Category Archives: Research

Assessment and Exit Instrument Tools for IFPS

The National Family Preservation Network recently released a research study that included findings from assessment tools and exit instruments.

The North Carolina Family Assessment Scale (NCFAS) was originally designed for use with a statewide IFPS program in North Carolina. It includes 5 domains that measure family functioning: Environment, Parental Capabilities, Family Interaction, Safety, and Child Well-Being.

The tool has been proven reliable and valid with dozens of IFPS programs. A later version of this tool, the NCFAS-G, includes the original 5 domains plus 3 additional domains of Social/Community Life, Self-Sufficiency, and Health. Initial reliability and validity for the NCFAS-G was established with a differential response program.

Some IFPS agencies have been reluctant to use the NCFAS-G because it had not been tested with an IFPS program. The research study included use of the NCFAS-G with 2 IFPS programs and 1 differential response program. The following is a chart showing the reliability of the NCFAS-G as used with these programs:

Reliability of NCFAS-G using Chronbach’s Alpha as the Reliability Statistic:

NCFAS-G Domains Intake Closure
Environment .913 .922
Parental Capabilities .838 .869
Family Interaction .881 .903
Family Safety .862 .919
Child Well-Being .894 .869
Social / Community Life .833 .822
Self-Sufficiency .920 .887
Family Health .800 .813
N 181 166

By convention and agreement among psychometric researchers and scale developers, Chronbach’s alphas above 0.8 are considered to be strong, and alphas above 0.9 are considered to be very strong.

The NCFAS tools are designed to assist workers with assessing the family’s needs, prioritizing goals and services, developing a case plan, and measuring the family’s progress following delivery of services. The NCFAS tools are also used in evaluation and research. In the recent research study, the following chart shows the percentage of families functioning below baseline (adequate) at intake and at case closure:

NCFAS-G Domains Intake Closure
Environment 16% 6%
Parental Capabilities 30% 8%
Family Interactions 22% 8%
Family Safety 19% 6%
Child Well-Being 35% 12%
Social / Community Life 11% 4%
Self-Sufficiency 25% 13%
Family Health 28% 8%
N 184 172

The research study also included testing of exit instruments designed by NFPN to align questions for the worker and parent(s) which correspond in general with the NCFAS assessment tools. You will note from the examples in the following chart that when families completed services, caregiver responses at termination almost mirrored the responses of the worker whereas there was more disparity between caregiver and worker when the family did not complete services:

Proportion of Responses About “Neutral” and At or Below “Neutral”

 Proportion of Responses Above , At, or Below Neutral

To read the full research study, visit:
http://nfpn.org/reunification/reunification-research

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

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Posted by Priscilla Martens, Executive Director, National Family Preservation Network

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IFPS and Step-down Services

From its inception, IFPS has been an all-inclusive service that is completed within four to six weeks. Early IFPS programs had no provision for step-down services.  This does not mean that families received no additional services.  IFPS therapists frequently refer families to other services prior to the close of the IFPS intervention.  But the question remains:  are IFPS step-down services ever justified?  If so, when is the optimal time to offer them?

I undertook a study of this issue in 2000 in the state of North Carolina.  What I discovered was a “window of vulnerability” that is depicted in the following chart by means of placement rates following the IFPS intervention:

Chart - Proportion Placed Out of Home

Note “window of vulnerability” from 120 days to 270 days post service.

The placement dynamics evident suggested that secondary interventions or additional services should be offered to families in the first 6 months following termination of the IFPS intervention.

Beginning in 2004, IFPS programs in North Carolina were required to track families for 6 months after receiving IFPS services:

  • Contact families monthly, inquire about functioning & needs.
  • Conduct a more comprehensive assessment of families during the contacts at 3 months and 6 months.
  • Verify that families were receiving the services that they were supposed to receive after IFPS and see if additional in-home services are needed.

IFPS workers were authorized to re-open services to the family for a maximum of 2 weeks and a maximum of 2 times during the 6 month follow-up period.

