NO 1825
Focusing on Outcomes of Out-of-Home Care
Data collection activities in social services naturally focus on questions of "Who was served?" and "What services did they receive?" Such input and process questions are important in determining if monies were properly spent [Newman & Turem 1974]. The field has experienced difficulty, however, in integrating data collection around short- and long-term effects of programs and services [Fischer 1976]. These difficulties arise from both conceptual and practical problems. In the first author of this book's consultation work with a state agency attempting to develop an evaluation system for a case review unit, it came as a major revelation to most of the staff that case review should ultimately be judged in terms of its contribution to the achievement of permanent placements for children rather than by the timeliness, content, or number of participants in the reviews. Indeed, a permanent placement itself is of value only in that it contributes to the final outcome — a well-functioning adult. Recall that out-of-home care was once viewed as an outcome, the result of an intervention designed to rescue a child from an abusive or neglectful home and assure his or her continuing safety and long-term out-of-home care was seen as a solution, not a problem [Kadushin & Martin 1988]. The notion of out-of-home care as essentially a planning process or step toward a permanent placement for children is a relatively new one and one with which the field is still struggling [Maluccio et al. 1986].
In addition to conceptual problems that exist in developing an outcome orientation to out-of-home care services, pragmatic obstacles also must be surmounted. Even with a clear understanding of the need to monitor outcomes, obtaining follow-up data on cases discharged months or even years ago can be difficult and costly.
Despite these difficulties, considerable progress has been made as reflected in both the numbers and quality of outcome studies that have been conducted in the social work field [Fischer 1976]. The Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) is output-and outcome-oriented in its focus on permanent placements for children. This legislation also embodies the perspective that out-of-home care is a planning process rather than an end-state solution. There would even appear to be some agreement about the use of basic standards and uniformity in outcome measurement emerging in child welfare programs [McDonald et al. 1989]. As will become clear in the review of the studies that follows, however, considerably more attention is still focused on characteristics of children coming into out-of-home care (inputs), the services they receive and time in care (process), and where they go at discharge (outputs) than on what happens to children after they leave the out-of-home care system (outcomes).
Out-of-home care will always retain its child-saving function — providing immediate relief from abuse or neglect — and permanency in the living arrangements is clearly desirable. The efficacy of an out-of-home care placement, however, must ultimately be judged by the long-term impact of that placement on the child's ability to function as an adult. Client and service typologies abound, and lists of child, family, and community characteristics are endless, as are the possible descriptors of the child's experience in care. The position taken here is that the only relevant criterion for sifting through these descriptors is to judge them by their importance in achieving desired outcomes for the children served by the out-of-home care system.
THOMAS McDONALD, REVA ALLEN, ALEX WESTERFELT and IRVING PILLAVIV
McDonald, T., Allen, R., Westerfelt, A. and Pillavin, I. (1996). Assessing
the Long-Term Effects of Foster Care: A Research Synthesis. Washinton: CWLA
Press. Pp. 21-22
