3,018 children) who were in various types of substitute care through the Department of Human Services as of May 1, 1989. Based on reviewers' judgments, the researchers found that 59 percent of children committed to the state's care were appropriately placed, 31 percent needed less intensive placement (including the option of not being in substitute care), and 10 percent needed more intensive placement. The study also found that too many children were placed in foster care. These and other findings from the study were used extensively in discussions with legislators to support the need to expand the HomeTies program; resulting ultimately in the dramatic increases in the program in the early 1990s.
One important limitation of this study was that only those cases in which children were already in substitute care were examined. This sample of cases skews the findings in the direction of concluding that more children need less intensive placements by: a) not examining non-placement cases, some proportion of which would likely to have been rated as needing more intensive services, including placement; and b) selecting cases only at the high end of the continuum of case severity, setting a ceiling for many of the cases on the possibility of recommending more intensive placements.
The University of Tennessee's statewide evaluation of the HomeTies program “was designed in response to both a legislative mandate and an interest in generating management information for ongoing program planning” (Homer, Cunningham, Bass, Collette, and Evans, 5/15/96). This research provides helpful descriptive information about referral sources, characteristics and problems of the population served, presenting problems in the family, prior placements, length of service termination status, and trends over time in these areas between FY93 and FY95. Some key information and findings are described below.
Demographic characteristics of children. Table 5-7 shows the age, race, and gender of children targeted as being at risk of placement for the state. For children at risk in FY95, 27 percent were under 10 years of age while 60 percent were teenagers (aged 13-18). There was no substantial change in the age of children at risk between FY93 and FY95. A large majority of the children served in The HomeTies program were white (67%), with African American children comprising 31 percent in FY95. This represented a slight increase in African American children, from 27 percent in FY93. The percentage of males grew from 52 percent in FY93 to 55 percent in FY95.
The relatively small proportion of cases referred for child maltreatment shows that, although CPS cases became eligible in 1991, the HomeTies program continued to serve a large majority of families with older children and families that were not referred because of child abuse or neglect.
a. Percentages that should add up to 100 but do not because of rounding errors.
(Note: missing data make up no more than 4.3 percent of the total of children or families for the characteristics listed here)
Presenting problems of parents and children. The most common presenting problems of families entering the placement prevention program in FY95 were parenting issues (91% of parents), child behavior problems (85% of children at risk), family conflict (78% of parents and of children at risk), and school problems (64% of the children at risk). Running away (29%) and juvenile delinquency (23%) were other frequent problems associated with children. These items are also indicative of the types of problems of families with older children and adolescents.
Home management needs (27% of parents), concrete service needs (21%), child and parental violence (19% and 17%), parental and child alcohol/drug abuse (17% for each), and severe financial hardship (16%) were also common problems of families. Mental illness of parents was listed as a presenting problem in 13 percent of families. The three types of maltreatment — physical abuse, neglect, and sexual abuse — were each listed as presenting problems in less than twelve percent of children at risk and in a separate listing of the problems of parents. There were few changes in presenting problems or demographic characteristics over time, although severe financial hardship declined by 6 percent from FY93 to FY95 — paralleling a 7 percent decline (from 20% to 13%) in families with gross family incomes of less than $5,000 and a 4 percent decline in families with concrete service needs.
Prior out-of-home placements. For children at risk at the time of referral to the placement prevention program, 28 percent had experienced at least one prior out-of-home placement. The mean number of prior placements was 1.6 for this population. Emergency/runaway shelters (43% of all prior placements) and juvenile court (37%) placements were the most common types of prior placements — no other placement types constituted over 10 percent. It is not clear how many children were in placement at the time of referral. Given the types of prior placements experienced by children, it is possible that many children were in short-term placements immediately prior to referral.
Demographic information about parents and families. Consistent with the paucity of infants served, only 13 percent of mother figures whose age was known were younger than thirty. Fifteen percent of the mothers being served by HomeTies were single, 30 percent were separated or divorced, and 43 percent were married. Only 3 percent of fathers being served were single, 11 percent were separated or divorced, and 73 percent were married. With regard to family composition, single parent families headed by birth or adoptive mothers (with no other adults) were the most common type of family — 32 percent of all families; followed by birth or adoptive parents (16%), birth mother and other adults (15%), and birth mother with stepfather or adoptive father (13%).
Forty-four percent of mothers served were employed full time, compared with 72 percent of fathers. Twenty-six percent of mothers were unemployed, compared with 11 percent of fathers. Seventy-three percent of families had gross incomes of less than $20,000 in FY95, with 37 percent of families earning less than $10,000, and 14 percent earning less than $5,000.
Findings: Out-of-home placement. The Homer et al report examined placement status of children at termination of HomeTies and six and twelve months later. “Placement data were obtained from the Client Operation and Review System database (CORS) by matching the information about children to HomeTies information” (Homer et al., 1995, p. 79). Two limitations of the data should be noted: only first placements were counted and data on the type of placement are available only for placements at termination of services. Data on identifying information (3.0%) or placement (.6%) were missing on 3.6 percent of cases. For children who received placement prevention services in FY95:
- 85.0 percent had no out-of-home placements for one year, conversely 15 percent (n = 523) of the children were placed;
- 5.3 percent were placed at termination of services; of these 186 children, most were placed in psychiatric hospitals (28.5% of the 186 children), foster homes (23.1%), or correctional institutions (14.0%);
- In addition to the 5.3 percent of children placed at termination, another 5.2 percent were living with friends or relatives and .9 percent were classified as runaways;
- 8.1 percent were placed between termination and six months after termination; and
- 1.6 percent were placed between six and 12 months after termination.
The figure of 15 percent of children placed within one year in FY95 is substantially lower than FY94 (20.4% of children placed within a year) and FY93 (24.7% of children placed within a year). Thus, there was s 40 percent decrease in the one year placement rate from FY93 to FY95. It is not clear whether differences are due to larger numbers of records missing in previous years (704 in FY93, and 216 in FY94), a trend toward less risky referrals, or improved program targeting and outcomes.
Cost analysis. The University of Tennessee report initially recognized the limitations of studying outcomes without a comparison group. Despite this, a detailed analysis of costs concluded that over $74 million was saved by the HomeTies placement prevention program as a result of preventing various types of placements. Like other optimistic estimates of cost savings, this estimate incorrectly assumes that all children at risk would have been placed in the absence of the program.