  • Between 2004 and 2008, 999 families received follow-up contacts
  • 593 received 3-month comprehensive assessment
  • 381 received 6-month assessment
  • Families had option to decline being contacted in the future; some families could not be located

 Family contacts during 6 months following case closure

Month

1

Month

2

Month

3

Month

4

Month

5

Month

6

Number of Families Contacted

999

791

662

535

471

407

Average Hours of Phone Contacts

1.07

.92

.92

.77

.73

.78

Average Hours of In-Person Contacts

1.89

1.33

1.28

1.19

1.11

1.20

Average # Worker Initiated Contacts

1.66

1.43

1.42

1.39

1.35

1.32

Average # Family Initiated Contacts

1.55

1.35

1.32

1.02

.92

.95

Number of Case Re-Openings

17

10

8

7

7

5

During the period 2000–2004, prior to implementation of follow-up contacts and possible additional services, the post service placement rate (attrition rate) during the first 6 months was approximately 7%, based on AFCARS data.

Among families receiving follow-up services between 2004 and 2008, post-IFPS service placement rate was:

  • 3.0% during first 3 months,
  • 1.5% during months 4–6.

Conclusion

Follow-up services during first 6 months post-IFPS services appear to reduce the placement (attrition) rate by about one-third.

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Posted by Ray Kirk, Researcher
Dr. Kirk’s research on the child welfare system includes assessment tools, IFPS, reunification, and prevention.

IFPS and Disproportionality

Racial/ethnic disproportionality in child welfare has been a topic of interest and controversy among child welfare researchers and administrators since data became available that permitted its investigation.

These findings from a Casey study in 2007 [1]  highlight the over- and under-representation of ethnic groups in foster care:

  • Black children are overrepresented in foster care by a ratio of 2:1
  • Native Americans are overrepresented in foster care by a ratio of 2:1
  • Whites are underrepresented by a ratio of 0.7:1
  • Hispanics are underrepresented by a ratio of 0.9:1
  • Asians are underrepresented in foster care by a ratio of 0.25:1

Disproportionate Need or Discriminatory Practices

Citing Hill (2006) [2], Casey Family Programs states that three national incidence studies revealed no significant differences between the base maltreatment rates of Black and White families.

This lack of differences in base rates suggests that disproportionality in the child welfare system is not due to disproportionate need, but rather to discriminatory practices in society (reports of abuse and neglect) or within the child welfare system (investigations, substantiations, placements, permanency outcomes).

Addressing Disproportionality

In order to determine effective strategies for reducing disproportionality, I undertook a study to examine an effort to address disproportionality with a policy and practice initiative utilizing Intensive Family Preservation Services (IFPS). [3] The study was based on data from the state of North Carolina:

IFPS is available in 70 of the state’s 100 counties, although IFPS is not available in sufficient quantity in any county to respond to all eligible families.

  • Families eligible for but that did not receive IFPS received traditional public and contract agency services, such as, counseling, skill training, protective supervision, day care, etc.
  • The study employed a retrospective, population-based design that permitted the selection of all high-risk abuse and neglect cases.
  • Data were merged from various statewide (NCCANDS, AFCARS) and program-specific (IFPS) databases.
  • The study included 2,056 high-risk families that received IFPS, and the comparison group included 28,004 high-risk families.
  • About three-fifths of the treatment population was White, a little more than one-third was Black, and the remainder comprised American Indians, Hispanics, and Asian/Southeast Asian families.
  • There were no differences on placement rates between Blacks and non-Black minorities, so these groups were combined.
  • White and non-White racial groups within the IFPS treatment condition were essentially equivalent with the exception of non-Whites having slightly more substantiated prior reports. Theoretically, any increased overall risk associated with this difference would be likely to diminish, rather than enhance the treatment outcome being investigated.
  • Independent variables: race, risk, IFPS versus non-IFPS
  • Dependent variable: cumulative risk of placement

The Results

  • High-risk minority children receiving traditional services were at higher risk of placement than White children, but minority children receiving IFPS were less likely to be placed than White children.
  • When only minority children were examined, those receiving IFPS were less likely to be placed than those receiving traditional services.

Figure 1—Risk of Placement After CPS Report for Children Receiving Traditional CW Services by Race

Figure1Disproportionality
Figure 2—Risk of Placement After Referral to IFPS for Children Receiving IFPS by Race

Figure2Disproportionality 

Figure 3—Risk of Placement After CPS Report/Referral to IFPS for Non-White Children

Figure3Disproportionality

Conclusion

IFPS is associated with a reduction in racial disproportionality of out-of-home placement among high-risk families. Within-race analysis suggests that IFPS may mitigate racial disparity in out-of-home placement existing in the remainder of the child welfare population that receives traditional services.

