ENCOMPASS PILOT YEAR

EVALUATION REPORT

Emily F. Rothman, ScD Julia Campbell, MPH Paulina Soria, BS

 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021

TABLE OF CONTENTS
Pilot Year Evaluation Summary..............................................................................................................................4
Background............................................................................................................................................................. 5
Description of Encompass and Context for Pilot........................................................................................... 5

ENCOMPASS PILOT YEAR Pilot Establishment................................................................................................................................................... 7

Step 1. Partnership................................................................................................................................................ 7

EVALUATION REPORT
Step 2. Trauma Coaches selection, orientation and supervision.............................................................. 7
Step 3. Evaluation team.......................................................................................................................................8
Step 4. Encompass Participant Identification.................................................................................................8
Step 5. Social norms change campaign...........................................................................................................9
Draft 5
Process Evaluation....................................................................................................................................................9
December 22, 2021 Outcome Evaluation................................................................................................................................................10
Design and Participants.....................................................................................................................................10
Enrollment and data collection procedures..................................................................................................11
Emily F. Rothman, ScD
Survey Measures.................................................................................................................................................. 12
Julia Campbell, MPH Interview questions and procedures.............................................................................................................. 12

Paulina Soria, BS Data analysis........................................................................................................................................................ 13

Results........................................................................................................................................................................ 13
Caregiver demographics................................................................................................................................ 13
Foster children demographics..................................................................................................................... 13
Confidence in trauma-informed foster care provision.......................................................................... 14
Opinions about DCF........................................................................................................................................ 14
External support care..................................................................................................................................... 14
Intentions to continue fostering................................................................................................................. 15
Acknowledgements: Placement stability......................................................................................................................................... 15
Thank you for Sarah Ahola, Megan Hempstead, Mary McGeown, Amie Shei, Ruben Qualitative data............................................................................................................................................... 15
Ferreira, Jaime Caron, Liz Flink, and Kate Stockbridge for contributing to this report. Discussion.................................................................................................................................................................16
References................................................................................................................................................................. 17

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 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021

enced at least one trauma in their lifetime (Cope-

Background
PILOT YEAR EVALUATION SUMMARY The Encompass program of the Massachusetts
land et al., 2007; Finkelhor et al., 2009, Dorsey et
al., 2012). It is estimated that approximately 90%
Society for the Prevention of Cruelty to Children of youth in foster care have experienced at least
(MSPCC) is designed to improve outcomes for one trauma, with almost half reporting experience
The Encompass program, developed by the with four or more types of traumatic events (Stein
children who receive foster or kinship care in Cen-
Massachusetts Society for the Prevention of et al., 2001; Fratto, 2016). A study of foster care
tral Massachusetts. The Encompass program trains
Cruelty to Children (MSPCC), trains foster and alumni found that 30% of respondents met life-
foster and kinship caregivers to recognize trauma
kinship caregivers to recognize trauma in chil- time criteria for PTSD compared to 7.6% of a gen-
in children, attend to foster children’s behavioral
dren, attend to foster children’s behavioral health eral population with similar demographics (Pecora
health needs, and provides additional supports to
needs, and provides additional supports to foster et al., 2009; Salazar et al., 2013). Youth in foster
foster caregivers in order to mitigate the impact of
caregivers in order to mitigate the impact of trau- care with mental health or behavioral problems
trauma on children and improve child outcomes.
ma on children and improve child outcomes. We are the least likely to achieve placement stability
The Encompass program was piloted with 29 fam-
used a one-group pre and post-test longitudinal or to display improved psychological adjustment
ilies in Central Massachusetts between January and
design to evaluate the effectiveness of the En- in their foster placement (Barber et al., 2001). As
September, 2021, with funding from The Health
compass program on foster child and foster par- Jill Cummings is a trauma coach with MSPCC’s Encompass a result, there have been calls for trauma-informed
Foundation of Central Massachusetts (THFCM)
ent outcomes among 17 foster caretakers caring foster care as a way to improve placement stability
and the CF Adams Trust.
for 25 foster children. Outcomes included foster ferences in placement stability among Encompass (Beyerlein & Bloch, 2014).
parent confidence in trauma-informed fostering, The foster care system is critical to the Com-
children compared to non-Encompass children.
opinions about DCF (Department of Child and monwealth’s child welfare system. When abuse
Qualitative data suggests that participants found
Family Services), use of external and natural sup- all components of the Encompass program to be
and neglect threaten children’s safety, children are Description of Encompass
and Context for Pilot
port care, intentions to continue fostering and removed from their birth parents and placed in
helpful and enjoyable, and recommend that future
use of mobile crisis intervention. We used data foster homes. Foster care is intended to be a short-
programming be longer, include more didactic
from DCF to examine placement stability among term solution while the Department of Children The inspiration for re-envisioning foster care in
training, and that information about the program
Encompass children compared to 122 non-En- and Families (DCF) works to reunify children with Massachusetts began with the 2018 Massachusetts
be more widely disseminated to social work-
compass foster children. We also conducted qual- their birth parents, place them with a trusted rel- Society for the Prevention of Cruelty to Children
ers across the state. On the whole, the evidence
itative interviews with caretakers. We observed ative, or find them an adoptive family. According (MSPCC) survey in which foster parents report-
suggests that the Encompass program may have
positive changes in caretakers’ confidence in to the DCF FY21 Quarterly Profile, as of June 30, ed finding deep satisfaction in providing safe and
a positive impact on caregiver knowledge about
trauma-informed fostering (p<0.07) and use of 2021, there were 8,464 children in out-of-home loving homes for children, but acknowledged a
trauma and capacity to provide trauma-informed
external support care providers (p<0.001). We placements in Massachusetts. Of these, 1,464 were unique set of challenges they were not prepared to
foster care to children. Continued evaluation of
did not observe significant changes in caretakers’ from Central Massachusetts. handle without support. These challenges includ-
the full-scale implementation of the Encompass
opinions about DCF, or intentions to continue program during 2022-2024 will be informative Traumatic events, including child abuse and ne- ed children’s behavioral issues related to trauma;
fostering. We also did not observe significant dif- about program effectiveness. glect, exposure to interparental violence, commu- lack of access to essential information, training,
nity violence and experiencing the death of a loved and services; few opportunities to engage with
one, and other adverse events, are too common other foster and kinship parents for support and
among US youth. As many as one-half to two-thirds mentoring; and feeling that they were not valued
of youth in the general population have experi- or respected as a member of a child’s treatment

