A Functional Approach to Reducing Runaway Behavior and Stabilizing Placements for Adolescents in Foster Care

Hewitt B. Clark Kimberly A. Crosland David Geller Michael Cripe Terresa Kenney Bryon Neff Glen Dunlap
University of South Florida, Tampa

Teenagers’ running from foster placement is a significant problem in the field of child protection. This article describes a functional, behavior analytic approach to reducing running away through assessing the motivations for running, involving the youth in the assessment process, and implementing interventions to enhance the reinforcing value of placements for adolescents, thereby reducing the probability of running and associated unsafe periods. A case study illustrates this approach and a study compares 13 adolescents who ran away frequently and received interventions with a group of matched adolescents who had similar patterns of running but received only services as usual. The percentage of days on runaway status showed a significant pre-post reduction for those in the functional group, in contrast to no statistical change in the comparison group. Potential benefits this approach may have for foster care and child protection in improving youth safety, permanence, and connections for life are discussed. Keywords: runaway behavior; functional assessment; applied behavior analysis; behavior analytic interventions; foster care; placement stability

Estimates on the number of youth who run away or are evicted by their caregivers each year in the United States range from 575,000 to over 1.6 million (Greene, Ringwalt, Kelly, Iachan, & Cohen, 1995; Hammer, Finkelhor, & Sedlak, 2002) and the number of homeless and/or runaway youth is increasing (Kipke, Palmer, LaFrance, & O’Connor, 1997; Thompson, Pollio, Constantine, Reid, & Nebbitt, 2002). Whether youth are missing from their parents’ home, a foster home or a

Authors’ Note: The authors wish to extend their appreciation to Arun Karpur for his assistance with the data analysis; Hans Soder for his assistance in accessing, analyzing, and interpreting state datasets; Dawn Khalil for her creative development of the case example graphic profile; and Amanda Fixsen for her editorial assistance on this paper. Correspondence concerning this paper may be addressed to Hewitt B. “Rusty” Clark, PhD, director, National Center on Youth Transition for Behavioral Health: System Development and Research Team, Department of Child and Family Studies, Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, MHC 2332, Tampa, FL 33612–3807, or via e-mail using clark@fmhi.usf.edu. Research on Social Work Practice, Vol. 18 No. 5, September 2008 429-441 DOI: 10.1177/1049731508314265 © 2008 Sage Publications

residential facility, running away can hold serious consequences for young people. They may be exposed to the risk of abusing alcohol and drugs, criminal and sexual victimization, sexually transmitted disease, arrest and incarceration, and/or prostitution (Biehal & Wade, 1999; Courtney et al., 2005; Hyde, 2005). Running away from foster care settings not only places young people in harm’s way, but also frequently jeopardizes their current placement, which often leads to more restrictive placements and an interruption in learning opportunities at school. These types of interruptions can hinder youths’ abilities to build the life skills needed for greater self-sufficiency and to form the social support network essential for resilience and quality of life (Choca et al., 2004; Christenson, 2002; Clark & Crosland, in press; Iglehart, 1994). Runaway behavior can contribute to placement instability, and placement changes can then contribute to the development of behavior problems in youth who previously did not exhibit such problems (Newton, Litrownik, & Landsverk, 2000). Two or more placement changes during the 1st year of out-of-home care was shown to be associated with more subsequent placement changes
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(Webster, Barth, & Needell, 2000). Multiple placement changes before the age of 14 have been associated with later delinquency arrests (Ryan & Testa, 2005) and subsequent placement instability (Webster et al., 2000). Some placement disruptions are associated with the externalizing behaviors (e.g., noncompliance, fighting) of children and youth (Newton et al., 2000). However, the majority of placement changes that children and youth experience are related to features of the foster home or agency, or system/policy issues such as kinship placement, sibling consolidations, or the use of temporary emergency shelter placements (Hartnett, Falconnier, Leathers, & Testa, 1999; Newton et al., 2000). Thus, placement changes can contribute to the development of problem behaviors and, in turn, these can contribute to increased placement disruption and incidents of running away. In Florida, it was estimated on the Florida Department of Children and Families (FL DCF) Missing Child Tracking System (MCTS) that 2,398 children and youth were reported missing from out-of-home placements during FY 2004-05, and 78% of these children and youth were on runaway status. Youth who ran were between 8 and 18 years old, with the highest incidence of running occurring for the 16-, 17-, 15-, and 14-year-olds, respectively. Approximately 60% were female, 39% Caucasian, 40% African American, and 14% Hispanic. Most of the youth had one episode (49%) or two episodes (21%) of running away during this 1-year period. However, 18% of the youth had four or more episodes of running away during this period. FL DCF defined the term running away as “A child who has left a relative placement, nonrelative placement, shelter home, foster home, residential group home, any other placement alternative, or their in-home placement without permission of the caregiver and who is determined to be missing.” A criterion was also set to define children who habitually run away as, “A child who has run away three or more times” (FL DCF, 2002). The duration of run episodes was distributed about equally across the following distributions: 0 to 1 day (26%), 2 to 7 days (27%), 8 to 30 days (24%), and 31 to 365 days or more (23%). Although different studies have found different risk factors associated with running away, some of the common factors are: history of runs, placement disruptions, use of substances, and victim of abuse (Thompson, Zittel-Palamara, & Macao, 2004; Witherup & Lee, 2007; Yoder, Whitbeck, & Hoyt, 2001). A large-scale study of children running away from out-of-home placements in Illinois provides factors that may be predictive of youth and situations associated with running away from placements (Courtney et al., 2005). Similar to the

