Can science save abused, neglected kids – and money, too?
The homeless high school dropout now in juvenile detention started out as someone’s baby. That truth, obvious though it may be, has become a virtual mantra to leaders in Washington State these days. And for good reason.
The combined costs of foster care and juvenile incarceration are rising, and low graduation rates are leaving too many youngsters unemployable. To contain expenditures for these downstream consequences, many public and private funders are asking agencies and organizations that serve at-risk kids to improve upstream strategies. Two notable efforts are drawing on science-based ideas about how to promote the well-being of children in Washington State.
First, legislators now require state-supported programs to employ practices that research has shown to have a superior track record for turning young lives around. These reforms won’t necessarily require new funding. Resources are already in the state budget to implement proven best practices, according to at-risk youth expert Eric Trupin, Vice Chairman of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Division of Public Behavioral Health and Justice Policy. We just need “the courage to move money from one place to the other.”
Second, several state-level departments are now united in sponsoring efforts to design new approaches that draw on the latest findings about how children’s brains develop. The idea is to weave science-based strategies into existing programs, or to use the science in wholesale redesigns.
The intentions behind both efforts are to improve the lives of children, help more at-risk youth graduate from high school and reduce spending on services like foster care or jail. A more far-sighted goal is to keep at-risk youngsters from developing the costly medical problems (heart disease, diabetes, drug addictions, obesity, immune-system disorders, etc.) that disproportionately afflict adults who grew up in adverse circumstances. Preventing these long-term consequences (see Crosscut’s award-winning four-part series The Neglected Brain) will extend downstream savings far into the future.
Using current science to guide services and spending
Three years ago the Washington State Legislature began requiring rigorous study of the science behind the services that state-funded agencies were offering families and children. Lawmakers wanted to reduce wasteful spending, expand the programs that delivered the best results and strengthen the accountability of program providers and directors.
House Bill 2536, whose chief sponsors were Rep. Mary Lou Dickerson and Sen. Jim Hargrove, passed unanimously in 2012. The bill ties social-service funding to how well programs are governed by Evidence-Based and Research-Based Practice (E/RBP). Resources, explains Eric Trupin, will be shifted to programs that produce “good outcomes and a positive economic effect in terms of public expenditure.” In short, programs that closely adhere to E/RBP standards — meaning they significantly improve outcomes for the children and families they serve — get more money.
Key to the allocation process are empirical assessments of a program's efficacy. Regularly updated assessments are sent to the legislature in the form of inventories jointly compiled by the Washington State Institute for Public Policy (WSIPP), established in 1983 to conduct non-partisan research for legislators, and the Evidence-Based Practice Institute, founded at the UW in 2007-2008 to train social service agencies throughout the state in best practices for treating children’s mental health. The September 2014 inventory assessed more than 70 child-serving programs supported by the state’s Department of Social and Human Services (DSHS) and Health Care Authority (HCA) in the areas of juvenile justice, mental health and child welfare.
Here's a brief look at the impact of HB 2536 on two of these areas: the state's juvenile justice system and the foster-care sector of the child welfare system.
Keeping kids out of the juvenile-justice system is critical to reducing downstream costs in Washington. But the 2014 inventory indicates that at least one program set up for that purpose, Scared Straight!, delivers “null or poor outcomes.” The program, popular nationwide since the 1970s, brings young lawbreakers into jail and prison settings where inmates shout at them and graphically describe what life behind bars is like. In 2006, the Scared Straight! program was actually associated with a 6.8 percent rise in the crime rate among participating youth in Washington, according to a WSIPP cost-benefit analysis released in 2007.
National studies indicate that young people involved in crime do better in programs that, unlike Scared Straight!, stress their positive potential and invest in their growth. In the 2014 inventory of our state's programs, Functional Family Therapy for youngsters on probation scores well. Besides counseling and motivating youth to make better choices, FFT teaches their families how to reduce negativity at home, resolve conflicts with each other and support constructive behavior.
Keeping children out of foster care (like reducing recidivism among youthful offenders) happens best when we strengthen families. Even in the case of families that have been reported to Protective Services, children are better off staying with their parents, as long as they are deemed reasonably safe, because pulling kids out of their homes to live with strangers inflicts further trauma. The 2014 inventory calls Homebuilders Intensive Family Preservation Services effective at keeping families intact by teaching parenting strategies and life skills that improve the way families function in crisis.
In light of inventory findings like these, HB 2536 further requires that HCA and DSHS submit yearly reports to the legislature showing how they allocate funds to various at-risk child and youth programs.
