Continuous Quality Improvement

The federal Administration for Children and Families—Children’s Bureau defines Continuous Quality Improvement (CQI) as the complete process of identifying, describing, and analyzing strengths and problems and then testing, implementing, learning from, and revising solutions.
The Children’s Bureau addresses quality assurance of state child welfare agencies through Child and Family Services Reviews (CFSRs). During the first round of reviews conducted from 2001-2004, the Children’s Bureau found that 31 states had QA systems. That number increased to 40 states in the second round of reviews conducted from 2007-2010.

The Children’s Bureau further lists five key components of an effective CQI system:
• A strong foundational administrative structure
• Quality data collection
• An effective case record review process
• Process to analyze and disseminate data
• Processes to provide feedback to stakeholders/decision-makers and adjust programs and process

More information is available here: http://www.acf.hhs.gov/sites/default/files/cb/im1207.pdf

One essential component of an effective child welfare system is Intensive Family Preservation Services (IFPS). Thus, it is critical to maintain and improve the quality of IFPS programs on an ongoing basis. The CQI-IFPS Instrument developed by the National Family Preservation Network allows states and contracted providers, through the case review process, to determine if they are meeting best practice for IFPS and that includes the safety, permanency, and well-being of children and families. The CQI instrument assists in determining what is currently being done well along with identifying areas that need improvement in the future.

The CQI-IFPS Instrument is grounded in many years of research on IFPS and includes the following materials:
• CQI-IFPS Introduction (Definition, Basis in federal law/policy, and Purpose of IFPS CQI)
• CQI-IFPS Instrument (10 domains covering a total of 75 items)
Domains include referral, assessment, safety, engagement, parent involvement, children, service delivery, outcomes, termination, supervision
• CQI-IFPS Tally Sheet (Checklist for case reviewers that allows tallying of up to 5 case files)
• CQI-IFPS Instructions (Preparation, Reviewing Case Files, Debriefing, Using Findings to Guide Improvement in Practice)
• CQI-IFPS Frequently Asked Questions (FAQs)

NFPN recommends that IFPS programs be operational for at least one year prior to using the CQI instrument. We will also work with agencies to revise the tool for use with other home-based services.

The CQ-IFPS is affordably priced, ranging from $125 for small private agencies to $250 for large private and government agencies. You may order and pay online.

To get started visit http://www.nfpn.org/preservation/cqi-ifps-instrument.

If you have questions or need more information, contact Priscilla Martens, Executive Director at director@nfpn.org or phone 888-498-9047.

Posted by Priscilla Martens
NFPN Executive Director

Family Preservation and Father Involvement

Several years ago the National Family Preservation Network (NFPN) conducted a survey of Intensive Family Preservation Services (IFPS) programs to determine the extent to which they involve fathers in their services. IFPS is a brief, intensive service designed to prevent unnecessary placement of children or to reunite children with their families. Findings showed that IFPS therapists identify the biological father about half the time, know the father’s location 30% of the time, contact the father at least once 27% of the time, involve the father in the case plan 17% of the time, and involve the father in services and connecting with the child 23% of the time.

The main barrier to not involving fathers was that the referral agency did not require it. Since most referrals to IFPS come from child welfare agencies, that finding may help explain why no state has met standards for father involvement in the most recent federal audits of state child welfare systems (2007-2010).

And, yet, it’s not impossible to meet standards for father involvement. Over the course of 18 months a family preservation agency in Kansas significantly improved worker performance in the areas of assessing fathers’ needs, providing services to fathers, and involving fathers in the case plan. The agency achieved this by focusing on father involvement, providing training to workers, and monitoring progress. For more details, visit http://www.nfpn.org/father-involvement/meeting-cfsr-standards.

NFPN conducted a demonstration study showing that, with training and assistance, child welfare social workers made gains in identifying the father as a resource, involving him in the case plan, and involving the father’s extended family. The report is available here: http://www.nfpn.org/father-involvement/fatherhood-research-report

Why is it worthwhile to involve fathers in their children’s lives? Because research has established that
• The presence and involvement of fathers are important to healthy child development, thriving families, and communities
• With involved fathers, mothers have less stress and better outcomes during and after pregnancy
• Children have better functioning in terms of cognitive and social skills, self-control, self-esteem, and empathy
• Children are 75% less likely to have a teen birth, 80% less likely to spend time in jail, and 50% less likely to experience depression
• Children are twice as likely to enter college and obtain stable employment after high school
These benefits are included in a report on young fathers available here: http://www.cssp.org/pages/changing-systems-practice-to-improve-outcomes-for-young-fathers

If you believe that father involvement is important, there are many resources available to help you. Here’s a place to start: http://www.nfpn.org/father-involvement.