Florida data, girls were more likely to run than were boys. Ninety percent of runners were 12 to 18 years of age, most of these being 14 years old or older. Other factors associated with higher likelihoods of running were histories of placement instability, the presence of mental health diagnoses or substance abuse problems, placements in residential facilities, and prior runaway episodes. Some of the factors that were associated with a lower likelihood of running were living with a relative or living in a setting with a sibling. A preliminary evaluation of children in Florida’s foster care system revealed some similar risk and protective factors associated with the likelihood of running away (Witherup, Vollmer, Van Camp, & Borrero, 2005). The primary risk factors included such things as being: female, between 13 and 17 years of age, in temporary custody of the system (e.g., adjudicated dependent, custody to DCF, termination of parental rights petition filed), and in a group-type placement (e.g., shelter facility, group home, residential). Some of the protective factors were being: male, under 13 years of age, Caucasian, in a more permanent custody status (e.g., termination of parental rights obtained, long-term custody to relative, temporary custody to relative or nonrelative), and in a home-type placement (e.g., foster home nonrelative, family shelter home nonrelative, approved relative caregiver). These researchers also examined risk factors related to frequent placement changes, and their preliminary findings suggest that being in settings with more than four children or in settings for older youth (ages 12 to 15 years of age) were associated with a higher risk of placement disruption. Based on interviews of youth who run away (Courtney et al., 2005), some adolescents reported that they were “running to family” in order to: touch base with family and friends; find a sense of safety, comfort, connection, or normalcy; or to assist their mothers or siblings.
Some recognize that their families of origin are neither healthy, safe, nor even reciprocally caring environments. But many youth equated being around a biological family with being “normal” and their desire for a “real home” (which foster care was not, in their minds). (Courtney et al., 2005, p. 4)

A FUNCTIONAL APPROACH In recent years there have been increased efforts to extend the perspectives and methods of behavior analysis to a variety of challenges encountered in child welfare and the foster care system. While behavior analysis has been well established for some decades in developmental disabilities and other areas, it has taken longer

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for the discipline to be demonstrated in the realm of child protection. The Behavior Analysis Services Program (BASP) represents a major step in this direction as it brings the programmatic application of behavior analysis to a statewide level (Stoutimore, Williams, Neff, & Foster, 2008, this issue). A hallmark of behavior analysis is its reliance on data to make decisions regarding appropriate treatments (Neef & Iwata, 1994), and this characteristic has become most evident within the past two decades with the advent of functional analytic and functional assessment perspectives (Horner, 1994; Iwata, Dorsey, Slifer, Bauman, & Richman, 1994; Repp & Horner, 1999). The functional approach of behavior analysis calls for a preintervention assessment of environmental conditions that serve to maintain a specified behavior and then uses assessment information to devise an intervention plan tailored to meet the circumstances and needs of the individual. The term functional assessment refers to the “process of gathering information that can be used to maximize the effectiveness and efficiency of behavioral support” (O’Neill et al., 1997, p. 3). Two of the primary outcomes of a functional assessment are: (a) identification of the consequences that maintain the target behavior, which leads to inferences about the function or outcome of the behavior for that individual, and (b) identification of the antecedent conditions (events, situations) that help predict when a target behavior is more likely to occur and when a target behavior is less likely to occur. Few intervention studies have been conducted on runaway behavior, and the studies that have occurred have not utilized a functional assessment approach to tailor the intervention to the runner (D’Angelo, 1984; Slesnick, 2001; Slesnick & Prestopnik, 2005; Thompson, 2002). For example, a study of adolescents who ran away compared those who attended at least three family counseling sessions to those who did not participate (Ostensen, 1981). The recidivism of running showed a moderate improvement over a 3-month period for the youth who participated in the counseling versus those who did not. However, a subgroup of adolescents in foster care who participated in the sessions did not differ from the nonparticipants. There is literature suggesting that a runaway-like behavior (i.e., wandering out of a designated area without permission) was maintained by escape/avoidance and/or positive reinforcement factors. Piazza et al. (1997) and Tarbox, Wallace, and Williams (2003) provided analog studies on elopement with children and adults with mental retardation, 4 to 39 years old. Both studies provided thorough functional analyses of elopement that was defined as movement away from the caregiver and/or into the next room, without permission. The general conclusions from

