Changing the Child Welfare System–2

In the last post, we discussed how the state of Connecticut is changing its child welfare system and the focus was on the back end of the system. This time we’ll look at efforts being made to change the front end of the system.

Joette Katz, Commissioner of the Department of Children and Families, says that the child welfare system has historically viewed families as the source of the problem rather than part of the solution. The system is risk averse so the default option is often the most drastic one: removal of a child from the home.

Commissioner Katz believes that families must be at the center of the solution so she has implemented the Strengthening Families practice model which has family engagement as its foundation. The model emphasizes support services for families, strength-based case plans that are responsive to the family’s needs and values, and a strategy to preserve the family. Connecticut is using the Eckerd Rapid Safety Feedback tool to identify the highest-risk families and then establish an action plan to mitigate safety risks and prioritize tasks.

Connecticut is a leader in trauma-informed practice and was one of the first to screen children in the child welfare system for trauma. Since 2007 more than 50,000 children have been screened for trauma and over 8,600 professionals, including child welfare workers, have received training. Trauma-focused services for school-age children have been expanding over the past decade. Now the focus is turning to children under age 5, of whom 12,000 were included in reports of child abuse/neglect in 2014.

The federal government is funding a five-year Early Childhood Trauma Collaborative that will train 500 people who work with young children on recognizing signs of trauma and connecting children to services. The funding will also be used to help outpatient clinics offer treatments that have been shown to be effective with young children.

Connecticut provides a robust Intensive Family Preservation Services (IFPS) program to prevent the unnecessary placement of children. A higher percentage of families in the child welfare system receive family preservation services in Connecticut than in other states. The state reports a 92% rate in keeping families together that have received IFPS.

Commissioner Katz says that her goal is to change the culture of child welfare from one of blame to one in which we are all members of a team with the goal of making families stronger and children safer. NFPN heartily endorses that goal as reflected in our logo: Safe Children, Strong Families!

Posted by Priscilla Martens
NFPN Executive Director

Changing the Child Welfare System

Ten years ago this month the National Family Preservation Network (NFPN) released a paper, An Effective Child Welfare System, featuring the Allegheny County child welfare system in Pittsburgh, PA. This child welfare system reduced foster care placements, reunified children with family, and placed children with relatives, doing all of these goals at two to three times the rate of other state child welfare systems. In addition, there were no child deaths from abuse or neglect for a period of three years in a population of over 1 million people. Allegheny County is still a model child welfare system and you can view the paper here: http://www.nfpn.org/articles/monograph-an-effective-child-welfare-system

In revisiting effective child welfare systems, this time we’re going to look at Connecticut’s child welfare system. We’ll begin with the back end of the child welfare system and work our way to the front. Connecticut is one of 21 states whose child welfare system is under federal oversight through a court consent decree. When Joette Katz, a former judge, was appointed 6 years ago as Commissioner of the Department of Children and Families, there were 50 group homes statewide in which dependent children were frequently placed and only 21% of children were placed with relatives. Many children were sent out of state for mental health treatment. Commissioners averaged 18 months on the job.

Commissioner Katz adopted a Strengthening Families practice model which has family engagement as its foundation. The goal is to preserve the family unit and minimize the disruption and trauma associated with the removal, placement, and separation of the child from the family. In two years Commissioner Katz reduced out-of-state placements by 97% and congregate care by 67% while doubling the number of children placed with relatives. All of this took place during a time of large cuts to the child welfare budget. The state has met 16 of the 22 outcome requirements from the consent decree and is on track to exit federal oversight. The child fatality rate is the third lowest in the nation.
One of the biggest impacts in the back end of Connecticut’s child welfare system was the dramatic reduction (67%) in congregate care. The Annie E. Casey Foundation has been instrumental in the reduction in use of congregate care. Take a look at their data:
 *57,000 children nationwide are living in group placements
 *4 in 10 children have no medical/mental health diagnosis or behavioral problem warranting group placement
 *Group placement costs 7-10 times the cost of placing a child with a family
 *States range from 4%-35% of children in the child welfare system placed in group care with an average of 14%

Casey Foundation states that one way to reduce group placements is to have the top child welfare administrator approve all group placements as is the case in Connecticut. To read the Casey report on group care visit http://www.aecf.org/resources/every-kid-needs-a-family/

The Casey Foundation also has a report on kinship care noting that 2.7 million children live with extended family, or 1 in every 11 children and about 29% of the children in foster care. Kinship care increases child safety, stability, permanence, and well-being by maintaining familial and community bonds, sense of belonging, and by minimizing trauma. View the kinship report at http://www.aecf.org/resources/stepping-up-for-kids/

Still another report focuses on the increase in the number of children being raised by grandfamilies due to the opioid epidemic. Over 40% of children placed with relatives are removed because of parental drug or alcohol abuse. Shaheed Morris was born with fetal distress due to his mother’s alcohol and drug use during pregnancy. When his mother deserted him at the hospital, his grandmother claimed him although she had little money and only a 5th grade education. Shaheed graduated from university this year with a degree in journalism. He is still close to his 89 year old grandmother. For more stories like Shaheed’s see http://www.gu.org/Portals/0/documents/Reports/16-Report-State_of_Grandfamiles.pdf

In the next post, we’ll see how Connecticut addressed the front end of the child welfare system.