NFPN has prepared a six-week work plan to involve fathers. The early emphasis on involving fathers is research-based as studies show that fathers who are not engaged early on will not be later on. To view the full report on family preservation and father involvement, including the six-week work plan, visit http://www.nfpn.org/father-involvement/ifps-guide-to-father-inv.

Posted by Priscilla Martens
NFPN Executive Director

The RFP Blueprint

Most government agencies contract for services for families through a Request for Proposal (RFP) or Request for Application (RFA). In this post we are going to look at an RFP for Intensive Family Preservation Services (IFPS).

RFPs may be open-ended and have limited requirements with provider agencies then expected to offer an extensive proposal. Or, the RFP may be very prescriptive and provider agencies then basically confirm that they will meet the specifications. Current RFPs for IFPS fall into the latter category. They are highly prescriptive. In effect, they are a blueprint for providing the services.

Let’s look at the state of Missouri’s RFP for family preservation services as an example. Here are some of the items included:
• Service Goals and Outcomes including targeted numbers for placement prevention and no confirmed neglect/abuse
• Referral and Screening Requirements
• Initial Family Assessment and Service Plan
• Services to the Family
• Termination of Services
• Personnel Requirements including qualifications for supervisors and workers
• Invoicing and Payment including the maximum daily rate

This list is by no means exhaustive and none of the specifications is optional. If you provide family preservation services in Missouri, you are closely following the state’s model of services! And Missouri is not alone—most other strong IFPS states also have highly prescriptive RFPs. Why is this so? Here are some reasons:
• The RFP blueprint defines the model of service that all providers must meet.
• Because there is a norm, the state can readily see when a provider is not meeting a standard and take corrective action
• Preordained outcome standards ensure that providers deliver high-quality services and meet goals for safely keeping families together
• The RFP blueprint for services flows directly into data collection, evaluation, and research.

Missouri conducts an annual evaluation of IFPS that includes:
• Demographic data such as age, gender, race, income
• Reason for referral
• Reason for families not accepted
• Substantiated child abuse/neglect during and following IFPS services
• Entry into out-of-home placement during and following IFPS services

Missouri is unique among states offering IFPS in that it tracks families for up to 4 years following the intervention. There is very low out-of-home placement in the 4th year, thus supporting the durability of IFPS interventions.

So, how can this RFP help your agency? Any agency that is developing or applying for an IFPS RFP should first read this RFP. In addition, the RFP provides excellent guidance for developing any in-home service. The caseload and length of services may not match in every RFP but the guiding principles are the same. The RFP is indeed a blueprint!

To view Missouri’s RFP for IFPS visit: http://www.nfpn.org/preservation/state-resources/missouri-rfp-for-ifps
To view Missouri’s most recent IFPS evaluation visit: http://dss.mo.gov/re/pdf/iis/2016-missouri-intensive-in-home-services-annual-report.pdf
To view additional state resources for in-home services visit: http://www.nfpn.org/preservation/state-resources

Posted by Priscilla Martens
NFPN Executive Director

Revisiting Reunification

When the National Family Preservation Network (NFPN) was founded 25 years ago, reunification research was in its infancy. Some of the earliest research on reunification involved Intensive Family Preservation Services (IFPS). IFPS was found to be very successful with reunifying families. Today far fewer families receive reunification services through IFPS; generally under 20% of IFPS services are provided to reunifying families as compared to intact families.

In terms of priority, emphasis, research, and funding, reunification has stalled at the state level. The percentage of families in the child welfare system that reunify has been stuck at 50% for at least the past decade. Only a few states devote funding to programs assisting families to reunify. Research on reunification has also lagged.

One doctoral research study in 2012 conducted a meta-analysis of reunification. The study identified the factors related to reunification failure/success:
• Infants and adolescents are less likely to reunify
• Children with behavior, emotional, cognitive problems, or physical disabilities are less likely to reunify
• After more than one year in care the likelihood of reunification decreases
• The more parental contact and visits, the more likely reunification will occur

To view the meta-analysis study of reunification visit https://kb.osu.edu/dspace/bitstream/handle/1811/52994/24_5_saunders-adams_paper_kb.pdf

Most of the current research and funding for reunification comes from federal laws, policies, and grants. This is in response to the explosion of misuse of prescription drugs and heroin. Half of the babies with exposure to opioids during the mother’s pregnancy are born with withdrawal symptoms. Babies also make up the largest group of the increasing number of children placed in out-of-home care due to parental substance abuse.

