The effect of the ZERO TO THREE Infant-Toddler Court Teams on type and time of exits from out-of-home care: A new study ten years after the first competing risks analysis

Infant-Toddler Court Teams (ITCTs) are a collaborative practice that improves, aligns, and integrates systems and builds community capacity to advance the health and well-being of very young children under court jurisdiction who are in foster care or at risk of removal from their homes, and their families. A permanent—forever—home that provides a safe, stable, and nurturing environment is crucial for supporting healthy development in the first three years of life. Through proactive collaborative problem-solving at the family and systems level, ITCTs expedite referrals for both children and their parents to comprehensive services and supports that prevent removal and that promote reunification and other lasting permanency outcomes. This retrospective, quasi-experimental study examines permanency outcomes for children who were served by an ITCT for at least one year between 2010 and 2018. The goal of the study was to examine differences in type and time to permanency between ITCT children in out-of-home care and a comparison group created using propensity score matching from a sample of children in the National Survey of Child and Adolescent Well-Being (NSCAW II). Overall, reunification was the most common type of permanency for ITCT children and was significantly higher among ITCT children compared to the NSCAW II sample (43.7% vs. 25.6%, p <.001). In addition, ITCT children were significantly less likely to remain in foster care by the end of the study period (2.7% vs. 16.9%, p <.001). ITCT children also had a shorter mean time to permanency at 450.6 days compared to 654.9 days for those in the NSCAW II group. In both unadjusted and adjusted survival models, the main effect of ITCT was significant, with children in the ITCT group being 1.6 times as likely to exit foster care to permanency compared to NSCAW II group. These findings replicate those of a previous study published ten years ago. The focus of ITCTs on proactively frontloading services for both parents and children, including integrated trauma and substance use disorder treatment and health and mental health services, is a crucial pathway toward safe and nurturing permanency outcomes for families in vulnerable situations that involve young children.