Posted by Priscilla Martens
NFPN Executive Director

The Leader in Me

September is back-to-school month. The National Family Preservation Network (NFPN) believes that strong families build strong schools. But is the opposite also true? Can strong schools build strong families?

An elementary school principal in Raleigh, NC, decided to build a strong school. She asked teachers, parents, and local employers what they wanted from a school. The teachers wanted to be proud of their school, use their talents, feel like they made a difference, and teach self-motivated students. Parents wanted their children to make responsible decisions, use their time well, and grow up to make positive contributions to society. Employers wanted employees to have a strong work ethic, self-motivation, and communication skills. What everyone wanted essentially boiled down to “leadership” and so The Leader in Me was born.

Franklin Covey’s 7 Habits of Highly Effective People were adapted to become The 7 Habits of Happy Kids (with following condensed explanation in kid language):
1) Be Proactive = You’re in Charge. I am a responsible person. I take initiative. I choose my actions, attitudes, and moods.
2) Begin with the End in Mind = Have a Plan. I plan ahead and set goals. I am an important part of my classroom and contribute to my school’s mission and vision.
3) Put First Things First = Work First, Then Play. I spend my times on things that are most important. I am disciplined and organized.
4) Think Win-Win = Everyone Can Win. I balance courage for getting what I want with consideration for what others want.
5) Seek First to Understand, Then to Be Understood = Listen Before You Talk. I listen to other people’s ideas and feelings. I listen to others without interrupting.
6) Synergize = Together is Better. I seek out other people’s ideas to solve problems because I know that by teaming with others we can create better solutions than anyone of us can alone. I am humble.
7) Sharpen the Saw = Balance Feels Best. I take care of my body by eating right, exercising, and getting sleep.

Do these 7 Habits build strong families? A boy diagnosed with a cognitive delay and oppositional defiance enrolled in a school with The Leader in Me program. Within days his father noticed a change in his son. Then his son started teaching the habits to his father and other family members. When the father attended a parent night, he stated that what the school was teaching students had changed his life. And then the father revealed that he had been involved with drugs, was arrested, and fled while awaiting a court hearing. After learning from his son about taking responsibility, the father decided to turn himself in. He said, “This boy’s my hero.” The school principal sent the judge a letter about the father’s relationship with his son. The judge decided not to impose jail time in order to allow the father to remain with his son and to continue to do things to make a difference in the community. That sounds a lot like strong schools building strong families!

The Leader in Me has been implemented in over 3,000 schools in all states and 50 countries. Panda Express frequently funds these programs. For more information, visit http://www.theleaderinme.org/

Posted by Priscilla Martens, NFPN Executive Director

Prevention Programs

The National Family Preservation Network (NFPN) frequently receives inquiries about effective prevention programs for families. In this blog post, NFPN will highlight two prevention programs. Both of these programs will be featured in The 2016 National Conference for America’s Children, October 17-20, Cincinnati, Ohio. For more information about the conference visit http://preventchildabuse.org/get-involved/2016-national-conference/.

The first program, Family Connections (FC), targets families at risk of child maltreatment. A practitioner performs the following tasks (condensed from the program description in the California Evidence-Based Clearinghouse for Child Welfare):
o Uses screening criteria that indicate a risk of maltreatment
o Initiates the therapeutic relationship through face-to-face contact with the family within one business day of acceptance into the FC program
o Provides at least one hour of face-to-face services to families at least once per week for at least three months
o Provides most services in the community, meeting families where they live
o Uses standardized clinical assessment instruments to guide the identification of risk and protective factors associated with child maltreatment
o Provides emergency/concrete services to address concrete needs
o Conducts comprehensive family assessments to guide the service delivery process
o Develops outcome-driven service plans geared to decrease risk and increase protective factors associated with child maltreatment
o Delivers tailored and direct therapeutic services to help families reduce risks, maximize protective factors, and achieve service outcomes and goals
o Advocates on behalf of families in the community and facilitates services delivery by other organizations/individuals

Evaluation of Family Connections produced these outcomes:
• Increase in appropriate parenting attitudes
• Increase in satisfaction with parenting, and social support of trusting and authoritative figures in their lives
• Decrease in depressive symptoms
• Decrease in caregiver drug use
• Decrease in caregiver stress and everyday stress
• Decrease in child behavior problems

For more information on Family Connections as an Evidence-Based Practice, visit http://www.cebc4cw.org/program/family-connections/detailed.