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PILOT ESTABLISHMENT
team (Massachusetts Society for the Prevention of an experienced foster parent who uses the Re-
Cruelty to children, 2018). Subsequently, in 2020, source Parent Curriculum (RPC) to provide one-
with funding from THFCM, in collaboration with on-one trauma focused skills training to foster par-
a select group of state and community leaders, ents to promote their role in supporting a child’s
MSPCC engaged in a full year of program plan- well-being and permanency. (2) Skill Enhancement Step 1. Partnership Cross, UMASS Memorial Employee Volunteer
ning. Planning entailed reviewing models of pro- and Peer Support Networking Groups: Each En- program, Clark University, Hanover Insurance,
Before MSPCC began to develop the content of Lasagna Love, Worcester State, Hadwen Park
viding support to foster care families from other compass family is assigned to a bi-weekly virtual
the Encompass intervention, they consulted with a Congregational, Young Parent Hope, Alpha
US states; reviewing outcome studies in the scien- group with 9 other families that meets for six ses-
Leadership Team comprising state and community Delta Kappa, Beta Chapter of Worcester, and
tific literature about foster care support programs; sions and that is facilitated by two Peer Trauma
experts in child behavioral health and foster care Catie’s Closet.
developing a training for Peer Trauma Coaches, Coaches. The groups are designed to expand trau-
on the essential elements of the program and the
Volunteer Coordinators, and volunteers; and in- ma-informed parenting techniques, increase infor-
ideal structure. Leadership Team members include
vesting time to develop strong collaborative rela- mal support, and facilitate networking. (3) Extend- Step 2. Peer Trauma Coach selection,
senior managers of DCF, The FaCES (Foster Child
tionships with a project leadership team, advisory ed Community Supports: Encompass recruits and orientation and supervision
Evaluation Services) clinic at University of Massa-
group, and with volunteer recruitment coordina- trains volunteers and community partners to help
chusetts (UMASS) Memorial Health, Court Ap- The centerpiece of the Encompass program is
tors. These partnerships are described in the Pilot support foster parents. Volunteers and community
pointed Special Advocates (CASA) Worcester, the the Peer Trauma Coaches. Peer Trauma Coach-
Establishment section below. partners donate their time and tangible goods, in-
Massachusetts Alliance for Families (MAFF) which es are current or former foster parents, some of
cluding grocery and meal delivery, care packages
serves as the statewide foster parent association, whom have also adopted children from foster care.
for tangible needs, and online or in-person tutor-
and LUK, Inc., a community-based agency serv- Encompass hired four part-time Coaches and one
ing or enrichment activities with foster youth.
ing children and families in North Central Mas- full-time Coach during the pilot period. The job
It should be noted that the COVID-19 pan- sachusetts. The Leadership Team met quarterly to description for the Peer Trauma Coaches was dis-
demic had an immediate and drastic impact on advise MSPCC on multiple aspects of Encompass seminated through the MSPCC job board as well
the child welfare system. As a consequence of program development and the project evaluation. as on public employment vacancy job websites. Al-
COVID-19 and social isolation, foster and kinship though many applicants for the position had ex-
The planning year (2020) also involved build-
caregivers were asked to care for children with in- perience working with foster children in a profes-
ing relationships with a supportive advisory group,
creased trauma and behavioral health needs in the sional capacity, relatively few had direct, personal
which includes state Senator Harriette Chandler
absence of supports that are typically available. In experience providing foster care in their homes.
(D-Worcester), state Representative Jim O’Day
addition, the ongoing uncertainty of the pandem- This was viewed as an essential selection criteria.
(D-West Boylston), The Office of the Child Ad-
ic required the Encompass team to provide Peer Each candidate was interviewed by a minimum of
Volunteers Gay Toomy and Billye Auclair vocate, DCF Worcester East and Worcester West
Trauma Coaching and Peer Support sessions vir- three people affiliated with the Encompass pro-
Area Offices, the Children’s League of Massachu-
The Encompass program comprises three com- tually. Finally, the Extended Community Supports gram before hire—meaning that they were care-
setts, the community-based agency All Our Kids,
ponents: (1) Peer Trauma Coaching: Each Encom- were impacted by statewide guidance and policies fully vetted. Once hired, Peer Trauma Coaches
YWCA of Central Massachusetts, MSPCC Kid’s
pass family is matched with a Peer Trauma Coach, around health and safety related to COVID-19. each received a standardized training from the En-
Net staff, four trauma specialists, and two mar-
keting specialists. In addition, MSPCC developed compass Project Coordinator, Ms. Sarah Ahola,
relationships with 12 entities for volunteer recruit- LCSW, on the responsibilities of a Peer Trauma
ment including: DCF Foster Parent recruiters, the Coach, background on the project, working with
Junior League of Worcester, College of the Holy DCF, the need of foster parents, and local resourc-

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 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021