At present, says UW’s Eric Trupin, “we’re spending a large portion of our resources on practices not demonstrated to be effective in terms of mental health outcomes, permanency planning for foster kids and intervening with kids on the path to the juvenile justice system.” By shifting resources to programs that we know to be stronger, Trupin says, “we can bring about better outcomes for kids and families and use taxpayer dollars more judiciously. ... We don’t have to wait for new resources.”
Experimenting with new approaches to youth care
Frontiers of Innovation is another ambitious effort by the state to fast-track better care for children. Begun here in 2011 under the auspices of Washington State’s Department of Early Learning, FOI combines the science of brain development with advances in the social and behavioral sciences to create and try out new programs for at-risk kids without waiting for “evidence-based” stamps of approval.
Anne Stone, the state’s FOI director, calls the initiative “cutting-edge stuff. We’re innovating, trying, capturing data, seeing what works, and if it doesn’t work we scrap it. Evidence-Based Practice is great as far as it goes, but we’re still leaving lots of children and families behind.” In an effort to speed effective new methods into practice, FOI “road-tests innovation, rather than wait the 20 years that gets us from innovation to EBP.”
FOI “innovation clusters” now operate in Walla Walla, Vancouver, Seattle, King County, Centralia and elsewhere around the state, says Stone. These collaborations are jointly supported by the state’s departments of early learning and health, DSHS, HCA and the Office of the Superintendent of Public Instruction. The clusters bring together university researchers, educators, practitioners and families to build and test science-based interventions to benefit vulnerable children. The results of these efforts will be used to improve child-serving programs statewide.
In one innovation cluster, Children’s Home Society of Washington worked with collaborators to produce video technology that teaches parents how to interact with infants in ways that build healthy neural circuits, which are the biological foundation for cognitive-linguistic abilities, social skills, emotional wellness and physical health. The guiding theory here is that “serve-and-return” interactions, in which the parent attentively responds to the child's different gestures, shape the lifelong architecture of the infant brain.
Another innovation cluster engaged UW researchers in practicing mindfulness strategies with young offenders in the juvenile justice system and their caregivers. Such practices strengthen the brain’s executive function, which lets us focus, recall information, multi-task, recover from distractions and choose constructive behaviors in stressful situations. If kids don’t have healthy relationships with adults who model these behaviors day-to-day, it becomes difficult for them to interact productively with others, learn in school and hold down a job. The best STEM classes in the world won’t help kids who can’t focus on coursework because they lack the requisite inner calm and interpersonal skills.
Such experimental projects with adolescents are now morphing into what FOI calls "Communities of Practice." In 2013 a team led by the Superintendent of Public Instruction began collaborating on ways to apply the science of adolescent brain development to policies and practices across Washington's systems, including education, health, juvenile justice and Children's Administration. The goal is to ground all youth-related state programs in the latest knowledge about how the brain develops during the teenage years.
Basic to FOI is a science of resilience, which assures us that even seriously neglected or maltreated children and youth can grow up to be productive citizens. Positive interactions combined with practice in coping skills help heal damage wrought by childhood adversity. Critically important to this success is a solid bond with at least one caring adult — if not a parent, then a teacher, coach or other grownup in the community — who pays attention to the youngster and serves as a role model for constructive behavior.
Washington is at the leading edge of the national FOI movement. It was the first state invited by Harvard University’s Center on the Developing Child to join the FOI initiative. The Harvard Center was founded in 2006 in response to the growing body of research showing that unless we address childhood adversity, we are sentencing at-risk youth to a lifetime of negative biological consequences.
The Center’s theory of change advises improving the childhood environment by developing the caretaking skills of the adults in an at-risk child’s life and by mitigating stresses in the community — all as a way to reduce the dangerous health impacts of toxic stress on kids. Leaders at Harvard predict that Frontiers of Innovation will not only shrink the downstream socioeconomic costs of childhood abuse and neglect, but will boost local and national economies by developing human capital, healthier families and a more productive workforce.
Can science really save money?
Cost-benefit analyses depend on complex statistical calculations, and it’s hard to put a dollar value on inputs and outcomes in social services. In many instances, the data aren’t available to make same-year, apples-to-apples comparisons. That said, there are examples from juvenile crime, foster care and education systems suggesting that science-based interventions in Washington are already saving money — and promise additional savings in the future.
Let’s start with juvenile justice. The Functional Family Therapy program for youth on probation cost taxpayers $2,325 per youthful participant in 2006. But FFT correlated with a 15.9 percent decrease in the crime rate among youth in the program, a reduction that saved taxpayers $34,126 per youth — or the predicted amount their crimes, if committed, would have cost that year. Total savings, subtracting the per-youth program costs: $31,801 per youth. (Numbers are from WSIPP’s 2007 cost-benefit study.)
