Substance Abuse and In-Home Services Video

In celebration of our 25th anniversary, The National Family Preservation Network (NFPN) is pleased to announce the release of a video training on Substance Abuse and In-Home Services. This is the second video training that NFPN has produced on substance abuse with the first one being released in 1996. That video is still being used for training in a university course on family preservation.

The release of the new video training comes at a time when substance abuse, particularly opioids, is the most urgent health and social issue. However, it does help to keep in mind that this is not the first drug epidemic.

The crack cocaine epidemic in the 1980’s caused widespread panic due to fears of children being irreparably damaged from being born addicted through exposure in the womb to the mother’s drug use. But a study by the University of Florida showed that the babies determined safe to be left with their addictive mothers were more developmentally advanced at six months than babies removed from their mothers and placed in foster care. It is possible to provide treatment to the substance abusing parent(s) and protect children while keeping the family safely together.

Intensive Family Preservation Services (IFPS) were successfully used to prevent out-of-home placement of children in one of the pockets of crack cocaine use in the 1980’s—the Bronx in New York City. Here’s a story of the effectiveness of IFPS during that time:

The house had no front door. There were bullet holes in the wall. Neighbors gathered on the front porch, a sentry at the door; drug traffic was heavy. The only furniture in the small two-story house was a potty seat for the toddler and a run-down couch. There were no beds, no chairs, no appliances. The family preservation therapist came daily to work with the mother and make sure the children were safe and fed. At first the mother didn’t want to get up from the floor where she slept. By the second week she was waiting on the porch for the therapist. Together they found another house. The mother moved, taking her children with her. She left the father of her four daughters; he remained on drugs. She completed a drug treatment program and is getting her GED. Now she says that if the therapist hadn’t arrived, she would not have survived.

A current IFPS program in Tennessee is proving very successful with drug-affected infants. There are also other in-home services mentioned in the video that help to preserve families involved in substance abuse.

The 90-minute video training package includes a list of 25 online supplemental resources for additional training. Pricing starts at $275. For more information and to order, contact Priscilla Martens, Executive Director, director@nfpn.org, 888-498-9047.

For quick reference, here is the link to the online information on the video: http://www.nfpn.org/videos/substance-abuse-and-in-home-services.

Posted by Priscilla Martens, NFPN Executive Director

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Assessment and Preserving Families

When we’ve known about something for a long time, we may gain a new perspective by looking at it through a different lens. Many of us are familiar with Intensive Family Preservation Services (IFPS), one of the most effective models of in-home services and one that has been in existence for over 40 years. Assessment of families has only been a focus for about that half that time and yet assessment and preserving families have become inextricably linked. So let’s look at preserving families through the lens of assessment.

An assessment tool specifically designed for IFPS appeared in the late 90’s. The North Carolina Family Assessment Scale (NCFAS) was developed by a researcher (Dr. Ray Kirk) at the University of North Carolina—Chapel Hill with the input of IFPS workers. These workers then tested the tool by using it with their IFPS families. The IFPS workers thus directly contributed to establishing the initial reliability and validity of the NCFAS, meaning that the tool was accurate and consistent and measured what it was designed to measure.

The tool was designed to measure family functioning. Workers use the tool to identify strengths and weaknesses of the family, prioritize goals, match needs to services, and monitor progress. The original outcome measure for IFPS was placement prevention but the difficulty with that lies not only in trying to prove a negative but in not having any positive measure of change in the family. Because IFPS is an intervention for high-risk families with multiple problems, it’s essential to know how these services impact the family in important areas such as safety, parenting, child well-being, etc.

The original NCFAS is a pre/post measure of family functioning in the areas of environment, parental capabilities, family interactions, safety, and child well-being. Based on the numerical difference of ratings from case opening to case closure, the family’s progress is measured in terms of progress, no progress, or regressing on the scale. Through subscales, the ratings provide specific information within a domain such as supervision of children, use of drugs/alcohol interfere with parenting as well as an overall rating on that domain (in this case parental capabilities). If families have made no progress or perhaps even regressed, the worker can identify where additional services are needed. Regression is also highly correlated with subsequent out-of-home placement.

The NCFAS tool was followed by the NCFAS-R for use with reunifying families. The “R” domains of Caregiver/Child Ambivalence and Readiness are critical elements of reunification and the ratings are closely tied to successful or failed reunifications. The NCFAS-R is one of the few reliable and valid tools available for use with reunifying families.

Another version of the tool, the NCFAS-G, added the domains of social/community life, self-sufficiency, and family health. The most commonly used tool combines all 10 of the domains into the NCFAS-G+R.

The most recent addition is the Trauma/Post-Trauma Well-Being domains which address the need and mandate for trauma-informed practice.
NFPN has conducted five studies on the tools with family preservation programs and in each study both the tools and the programs performed well. The assessment tools and family preservation services are intertwined in understanding families, prioritizing goals and services, monitoring progress, data collection, evaluation, and research. They have become inseparable!

For more information on the assessment tools, visit http://www.nfpn.org/assessment-tools.
For information on IFPS visit http://www.nfpn.org/preservation.

Posted by Priscilla Martens, NFPN Executive Director

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