Colorado Showed Increased Kinship Care Utilization Paired with Fiscal Savings during Title IV-E Waiver

This evaluation examined the process, outcome, and fiscal impact of a Title IV-E Waiver in the state of Colorado. Specifically, Chapin Hall examined the system-level child welfare outcomes and fiscal trends occurring during Colorado Department of Human Services’ (DHS) five-year Title IV-E Waiver child welfare demonstration project. Chapin Hall participated in this evaluation in partnership with the Human Services Research Institute and the Colorado State University Social Work Research Center.

Beginning in 2013, Waiver funding allowed Colorado DHS the flexibility to implement five primary interventions: facilitated family engagement meetings, kinship supports, Permanency Roundtables, trauma-informed screening and assessment, and trauma-focused treatment. Colorado’s Waiver interventions were far-reaching, with 53 of 64 counties in the state receiving funds and almost 30,000 children and youth receiving at least one intervention.

What We Did

Researchers evaluated the impact of the Title IV-E Waiver on key child welfare outcomes in Colorado by comparing pre-Waiver activity to post-Waiver activity in the 35 counties that participated in each of the Waiver’s five years. Controlling for child-level demographics, Chapin Hall examined state- and county-level outcomes, including the out-of-home placement rate, least restrictive placement use, placement stability, time to permanency, and reentry into out-of-home care.

The evaluation paired the outcome study with a fiscal study looking at the effect the Waiver had on child welfare expenditures in participating counties. Comparing pre- to post-Waiver activity, and controlling for inflation, Chapin Hall examined the expenditure trends. Researchers focused on total child welfare expenditures, out-of-home expenditures and utilization, and waiver intervention spending. Connecting expenditures to placement day utilization, Chapin Hall also calculated the average daily unit cost of out-of-home care and the financial impact of a shifting placement type mix.

What We Found

The likelihood of child initially entering a kinship placement significantly increased during the post-Waiver period. A child coming into care for the first time in the baseline period prior to the Waiver had a 34% chance of initially entering a kinship placement; during the Waiver, this likelihood increased to, on average, 46%. This finding was echoed in the observed increase in kinship placement day usage and in the fiscal study findings, which showed shifts in out-of-home placement costs.

The fiscal study found that, after controlling for inflation, counties increased total child welfare expenditures while holding steady or decreasing out-of-home care board and maintenance expenditures over the course of the Waiver. During the Waiver, demonstration counties reduced the average daily unit cost of out-of-home care by 8% between pre- and post-Waiver periods. The fiscal study projected that this decrease in average daily unit cost was a likely source of savings for the state. If the placement mix had held steady to that immediately prior to the start of the Waiver, researchers estimated these savings would be $69.8 million over the course of the Waiver.

What It Means

When observing the results of the outcome, process, and fiscal studies together, it can be hypothesized that the Waiver interventions were drivers or contributors to the reduction in average daily unit costs through changing the mix of placement types. The Waiver intervention provided supports to kinship providers and sustained both certified and noncertified kinship placements; under the intervention, children spent more days in kinship care than in more restrictive placements. Facilitated family engagement meetings enhanced this impact, serving as a platform for the identification of kin and the assessment of their needs to support them.

Additionally, the expenditure trend analysis showed that the category of spending that increased the most (by 18% over the course of the Waiver) was direct county spending. This trend reflected (1) a statewide push to explore and encourage services and supports for children and families beyond out-of-home placements and (2) county choices to primarily invest in county staff to deliver these services rather than purchasing those services from contract providers.

Colorado Title IV-E Waiver Final Evaluation Report Colorado Title IV-E Waiver Final Evaluation Report Appendices Colorado Title IV-E Waiver Final Evaluation Report Annex