ily in one instance, but this had limited success so understanding of the public’s knowledge of and
es. They also participated in a 30-hour training with the families they worked with. However, feel- it is not considered a best practice. attitudes towards foster care, and also to find out
(three hours per day for ten days) on the Resource ing ill-equipped to respond to questions from fam- how members of the public could see themselves
Parent Curriculum (RPC) provided by trainers ilies, DCF began to forward contact information getting involved. In 2020, MSPCC conducted a
from LUK, Inc., and UMASS Medical/FaCES. for families to the Encompass Project Coordinator
Step 5. Social norms change campaign
survey of 244 Massachusetts residents about their
who would then call the family to invite them to The project includes a comprehensive advoca- perceptions of foster care, foster parents, foster
Step 3. Evaluation team participate in the program. Because recruitment cy-oriented public engagement campaign to in- parents’ impact, reasons why people would choose
was slower than anticipated using this method, in form various stakeholders of the pilot, build in- to foster, and other factors in order to inform the
MSPCC selected to collaborate with a research May 2021, MSPCC reset the target recruitment terest and momentum for the program, and start content of the planned social norms campaign.
team from Boston University on the evaluation of goal to 30 families. In total, Encompass received to change the statewide dialogue about foster The results of the survey indicated that – contrary
the Encompass pilot. The evaluation team leader the contact information for approximately 110 in- parents and the foster care system. In collabora- to what was anticipated by MSPCC – most respon-
was Dr. Emily F. Rothman, Professor and Chair of dividuals and ultimately 29 families elected to par- tion with MSPCC’s Marketing and Communica- dents had positive perceptions of foster caregivers.
Occupational Therapy. Ms. Julia Campbell, MPH, ticipate in the program (~26% yield). tions Committee, project staff planned to facilitate Results from the survey informed the recruitment
and Ms. Paulina Soria, BA, were evaluation co-in- a series of focus groups with various stakeholder
Encompass also began recruiting volunteers to strategies for volunteers as well as content for print
vestigators. The evaluation team was responsible groups, including foster parents, to gain a better
support the foster families. Encompass original- and social media campaigns for Encompass.
for obtaining IRB approval to conduct the pilot
ly aimed to recruit two volunteers for each foster
evaluation research, developing survey instru-
family, but actual recruitment of volunteers also
ments, collecting and analyzing qualitative and
went more slowly than anticipated. Using Face-
quantitative data from foster family participants,
book and Instagram was not a productive way to
and analyzing data provided by DCF to the eval-
find volunteers, though the hope had been that
uation team. The evaluation team worked collab-
social media would be useful. Recruiting volun-
oratively with MSPCC and the funder, THFCM,
teers through faith-based organizations was not
throughout the planning year and pilot project
highly useful. Once volunteers were recruited,
period to design and execute the evaluation. How-
they participated in a two-hour training delivered
ever, the evaluation was independent in that it was
by Sarah Ahola and the two Volunteer Coordina-
conducted by researchers who were not part of the
tors. It described DCF and DCF processes, back-
Encompass design or implementation process.
ground about the foster parent experience, and
Importantly, one of the evaluation team members
explained why children come into care, among

PROCESS EVALUATION
is fluent in Spanish and was able to conduct data
other topics. In total, the pilot programming in-
collection qualitative interviews in Spanish with
volved 14 volunteers for 29 families. Some foster
the Spanish-speaking participants.
families were not interested in being matched with
a volunteer. There were also four families that MSPCC collected information throughout the sions were delivered during the pilot period. In
Step 4. Encompass Participant were Spanish-speaking and would have benefited pilot year on how many coaching sessions fami- terms of the skill enhancement groups, families
Identification from a match with a Spanish-speaking volunteer. lies received and how often they participated in attended between 0 to 5 of the 5 sessions offered.
The Encompass pilot involved only one Span- Skill Enhancement group sessions. On average, On average, families attended 2 out of the 5 ses-
The Encompass project began recruiting fami-
ish-speaking volunteer despite efforts to recruit participants selected to participate in 9 sessions sions. Reasons for low participation in the groups
lies in March 2021. The original goal was to recruit
more. Encompass experimented with matching with their Peer Trauma Coach (range: 2 to 18 ses- included not having the time and experiencing
40 families. Initially, DCF case workers recruited
an English-speaker with a Spanish-speaking fam- sions). A total of 158 peer trauma coaching ses- technological difficulties.
families by talking about the Encompass program

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period of approximately 10 weeks between March disagree) to 4 (strongly agree). The Cronbach’s al-
OUTCOME EVALUATION and May 2021, so the baseline data collection oc-
curred over a 10-week period. In September 2021,
pha for this scale was 0.95 in this sample.
Opinions about DCF: Participants were asked
which was approximately 4-6 months after base- 18 questions about their feelings about DCF. This
Design and Participants the Robert Van Wart DCF office was managing
the placement. All children included in the sec-
line, each participant received a new email mes-
sage with a link to the online follow-up survey and
was an original scale. A sample item is: “I am satis-
fied with how DCF considers my needs as a foster
The evaluation team used a three-pronged ap- ondary data analysis were between 0-15 years old was asked to complete it. Each participant also parent.” Response options were on a 4-point scale
proach to evaluate the Encompass pilot program. as of May 1, 2021, in a departmental foster care received a message asking them to sign up for a from 1 (strongly disagree) to 4 (strongly agree).
First, the team collected quantitative survey data placement (meaning, all types of departmental Zoom-based interview with a research team mem- The Cronbach’s alpha for this scale was 0.96 in
both before and after the pilot period from En- foster care placements other than out of state, ber. After completing the follow-up survey and this sample.
compass families. Second, the team collected qual- emergency, or hotline). DCF provided de-identi- interview, each participant received a second $20
External and natural support care: Participants
itative interview data from families at the conclu- fied data, and all procedures were reviewed and gift card via email.
were asked 7 questions about their use of external
sion of the pilot period. Third, the team used data approved by the Boston University Institutional
shared by the Department of Children and Fam- Review Board (IRB). Survey Measures support care (i.e., volunteers). This was not a scale;
it was a series of discrete questions. A sample item
ilies (DCF) to examine placement stability out-
comes for youth in Encompass foster family homes Enrollment and data The survey took respondents approximate- is: “Approximately how many total hours of ex-
ly 30 minutes to complete. The baseline survey in- ternal support care have trained external support
and in comparison families that had not participat-
ed in the Encompass program.
collection procedures cluded 7 questions about demographics, including providers provided to you in the past month?”
All Encompass families received an email from town of residence, age, gender, primary language, Intentions to continue fostering: Participants
Participants in the survey and interviews were race/ethnicity, number of biological children liv- were asked one close-ended and one open-ended
Encompass family members. There were 29 fam- the Project Coordinator (Ms. Sarah Ahola) upon ing in the home, number of foster children, foster question about their intentions to continue pro-
ilies that signed up to participate in Encompass, beginning the program informing them that they care role (e.g., kinship caregiver, unrestricted or viding foster care. These were original questions.
but 11 of these disengaged before participating in would be contacted by a Boston University re- Departmental caregiver, comprehensive caregiv- The close-ended question was: “Please indicate
any peer trauma coaching or skill enhancement search team member who would invite them to er, emergency caregiver, etc.), and current employ- how long you intend to be a foster parent (in gen-
sessions. Of the 18 Encompass families that did participate in the survey and interview evaluation. ment status. Participants were asked 11 questions eral, not just to the child in your home currently)”
participate in the programming, one opted not to Families were told that they could choose not to about each foster child. They were asked two ques- with response options including (1) 3-6 months; (2)
complete an evaluation survey or interview, leaving have their contact information shared with Boston tions about receiving prior training on trauma. 6-12 months; (3) 1-2 years; (4) 2-5 years; (5) 5 years
an analytic sample of N=17. Of the 17 participating University; however no family opted out of the
Confidence in trauma-informed fostering: Par- or longer; and (6) I no longer want to be a foster
families, 3 spoke Spanish only and completed the Boston University contact. Evaluation research
team members emailed each Encompass family ticipants were asked 21 questions about their un- parent. The open-ended question was, “In your
online survey and interview in Spanish.
member an invitation to participate in research derstanding of trauma. This was an original scale, own words, why do you feel that you want to be a
Participants in the DCF secondary data analy- though questions were adapted from the Duke foster parent?”
with a link to the online consent form. Messag-
sis were 25 children who were placed with an En- University evaluation of the National Child Trau-
es from Boston University were in English or in Placement stability: On the follow-up survey,
compass family and a comparison group of 122 matic Stress Network’s Caring for Children Who
Spanish, based on family preference. Those who participants were asked five questions about how
children who were placed with foster families that have Experienced Trauma; A workshop for Re-
reviewed the consent form and agreed to partici- long the placement of each foster child had lasted,
did not participate in Encompass. All Encompass source Parents Demographic Survey (The Na-
pate were automatically routed to the online base- if the placement timeline was extended or short-
families were served by Worcester East or Worces- tional Child Traumatic Stress Network). A sample
line survey. After completing the baseline survey, ened, and if the long-term plan for a permanent
ter West DCF Area Offices. All comparison group item is: “I routinely think about how a child could
the research team emailed an electronic Amazon. placement for the child had changed. These were
children were in the Robert Van Wart DCF Office be physically safe in my home, but might not feel
com gift card worth $20 to the participant. Enroll- each original questions.
catchment area for their placement, meaning that safe.” Response options ranged from 1 (strongly
ment in the Encompass program occurred over a