these studies were that elopement was maintained by positive reinforcement (e.g., attention, edibles, toy play) and was successfully reduced through interventions such as differential reinforcement of other behaviors, functional communication training with social praise, or differential reinforcement of appropriate walking with the caregiver. Although these studies examined a topographically different behavior than running away and conducted a direct functional analysis (i.e., attention and access to toy play were systematically controlled)—the findings of the Piazza et al. (1997) and Tarbox et al. (2003) studies hold implications for designing interventions with adolescents who engage in runaway behaviors, even though a more indirect assessment method would typically be required. An indirect functional assessment would include information gathering via multiple methods such as focused interviews with caregivers, friends, family, and the youth themselves (Kern & Dunlap, 1999). The functional assessment process would seek information related to: (a) the motivations for the adolescent’s running (e.g., what the youth was seeking to obtain by running, and/or what the youth was attempting to avoid by leaving the foster care placement); as well as (b) the specific circumstances or situations that might have triggered the running episode. This information would then be used to devise an individualized, multicomponent intervention plan focused on reducing the youth’s motivations for running away and increasing the youth’s motivations for staying in a safe setting. The purpose of this article is to describe and demonstrate the impact of behavior analytic functional assessments and resulting intervention strategies to address the runaway behaviors of youth who met the criteria of FL DCF for habitually running away. The analyses were conducted in the context of the BASP and are presented in two parts. Part I provides a case example to depict the types of placement and runaway histories youth experience and the array of interventions that may be used regarding runaway behaviors and placement instability. Part II provides the results of a pre/post analysis of runaway behaviors and placements of 13 youth in foster care who were referred to the BASP for habitually running away. A matched comparison group of children with similar rates of run behaviors who were not served by the BASP during this period were also included in the analysis to illustrate the contrast to services as usual.

PART I: CASE EXAMPLE A case example is presented to provide the reader with a sense of the types of placement and runaway

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Figure 1: Katrina’s Placement and Run History From Her Entry into the Foster Care System at About 14 Years 9 Months Old to Her First Run at About 14 Years 11 Months, Through to The Behavioral Analysis Services Program Intervention Starting at About 17 Years 5 Months (Vertical Broken Line) and Ending With Her Independent Living Experience Shown Through to Her Age of About 19 Years 6 Months.

trajectories of some youth in the foster care system, and to illustrate the types of functional assessments and interventions used to address runaway behavior. The case example is that of a Hispanic female who was placed in the Florida foster care system a few months prior to her 15th birthday. This girl was the first youth with whom the functional approach described in this article was used on runaway behaviors by the BASP. The data for this case example were obtained from the behavior analyst’s case records as well as two of the FL DCF databases (MCTS and Florida’s Integrated Child Welfare Services Information System [ICWSIS] database).
Katrina’s Story

Katrina (a pseudonym) was removed from her home at the age of 14 years 9 months due to confirmed physical and sexual abuse. Figure 1 depicts the placement and runaway pattern from Katrina’s first out-of-home placement through to her achieving independent living at age 18 years 4 months, where she remained at the time of the writing of this article. However, her road to independent living was a very rocky one, as is illustrated in Figure 1. The vertical axis lists the types of settings she experienced and the horizontal axis shows the days from her removal starting with her placement in an emergency group shelter facility. Katrina was moved to her first foster home after being in the shelter facility about 2 months. After being in this foster home for 2 days she ran away for a day, returned and was placed in a second foster home for 10 days, and was then placed in a second group shelter facility. Five days later she ran away again for a couple

of days and was then placed in a new foster home where she stayed for almost 2 months. After this period she ran away for a day and then returned to the foster home for another 18 days, at which time she was transferred to the group shelter again. She immediately ran for a 10-day period, returned to the original shelter for a day, ran for another day and was placed at another foster home from which she ran for another 10-day period. Upon her return, she was placed in the shelter facility where she stayed for 3 months, at which time she was sent to another foster home. Fifteen days later, she was placed in a third group shelter facility for 16 days, then placed in another foster home where she remained for over 4.5 months. Katrina then returned to the second emergency group shelter facility where she remained for approximately 4 months. On Figure 1, the data points between approximately 560 to 710 days depict her placement of roughly 5 months in foster care—which involved several brief placements in different foster homes—ranging from 6 days to 121 days, followed by a fourth foster home placement. At the age of 16.5 years, Katrina began a series of short and extended periods of running (one for over a month and another for over 2.5 months), with brief returns to the foster home or shelter facility. She was then placed in a group home where she remained for over 3 months before the brief runaway pattern resumed. During the 2-year 8-month period from age 14 years 9 months to 17 years 5 months, Katrina experienced some 20 plus placement changes and 13 runaways, some of which were for extended periods. These placement changes were across nine different foster homes, three different group shelter facilities, and a group home. Also, during this period, she was missing from

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the foster care system for over 160 days and had numerous different caseworkers. On the 7th day of a 16-day run, Katrina showed up at the caseworker’s office and it was at that time that a BASP behavior analyst was called in to assist. The behavior analyst was introduced to Katrina as someone who had worked with youth who ran away and was interested in hearing what Katrina had to say about her situation. However, this meeting was not sufficient to convince her to return to the group home at this time, rather she resumed her run. Through this initial conversation with Katrina, as well as several subsequent ones upon her return, the behavior analyst and the caseworker were able to conduct an informal functional assessment to determine the variables that were possibly maintaining her running away from placements. The process involved asking her a number of questions regarding her preferred places, people and activities, as well as asking about those that she found aversive. In particular, questions such as the following evoked helpful responses from Katrina: “What type of a home would you like to live in?” “How would you like to be treated where you live?” “How is school going for you?” “What would make your living situation more workable so you wouldn’t need to run away?” She indicated that a particular home where her brother lived would be her most highly preferred placement. She also stated that it was important to her that she be afforded the opportunity to seek employment that fit in with her time in school. Katrina also reported some anxiety about what would happen to her upon leaving the foster care system and that she did not believe that her current and past placements prepared her for independence. Finally, she expressed distaste for what she viewed as unfair and selective discipline in her current placement. Given the information from the initial interview, the behavior analyst was able to provide some immediate feedback as to what Katrina could expect from him in terms of helping her to get where she could access more preferred people and activities, and experience less exposure to aversive events that might set the stage for her running away. Results of the interview with Katrina allowed the behavior analyst to formulate hypotheses as to what maintained her running away behavior and what might reduce the likelihood of running again. First, Katrina’s preference for being placed with her brother suggested that remaining in an approved placement could potentially be positively reinforced by placement with him. Although the behavior analyst and caseworker were unable to confirm it, it was thought when she ran she often saw her brother. Katrina was informed that a potential placement with her brother was being

