February 27, 2020
CLEVELAND – Cuyahoga Partnering for Family Success (PFS), the nation’s first Pay for Success project in the combined areas of homelessness and child welfare, has concluded after five years and found its approaches yielded promising results in reuniting African-American children in the county’s foster-care system with their families, who have a history of housing instability.
Pay for Success is an innovative funding model (social impact bond) that expands available funding for social services and tracks the effectiveness of programs over time to ensure funding is directed toward programs that succeed in measurably improving the lives of people most in need. In Pay for Success, government entities have greater resources to tackle social problems by tapping private investments for the upfront costs of the programs.
“The families we served in this program often face sometimes unimaginable challenges: needing to move from place to place, escaping domestic violence, dealing with mental health and substance use issues and taking care of their children,” said Dana Santo, director of Family and Young Adult Services at FrontLine Service, which provided support to families in the program. “Growing up in today’s world can be tough enough when you have an abundance of support and resources. Imagine being a child who doesn’t know where they will sleep, has witnessed violence, and whose parents suffer from a mental health or substance use problem. It is overwhelming to think about, let alone experience for both the parent and the child. The Cuyahoga PFS program allowed us to design a program that utilized evidence-based practices to create a new and innovative approach and supports for families with extensive barriers to housing and reunification.”
Cuyahoga Partnering for Family Success delivered intensive treatment to 135 families, with the goal of reducing the length of stay in out-of-home foster care placement for children whose families had a history of homelessness or housing instability. Children in housing insecure families spend considerably more time in out-of-home placement as compared with children in families that have stable housing. Nearly half of the children in the program were under the age of five when they were taken into county custody, and 69% of families reported they experienced domestic violence.
The program did not reduce the number of days in out-of-home care as predicted, but it had an important finding: African-American caregivers in the Cuyahoga PFS program were reunified with their children at a higher rate than both white families in the Cuyahoga PFS program and African-American families who received conventional county services. Specifically, 69% of African-American children who exited care reunified with their families, versus 55% of African-American children receiving conventional services.
David Merriman, interim director of Health and Human Services at Cuyahoga County, said the County is proposing to fund the program for another year, with an additional option year possible, to determine if this approach continues to work better for African-American families. “We believe we have found a promising alternative solution to help reunify African-American families who have a history of housing instability and who face other challenges. The County values the impact these services have had on reunification, particularly for African-American families,” he said. “We want to see if this is replicable and continue to learn from it because African-American families are disproportionately represented in our child welfare system. Thirty percent of children across the Cuyahoga County are African American, but 64% of the children in foster care are African American.”
How the program worked:
- The study enrolled 273 housing unstable caregivers who had a total of 540 children in out-of-home placement. The caregivers were randomly assigned to either receive conventional services from the County (138 caregivers, 261 children) or County services coupled with the PFS intervention (135 caregivers, 279 children).
- FrontLine created a service plan tailored to each family’s needs.
- In partnership with the Program’s housing partners, FrontLine linked each caregiver to housing, most often through Cuyahoga Metropolitan Housing Authority (CMHA) and delivered an evidence-based homelessness transition case management model known as “Critical Time Intervention” (CTI) to help them settle into the new home, along with family trauma assessment and therapy.
- After reunification, families continued to receive Trauma-Adapted Family Connections therapeutic services.
- By providing caregivers critical access to housing before they are reunited with their children, this program helped caregivers more successfully receive mental health services, complete substance use counseling, and allowed for an increased amount of child visitations with their caregivers in a safe and stable home.
- As a result of the program:
- 118 of families have been stably housed
- 46 caregivers participated in substance use treatment
- 69 caregivers took advantage of mental health treatment
Mark McDermott, vice president and Ohio market leader for Enterprise Community Partners, said the unintended findings are promising for all families. “The changes this program has made in families’ lives have been widespread,” he said. “Any time a child or children can go back with their birth family and it’s a safe situation, it’s a win. Right now, the benefits are to the families who were impacted by the project, but there are lessons learned that can benefit all families who have children in the child welfare system in Cuyahoga County.”
Marcia Egbert, senior program officer at The George Gund Foundation, said the learnings from the program will help private and public organizations work better together in the future. “As organizations that support children and families, we have learned how to work together more effectively to the benefit of Cuyahoga County families,” she said. “There was a certain amount of risk involved. We didn’t know how this program was going to work, but as a group, we were willing to put the calculated risk on the table to offer better services to families.”
When the program was designed, it had only one specific metric to determine if the County would need to make “success payments” that would ultimately be used to repay the funders – a Pay for Success practice that has evolved during the last five years to include multiple metrics to trigger “success payments.” Cuyahoga County would have made a payment only if FrontLine’s services were proven to shorten the length of stay in out-of-home foster care, as determined by the independent evaluator Case Western Reserve University. The services did not shorten the length of stay; therefore, the County will not make a payment to the program’s intermediary and the funders will not be repaid.
The Cuyahoga PFS program was a collaboration of local and national partners: FrontLine Service, Enterprise Community Partners, Inc., Cuyahoga County, Ohio, Case Western Reserve University, Third Sector Capital Partners, Inc., Reinvestment Fund, The George Gund Foundation, The Cleveland Foundation, the Sisters of Charity Foundation of Cleveland, Nonprofit Finance Fund, and The Cuyahoga Metropolitan Housing Authority, among others. Both private funders and philanthropic organizations provided a total of $4 million in upfront funding for the Partnering for Family Success Program.