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Mobile crisis intervention: On the follow-up have you called the state Emergency Services Pro-
survey, participants were asked relative to each gram/Mobile Crisis Intervention (ESP/MCI) for Data analysis set to the level 0.10 for statistical significance, giv-
en the small sample size and exploratory nature of
foster child: “how many times in the past 6 months help managing their mental health needs?”
Baseline and follow-up survey data were com- this pilot study. Qualitative interview data were
pared using chi-square and t-tests. One logistic re- analyzed using a content-based analysis approach.
Interview questions and procedures gression analysis was conducted to assess odds of Secondary data from DCF were also analyzed us-
achieving permanency (see Table 8). P-values were ing chi-square analyses.
Fifteen participants agreed to participate in a Zoom-based interview with a research team member
in September 2021. Each interview took approximately 20-30 minutes, was audio-recorded, and tran-
scribed. Interviews were in English or in Spanish. Interview participants were asked 18 questions. These
questions included: RESULTS
1. Tell me what kinds of extra services or supports you 10. Overall, what’s been going well for you in terms of
fostering?
Caregiver demographics Foster children
have received because you are part of the Encompass
program? 11. What has been hard or challenging for you and your A total of 17 caregivers completed the baseline demographics
family? survey (see Table 1). All (100%) caregivers were fe-
2. What have you enjoyed best about these supports? A total of 25 children were receiving foster care
12. How do you think DCF could be even more supportive male. Caregiver ages ranged from 26-68 years old
of you given those particular challenges you just men-
from the Encompass caregivers (see Table 2). Their
3. Can you think of a time when something you learned (mean 44 years old). The majority (71%) were En-
tioned? What could they be doing? ages ranged from 5 months old to 18 years old.
from the Encompass program came in handy in real life? glish speakers, and 5 (29%) were Spanish speak-
Please tell me that story. 13. Do you feel like a member of the care team with DCF? On average, children were approximately 8 years
ers. The majority identified as white (53%), with
In what ways do you feel recognized as a team member, old. The majority were male (68%), and 28% were
4. Did you attend the trauma coaching peer group sessions? and in what ways do you feel like you could be more fully 35% identifying as Hispanic or Latina, 6% African
female. One-third (36%) of children were White
probe: If so, what did you find helpful about them? What integrated into the care team? American, and one person as another race. Care-
(that is, non-Hispanic and of European descent),
did you find unhelpful about them? 14. If you could wave a magic wand and have DCF (or givers were fostering between 1-3 children at base-
Encompass program) do anything and everything that you
24% were Hispanic/Latinx, and 4% were African
probe: If not, why not? What changes could be made to line, with an average of one foster child in their
needed, what would be on your wish list of extra steps or Caribbean Islander. Approximately one-third
make it more likely that you’d attend in the future?
they would take to meet every single one of your needs
home. Most were not employed. Forty-one per-
(36%) of the children were experiencing their first
5. Which trauma coach led the peer group sessions that as a foster parent? cent were employed part-time or full-time, with
foster placement, and 36% were in their second
you attended (or didn’t attend)? Was there anything 15. Tell me about a time when you felt 100% supported by 41% reporting they were out of work and not look-
about the trauma coach and/or the style of the group
placement. Approximately 16% were in their third,
DCF in your fostering experience. What did they do that ing for work.
that you enjoyed? Or didn’t enjoy? made you feel that way? fourth or fifth foster care placement. [Note that
The majority of caregivers were unrestricted the demographics of Encompass children provid-
6. Can you think of a time when the coaching you got 16. If you were able to talk to a legislator who has to
from the Encompass program made a difference to you?
or departmental caregivers (71%), and 35% were ed in Table 2 vary from those in Table 7; Table 2
decide whether or not to fund the Encompass program
Why did it? for other families in the future, what would you want pre-adoptive caregivers. Some participants indi- data were provided by foster parents, while Table 7
them to know? cating being more than one type of caregiver: One- data were collected by DCF].
7. How has the Encompass program impacted your
interactions with your foster child (or children)’s birth 17. What is the permanency plan for the child(ren) that third (29%) were pre-adoptive and unrestricted One-third (36%) of the children had been diag-
parents? you are currently fostering? Do you intend to continue caregivers, and 29% (n=5) were kinship caregivers.
to foster this child(ren) for as long as needed? Do you nosed with a mental or physical disability. Two-
8. How has the Encompass program impacted your intend to take in new foster children in the future? The caregivers were generally experienced with thirds (69%) either had an Individualized Educa-
understanding of trauma? providing foster care. On average, they had near- tion Plan (IEP) at school, or the caregiver was in
Why or why not?
9. How has the Encompass program impacted your
ly 5 years of experience as foster caregivers (range: the process of trying to obtain an IEP. An addi-
18. What else did I forget to ask you that you think I
understanding of the behavioral health needs of your should have asked you? What else is important for me to less than one year to 16 years). Collectively, they tional 13% had a school 504 plan. Two thirds of
child/children? How would you describe your own ability hear? were providing foster care to a total of 25 children,
to manage behavioral health needs in the home?
those diagnosed with a mental or physical disabili-
with a range of 1 to 3 children per home.