explored, but that the process might take a while. The behavior analyst assured her that he would take forward her expressed interest in this placement and attempt to represent her wishes during the placement review process. In turn, he told Katrina he would be better able to advocate for her if she were stable in her current placement. Such an approach may not have addressed a function per se, but it could be said to have acted as a setting event whereby the reinforcing value of remaining in the current placement was increased. Another possible function of Katrina’s behavior was to escape from settings she found aversive. The behavior analyst and case manager gleaned information from Katrina and group home staff that suggested running away may function as a negative reinforcer (i.e., escape from aversive situations such as coercive staff interactions). Staff reported difficulties interacting with her saying that she was “loud, disrespectful and excitable.” They complained that when she got upset, she spoke in Spanish so that they did not understand what she was saying. Her group home behavior plan indicated that if her behavior was poor, she would not be allowed to go on weekend visits, rather her brother and his guardian could come by to see her at the group home. There had also been conflict over her desire to have certain, inexpensive food items available to take to school rather than the standard grouphome bagged lunch. In the overall picture of her day-today life there were several indicators that her running away behavior was, in part, maintained by escape from unpleasant situations in her placement. Through interviews with Katrina and staff, reviewing her history in foster care and considering her running away in light of its possible behavioral functions, several approaches to keeping her safe and stable in a more preferred placement were brought to light. A placement with her sibling was explored and she was kept fully informed as to the progress of efforts in this direction. The case manager and behavior analyst met with staff at the group home in order to address some of the aspects of that placement that might be motivating Katrina’s running away. As a result, some key staff began to explore possible employment for her while she remained at the group home. The case manager and behavior analyst explored other placement options in case her first choice was unavailable. Throughout this process, Katrina was kept informed, via frequent phone calls and visits, of the progress toward addressing her concerns. She was praised for maintaining stability in the group home while the process unfolded. Katrina committed to and did make progress on the level system at the group home following these efforts. The behavior analyst and caseworker worked quickly to implement as many of these interventions as possible,

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visiting and communicating with Katrina and the group home staff frequently regarding their progress. In just over 2 weeks after she had returned to the group home, they were successful in arranging for Katrina to meet a foster family and, based on her interest, she moved in with the family. This foster parent had experience with older youth and had been trained and certified by the BASP as a Competency Trained Home in the Essential Tools for Positive Behavior Change (FL DCF, 2005; Stoutimore et al., 2008, this issue). By the week’s end, Katrina and the foster mother had “hit it off” really well. Over time, Katrina reported that she really felt a part of this family and that they cared about her. She stayed in this home consistently for almost a year (310 days), with the foster family and funding agency allowing her to continue living with them beyond her 18th birthday, when she was emancipated. Of the 12 other foster homes in which Katina had been placed, this was the first home where at least one of the foster parents had been through this competency training. The behavior analyst and caseworker encouraged the foster parents to be attentive to all of the features of the intervention as well. Thus, the foster parents made sure Katrina had some time to talk privately with one of them each day, go on outings, go on visits and outings with her girlfriend and/or brother; learn how to make her own lunch with healthy items and favorite snack items; and do activities that made her feel apart of this family. After about 6 weeks, Katrina had an opportunity to interview for an after-school job. Although she didn’t get this one, she did get one soon thereafter. However, none of the after-school jobs she had really interested her until she happened upon an opportunity to provide in-home support for an elderly lady. In addition to being paid, this job included room and board. This independent living and work arrangement proved to be a good mix for Katrina, particularly since the location was not far from her foster family—she was able to maintain her supportive relationship. After a 1-year 3-month period, Katrina was still in this independent living situation and was beginning to explore alternative postsecondary training, community college, and/or other work options. Katrina’s foster mother continued to be actively involved in mentoring and guiding her.

such as multiple placement changes, living in residential group-type placements and having limited acceptable options to respond when confronted with aversive conditions. This case example suggests the value of informal functional assessments and assessment-based interventions that the behavior analysts, caseworkers, and caregivers used resulting in a dramatic change in the placement and runaway trajectories for Katrina. By assessing what Katrina suggested were reasons for her running and what she suggested were her preferences, the behavior analyst and caseworker were able to formulate a hypothesis of escape and noncontingent reinforcement factors that may have triggered and/or maintained her runaway behavior. Based on this, they worked with Katrina and her caregivers to implement an assessmentbased intervention that provided her with the most extensive placement stability, in the most normalized types of settings that she had experienced since removal from her home. Katrina also achieved “family” connections that may prove to be enduring lifetime supports.