References

1. Casey Family Programs. (2007). Fact Sheet: Disproportionality in the Child Welfare System: The Disproportionate Representation of Children of Color in Foster Care.

2. Hill, R.B. (2006). Synthesis of Research on Disproportionality in Child Welfare: An Update. Washington, DC: Casey/Center for the Study of Social Policy Alliance for Racial Equity.

3. Kirk, R.S. & Griffith, D.P. (2008). Impact of intensive family preservation services on disproportionality of out-of-home placement of children of color in one state’s child welfare system. Child Welfare, 87 (5), 87–105.

 

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Posted by Ray Kirk, Researcher
Dr. Kirk’s research on the child welfare system includes assessment tools, IFPS, reunification, and prevention.

Celebrating 40 Years of IFPS – Part 2

IFPS - Keeping Families Together and Children SafeIn this post we look at the target populations with which IFPS has been found to be effective and an assessment tool for use with IFPS.

IFPS is Effective with High-Risk Families

Dr. Ray Kirk from the University of North Carolina-Chapel Hill conducted a retrospective study (NC DSS, 2001) of more than 1,200 children who had received IFPS services in North Carolina and compared them with over 110,000 children who had not received these services.

IFPS outperformed traditional child welfare services in every case by reducing the number of placements or delaying placements. IFPS interventions improved family functioning and were most effective with the highest risk families.

IFPS Reduces Disproportionality

In this study, high-risk minority children receiving traditional services were at higher risk of placement than white children, but minority children receiving IFPS were less likely to be placed than white children.

Note: a future blog post will provide details of this study.

IFPS is Effective with Older Youth

A study showed that IFPS services resulted in a 92% placement prevention rate for older youth (ages 12-17) in comparison to an 88% placement prevention rate for younger children (ages 0-11). For more details of this study, visit:
http://ifpscoasttocoast.wordpress.com/2013/10/23/ifps-is-effective-with-older-youth/

IFPS is Effective with Juvenile Offenders

HOMEBUILDERS® received funding from the U.S. Administration for Children, Youth and Families to provide services to youth and families referred from the Pierce County Juvenile Court.

Twelve months after intake, 73% of youth served were not placed in out-of home care. Data from the overflow comparison group showed that only 28% of the comparison youth avoided placement. For the full report, visit:
http://ifpscoasttocoast.wordpress.com/2013/11/13/ifps-with-juvenile-justice/

IFPS is Effective with Children with Mental Health Challenges

HOMEBUILDERS® was originally developed to prevent the psychiatric hospitalization of severely behaviorally disturbed children. From January 2009 through April 2013 the program served 3014 children at risk of placement, 383 of whom were reported to have serious mental health symptoms.

In the entire population, 97.5% of children successfully avoided placement at termination of services. Ninety-six percent of the 383 youth with serious mental health issues avoided out of home placement at termination of services. For additional studies involving IFPS and mental health visit:
http://ifpscoasttocoast.wordpress.com/category/mental-health/

IFPS is Effective with Adoptive Families

Dr. Marianne Berry and NFPN conducted a study on the use of IFPS with post-adoptive families in Missouri. 83% of the adoptive families studied were preserved by the end of IFPS. At a six-month follow-up point, 76% remained intact. No families contacted at the six or 12-month follow-up checks had legally disrupted. To view the complete report, visit:
http://nfpn.org/articles/ifps-with-post-adoptive-families

IFPS is Effective with Reunifying Families

The earliest study of the use of IFPS with reunifying families was conducted in Utah in 1995.

The IFPS intervention lasted 90 days and children were returned to the families within 15 days of referral. Following IFPS services, 92% of the children were at home vs. 28% of the control group. For additional information, view the IFPS ToolKit (chapters 10 and 11) here:
http://www.nfpn.org/preservation/ifps-toolkit

Assessment Tool Created for Use with IFPS

Development of the North Carolina Family Assessment Scale (NCFAS) for use with IFPS services provided an opportunity to measure a family’s progress following an IFPS intervention. The family’s progress is also closely tied to successfully remaining intact. Here’s a chart with typical pre/post ratings from research on use of the NCFAS with IFPS families (the percentages refer to the families that are at baseline or above, meaning that no intervention is required in that domain):

NCFAS Ratings of Baseline or Above at Intake and Closing
The NCFAS tools continue to demonstrate strong reliability and validity with IFPS programs. For a more detailed report, visit:
http://www.nfpn.org/assessment-tools/ncfases-scale-development-report

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Posted by Charlotte Booth, Executive Director, Institute for Family Development
and Priscilla Martens, Executive Director, National Family Preservation Network

IFPS is Effective with Older Youth

Several years ago, the National Family Preservation Network, in association with Dr. Ray Kirk and the National Alliance to End Homelessness, conducted research on the use of IFPS with older youth.

