The fiscal reality isn’t that surprising, said Lisa Zerden, a School of Social Work clinical associate professor and associate dean for academic affairs. After all, even when there is overwhelming evidence of ineffective policies, public perception can still be far more politically persuasive, especially when dealing with “morality-based,” policies, said Zerden, who has published on the issue.
For example, despite ample research, including from the Centers for Disease Control and Prevention, that supplying sterile syringes to people who inject drugs are cost effective and help prevent HIV, hepatitis and other blood-borne diseases, the federal government and most states continue to ban needle exchange programs, and federal funding is prohibited. Many opponents worry that these programs encourage drug use instead and send a contradictory message about drug policy.
“And yet, when you look at the public health and social work literature, we have findings that show that for every one dollar spent on a clean syringe, you can save over $300,000 on HIV care per year,” Zerden said. “So if you are dealing with very marginalized groups who are receiving Medicaid or any other subsidized health care, the question is how do you want to spend those very scarce resources?”
In fact, financial conundrums like these are why conversations are shifting ever so slightly toward a better understanding of how taxpayer dollars might best serve those in need and improve communities in the process, she said.
“The cost benefit approach is really the most powerful tool because it makes the most common sense, especially in a time of retrenched funding,” said Zerden, who has helped reform criminal drug policies involving accidental overdose in North Carolina and strengthened law enforcement training around these new laws. “It’s only getting harder to provide services to people, and the safety net is shrinking. So we have to figure out another way to provide services that are both effective and based on evidence.”
For Testa, this new era really isn’t all that new. He’s long been a champion of translating evidence-base interventions into more effective policies and practices that enhance the safety, stability and well-being of abused and neglected children nationwide. He also has a track record to show for it.
As the former director of the Children and Family Research Center at the University of Illinois at Urbana-Champaign, Testa’s research work in the fields of child protection and foster care led to a significant overhaul of that state’s Department of Children and Family Services. In fact, his intervention research helped decrease the number of children in foster care in Illinois by 62 percent and saved the state an estimated $90 million.
Furthermore, one specific reform in Illinois—subsidized guardianship—was successfully replicated in Tennessee and Wisconsin and eventually resulted in national legislation that among other things, now allows states to offer kinship guardianship assistance payments, helping family members to more affordably care for related children.
Since arriving at UNC, Testa’s efforts to reform and influence child welfare policies have intensified, leading to the creation of the “Wicked Problems of Child Welfare Institutes.” These novel conferences, which have been hosted in Chapel Hill, Chicago and twice in Washington, D.C., were developed with the understanding that the problem of child maltreatment is complex, lacks any single solution and that solid scientific evidence must be used to inform direct practice and public policy.
Testa, the School of Social Work’s Jordan Institute for Families and the Children’s Home Society of America have collaborated to use these institutes to assemble child welfare experts, service providers and government officials all to the same table. Among the goals: Encourage and disseminate sustainable solutions that are grounded in evidence that positively affect young lives that come into contact with state child protective systems.
More simply, Testa sees the work with Wicked Problems as an opportunity to address the grand challenges of child welfare and to move the country’s social policies forward.
“We’re trying to build a 21st century child welfare system that’s built on the whole idea that every child deserves a safe and permanent home,” Testa said. “The trouble is because of political gridlock, all of our resources are still tied up with that old 20th century foster care system that says you can cure the ills of child abuse simply by removing kids from families and placing them in foster care. But the evidence indicates that removal and long-term foster care often compound the problem. We have to figure out evidence-informed ways to redirect that investment to more effective treatments that address the trauma of child maltreatment within the context of safe and permanent family relationships.”