Two federally-funded programs are addressing the issue of how to reunify families when parental substance abuse is a factor in removal of children. The Regional Partnership Grant Program and the Children Affected by Methamphetamine Program use a set of common ingredients and strategies including:
• A system of identifying families in need of treatment
• Timely access to treatment
• Recovery support services
• Comprehensive family services
• Increased judicial oversight
• Cross-systems response
• Collaborative structures

The Regional Partnership Program has served over 15,000 families with these outcomes:
• 83% of children discharged from foster care were reunified
• 73% of infants were reunified within 12 months, an astonishing figure considering that infants as a group are less likely to reunify

The Meth Program has provided funding for drug courts which are also proving to be very effective:
• 68% of children were reunified in less than 12 months
• Less than 6% of children reentered foster care within 12 months after being returned home (about a third the national average for reentry with traditional services)

For more information on these programs and opiate misuse visit https://www.finance.senate.gov/imo/media/doc/23feb2016Young.pdf

This post began with research on IFPS reunification and will end with a research study on IFPS reunification published by NFPN in 2014. The study found that IFPS reunification was effective with families involved in substance abuse, domestic violence, and mental health problems. Step-down services and involvement of biological fathers improved the durability of reunifications. Finally, exit instruments designed for both the worker and parents showed very strong alignment in perceptions.

For more information on exit instruments for workers/parents visit http://www.nfpn.org/products/exit-instruments (free with purchase of NCFAS-G+R assessment tool)

Posted by
Priscilla Martens, NFPN Executive Director

History of Federal Funding for Family Preservation

The National Family Preservation Network (NFPN) was in its infancy when it became one of the chief advocates for passage of the federal Family Preservation and Support Services Act of 1993. The purpose of this legislation was to “develop and establish, or expand, and to operate a program of family preservation services and community-based family support services.” Initial funding of $60 million was allotted to states based on the number of children receiving food stamps. States were required to contribute 25% in matching funds.

In 1997 Congress reauthorized funding through the Adoption and Safe Families Act but changed the name from Family Preservation and Support Services to the Promoting Safe and Stable Families Program. States could also now spend funds on two additional service categories: time-limited reunification (within 15 months from date of removal of a child) and adoption promotion and support. Congress authorized mandatory funding to increase annually, rising to $305 million by FY 2001.

The PSSF program was reauthorized in 2001 with $200 million in discretionary funds added to the $305 million in mandatory funds. The discretionary portion of the funding included set-asides for tribal services, court improvement, and research/training/technical assistance.

In the 2006 reauthorization of PSSF, mandatory funding was increased to $345 million for one fiscal year. New funding of $40 million was allocated to support monthly caseworker visits and to improve outcomes for children affected by parental abuse of meth or other substances. PSSF was most recently reauthorized in 2011.

States are required to report how funds are spent. Currently, states spend about 30% of funds on family preservation, 29% on family support, 21% for reunification, and 20% for adoption promotion and support. States vary in the degree to which they use PSSF funds to pay for Intensive Family Preservation Services (IFPS), ranging from using no PSSF funds for IFPS to using all their PSSF allocation to pay for IFPS. Total mandatory and discretionary funding for PSSF has averaged $382 million in each of the past four fiscal years (FY 2013-FY 2016) with both types of funding reduced over the years due to budget cuts.

In 2016 reauthorization for PSSF was included in the Family First Prevention Services Act. This legislation was not passed by Congress so PSSF operates under a continuing resolution. The Family First Prevention Services Act was reintroduced this year in the House as H.R. 253 and the bill includes extending funding authority for the PSSF program. There could also be other bills introduced to extend authorization.

NFPN gratefully acknowledges reports on PSSF by Emilie Stoltzfus, Congressional Research Service, in preparing this history of federal funding of family preservation.

Posted by Priscilla Martens
NFPN Executive Director

IFPS Nationwide Surveys

When the National Family Preservation Network (NFPN) was founded 25 years ago, the first publication, released in 1994, was a nationwide survey of Intensive Family Preservation Services (IFPS).

The first IFPS survey was at the program level with 223 IFPS programs listed as meeting the following criteria:
• Serve a maximum of 4 families per worker
• Deliver services in the home and community
• Meet at least 15 of the 20 characteristics of IFPS (based on Homebuilders model)

Most of the programs listed were in a dozen states that had a statewide model. The bulk of funding was provided by the states with a small number of programs also receiving federal, county, city, or private foundation funding.

