Evaluating the Quality Improvement Center for Research-Based Infant-Toddler Court Teams

Measuring the gains of a new approach to expediting child welfare cases

Few individuals in American society are as vulnerable as infants and toddlers who through abuse or neglect have landed in the care of the child welfare system. Already exposed to the risks of toxic stress, they face the additional trauma of being removed from the only homes they have ever known. The journey back to safety and stability is well beyond their understanding and control. Though often hidden from public view, these cases are widespread: in the 2016 fiscal year, 7.4 million children were referred to the child welfare system.

The goal of the system is to protect children from harm and ensure safety, permanency, and well-being. The process, though, is complicated, involving families, courts, public and private agencies, schools and child care providers, nonprofit groups, and more. Getting an infant or toddler to permanency sometimes takes longer than the child has been alive up to that point.

The nonprofit organization ZERO TO THREE works to help all infants and toddlers reach their full potential. ZERO TO THREE designed a new approach for supporting the health, mental health, and developmental needs of young children in the child welfare system and expediting safe and nurturing permanency outcomes. Known as Safe Babies Court Team^TM (SBCT), this approach is a collaborative, problem-solving systems-change innovation focused on supporting the health, mental health, and developmental needs of babies and toddlers under the court’s jurisdiction and expediting safe, nurturing permanency outcomes. SBCT offers a structure for systems to work together—the court, child welfare agency, and related child-service organizations—to ensure better outcomes for the youngest children in care and for their families. The structure comprises a Family Team (attorneys, case planner, service providers, and family) that comes together at least monthly to identify and address barriers to reunification, and a community stakeholder team, or Active Court Team, that engages in broader systems reform efforts. 

More than 70 sites around the country have established SBCT since 2005. In 2014, the Children’s Bureau provided a grant to ZERO TO THREE and its partners to develop the Quality Improvement Center for Research-Based Infant-Toddler Court Teams (QIC-ITCT), which provides technical assistance and training to participating sites. The QIC-ITCT provides access to evidence-based interventions and best practices for individuals and agencies working with the birth-to-3 population. The mission of the QIC-ITCT is to support implementation and build knowledge of effective, collaborative court team interventions that transform child welfare systems for infants, toddlers, and families (see http://www.qicct.org/). ZERO TO THREE engaged RTI to conduct a process and outcome evaluation of the SBCT approach.

Identifying Practices that Support Successful Court Teams

We conducted baseline and follow-up visits to 10 communities that had implemented the approach. The qualitative side of the study brought many opportunities to watch the system in action firsthand, as we visited sites, observed court proceedings and relevant meetings, and sat down for in-person interviews with judges, caseworkers, attorneys, community coordinators, and service providers. We also collected and analyzed data from a broader group of stakeholders via a web-based survey. The outcome evaluation was a non-experimental design using secondary data analysis across sites. The database is used by community coordinators and data entry personnel to input and track case-level information.

Of the 12 core components of the SBCT approach, three are most critical to the program’s success:

• Strong judicial leadership
• A community coordinator
• An active court team

When one of these critical components is absent, infant-toddler courts can survive, but the pace of progress is slower and other core components begin to falter.    

A Better Path to Stability for Children in the Welfare System

SBCT sites established a variety of new and improved practices. We found evidence of new ways to prepare for court hearings, better support for parents’ voices and needs, and a high focus on quality placements. Parents were engaged as key stakeholders—a trend that will prove especially relevant as states increase their emphasis on keeping families together.

Better still, we found signs that the child welfare system was working more effectively:

• For the 231 children that reached the closing of their case during the time in the study, the vast majority—83.6 percent—reached permanency within 12 months, a rate that well exceeds the Children’s Bureau national standard of 40.5 percent
• Across 430 children with both open and closed cases, maltreatment recurrence within 12 months was 0.7 percent, compared to the Children’s Bureau national standard of 9.1 percent.

Another notable outcome concerned children of color. We found that black, Hispanic, and Other children in SBCT sites reached permanency at an equivalent rate to white children, even more, there were no significant differences by child race/ethnicity on having two or fewer placements or access to services—a contrast to data from the National Survey of Child and Adolescent Well-being (NSCAW), which showed racial inequities. This finding deserves further investigation and is very promising for children of color who have historically experienced more difficulty in the child welfare system.

Our evaluation, overall, shows that the Safe Babies Court Team approach has great promise. Despite limited resources, court teams work actively to support young children and their families. Through measurable changes in the way they operate, the teams have brought about positive results for the children they serve. Based on our findings, we have made recommendations for communities looking to achieve similar results, as well as a redesign of the evaluation itself. With new funding from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, we will partner with ZERO TO THREE and conduct a new evaluation of the SBCT approach. Our new, quasi-experimental design will include a comparison group generated from NSCAW, a comprehensive study of the experience of children in the child welfare system. RTI has been involved in NSCAW since 1999 and is currently working on the study’s third cohort.

These are all steps on the path to a more effective, beneficial experience for children who truly need protection and care.