PART II: COMPARISON GROUP ANALYSES This part of the study involved examining the impact of the BASP interventions on the percentage of days on runaway status, rate of runs, and rate of placement changes for 13 youth who met the criteria of habitually running away. To provide a basis for understanding changes from pre- to postintervention conditions, a comparison group of youth, who met the runaway criteria and were matched on several additional factors, was also examined. The effectiveness of the behavior analytic functional assessments and intervention strategies were examined by comparing the changes across conditions for the BASP group of children who habitually ran away, in contrast to the matched comparison group. The following hypothesis is addressed in this part of the study: The behavior analytic functional assessments and individually tailored interventions will result in improvements in the: (a) percentage of days on runaway, (b) rate of running away, and (c) rate of placement change over the pre/ postconditions for the BASP group in contrast to that of the comparison group.
Methods
Participants

CONCLUSION Katrina’s case example illustrates the types and fragmented placement histories that foster care youth may experience. Many features of this placement history have been associated with the likelihood of runaway behaviors,

Thirteen youth from two metropolitan counties in Florida who habitually ran away during the period from late 2002 to 2004 were referred to the BASP. These were

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the first 13 youth that the BASP worked with on runaway behavior who had not previously been served by the BASP; were ages 12 to 17 at the time of intervention; and had not been incarcerated for extended periods during their pre/postperiods (youth were not excluded from this analysis for detention stays which might range from 1 to 5 days, but rather for incarcerations in locked secure facilities with little opportunity for running away). Of these 13 BASP participants, 11 were female, 9 were Caucasian, 2 were African American, 1 was Hispanic, and 1 was biracial. Katrina, the case example presented in this paper, was not included as one of these 13 because she had been involved prior to the time period referenced above. In order to match comparison youth to treatment youth for the same period and geographic area, data were secured from two state databases maintained by FL DCF: MCTS and ICWSIS. All comparison youth were matched to treatment youth by gender and race. Then the three comparison youth closest in age at first run to each of the treatment youth were selected as their respective matches. The overall mean difference in age at first run between all treatment youth and their assigned comparison youth was 0.52 years, with a standard deviation of 0.65. Youth were not used as matched comparisons if they were not habitual runners (i.e., had run away fewer than three times), had ever received services from the BASP, or had experienced any extended periods of incarceration during the comparison pre- or postconditions. The decision to use three comparison youth per treatment youth was made to provide additional statistical power, which is particularly appropriate with a small sample size (Hennekens, Buring, & Mayrent, 1987). Only three comparisons were used for each BASP youth because of the limited size of the comparison pool and the fact that there is not a significant increase in power beyond a 1:4 match (Miettinen, 1969). In several cases the best matches for age at first run were comparison youth who had already been used as matches for another treatment youth. Thus, the 39 total matches (3 for each of 13 treatment youth) were made with a total of 26 comparison youth. Seven comparison youth were best matches to each of 2 different treatment youth and 3 comparison youth were best matches for each of 3 different treatment youth. In each case, the comparison youth’s hypothetical intervention date was set from his or her date of first run to match the number of baseline days for the BASP participant.
Data Sets and Data Analyses

(b) annualized rate of running away; and (c) annualized rate of placement change. For treatment youth, baseline began with their first run episode and ended at the start of the BASP involvement. The postperiod began with the BASP involvement and was arbitrarily defined as lasting 365 days. For comparison youth, baseline began with their first run episode and was defined as having the same duration as the matched treatment youth. (Note that a comparison youth could have two or three different baseline durations, if matched with two or three different treatment youth.) The postperiod consisted of the following 365 days, except for four cases where there were only between 161 and 349 days of data available (e.g., a participant left the foster care system). For each of the dependent variables, three statistical comparisons were conducted. First, a comparison between the baseline for the BASP group and that of the comparison group was made using the two-sample Wilcoxon rank–sum test (two-sample test), a nonparametric equivalent of independent sample t test, as the dependent variables did not strictly conform to the normality assumptions. The statistical significance for all analyses was tested with α = .05. Second, differences between the baseline and postperiod for both groups were assessed separately using the Wilcoxon matched pairs signed-rank test, a nonparametric equivalent of a paired t test. Third, the two-sample Wilcoxon test was used to compare the change from baseline and postperiod for the BASP group to the pre/postchange found for the comparison group.
Intervention Procedures

Baseline, or preintervention data, and postintervention data were gathered from ICWSIS and MCTS and were examined for each youth across the dependent variables of: (a) percentage of days on runaway status;

Functional assessments. The functional assessments that were conducted by the BASP behavior analysts for this study suggested that some of the escape/avoidance factors for runaway behaviors included: restrictions imposed by the foster home, group home, or emergency shelter facility; no one seeming to care and feelings of alienation/aloneness; mistreatment by caregiver/staff; bullying at school or in the neighborhood; gang pressures; and avoiding/escaping the rules or expectations of the living and/or school settings. Alternatively, or concurrently, running away could have been running to access positive reinforcers. The functional assessments indicated that some of the runaway behaviors were to access: greater control and autonomy; parents, siblings, or extended family members; preferred home settings; girlfriend or boyfriend; friends; teenage activities and parties; experimentation with drugs and sex; peer recognition for beating the system; a sense of fun, risk, excitement, normalcy, and freedom; or to demonstrate that they are adults and “can take care of themselves.” Some of the antecedents (or triggers) for runs were

