Commit to Innovation

Challenge

The Duke Endowment recognizes that evidence-based solutions are not available for every issue confronting children and families. Gaps persist in our knowledge, in our research and in the service models we support. 

Well-structured models may have limited, if any, data on effectiveness with racial and ethnic minorities. Given the disproportionate number of African American children in the child welfare system, interventions must pass scrutiny under a racial equity lens if we truly seek to improve outcomes. 

We also must consider the applicability of interventions in rural contexts and with special populations, such as young children or teens in foster care. 

Through the work of our Child and Family Well-Being program area, we hope to encourage the development of well-studied models to address gaps in early intervention, foster care, therapeutic foster care, kinship care and adoption (to name a few specific funding priorities). To that end, we support a range of program evaluations, from pilot tests to randomized controlled trial studies.

Response

Without a commitment to innovation, opportunities to harness new programs that can improve outcomes are missed. 

In 2021, our Board of Trustees approved an innovative grant to the Dougy Center, which provides grief and bereavement support to children, youth and families who have been impacted by significant loss. 

Studies have validated the therapeutic value of death-related grief support, but little research has been conducted on the non-death grief and loss experienced by youth in foster care and the impact on their well-being.

In the United States, more than 423,000 children and youth are in foster care separated from their parents, siblings and community. 

This disconnect from the familiar — coupled with the uncertainty of when, or if, reunification will occur— is traumatic. Youth have identified this type of unresolved loss as a primary contributor to behavioral and emotional challenges. 

The Dougy Center hypothesizes that a tailored peer support program to address grief and loss experiences will reduce these challenges. Promising findings from a pilot program in South Carolina showed participants between the ages of 12 – 16 reported a slight decrease in problem behaviors and a small increase in hope and social support. 

In our ongoing commitment to encourage innovation, The Duke Endowment supported the Henderson County Department of Social Services in 2021 as it paired substance abuse treatments with Family Centered Treatment, an in-home model for families involved in the child welfare system. Often, families struggling with substance abuse are referred to multiple uncoordinated services that are confusing and inconvenient to access. The pilot seeks to boost treatment rates, lower the number of children removed from homes and increase reunification rates. Early results have been encouraging. 

Impact

In 2018, the Endowment funded a three-year evaluation that sought to build upon early findings and test the efficacy of the Dougy Center’s intervention. The randomized control trial enrolled 42 youth (23 in treatment group) from three children’s homes in South Carolina.

Campus staff were trained as facilitators. Groups were open-ended for six weeks and 90 percent of youth attended all six sessions. 

Pre- and post-intervention measures indicated an increase in social supports, hopefulness, self-worth, and perception of their ability to cope with problems. 

Our most recent grant, approved in late 2021, supports a second randomized control trial to expand the program to include six community sites and youth residing in family foster homes and young adults in out-of-home care up to the age of 23. Sixty-two to 112 youth will be enrolled.

In the case of the Henderson County in-home substance abuse treatment model, early data looks promising. The pilot used a pre-test, post-test evaluation design and state administrative data to determine if new reports of abuse and neglect are made after program completion. 

While the number of participants in the initial evaluation was only 17, 10 families completed the pilot with no child welfare involvement since graduation. Cost savings from avoiding foster care, in-patient treatment and the criminal justice system are estimated at $100,000 to $200,000 per family. 

In supporting such new evidence-based and evidence-informed models, we hope to improve the child welfare system, improve parenting across relevant populations, increase connections between youth and supportive adults, reduce child maltreatment and improve child well-being.