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Intentions to Really, in foster care, the Encompass Program was

ty (67%) had been diagnosed with a developmental
Opinions about DCF the only support I have right now. So, I don’t really
delay, 56% had been diagnosed with anxiety, de- continue fostering have outside support of any kind. DCF is kind of just
pression, PTSD or another mental health disor- We did not observe substantial change on care- in the background when I need them. So, I think the
der, 33% with ADHD/ADD, 11% were diagnosed givers’ satisfaction with DCF from pre- to post- There was no substantial change in intentions to Encompass Program has been a highlight of my year.
with autism or pervasive developmental disorder, test, although of the 18 questions posed about continue fostering. There was also no substantial
Another participant commented:
11% with oppositional defiance disorder, and 33% change in the number of times in the past 6 months
DCF, we did observe positive change on two of
were diagnosed with a chronic medical problem. that caregivers called the state Emergency Services I just think it should be longer. That’s the only sad
them. The items that reflected positive change
Program/Mobile Crisis Intervention (ESP/MCI) part of this. The only downfall is that it’s ending.
were: “I am satisfied with how DCF considers my for help managing their children’s mental health
Confidence in trauma- needs as a foster parent,” and “I have reasonable
access to a social worker and family resource work-
needs. Notably, the use of ESP/MCI was exceed- Second, participants particularly appreciated the
material supports (e.g., school supplies and lasa-
ingly rare.
informed foster care er.” Note that no Bonferroni correction was used gna) because it freed up time and money that they

provision because this is a small scale and exploratory study.

Placement stability
could then put into other needs that their child
had. One participant commented:
We observed a positive change from pre- to post-
test in caregivers’ knowledge about the impact of External support care Placement stability, or permanency, refers to I really liked the help they gave us with the school
supplies. That was of great help because sometimes
providing foster children with a safe, stable, per-
traumatic events on children and confidence in Participants were 8.4 times more likely to re- manent home, either through reunification with money is tight. And the thing that I liked the most,
their capacity to provide trauma-informed care to port having utilized an external care provider in birth parents or through adoption by the fos- honestly, was the [Lasagna Love] program. Because
foster children (see Table 3). Note that p-values of the past month at post-test as compared to pre- sometimes everyday life, stress, and the situations you
ter family. Data provided by DCF revealed that
p≤.10 were interpreted as statistically significant, test. At pre-test 8% reported having used one or have to face with the children, having one day off
77% of Encompass foster youth remained in their
rather than the standard p≤.05 because of the small cooking is fantastic.
more external care providers in the past month, placement between May and September of 2021,
sample size. There were several items on the sur- and at post-test 67% reported the same (p<.001). and that 69% of those in the comparison group Third, people found the one-on-one peer coach-
vey about trauma-informed fostering that particu- There was also a meaningful difference between did (Table 7); this was not a substantial or statisti- ing particularly useful.
larly stood out as reflecting positive change. These the percentage of caregivers who were connect- cally significant difference. However, 19% of En-
included: “I understand why traumatic events im- Because we’re new to this whole situation, and it is
ed with at least one external support provider compass youth and 7% of comparison group youth hard and traumatic for everyone. And so just for [the
pact the way a child’s brain works, well enough that (i.e., respite provider) through DCF from 21% at achieved permanency (as per the definition in the Trauma Coach to offer] insight into kind of what’s
I could explain it to someone else,” “I routinely pre-test to 47% at post-test. There was no differ- first sentence of this section) as of September 30, normal and what’s not normal, and who to talk to,
think about how a child could be physically safe in ence in the number of external support provid- 2021 (Chi-sq. 5.82, p<.10; Table 7). and what to do…[the Peer Trauma Coach is…]
my home, but not feel safe,” “An important part of ers that caregivers reported that they knew, but someone who’s experienced it. So, I would say the
my role as a parent is to identify trauma remind- the number of hours of external support care that most valuable was the one-on-one trauma coaching.
ers (i.e., “triggers”) in the lives of the children I they received did increase from an average of 0 Qualitative data
foster,” “Bedtimes and mealtimes are stressful for Fourth, the Skill Enrichment support groups were
hours in the past month to 2.46 hours in the past Qualitative interview data was collected from
children who have been in traumatic situations,” “I helpful for those able to attend.
month. The difference from pre-test to post-test 15 participants. We detected six themes in their
feel confident about my ability to handle challeng- in the number of hours of external support care The support group was helpful because you got to
comments.
ing behaviors,” “I know strategies to help my child received was driven by two of the 15 respondents. speak to people kinda going through the same thing
express a variety of emotions,” and “I know things First, participants generally enjoyed the program, or if they’d gone through the same thing that you’re
about being a foster parent that would be helpful were satisfied with it, and wished it were on-going going through as far as fostering kids and stuff like
or lengthier. In the words of one participant: that. I think that was maybe the most helpful thing.
to other parents.”

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 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021 ENCOMPASS PILOT YEAR EVALUATION REPORT, 2021

Fifth, some participants felt the support groups

were less than optimally valuable because they did
Sixth, participants felt like more social workers
should know about Encompass. REFERENCES
not offer didactic information nor guidance on
I don’t feel like there were a lot of social workers
how to handle specific troubling situations with Barber, J., Delfabbro, P., & Cooper, L. (2001). The Massachusetts Society for the Prevention of Cruelty to
who knew this program was out there. Except for Predictors of Unsuccessful Transition to Foster Care. Children (2018). Massachusetts Foster Parent Survey Report.
their children.
one of the social workers, my kiddo’s social workers The Journal of Child Psychology and Psychiatry
I wanted more guidance on how to deal with definitely didn’t know about the program. And I and Allied Disciplines, 42(6), 785-790. doi:10.1017/ Pecora PJ, White CR, Jackson LJ, Wiggins T (2009)
certain situations that I see with someone that’s feel like that should be something that I think all S002196300100751X Mental health of current and former recipients of foster
experiencing trauma. the social workers should know, that that is avail- care: A review of recent studies in the USA. Child Fam Soc
able to their parents. Beyerlein, B.A., & Bloch, E.L. (2014). Need for Trauma- Work 14(2):132–146
Informed Care within the Foster Care System: A Policy
Issue. Child Welfare, 93, 7. Salazar, A.M., Keller, T.E., Gowen, L.K., Courtney,
M.E., 2013. Trauma exposure and PTSD among

DISCUSSION Copeland WE, Keeler G, Angold A, Costello EJ.

