Keeping Children With Families by Strengthening Director’s Approval Processes in Michigan

Project Context: 

• There is growing consensus among child welfare researchers that children should be placed in residential programs only when they have complex medical or behavioral needs that cannot be met in a family-based setting. 
• In 2019, among children in out-of-home care in Michigan, 8% were in group or institutional settings — in line with national averages at the time, but at a level leaders in the Michigan Department of Health and Human Services (MDHHS) wanted to reduce.  
• MDHHS policy already required county director sign-off if case workers wanted to place children in residential programs. MDHHS leaders wanted to strengthen approaches that could further reduce entries.    

How the GPL Supported: 

• Developed a “toolkit” of services and resources that leaders could utilize to help maintain placement in family-based settings for children at imminent risk of placement disruption or entry to a residential program.  
• Potential interventions in the toolkit included community mental health services, family preservation programs, as well as mobile crisis units and increased daily maintenance rates for caregivers. 
• Designed a framework for triaging potential residential referrals. A “no” answer to any of the questions below indicated the case needed further review and rapid intervention to try and preserve the family-based placement:  
  • Age – Is the child over the age of 13? Children under 13 are particularly vulnerable to experiencing poor outcomes from long stays in residential programs. 
  • Prior supports – Has the child been connected to existing local community mental services? 
  • Recent behaviors – Has the child exhibited any “high-level” behaviors in the last 6 months that may be difficult to support outside of a clinical setting?

Results: 

• In the first six months after launching these new protocols, the overall number of children being referred for residential programs from four pilot counties in the Detroit metro area declined by 50 percent — double the improvement seen in the rest of the state during the same period (Figure 1). 
• From 2019 to 2023, Michigan reduced the share of children in congregate care settings by half, including by addressing additional upstream factors.