SAFE Homes: is it worth the cost? An evaluation of a group home permanency planning program for children who first enter out-of-home care.
OBJECTIVE
To evaluate the SAFE Homes (SH) program, a short-term group care program for children between 3 and 12 years of age who enter care for the first time. The program aims to improve case outcomes by consolidating resources to facilitate assessment and treatment planning.


METHODS
The 1-year outcomes of 342 children who received SAFE Home services and 342 matched foster care (FC) control children were compared. The 684 subjects used in this report were selected from a larger pool of 909 subjects using propensity score matching to control for hidden bias in treatment group assignment. We hypothesized that SAFE Homes would result in greater continuity of care for children (e.g., fewer placements, more placements with siblings and in towns of origin), identification of more relatives for substitute care when needed, reduced use of high-cost restrictive care settings (e.g., residential, inpatient), and reduced rates of re-abuse through earlier detection and provision of services to meet child and family treatment needs.


RESULTS
Prior to the initiation of the SAFE Homes program, 75% of the children who entered care in the State experienced three or more placements in the first year. The outcomes of both the SH and FC cases were significantly improved over pre-SAFE Home State statistics. The FC group, however, had comparable or better outcomes on most variables examined. In addition, the total cost for out-of-home care for the children in FC was significantly less, despite the fact that the two groups spent similar amounts of time in care (average time in care: 7 months). This finding held when the total placement cost was calculated using the State reimbursement rate of 206.00 US dollars per day for SAFE Home care (SH: 20,851 US dollars +/- 24,231 US dollars; FC: 8,441 US dollars +/- 21,126 US dollars, p < .001), and a conservative SAFE Home program fee of 85.00 US dollars per day that only considered the child care and custodial staffing costs uniquely associated with the program (SH: 13,314 US dollars +/- 21,718 US dollars; FC: 8,441 US dollars +/-21,126 US dollars, p < .001).


CONCLUSIONS
Improvements in outcomes related to continuity of care can be attained through staff training. The SAFE Home model of care is not cost-effective for first-time placements.
Yale University, Department of Psychiatry, Child and Adolescent Research and Education (CARE) Program, University Towers, New Haven, CT 06511, USA.
Allen D
AD
DeSena
Robert A
RA
Murphy
Heather
H
Douglas-Palumberi
Gary
G
Blau
Blandina
B
Kelly
Sarah M
SM
Horwitz
Joan
J
Kaufman
D002648:Child; D002649:Child Abuse; D002669:Child Welfare; D002675:Child, Preschool; D003237:Connecticut; D005260:Female; D005500:Follow-Up Studies; D005581:Foster Home Care / Q000191:economics*; D016352:Group Homes / Q000191:economics*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012307:Risk Factors; D035781:Siblings