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Mean Percent of Days on Runaway Status

factors such as: peers in the setting or other friends prompting a run; an incident of mistreatment or a situation that the youth saw as unfair; an opportunity to escape from a highly monitored or locked facility; avoidance of a consequence related to problem behaviors at school or residence; a positive or negative telephone conversation with a parent or sibling; and a feeling of loneliness or depression. Description of the array of individually tailored interventions. The behavior analysts and caseworkers in this study used an array of interventions to stabilize the adolescents’ placements at home, in school, and to meet their current and longer term needs and wishes. The following features that, singularly or in combination, composed most of the 13 interventions that were implemented with the youth and their caregivers and caseworkers were: (a) informal functional assessments which involved exploring the youth’s interests, preferences, and reasons for running away; (b) someone to spend some time each day listening and talking with the youth in a nonjudgmental fashion; (c) access to family, siblings, and other preferred people through safe visitations; (d) enhancing the reinforcing features of the current living situation through increased access to preferred items and activities, time with special people, and improved interactions between staff personnel and the youth; (e) more active communication with relevant school personnel and supports for the youth, for example, supervised homework time, tutoring; (f) exploring and acting on the type of living situation that the youth might want to have in the short term or long term; and (g) for older youth, conducting informal “futures planning” regarding possible jobs, postsecondary education, and/or independent living situations the youth might be interested in. A more detailed description of some of these types of interventions is outlined on Table 1. The youth in both the BASP and the comparison groups received services as usual for regular foster care in Florida—with those in the BASP group having additional services provided by a behavior analyst during the intervention related to the run behaviors. Services as usual includes but is not limited to: a comprehensive behavioral health assessment for every child entering into dependent care (conducted by a licensed mental health provider); minimum monthly face-to-face visits by a caseworker, staffings to address specific needs and recommendations for services/treatment/therapy/placements; and judicial reviews, typically two to three times per year.
Results

40% 35% 30% 25% 20% 15% 10% 5% 0% Baseline Period

Comparison

BASP

Postperiod (1-Year) Conditions

Figure 2: The Mean Percent of Days on Runaway Status Shown

for the Behavioral Analysis Services Program (BASP) Group (solid dots) and The Matched Comparison Group (Open Triangles) Across The Baselines and the Postperiods.

Figure 2 shows the mean percentage of days on runaway status for the baseline and postcondition for the

BASP group (solid dots) and comparison group (open triangles). The BASP group was on runaway 38% of the time during baseline decreasing to 18% after the intervention. The baseline for the comparison group was 34% of days on runaway status and the postcondition was slightly higher at 38%. The two-sample Wilcoxon test found no statistical difference between the two baselines. The signed-rank test indicated a statistically significant decrease in the mean percentage of days on runaway status between the baseline and postperiod for BASP group (p = .05), while the difference was not statistically significant for the matched-comparison group. Additionally, the change from baseline to the postperiod was significantly larger for the BASP group than for the comparison group (two-sample test, p = .05). As is evident from the slope of the lines on Figure 2, the BASP group showed a substantial reduction in the percentage of days on runaway status versus the comparison group that showed an increase. The average annualized number of runaway episodes is shown in Figure 3 for both groups and conditions. The baseline rate of runaway between the BASP and comparison group was statistically different, with the BASP group having an average rate of 12.6 runs per year and the comparison group with an average rate of 7.0 runs per year. The average rate for the BASP group decreased from 12.6 to 3.0, while the comparison group decreased from 7.0 to 3.1 in the postperiod. The decreases in annualized rate of runs were statistically significant for both groups. The difference between the baseline and postperiod was significantly larger for the BASP group in contrast to the matched comparison group. The average annualized number of placement changes is shown in Figure 4 for both groups and both conditions. As with the rate of running away, the rate of placement change is substantially different between the

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TABLE 1: An Array of Intervention Strategies for Consideration

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Category
Preference strategies

Intervention
Introduce more preferred activity equipment and materials (e.g., workout equipment, bicycles), activities (e.g., video games, sports, music), and extracurricular activities (e.g., attending sporting events or concerts) to increase the likelihood of youth engagement. Establish safe visitation arrangements with preferred people (e.g., parents, siblings) to allow the youth access to these people without having to run to them. Involve the youth in determining their preferred type of living situation or specific living setting. Arrange access to a more preferred placement. Make available an array of “youth-preferred” living situations (e.g., supervised apartments, dorm-type settings) for older youth. Establish a “behavioral contract” so a youth can earn rewards based on individual target behaviors such as requesting permission to go places, reporting whereabouts, not running away, or completing school homework. Establish allowances for assuming responsibilities around the house. Create a flexible fund for personnel to use with youth to support the above types of incentives and activities. Support older youth in their interests in exploring and getting jobs. Conduct training and consultation with caregivers, caseworkers, resource coordinators, and supervisors to enhance their ability to provide a more reinforcing approach and environment for the youth. Provide training to caseworkers and supervisors on the Positive Parenting Tools to enhance their ability to interact with youth in ways that will more fully engage the young people. Improve personnel’s competencies with these transition-age youth by: (a) increasing the rate of positive social descriptive praise and associated reinforcers, increasing sincere care statements, and decreasing the rate of coercives; (b) increasing the opportunity for youth to talk about how things are going (e.g., what’s happening in their daily life, problems or concerns they might have);(c) identifying youth interests, goals, and dreams; and (d) supporting their pursuit of these (e.g., get an after school job, opportunity to earn a driver’s license); and (e) providing more engaging activities and activity materials in their living situations. Enhance the abilities of caseworkers and their supervisors to be able to: (a) receive contacts from youth on runaway in inviting and reinforcing ways; (b) conduct informal functional assessments with youth regarding their reasons for running away; and (c) identify preferences of youth that might provide information regarding preferred placements and/or other strategies to make it likely that they would be more engaged and stick around. Provide guidance to foster care caseworkers and supervisors to enhance their coaching skills for assisting foster parents, adoptive parents, and natural parents to use improved interactional skills with young people.