The other prevention program highlighted in this post is the Integrated Family Services program in San Francisco. Integrated Family Services is a way of organizing direct services to families that focuses on Five Protective Factors (parental resilience, social connections, concrete supports, knowledge of parenting and child development, social and emotional competence of children) as outcomes. Families who meet eligibility requirements (residing in San Francisco and caring for a child 12 or under) are primarily referred by doctors, schools, health department, and self-referred.

Families participate in an assessment process to identify the family’s strengths and challenges vis-à-vis the Five Protective Factors. Based on this assessment and the family’s articulation of their needs, the program offers team-based services, including intensive case management, psychotherapy, and parent education.

Service planning is directed by a Clinical Care Coordinator, who is the primary contact with the family and is accountable for outcomes. Reassessment and revision of the service plan, if necessary, happens every three months, until families reach their desired goals and protective factors are strengthened. Care coordinators provide six months of low-intensity aftercare, to support families in the gains they have made.

For more information, visit http://sfcapc.org/

Posted by Priscilla Martens, NFPN Executive Director

Designing an IFPS Program

Several agencies have used the IFPS Toolkit produced by the National Family Preservation Network (NFPN) to design an IFPS program. Let’s take a closer look at how the ToolKit and other resources can be used for that purpose.

The IFPS ToolKit is a comprehensive resource that includes:
 Definition and History of IFPS
 Benefits of IFPS
 Essential Components of IFPS
 RFP and Pay Structure for IFPS Contracts
 Reunification Model
 Step-Down Services….and much more!

The ToolKit contains the basics for designing an IFPS program.
To view the IFPS ToolKit, visit http://www.nfpn.org/preservation/ifps-toolkit

While the ToolKit is a good place to start, NFPN has other resources available to further assist in designing an IFPS program. NFPN has conducted several nationwide surveys of IFPS. The surveys provide data on exemplary IFPS programs nationwide including the following service components:
 Caseload
 Timeframe for first visit
 Total hours for intervention
 Length of service
 Clinical models
 Training requirements
 Outcomes
 Cost

As you build your IFPS program, you can comparing your design to the well-established, exemplary programs included in the nationwide survey.

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

Dr. Ray Kirk and NFPN have conducted numerous studies on IFPS. The studies use the North Carolina Family Assessment Scales (NCFAS) as pre/post measures of improvement in family functioning. The NCFAS scales were originally developed with and for IFPS programs. The majority of exemplary IFPS programs use the NCFAS tools. Improvement in family functioning is closely associated with placement prevention and successful reunifications. Thus, you can use the NCFAS scales for multiple purposes: prioritizing needs, goals, services, developing a case plan, data collection, and evaluation.

For an overview of the research on the NCFAS scales, including six studies on IFPS, visit http://www.nfpn.org/assessment-tools/ncfases-scale-development-report

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

Following development of an IFPS program, it’s critical to ensure ongoing quality. NFPN has developed a Continuous Quality Improvement (CQI) instrument for use with IFPS programs. The CQI-IFPS Instrument and supporting materials include the following:
 Introduction (definition, basis in federal law/policy, and purpose of the CQI-IFPS)
 CQI-IFPS Instrument (10 domains covering a total of 75 items)
 Tally Sheet (checklist for reviewers that allows tallying of up to 5 case files)
 Instructions (preparation, reviewing case files, debriefing, using findings to guide improvement in practice)
 Frequently Asked Questions (F.A.Q.)

You can begin using the CQI with your IFPS program in the second year of operation to establish a baseline.

For more information on the CQI-IFPS instrument visit http://www.nfpn.org/preservation/cqi-ifps-instrument

Finally, NFPN is always available to provide technical assistance for IFPS program design. Call 888-498-9047 or email director@nfpn.org.

Posted by Priscilla Martens, NFPN Executive Director

Family First Prevention Services Act

Federal financing of child welfare is an open-ended entitlement for out-of-home placements whereas funding for prevention (keeping families together) is much more limited and capped. Thus, federal funding is skewed toward placement services with a ratio of 6:1 or perhaps even higher for funding of placement vs. prevention services.

This month ground-breaking legislation has been introduced in Congress to allow foster care funds (Title IV-E) to be used for prevention services. The Family First Prevention Services Act of 2016 (H.R. 5456/S. 3065) is a jointly developed House/Senate bill that is now moving forward in the House of Representatives.

