Safety

With the most recent mass shooting, an incomprehensible tragedy, it’s a reminder that those in the helping profession are increasingly faced with trying to navigate a perilous journey while maintaining the safety of themselves and those they are trying to help.

While we tend to think of first responders as police, firefighters, and medical personnel, first responders are also in-home services workers who are on the front lines helping families. Let’s look at the issue of safety through one type of in-home services, Intensive Family Preservation Services (IFPS).

From the beginning, safety has always been the highest priority of IFPS. For over four decades, IFPS has had a stellar safety record. There have been very few deaths of a child during an IFPS intervention despite the fact that IFPS serves high-risk families. There are no known deaths of an IFPS worker during the course of an intervention.

Safety is baked into the model of IFPS. Frequent contact with the family, 24/7 availability of the worker, and very small caseloads serve as a protection for family members and assure a rapid response when a crisis occurs. The worker’s safety is enhanced through a high degree of training and skills, 24/7 back-up, and constant support of a supervisor. And the IFPS workforce share many traits in common with emergency responders such as integrity, communication skills, flexibility and adaptability, dedication, and team player.

In effect, the IFPS model itself contributes to the safety of the family and the IFPS worker. Thus, the best reason for model fidelity is that when it is weakened or abandoned, child deaths are the inevitable result. A tragic example occurred when the child welfare administrators in the state of Illinois thought they could keep families together and still save money by assigning workers high caseloads. Then a child was killed by his mother in 1993 and Illinois completely abandoned any resemblance to family preservation. Within a few years, Illinois had the highest rate of out-of-home placement in the nation. The foster care system was overwhelmed. Child abuse deaths statewide increased and there were also child abuse deaths in foster care. Not until Illinois again embraced preserving families through best practice did the deaths decrease along with a dramatic decrease in out-of-home placements. Safety outcomes also improved.

Here are some steps that we can all take to increase safety:

1. Be alert and prepared. We need to become more aware of our surroundings and what action to take if safety is threatened. When I’m in public places, I look for exits and places to take shelter if the worst happens. Ask your local emergency responders how to prepare for situations that threaten your safety and the safety of others around you.
2. Train your organization’s staff on safety. Here is one online resource for safety training for in-home services workers and it also includes training on ethics:
http://www.nfpn.org/articles/ethical-and-safety-guidelines.
3. Advocate for keeping children safely in their homes and not overwhelming the foster care system. Here’s a summary of what happens in foster care panics: https://drive.google.com/file/d/0B291mw_hLAJsMGdWQ2NhYTM2Ulk/view.
4. Advocate to strengthen and expand IFPS programs as a strong safety model of in-home services. For a comparison of the safety record of foster care vs. IFPS visit https://drive.google.com/file/d/0B291mw_hLAJsMGdWQ2NhYTM2Ulk/view
5. Find ways to help your community. You have skills that are needed not only by your agency but also by your community as a whole. The community will benefit and so will you by investing in the well-being of your community.

Posted by Priscilla Martens, NFPN Executive Director

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Gatekeeping

Gatekeeping occurs at many levels. The simplest way to define “gatekeeping” is control of access to something or someone. This control of access may include events, facilities, services… and even children! Today we’re going to take a look at gatekeeping through the lens of Intensive Family Preservation Services (IFPS), especially the link between targeting services and gatekeeping.

From its inception, IFPS has been targeted to families in which there is imminent risk of placement of a child(ren). That basically means that without the IFPS services, the child will be placed. The underlying theory for this eligibility requirement is that IFPS prevents placement into out-of-home care and “imminent” placement establishes certainty that placement would actually occur shortly, in the absence of IFPS services. In addition, the cost savings for IFPS are based on comparison with out-of-home costs. If placement would not have occurred, then there are few or no cost savings. Finally, if out-of-home placement will not occur, lesser intensive services could be provided to the family.

In theory, targeting services to families on the basis of imminent placement is simple. In practice, it’s challenging to hit the target because of moving parts: the various definitions of “imminent,” who controls placement, length of time until a child would be placed, and, most challenging, would the child actually be placed in the absence of IFPS services. These challenging issues have also resulted in challenges in research. There is only one known study that specifically addressed targeting: in Michigan a judge signed an order to remove the child unless IFPS services were provided to the family.

So, faced with these challenges in targeting IFPS services to appropriate families, some states have turned to gatekeeping. Most exemplary IFPS states limit services to families facing imminent placement and the states define imminent. But, as previously stated, there is no easy way to track if referrals are appropriate. So, some states have assigned a gatekeeper to approve all referrals. The gatekeeper does not only know the guidelines for referrals but is also familiar with the referring workers and the type of families that are referred. In effect, the gatekeeper is making a judgment based on the best information available. There is no state that provides IFPS to all eligible families so it’s essential to direct the services to the families that can most benefit from them.

States contract with provider agencies to deliver IFPS services. Some of the provider agencies also have gatekeepers for IFPS. These gatekeepers coordinate with the state gatekeeper(s) by accepting referrals and assigning them to workers. In the best scenario, the provider agency gatekeeper can decline a referral if the family is not appropriate for IFPS. At a minimum, the gatekeeper can ask if this is the best use of the limited funds available for the IFPS program.

At the national level, more research is needed on optimal referral criteria. One way to do that is to determine the extent to which children and families served through IFPS are similar to children and families in which out-of-home placement has occurred. In the meantime, NFPN recommends that both the referring agencies and agencies providing the IFPS services have gatekeepers and written referral criteria.

Please share how your IFPS program targets appropriate referrals and if there are gatekeepers.

Posted by Priscilla Martens
NFPN Executive Director

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

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