Traumatic Events and Posttraumatic Stress in
older adolescents in foster care. Social Psychiatry and
Psychiatric Epidemiology 48, 545–551.. doi:10.1007/
Childhood. Arch Gen Psychiatry. 2007;64(5):577–584. s00127-012-0563-0
This pilot evaluation found support for the con- most foster parents are not exposed to informa- doi:10.1001/archpsyc.64.5.577
tinued testing of the Encompass program for foster tion about trauma and trauma-informed parent- Stein B, Zima B, Elliott M, Burnam M, Shahinfar A, Fox
parents. Specifically, we observed positive changes ing. Second, the Encompass intervention group Dorsey S, Burns BJ, Southerland DG, Cox JR, Wagner N, et al. Violence exposure among school-age children
overall in confidence in trauma-informed foster was small. Although participation in the evalua- HR, Farmer EM. Prior Trauma Exposure for Youth in in foster care: Relationship to distress symptoms. Journal
care provision, and the use of external support tion study was excellent (94%), there were only 17 Treatment Foster Care. J Child Fam Stud. 2012;21(5):816- of the American Academy of Child & Adolescent Psychiatry.
824. doi:10.1007/s10826-011-9542-4 2001;40(5):588–594
care. While we did not observe statistically signif- respondents. Future evaluation of Encompass us-
icant changes in satisfaction with DCF overall, we ing a larger sample is needed. Finally, out of neces- Finkelhor D, Ormrod RK, Turner HA. Lifetime The National Child Traumatic Stress Network (2013). Caring
did observe positive changes on two items. There sity, we used original measures to assess parents’ assessment of poly-victimization in a national sample for Children Who have Experienced Trauma: A workshop for
was preliminary evidence that placement stability knowledge of trauma and confidence in providing of children and youth. Child Abuse Negl. 2009 Resource Parents Pre-Workshop Survey. https://duke.qualtrics.
could be improved for those youth in foster care trauma-informed foster care. However, our mea- Jul;33(7):403-11. doi: 10.1016/j.chiabu.2008.09.012. Epub com/CP/File.php?F=F_6VeEpCOYusmUwDz
whose foster parents receive Encompass program sures had good face validity as determined by clin- 2009 Jul 8. PMID: 19589596.
supports. Qualitative evidence suggests partici- ical experts and had good reliability in this sample.
Fratto, C. M. (2016). Trauma-Informed Care for Youth
pants were satisfied with the program, would like On the whole, the pilot-year evidence suggests in Foster Care. Archives of Psychiatric Nursing, 30(3),
more didactic information, and would like the pro- that the Encompass program may have a positive 439-446. https://doi.org/https://doi.org/10.1016/j.
gram to be lengthier. impact on caregiver knowledge about trauma and apnu.2016.01.007
There are several limitations of this evaluation capacity to provide trauma-informed foster care
study. First, we did not use a control group or com- to children. Continued evaluation of the full-scale
parison group for the survey study. It is possible implementation of the Encompass program during
that all foster parents increase their confidence in 2022-2024 will be informative about program ef-
trauma-informed foster care provision over time. fectiveness.
However, that possibility seems unlikely because

PAGE 16 PAGE 17
Table 1. Caretaker demographics (N=17) Table 2. Foster children demographics (N=25)
% (n)
% (n)
Child age (n=24)*
Caregiver age (years)
Mean + SD (years) 7.9 + 5.1 years
Mean + SD 43.9 + 10.8 yrs.
Range 4.8 monthsyears
– 18
Range 26-68 yrs.
Caregiver gender Child gender
Male 68% (17)
Male 0% (0) Female 28% (7)
Female 100% (17) Missing 4% (1)
Primary language spoken at home Child race/ethnicity
African National or Caribbean Islander 4% (1)
English 71% (12)
Hispanic or Latino 24% (6)
Spanish 29% (5) White (non-Hispanic/European American) 36% (9)
Caregiver race/ethnicity Multiracial 24% (6)
Prefer not to answer 8% (2)
African American or Black 6% (1) Missing 4% (1)
Hispanic or Latino 35% (6) Number of prior foster placements
White (non-Hispanic/European American) 53% (9)
0 36% (9)
Multiracial 0% (0)
1 36% (9)
Other 6% (1)
2 8% (2)
3-4 8% (2)
Number of biological children under 18 living in home ≥5 placements 0% (0)
Mean + SD 0.94 + 1.1 children
Unknown 8% (2)
Range 0-3 children
Missing 4% (1)
Caregiver employment status
Diagnosed with mental or physical disability 36% (9)
Full-time 29% (5)
Among those with a disability (n=9)*
Part-time 12% (2)
Developmental delay 67% (6)
Out of work but not currently looking for work 41% (7)
Unable to work 6% (1) Anxiety, depression, PTSD or other mental disorder 56% (9)

Retired 6% (1) Attention deficit hyperactivity disorder or ADD 33% (3)

Prefer not to say 6% (1) Other chronic medical problem 33% (3)

Foster parent role* Autism or pervasive developmental disorder 11% (1)

Kinship caregiver 29% (5) Oppositional defiance disorder 11% (1)
Unrestricted or departmental caregiver 71% (12) Among school-age children (n=16)
Comprehensive caregiver 0% (0) Has an Individualized Education Plan (IEP) 44% (7)
Hotline/Emergency caregiver 6% (1) In process of trying to obtain IEP 25% (4)
Respite caregiver 0% (0) Has a 504 plan 13% (2)
Pre-adoptive caregiver 35% (6)
Has an IEP, 504 or in process of obtaining IEP 82% (13)
Kinship and Pre-adoptive caregiver 6% (1)
Pre-adoptive and Unrestricted caregiver 29% (5) Frequency of contact with biological parents (by phone, Zoom or in person)
Other 6% (1) Every day or almost every day 12% (3)