Living arrangements

Incentive arrangements

Train and coach personnel

baseline rates, with the BASP group at 29.6 and the comparison group at 15.6 and these differences were statistically significant. The rate of placement change reduced significantly for the BASP group from baseline to post-period (29.6 to 10.1) and for the comparison group (15.6 to 8.4). Also, the difference between the baseline and postperiod rate of placement change was significantly larger for the BASP group when compared to the matched comparison group’s change.

DISCUSSION AND APPLICATIONS TO PRACTICE This study provides an illustration of the impact of behavior analytic assessments and interventions to reduce the percentage of days on runaway, frequency of runaway episodes and to improve the stabilization of placement for youth who have a history of running away. The findings across the 13 youth with habitual

running patterns with whom the BASP was involved suggest that the array of interventions implemented collaboratively by the behavior analysts, caseworkers, and caregivers were effective in reducing the percentage of days and rate of runaway. The percentage of days on runaway for the BASP group decreased from 38% in baseline to 18% postintervention. For the comparison group, the percentage of days on runaway increased following the hypothetical intervention, possibly placing them at even more risk of abusing alcohol and drugs, criminal and sexual victimization, contracting/spreading sexually transmitted diseases, arrest and incarceration, prostitution, and further placement disruptions (Biehal & Wade, 1999; Courtney, et al., 2005). The annualized baseline rate of runaway episodes was statistically different between the two groups, with the BASP group being at 12.6 runs and the comparison group at 7.0 runs. Both groups’ rates of runs were reduced during the postperiod, with the BASP group reduction being statistically significantly larger than that of the comparison

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14 Mean Number of Runs per Year 12 BASP 10 8 6 4 2 0 Baseline Period Conditions Postperiod (1-Year) Comparison

Figure 3: The Mean Annualized Rate of Runaways Shown for The Behavioral Analysis Services Program (BASP) Group (solid dots) and The Matched Comparison Group (Open Triangles) Across the Baselines and the Postperiods.

Mean Number of Placement Changes per Year

30

25 BASP 20

15 Comparison

10

5

0 Baseline Period Conditions Postperiod (1-Year)

Figure 4: The Mean Annualized Rate of Placement Change Shown for The Behavioral Analysis Services Program (BASP) Group (Solid Dots) and The Matched Comparison Group (Open Triangles) Across the Baselines and the Postperiods.

group. The average annualized rate of placement change across the two groups was also statistically different during the baseline periods, with the BASP group showing a placement change rate almost twice that of the comparison group. The functionally determined interventions applied to the BASP group resulted in an almost 200% reduction in placement change between the baseline and postperiod and less than a 100% reduction for the comparison group. As was the case with the other dependent variables, the pre/postplacement change rate for the BASP group was greater than that of the comparison group. One of the implications of the data across all three of these dependent variables is that certain factors may trigger a referral to the BASP by the foster care system personnel. A youth who runs or requires a placement change more frequently in comparison to a youth who

runs for extended periods may get more attention from the system even though extended runaways may also put the youth at considerable risk. Another feature of the data is a possible interaction effect between the percentage of days on runaway and the rate of runaway. If youth are on runaway status, they have no opportunity to run again until they return. However, this interaction is not fully supported by the data in that some of the highest rates of runaway occurred during the periods with the highest proportion of days on runaway (e.g., refer to BASP baselines on Figures 2 and 3). That is, during the periods in which both groups had 38% of days on runaway (i.e., BASP baseline and comparison group postperiod on Figure 2), the average rates of runaway were highest during BASP baseline and lowest during the comparison group’s postperiod (Figure 3). The case example and analyses across the aggregate of youth provide compelling support for the feasibility and effectiveness of this behavior analytic approach for assessing and intervening with youth who have serious histories of runaway behaviors. However, as encouraging as these findings are, neither part of this study involved a rigorous experimental design. The use of the matched comparison group did provide a quasiexperimental demonstration that the proportion of days on runaway would not have decreased without the intervention. The difference in rate of runaway and placement change were substantial and statistically significant for the BASP group in contrast to the comparison group, but both groups did show a reduction from the baseline to the postperiod for these two variables. The use of archival records for both case examples and group data has advantages and numerous limitations. Data systems change (e.g., definitions of placement type) and more attention to the accuracy of data entry may vary for different years and under different administrations. However, using the dataset from which placement payments (i.e., ICWSIS) were made may mean that these study findings are more accurate than had a dataset been used for which these contingencies were not in place. These archival datasets do not include information such as the reason for a placement change (e.g., youth behavior, availability of a placement at a specific time, system policy changes such as placing siblings together or matching youth and foster families based on ethnicity). There continues to be a critical need and rich opportunity for future research to provide a stronger examination of the functional relationship between assessment/ intervention and runaway behaviors. As was mentioned in this section previously, the relationship between youth runaway patterns and the system’s response may not reflect the level

