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