Years fostering Weekly or almost weekly 48% (12)

Mean + SD 4.9 + 5.1 years Monthly or almost monthly 8% (2)
Range 0.22-16.1 years Never in past month 28% (7)
Number of foster children in home Missing 4% (1)
Mean + SD 1.5 + 0.70 children
* Respondents were allowed to choose all that apply, indicating that some children have been diagnosed with more than one
Range 1-3 children disability, so percentages add up to more than 100%.
*Note: percentages add up to over 100% because participants were given the option to select more than one response

PAGE 18 PAGE 19
Table 3. Confidence in trauma-informed fostering (N=15) Table 4. Opinions about DCF (N=15)

Pre-test Post-test t-test, p-value Pre-test Post-test t-test, p-value

Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Total scale score (summary of all items below) 2.84 (0.59) 3.11 (0.33) 1.52, p=.07 Total scale score (summary of all items below) 2.95 (0.72) 3.09 (0.34) 0.63, p=.27
I am satisfied with how frequently I am contacted by DCF staff to receive 2.92 (0.86) 3.00 (0.71) 0.27, p=.40
I understand why traumatic events impact the way a child’s brain works 2.62 (0.77) 3.13 (0.64) 1.95, p=.03 information or check-ins about my foster child or children

(well enough that I could explain it to someone else). I am satisfied with the quality of my interactions with DCF staff about my 2.92 (0.86) 3.15 (0.55) 0.82, p=.21
foster child or children
I routinely think about how a child could be physically safe in my home, 2.64 (1.08) 3.20 (0.68) 1.68, p=.05
As a foster parent, I feel like I am treated with respect by my neighbors and 3.08 (0.86) 3.23 (0.44) 0.69, p=.25
but might not feel safe
community
An important part of my role as a parent is to identify trauma reminders 3.23 (0.83) 3.64 (0.50) 1.39, p=.09
I feel that I am treated with respect by DCF staff 3.08 (0.76) 3.23 (0.44) 0.81, p=.22
(i.e., “triggers”) in the lives of the children I foster.
I am satisfied with how DCF protects my privacy 2.92 (1.00) 3.08 (0.51) 0.69, p=.25
I know how to make a child feel better when they are experiencing a 2.71 (0.91) 3.0 (0.70) 1.17, p=.13
I am satisfied with how DCF considers my needs as a foster parent 2.69 (0.95) 3.31 (0.48) 2.13, p=.03
traumatic reaction to something
A child’s past experiences impact how I respond to their misbehavior 3.00 (0.78) 3.33 (0.72) 1.19, p=.12 I am satisfied with how DCF involves me in decision-making related to my 3.00 (0.85) 3.00 (0.43) 0.00, p=.50
child or children’s placement
In my opinion. praises and rewards should outnumber commands and 3.14 (0.86) 3.33 (0.62) 0.69, p=.25
I have reasonable access to a social worker and family resource worker 3.08 (0.6) 3.54 (0.52) 1.72, p=.06
consequences
I feel included in DCF decision-making about supervised or unsupervised 2.62 (1.04) 2.85 (0.80) 1.15, p=.13
There is always a reason for misbehavior 3.0 (0.83) 3.29 (0.61) 0.78, p=.22
visitation for my child/children with their biological parents
Bedtimes and mealtimes are stressful for children who have been in 2.93 (0.73) 3.47 (0.64) 2.11, p=.02 I feel that DCF staff treats me as a professional member of a care team 2.85 (0.99) 3.08 (0.49) 1.00, p=.17
traumatic situations
As a foster parent, I view myself as a professional member of a care team 3.15 (0.90) 3.23 (0.60) 0.32, p=.38
When a child has intense feelings that don’t seem to make sense, I un- 3.08 (0.76) 3.20 (0.68) 0.45, p=.33
I am satisfied with the amount of information that I have received from DCF 2.77 (1.09) 2.85 (0.90) 0.23, p=.41
derstand how those feelings might be related to his/ her past about my foster child/children’s physical health, mental health, and trauma
When a child is having a tantrum or meltdown, I should remove other 2.86 (0.86) 2.93 (0.46) 0.30, p=.38 history
children from the room.
DCF has provided me with everything that I need to be a successful foster 2.69 (1.03) 3.08 (0.64) 1.24, p=.12
When a child is having a tantrum or meltdown, it is okay for me to step 2.93 (0.83) 3.27 (0.59) 1.27, p=.11
parent
out, or remove myself from the room for a little while, provided I don’t
I am satisfied with the support/ assistance I receive from DCF staff when I 2.77 (1.01) 3.00 (0.41) 0.82, p=.21
believe my child is a danger to him/herself or others ask for it
There are many times when I don’t know what to do as a parent.* 2.57 (0.76) 2.47 (0.52) -0.44, p=.67 Social workers and other DCF staff listen to my input 2.92 (1.00) 3.08 (0.51) 0.62, p=.28
I feel confident about my ability to handle challenging behaviors 2.79 (0.70) 3.07 (0.46) 1.29, p=.10 Being a foster parent is difficult but rewarding 3.33 (0.89) 3.50 (0.52) 0.56, p=.29
I know strategies to help my child express a variety of emotions 2.64 (0.93) 3.07 (0.70) 1.39, p=.09 Being a foster parent is meaningful and worthwhile 3.42 (0.90) 3.50 (0.52) 0.27, p=.40
I feel confident in my ability to care for a child who curses at me or says 2.79 (0.89) 2.93 (0.59) 0.53, p=.30 Barring unforeseen problems, I plan to continue to be a foster parent for as 3.23 (0.83) 3.08 (0.64) -.46, p=.67
mean and hurtful things to me long as I can
I feel confident in my ability to care for a child who rejects me 2.64 (0.84) 3.00 (0.65) 1.28, p=.11 Note: Participants responded to each statement on a 4-point scale where 1 was “strongly disagree,” 2 was “disagree,” 3 was “agree”
I feel confident in my ability to care for a child with inappropriate sexual 2.29 (0.73) 2.60 (0.74) 1.16, p=.13 and 4 was “strongly agree.” A higher score is desired.
behavior
I feel sure of myself as a parent of a child who has experienced trauma 2.71 (0.91) 2.73 (0.80) 0.06, p=.47
I know I am doing a good job as a foster parent 2.92 (0.83) 3.13 (0.35) 0.88, p=.19
I know things about being a foster parent that would be helpful to other 2.79 (0.89) 3.21 (0.58) 1.51, p=.07
parents
I feel confident in my ability to solve most problems between my foster 3.14 (0.77) 3.21 (0.58) 0.28, p=.39
child (or children) and me

Note: Participants responded to each statement on a 4-point scale where 1 was “strongly disagree,” 2 was “disagree,” 3 was “agree”
and 4 was “strongly agree.” A higher score is desired, unless marked with an asterisk.