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of risks functioning in a youth’s life. For example, is a youth who runs frequently at greater risk than one who is on a long duration run? Also it is extremely important to better understand how to be proactive and prevent a child from running the first time, thus possibly avoiding a pattern of unsafe run experiences and placement disruptions. (Biehal & Wade, 1999; Courtney et al., 2005; de Man, 2000; Miller, Eggertson-Tacon, & Quigg, 1990). The goal of addressing runaway behavior with youth in out-of-home placements is not only to reduce the rate of running away and duration of unsafe days, but, more importantly to stabilize these young people in settings that they would prefer or with arrangements that make their placements more livable. For example, one thing that Katrina wanted while at the group home was to be able to take the snack food Lunchables as one of the items in her lunch and to have someone to talk with each day. She also expressed an interest in a home-like setting and efforts were successful in securing this for her. Using a functional assessment framework while listening to her wants/needs assisted in guiding the behavior analyst, caseworker, and caregiver in developing effective and appropriate interventions. The strategies employed provided a dramatic change in the trajectory for this young woman and created an opportunity for the development of social networks that might represent the kind of lifetime support that leads to improved quality of life.
Applications and Considerations for Improving Practice and Policy

The findings from this current study should assist the fields of child welfare, mental health, and juvenile justice in examining their practices to prevent and ameliorate runaway behaviors. Transformation of these fields will require a major paradigm shift, one that if adopted will necessitate changes at the system and policy levels to support personnel in the use of new child friendly and effective practices. This, and a focus on assisting children in maintaining and building their connections to lifetime support networks, should greatly improve the long-term adjustments and outcomes for our children and youth. Some of the evidence-based practices, and other more recent promising practices, might prove to be particularly helpful in serving children and youth more humanely and effectively. A few of these that are worthy of mention are described here briefly.
1. Dependency systems should implement evidence-based programs to effectively serve youth at-risk with conduct disorders and/or emotional/behavioral disturbances. These include programs such as Multidimensional Treatment Foster Care (Shepard & Chamberlain, 2004) and the Teaching-Family Group Home Treatment Model (Wolf, Kirigin, Fixsen, Blase, & Braukmann, 1995). 2. A functional assessment method is being researched for assisting youth in making informed choices regarding their preferences in living situations (Witherup et al., 2006). 3. The Transition to Independence Process (TIP) model is an evidence-informed practice for working with youth and young adults who have emotional/behavioral challenges (Clark & Davis, 2000; Clark & Foster-Johnson, 1996). The TIP model engages young people in a process of personal futures planning and coaches them in preparing and facilitating their transition toward greater selfsufficiency and achievement of their short-term and long-term goals. The TIP model is driven by seven principles and associated practice elements. The model has been shown to improve outcomes across the transition domains of employment, education and career training, living situation, personal effectiveness/wellbeing, and community-life functioning (http://tip.fmhi.usf.edu; Clark, Pschorr, Wells, Curtis, & Tighe, 2004; Karpur, Clark, Caproni, & Sterner, 2005). 4. Recognizing that these youth in out-of-home care are in a mode of discovery just as their peers from families of origin are, one European program has implemented a cell phone connection so that young people who “take off” are encouraged to keep in touch. Personnel are trained to receive these calls in ways that may be reinforcing to the youth; and the staff, to the extent possible, guide the youth to remain safe and express to them: that they are missed; statements of caring, empathy, or concern; and that they are welcome to call and return (J. Roethlisberger, personal communication, 2004). This same communication link is used at entry to the program to help teach young people appropriate behaviors such as requesting permission to go places and reporting their whereabouts. 5. The staff interactions described in the previous item are similar to those used within the TIP model and a youth interaction tool training that BASP provides to foster caseworkers and supervisors (FL DCF, 2004).

The term human or social capital has been coined to refer to the complex social mechanisms that parents garner to advance their children’s chances of success (Coleman, 1988). Carneiro and Heckman (2003) have suggested that social capital in the form of social skills, attitudes, and cognitive abilities learned in childhood and adolescence may be variables predictive of success in school and life. Whereas the majority of typical young people develop social networks that include family, friends, and other community members who provide guidance and support both financially and socially, many youth living in out-of-home dependency systems lack opportunities to develop these types of social and economic capital (Clark & Crosland, in press; Shirk & Stangler, 2004). It would seem that one of the first steps in minimizing this gap for these foster youth would be to assist them in identifying their preferred living situations and stabilizing them in these settings (e.g., Clark & Davis, 2000; Witherup, Van Camp, Vollmer, & Prestemon, 2006).

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