Those eligible for the prevention services include children who are at imminent risk of out-of-home placement, children experiencing disrupted guardianships or adoption, and young people in foster care who are pregnant or parenting. There is no income eligibility requirement.

Criteria for services eligible for federal reimbursement include:

  • substance abuse and mental health prevention and treatment services provided by a qualified clinician
  • in-home parent skill-based programs including individual and family counseling
  • services and programs that are trauma-informed
  • services and programs that are evidence-based (based on criteria from the California Evidence-Based Clearinghouse for Child Welfare http://www.cebc4cw.org)
  • services provided for a maximum of 12 months

The Department of Health and Human Services will provide technical assistance and best practices to states on prevention programs. In addition, the department will establish a clearinghouse of promising, supported, and well-supported practices based on research findings. States must include a well-designed research evaluation for any practice used unless they receive a waiver based on compelling evidence of effectiveness.

The legislation also extends the Promoting Safe and Stable Families Program (Title IV-B, Subpart 2) for another 5 years (FY 2017-FY 2021). Mandatory funding of $345 million is provided each year plus whatever discretionary funding Congress allocates. There are two changes to the PSSF program that currently funds four types of services: family support, preservation, reunification, and adoption services:

  • the definition of “family support services” is amended to include community services that are designed to support and retain foster families
  • eliminates the current 15-month time limit for reunification services

To view the bill, visit http://waysandmeans.house.gov/wp-content/uploads/2016/06/BUCHAN_031_xml2.pdf

A detailed summary of the bill is available here: http://www.childrensdefense.org/policy/welfare/assets/family-first-prevention.pdf

If your organization is interested in signing on to support the legislation, please contact: Stefanie Sprow, Children’s Defense Fund, ssprow@childrensdefense.org

Priscilla Martens, NFPN Executive Director

 

 

Framework for Safety

The National Family Preservation Network (NFPN) was invited to give a workshop on Safety this month. Sheila Searfoss, an NFPN board member, clinician, and trainer, presented the Framework of Safety that she developed to help IFPS therapists and other direct services workers address safety with the families they serve. Here is an overview of the workshop:

Safe is a condition in which the threat of serious harm is not present or imminent or the protective capacities of the family are sufficient to protect the child. Protective capacities refer to the individual and family strengths, resources, or characteristics that mitigate threats of serious harm to the child.

To conduct an effective safety assessment, the worker must answer the following critical questions:

  1. Is there serious harm to the child? If yes, what is the harm?
  2. Is there an immediate threat of serious harm? If yes, describe in behavioral terms.
  3. Is there a vulnerable child?
  4. Are there protective capacities within the family to adequately mitigate any threats of immediate serious harm?
  5. Is there a need for an immediate safety intervention or action?

A decision of “unsafe” requires an immediate safety response to protect the child. It does not necessarily equate with removal of the child from the home but does require a safety plan to protect the child. A safety response also requires interventions. Interventions are specifically employed to control the safety threat and protect a child until more permanent change can take place. Here are some examples of safety interventions if the child remains in the home:

  • Use of family, neighbors, etc. as safety resources
  • Alleged perpetrator leaves the home
  • Family preservation services
  • Emergency medical/mental health services
  • Emergency substance abuse services

The safety plan incorporates all safety interventions and includes the following components:

  • Family involved in developing and implementing the plan
  • A written document prepared by the worker and approved by the supervisor
  • Clear description of the harm, child’s vulnerability, and caregiver’s protective capacities
  • Description of how the caregiver views the situation
  • Description of each intervention, how it will protect the child, who is responsible for implementation, and time frames
  • Details of how the plan’s effectiveness will be monitored

Managing a safety plan involves

  • Regular contacts with the child and all others that have a role in the plan
  • Continuous assessment for new threats of serious harm
  • Continuous work on family engagement
  • Periodic evaluation of the need to alter the safety interventions
  • Inclusion of the safety plan in the case plan
  • Keeping the supervisor informed of the status of the safety plan

Safety reviews provide a formal structure for monitoring and evaluating all the safety issues in a case. The purpose of the safety review is to:

  • Measure the growth in a caregiver’s ability to protect the child
  • Assess whether there have been any changes in the child’s vulnerability that affect safety
  • Decide whether and how to adjust the safety plan (may include increasing or decreasing service intensity)
  • Evaluate the suitability of the safety interventions
  • Consider whether caregiver responsibility and involvement can be increased.

A comprehensive framework for safety guides the worker in assessing harm, developing, implementing and monitoring a safety plan; protects the child from harm; and assists the family with enhancing protective capacities to prevent future harm.

Priscilla Martens, NFPN Executive Director