It would be another 13 years before the next IFPS nationwide survey was published in 2007. Twenty states responded to the survey stating that they provided IFPS services. However, there was a wide variation in the models of service and thus limitations on any conclusive findings.

In 2011 NFPN released another IFPS survey and this time exemplary IFPS programs were separated from less intensive programs. Fourteen states met criteria for exemplary IFPS and findings included:
• Safety is a hallmark with few IFPS deaths reported in a five-year period of time
• Key components of intensity are adhered to including 24/7 availability of worker, low caseload (2-4 families), brief length of service (4-6 weeks), and high number of face-to-face hours spent with families (average of 47 hours per IFPS intervention)
• Exemplary IFPS programs have written program standards, monitor compliance, and conduct evaluations
• A clinical model was used by 65% of IFPS programs

To view the 2011 IFPS Survey visit: http://www.nfpn.org/preservation/2011-ifps-survey

In recognition of the 40th anniversary of IFPS, NFPN released a special edition of the IFPS nationwide survey in 2014. A dozen states were listed with exemplary IFPS programs. A comparison of IFPS then and now included a letter from an early supporter of IFPS, Douglas Nelson from the Annie E. Casey Foundation, a side-by-side comparison of IFPS in 1992 and in 2104 for several states, and an IFPS timeline.

To view the special edition IFPS Nationwide Survey visit: http://www.nfpn.org/preservation/2014-ifps-survey

More information about the early years of IFPS and the 40th anniversary are available on the Intensive Family Preservation website: http://www.intensivefamilypreservation.org/

In summary, the four nationwide surveys provide a snapshot view of IFPS during a point in time. There have been 7 states with strong IFPS programs that appeared in all the surveys (KY, MO, CT, MI, NC, ND, WA). Cumulatively, the nationwide surveys provide critical information about both the evolution and consistency of IFPS programs and thus serve as a guide for the future development and expansion of IFPS.

Posted by Priscilla Martens
NFPN Executive Director

Preserving Families for 25 Years

The National Family Preservation Network (NFPN) is celebrating its 25th anniversary this year. Our legal name, Intensive Family Preservation Services National Network, reflects the original purpose of the organization: to promote Intensive Family Preservation Services (IFPS). And we have! From the early days when NFPN served as a clearinghouse for IFPS, conducted the first nationwide survey of IFPS, and developed two videos on IFPS and Mental Health and IFPS and Substance Abuse, to the present where NFPN continues to serve as a clearinghouse for IFPS, has conducted three additional nationwide surveys of IFPS, and has over 30 resources on the website related to IFPS for both intact and reunifying families, NFPN is still promoting IFPS!

NFPN partners with state agencies and private organizations in researching IFPS and developing resources for the field. NFPN has conducted six research studies involving IFPS in the past 15 years. All of them support IFPS as an effective intervention for high-risk families with a wide variety of presenting problems. The most recent study demonstrated that IFPS services are effective with families exhibiting trauma symptoms and indicators.

Resources on NFPN’s website include Request for Proposal (RFP) samples, state annual IFPS reports, practice standards, and training. NFPN has developed a CQI instrument that IFPS programs can use to demonstrate quality assurance. One of the most popular resources is the IFPS ToolKit, a guide for developing and maintaining strong and effective IFPS services that includes the following:
• Definition, history, and benefits of IFPS
• Essential components, standards, and performance measures
• Federal funding sources and payment structure for contractors
• Research and evaluation measures
• A model for Intensive Family Reunification Services

Several state agencies have used the IFPS ToolKit to develop their model of IFPS. To view the ToolKit visit http://www.nfpn.org/preservation/ifps-toolkit.

IFPS is now at a crossroads. Federal and state mandates require that programs meet standards for Evidence-Based Practice. In a study of IFPS programs, Schweitzer et al (2015) report that IFPS does not meet the criteria for the highest level of Evidence-Based Practice because it does not have two random-controlled, published studies of efficacy. However, they do say that IFPS meets a lower standard, that of promising practice. Thus, more studies are needed to fully establish IFPS as Evidence-Based Practice.

NFPN is committing to another 25 years of promoting IFPS, conducting research studies on IFPS, and providing resources, training, and technical assistance to the field.

To view resources on IFPS, visit http://www.nfpn.org/preservation

Posted by Priscilla Martens
Executive Director