Two agencies provided data on IFPS services to older youth with one of the agencies providing comparative data for younger children. Older youth were defined as ages 12–17 while younger children were defined as ages 0–11.

The major findings of the study:

  • IFPS services were highly effective with older youth for both placement prevention services and reunification. The difference in outcomes for older youth vs. younger children was very small:
    Younger Children Older Youth
    Placement Prevention Success Rate 88% 92%
    Reunification Rate 97% 92%
  • Older youth were more likely to be female and had significantly higher rates of physical and sexual abuse than younger children, as well as family conflict. Other issues much more prevalent in older youth than younger children included adoption disruption, behavior problems, delinquency, child-centered violence, school problems, mental health problems, and substance abuse. All of these issues were effectively addressed in terms of preserving the placement or reunifying the older youth with their families.
  • The NCFAS and the NCFAS-R assessment tools were found to be reliable for use with both the older youth and younger children. This is critical because the tools measure over 40 factors of family functioning that affect youth and their families and are used in a wide variety of youth- and family-serving systems.
  • Despite having many more presenting problems than younger children, older youth and their families made just as much progress as younger children and their families on all measures of family functioning with one exception. That exception was the area of child well-being which includes the factors of mental health, child’s behavior, school performance, relationship with caregivers, relationship with siblings, and relationship with peers. Since these factors are child-focused, rather than parent-focused, and tend to reflect the older youth’s desire for independence and ability to make choices, including bad choices, less progress in this area is perhaps understandable. In any event, somewhat less progress in the area of child well-being did not adversely affect the overall positive outcomes for older youth.
  • Early IFPS programs served primarily older youth and we are now coming full circle to realizing that IFPS is still an excellent resource for adolescents.

To view the Older Youth Research Report, visit:
http://nfpn.org/preservation/186-older-youth.html

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Posted by Priscilla Martens, NFPN Executive Director

IFPS with Adoptive Families

The National Family Preservation Network, in association with Dr. Marianne Berry, conducted research on the use of IFPS with post-adoptive families in a project funded by a grant from the Annie E. Casey Foundation. Data on IFPS were provided by the state of Missouri.

The published research included these key findings:

• Services focused primarily on parent/child conflict, communication problems, the child’s emotional problems, and school problems.

Variable (N = 99)

n

%

Primary Problem Addressed in Adoption IFPS Intervention
Parent/child conflict

62

62.6

Communication skills

47

47.5

Parenting skills problems

47

47.5

Emotional problems

22

22.2

Physical abuse

19

19.1

Mental health problems

19

19.1

Pregnancy

13

13.1

School problems

13

13.1

Medical illness/disability

8

8.0

Physical violence

8

8.1

Delinquent behavior

7

7.1

Child neglect

4

4.0

Severe financial problems

3

3.0

Criminal behavior

2

2.0

Sexual abuse

2

2.0

Marital conflict

2

2.0

Runaway

2

2.0

Drug abuse

1

1.0

Developmental disability

1

1.0

Shelter

1

1.0

Other

10

10.1

• 83% of the adoptive families studied were preserved by the end of IFPS. At a 6-month follow-up point, 76% remained intact. No families contacted at the 6- or 12-month follow-up checks had legally disrupted.

Table 9: Case Outcomes

Variable (N = 99)

n

%

Type of Placement Originally Anticipated
Foster Home

42

42.4

Residential

39

39.4

Relative Care

7

7.1

Psychiatric Hospital

5

5.1

Detention

5

5.1

Emergency Shelter

1

1.0

Placement
No placements

82

82.8

Prior to IFPS services

9

9.1

During IFPS services

2

2.0

After IFPS services cease

6

6.1

• The adopted children who were most likely to experience placement during or after IFPS were those who were significantly older and IFPS was being used to reunify the family, rather than avert placement. Placement rates were highest for children served for delinquent or criminal behavior, running away, or where the family was experiencing physical violence, severe financial problems or medical illness or disability.