* = a lower score is desirable

PAGE 20 PAGE 21
Table 5. External support care Table 6. Intentions to continue fostering, and mobile crisis intervention use (N =14)

Pre-test Post-test Chi-sq/Fisher’s exact Pre-test Post-test Chi-sq/Fisher’s exact

or t-test, p-value
or t-test, p-value

Since becoming a foster parent, has been connected with at least 21.4% (3) 47% (7) 2.40, p=0.25
one external support provider (aka respite provider) through DCF How long you intend to be a foster parent (in general, not just to the NS
The number of external support providers available to help with 0.57 (0.79) 1.0 (1.9) 0.58, p=0.29 child in your home currently)
foster parenting needs (i.e., you know their name and phone number 3-6 months 7% (1) 7% (1)
(Range: 0-2) (Range: 0-6)
and can call on them to help you)? 6-12 months 7% (1) 0% (0)

Mean (SD); (Range) 1-2 years 36% (5) 36% (5)

Have utilized one or more external care providers to provide tempo- 8% (1) 67% (10) 11.63, p=.00 2-5 years 0% (0) 21% (3)
rary external support or care for your foster child(ren) outside of the 5 years or longer 36% (5) 21% (3)
home in the past month
I no longer want to be a foster parent 14% (2) 14% (2)
The number of times in the past month utilized an external care .17 (.58) 0.25 (0.62) 0.34, p=0.37
provider for temporary care of your foster child(ren) outside of the
(Range: 0-2) (Range: 0-2) How many times in the past 6 month you have called the state Emer- 0 times 0.27 times 0.96, p=0.17
home: Mean(SD); (Range)
gency Services Program/Mobile Crisis Intervention (ESP/MCI) for
The number of hours of external support care that trained external 0 (0) 2.46 (6.49) 1.31, p=.10
help managing the child’s mental health needs?
support providers provided in the past month (Range: 0) (Range: 0-2)
(Range: 0) (Range: 0-10)
Mean (SD); (Range) NS=not statistically significant/no change

PAGE 22 PAGE 23
Table 7. DCF data (N=148) continued

ENCOMPASS Comparison Chi-sq/Fisher’s exact Placement stability, May-September, 2021

group or t-test, p-value
Remained in index placement between May and Sept 2021 77% (20) 69% (103) 0.86, NS
Total 100% (26) 100% (122) … Achieved permanency as of Sept 30, 2021* 19% (5) 7% (9) 5.82, p<.10
Child’s age (Mean, SD) 4.88 (3.75) 6.24 (4.9) -1.32, NS Moved to a new placement between May and Sept 2021 31% (8) 21% (26) 1.08, NS
Child gender 6.33, p<.05 No placement moves between May and Sept 2021 77% (20) 79% (96) 0.04, NS
Male 73% (19) 46% (56) Number of placement moves between May and Sept, 2021 .31 (0.62) .38 (0.82) -0.41, NS
Female 23% (7) 54% (66) Caregiver attended most recent 6-month Foster Care Review (FCR) if 57% (12) 50% (62) .57, NS
Hispanic origin 2.46, NS convened 5/21-9/21

Hispanic/Latino 50% (13) 42% (51) FCR attended by index placement 58% (7) 63% (39) .09, NS

Not Hispanic/Latino 50% (13) 50% (61) *This is the variable modeled in Table 8; It means that the child is no longer in care and achieved permanency through reunifica-
tion, adoption, guardianship, returned to custody of kin, guardian, or are currently in the process of a “Trial Home Visit.”
Race 11.99, p<.05
American Indian/Alaskan Native 0% (0) 2% (3) Definition: Identifies whether the index placement was the foster parent/placement resource that attended the Foster Care Review
(if a Foster Care Review was convened between 5/1/21 and 9/30/21).
Black 8% (2) 14% (17)
Multi-racial 19% (5) 3% (4)
White 62% (16) 74% (90)
Declined or unable to determine 12% (3) 7% (8)
History of placements
Lifetime placement count 5.23 (4.31) 3.86 (4.41) 1.44, p<.10
Index placement is first placement 15% (4) 24% (29) 0.87, NS
Total number of Home Removal Episodes (HREs) by May 1.35 (0.56) 1.31 (0.58) 0.28, NS Table 8. Odds of achieving permanency by intervention group, controlling for child gender, child
Number of days in index placement as of May 1, 2021 357 (300) 430 (396) -.89, NS race, lifetime placement count
Case type
OR 95% CI p-value
Clinical 46% (12) --
Achieving permanency* 2.99 0.91-9.83 p=.07
Adoption 54% (15) --
Type of placement in May 2021 Table 8a. Relative risk achieving permanency by intervention group, controlling for child gender, child race, lifetime placement count

Unrestricted 42% (11) 41% (50) 0.02, NS

RR 95% CI p-value
Pre-adoption 8% (2) 3% (4) 1.07, NS
Achieving permanency* 1.13 0.99-1.27 p=0.06
Child specific 27% (7) 12% (15) 3.62, NS
Kinship 19% (5) 43% (53) 5.37, p<.05
* It means that the child is no longer in care and achieved permanency through reunification, adoption, guardianship, returned to
custody of kin, guardian, or are currently in the process of a “Trial Home Visit.”
Caring Together (group home) 4% (1) 0% (0) NS
No placement 0% (0) 0% (0)
Type of placement in September 2021
Unrestricted 42% (11) 38% (46) 0.19, NS
Pre-adoption 8% (2) 2% (3) 1.80, NS
Child specific 27% (7) 11% (14) 4.20, p<.05
Kinship 19% (5) 39% (47) 3.50, p<.10
Caring Together (group home) 4% (1) 2% (3) 0.16, NS
No placement 0% (0) 7% (9) 2.04, NS

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