On the other hand, the price of incarcerating youngsters is steep. In 2014, keeping a single youth in the state’s juvenile institutions cost taxpayers $277.91 per day, and every day there are 430 youth, on average, inside the system. (These figures come from DSHS Juvenile Justice & Rehabilitation Administration.) Multiplied, these numbers indicate an average cost to taxpayers of nearly $120,000 a day.
Turning to the foster care system: Cost-benefit data in the 2014 inventory sent to the legislature show that Homebuilders Family Preservation Services, besides getting high E/RBP marks, also saves child welfare dollars, partly by preventing the kind of abuse or neglect that lands children in foster settings. In 2008, per-child costs of the Homebuilders program were $3,224, and per-child benefits totaled $10,995, for a savings of $7,771 per child.
Having to send even a few of those kids into foster care would significantly strain the public purse. National data show that foster care costs more than $22,000 per child per year, and about 53 percent of foster children remain in the system for a year or more. In Washington State, 8,382 children were in out-of-home foster placements in the first quarter of 2015, according to Partners for Our Children. Using the national per-child-per-year figure above, keeping just 3,000 of these youngsters in foster care for one year would cost the state $66 million.
Finally, high school graduation rates have economic consequences. The 2012 U.S. Census put the average annual income of a high-school dropout at roughly $20,241. That’s $10,300 less than the average annual income of a high-school graduate. A 2009 Northeastern University study determined that, compared to peers who finish school, the cost to U.S. taxpayers of each dropout over his or her lifetime is nearly $300,000, owing to higher rates of incarceration and fewer dollars paid in taxes. Between the years 2000 and 2014, 9,670 Washington students dropped out of high school.
Science-based approaches to raising graduation rates can be readily applied to classroom-management training for K-12 teachers. Lincoln Alternative High School, located in a crime-ridden district of Walla Walla, is a good example. Lincoln serves students who struggle with behavior disorders, addiction and truancy. Since its former principal, Jim Sporleder (below), and his teachers started using trauma-informed approaches to instruction and discipline, Lincoln’s graduation rate has tripled.
Sporleder heard about the Adverse Childhood Experiences (ACE) study in 2010, and in 2012 instituted staff trainings based on the research. Staffers learned that youthful misconduct is often the expression of a neurological system compromised by early and ongoing shocks. In short, the childhood violence and neglect experienced by Lincoln teenagers had virtually wired them to be distracted in class, out of control and hostile to authority.
Training helped teachers and administrators stop taking misbehavior personally. Instead, says one teacher in this video about the school, she'll ask the counselor what's going on in the life of a kid who's acting out. Staff talk students through their mistakes as a way to teach them resilience and keep them aware that school is a safe place where they matter. Instead of kicking a youngster out for cursing, Sporleder would say, “‘This doesn’t sound like you. What’s going on?’ It’s amazing how kids just open up and let you know.”
Conversation doesn’t replace penalties, which follow in due course, but kids are no longer suspended for minor infractions like swearing, the length of suspensions has been shortened and in-school suspensions, where students work in study hall and talk with a teacher about their behavior and plans, are substituted when appropriate.
Students in the video say things like, “I started doing my work more because teachers help you more,” and “They calm me down and talk to me ... and things feel better.” When Sporleder asked one youngster whether gang membership was really what he wanted to do with his life, “I felt kinda bad,” said the student. “Like I disappointed him. It opened up my mind ... and that's when I thought about going to college.”
In an online essay, Sporleder describes how he talked with a student about emotional triggers, “about the options that he had before allowing himself to get into the red zone, where he physiologically cannot problem-solve, his brain is flooded with cortisol and blocks his ability to make good decisions.” Now that the student has learned some cool-down strategies, he keeps his temper more often and holds himself accountable when he doesn't.
In the first year that Lincoln employed these more compassionate, trauma-informed approaches, out-of-school suspensions went down by 85 percent. By 2014 attendance had risen, police arrests at school declined and college admissions were five times higher.
“We have to get out of this mindset that punishment needs to hurt,” writes Sporleder. “The truth of the matter is that it does hurt kids, but in a way that hurts us, too. They walk away, labeled by the system, and end up costing us much more in tax dollars on the other side — in police, courts, jails, emergency services, welfare [and] unemployment.”
In short, refusing to cultivate kids — whether it's turning our backs on them, imposing harsh penalties or trying to “scare them straight” — is not a best practice, and the benefit-cost ratio is dismal.
Fortunately, science has given us some upstream interventions that can keep more kids out of foster care, out of jail and in school — and save tax dollars in the process. Washington State is adopting some of these best practices and experimenting with new strategies. It will be several years before we can say with statistical confidence which of these upstream interventions pencils out best, and still more years before they become mainstream practices. But we are moving in the right direction.