• The content of training for preservation workers who work with adoptive families is significantly enhanced with information of special importance to adoptive families. These content areas include grief and loss, attachment, parental expectations, and ways to enhance the parental characteristics of patience, flexibility, humor and acceptance.

• Findings from this study indicate the need for greater availability of IFPS services to adoptive families, given placement prevention rates in the 80% + range, and high parental satisfaction.

Click here to get the full report on IFPS with Post-Adoptive Families:
http://nfpn.org/articles/ifps-with-post-adoptive-families

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Posted by Priscilla Martens, NFPN Executive Director

IFPS and Evidence-Based Practice, Part 2

Last week we introduced the topic of evidence-based practice.  This week we look at how the state of Washington is implementing evidence-based practice that includes IFPS.

In 2012 the Legislature passed E2SHB 2536 with the intent that “prevention and intervention services delivered to children and juveniles in the areas of mental health, child welfare, and juvenile justice be primarily evidence-based and research-based, and it is anticipated that such services will be provided in a manner that is culturally competent.”  Washington is one of the few states to have enacted a law for implementation of evidence-based practice. You can view the legislation here:
(PDF, 29Kb) http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/House%20Passed%20Legislature/2536-S2.PL.pdf

Two independent research groups were designated to create an inventory of  evidence-based, research-based, and promising practices and services.

One of these research groups, the Washington State Institute for Public Policy (WSIPP), had previously conducted an extensive review of IFPS.  WSIPP reviewed all rigorous evaluations of IFPS programs that included a comparison group and then sorted the evaluations based on fidelity to the Homebuilders® model. IFPS programs with high model fidelity had a significant reduction in out-of-home placements of children and produced $2.59 of benefits for each dollar of cost. IFPS programs that did not adhere to the Homebuilders® model produced no significant effects.  You can view the full study here:
(PDF, 45Kb) http://www.wsipp.wa.gov/rptfiles/06-02-3901.pdf

Because fidelity of IFPS programs to the Homebuilders® model is key to their effectiveness, it’s important for the IFPS field to be informed of the fidelity measures.  The more familiar measures include

  • 24/7 availability,
  • caseload of 2 families at a time,
  • meetings with family 3–5 times a week, and
  • services provided for 4 weeks.

Other measures include

  • standards for supervisors,
  • comprehensive assessment,
  • goal setting and service planning,
  • engagement and motivation enhancement, and
  • cognitive and behavioral approach.

For a complete list of the Homebuilders® fidelity measurs and accompanying performance measures, see:
(PDF file, 82Kb) http://www.institutefamily.org/pdf/HOMEBUILDERS-FidelityMeasures-Abridged-2-6.pdf

If your agency is considering implementing or strengthening an IFPS program, you can easily incorporate these standards and performance measures into the design.

Washington State is the birthplace of the Homebuilders® program and thus state policy makers had access to a good example of evidence-based practice. Homebuilders® IFPS is included in two places in the current state inventory of evidence-based programs. You will note in the inventory chart (see link below) that Intensive Family Preservation Services (Homebuilders) is the fourth item in the child welfare category and is ranked as an evidence-based program (top ranking). It is also listed in the mental health category under “serious emotional disturbance” as a research-based practice, based on a single evaluation. You will find the rankings for many other familiar programs in the chart.

WSIPP Inventory Chart:
(PDF file, 66Kb) http://www.wsipp.wa.gov/rptfiles/E2SHB2536-3i.pdf

We have seen in this series of posts how evidence-based practice has developed and where IFPS fits in. The field of IFPS is heavily dependent on the Homebuilders® model of IFPS for its inclusion in evidence-based practice. Charlotte Booth and Shelley Leavitt at the Institute for Family Development (parent agency of Homebuilders®) have spent decades building, maintaining, and training on model fidelity, and contributing data on their program. You can join me in publicly thanking them by posting a comment below.

Thank you, Charlotte and Shelley and all IFD staff, for your dedication and commitment to make IFPS one of the most effective programs for families!

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Posted by Priscilla Martens, NFPN Executive Director