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Family Preservation and Disproportionality

One of the most challenging issues of the social services system is addressing disproportionality. The National Council of Juvenile and Family Court Judges tracks disproportionality in the child welfare system. The Council defines disproportionality as the level at which groups of children are present in the child welfare system at higher or lower percentages or rates than in the general population. An index of 1.0 reflects no disproportionality. An index of greater than 1.0 reflects overrepresentation. An index of less than 1.0 reflects underrepresentation.

The index in 2013 was as follows:
African American 1.8
White .8
Hispanic .9
Asian .1
Am Indian/AK Native 2.5

The index shows how disproportionality is concentrated in African American and American Indian/Alaska Native families. In 1978 Congress addressed disproportionality of the latter through the Indian Child Welfare Act (ICWA). Casey Family Programs released a compliance study of ICWA in 2015. They reported that there are inconsistent and varying degrees of state compliance with ICWA. There is no federal oversight or enforcement of the law. A lot more needs to be done to preserve Indian families and their culture.

There is no federal law regarding African American disproportionality. In Minnesota, the state United Black Legislative Caucus is introducing the African American Family Preservation Act. The legislation aims to improve outcomes for black families involved with child protection, including by keeping more children with family members and relatives.

While there are various initiatives and programs to address disproportionality, one program has already been demonstrated effective in reducing disproportionality. In a large study of Intensive Family Preservation Services (IFPS), over 30,000 children in one state’s child welfare system were categorized by race, risk, and services received. The results were as follows:
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.

Why is IFPS effective in reducing disproportionality? Here are some principles of IFPS that contain some answers:
1. The family is the best resource for the nurture, care, and well-being of children.
2. The most durable way to help children is to help their parents.
3. Keeping families safely together, whenever possible, must be the highest priority of government laws, policies, and funding.
4. Because the integrity of the family is critical to its functioning, services to families must primarily focus on keeping families together or reunifying families when out-of-home
placement is necessary.
5. Services provided in the home demonstrate respect for families and allow for optimal assessment of needs and delivery of services.
6. Families must be assessed for strengths as well as weaknesses. Strengths can be used to help address weaknesses.
7. All members of the family must be offered services, including fathers, whether residing or not residing in the home. Involving fathers can have a beneficial effect on both the
children and the children’s mother.
8. Families must be involved in decisions about every aspect of an intervention: safety, assessment, goals, services, progress, placement (if necessary), and outcomes.
9. Families must be empowered through services, not kept dependent on them. Services should be provided only until the family is stabilized and has the necessary skills to remain safely
together. Families can then choose whether or not they want additional services.
10. We owe families the best possible services at the lowest cost to whoever is paying for the services. All services must be evaluated for their effectiveness and cost-benefit.

Posted by Priscilla Martens, NFPN Executive Director

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Family Preservation and Evidence-Based Practice

The National Family Preservation Network (NFPN) was founded in 1992 to serve as the primary national voice for the preservation of families. At that time, our voice promoted Intensive Family Preservation Services (IFPS). These services are targeted to families with children at imminent risk of placement in foster care. The first comprehensive evaluation of IFPS was funded by the federal government in 1989. Findings included that families showed improvements on 26 of 28 problems affecting family functioning.

Thirty years after that study states are planning implementation of the federal Family First Prevention Services Act targeted to families with children at risk of imminent placement in foster care. We’ve come full circle! What have we learned through research in the past 30 years about preserving families and preventing unnecessary placement of children?

The earliest research on IFPS was quite favorable but subsequent research in the early 1990’s was flawed with respect to design and implementation. From about 2000 on, research has found IFPS to be effective in terms of placement prevention and cost-effective in comparison to the costs of foster and residential care. NFPN has conducted 6 research studies involving IFPS, all of them demonstrating the effectiveness of IFPS.

IFPS has also been used as a successful intervention with reunifying families. The earliest study, conducted in 1995, had a treatment and control group. Families received IFPS services for 90 days. At the end of the intervention, 92% of the treatment group had returned home compared to 28% of the control group.
For an overview of research on IFPS for both preservation and reunification, see the section “Research on IFPS” in the IFPS ToolKit: http://www.nfpn.org/preservation/ifps-toolkit

Recall that the first study of IFPS included measures of family functioning. Dr. Ray Kirk (University of North Carolina, Chapel Hill) designed a family functioning tool for IFPS, the North Carolina Family Assessment Scale (NCFAS). NFPN partnered with Dr. Kirk on subsequent versions of the tool, including one of the first assessment tools for reunifying families. There is a wide body of research on the assessment tools establishing their reliability and validity. NFPN has conducted 7 research studies, all successful, involving the NCFAS tools. For an overview of the studies on the NCFAS assessment tools visit http://www.nfpn.org/assessment-tools/ncfases-scale-development-report

The Family First Prevention Services Act requires that all programs receiving the 50% federal matching funds meet Evidence-Based Practice criteria. The issue for IFPS programs is that in recent years states have largely developed their own models that are not yet validated as Evidence-Based Practice through research findings. Thus, states will need to conduct research studies in order to establish their IFPS programs as Evidence-Based Practice and qualify for the federal funding.

NFPN stands ready to assist states in this endeavor. Please contact Priscilla Martens, Executive Director, director@nfpn.org, 888-498-9047.

Posted by Priscilla Martens, Executive Director

Wrapping up 2018

During this past year, the Preserving Families blog looked at trauma, kinship care, opioids, reunification, and the federal Family First Prevention Services Act.

The Family First Act appears to have been custom-designed for Intensive Family Preservation Services (IFPS). Both Family First and IFPS target children who are at imminent risk of out-of-home placement in order to prevent unnecessary placement of children and help families stay safely together. IFPS has been in use for many years and is highly effective at keeping families together.

The federal Administration for Children and Families (ACF) is issuing implementation policies for Family First. All services and programs funded by Family First (50% federal matching funds) must be Evidence-Based Practice and approved by a clearinghouse. ACF has selected 10 programs for initial review and approval by the clearinghouse. Unfortunately, no model of IFPS was selected for initial review. States need to conduct their own research to establish IFPS programs as Evidence-Based Practice.

For more information on implementation of Family First and the clearinghouse visit https://www.cwla.org/wp-content/uploads/2018/12/ACYF-CB-PI-18-09-State-FFPSA-Prevention-PI.pdf and https://www.cwla.org/wp-content/uploads/2018/12/ACYF-CB-PI-18-09-Attachment-C-Clearinghouse-Initial-Criteria.pdf.

ACF is also issuing guidance on other aspects of child welfare. One long-overlooked critical aspect of court involvement in child welfare is reasonable efforts. ACF is breathing new life into reasonable efforts after years of neglect: “evidence remains scarce based on round 3 of the Child and Family Services Review, court observation work conducted across the country by Court Improvement Programs, and current trends in child welfare outcome data that reasonable efforts determination is treated with the rigor or seriousness required under the law.”

Federal law requires courts to determine whether the child welfare agency has made or not made reasonable efforts to prevent the removal of children from their parents. Early on, reasonable efforts were often defined as providing IFPS services to a family. Currently, reasonable efforts have nearly faded into oblivion. Yet, 98% of appeals following termination of parental rights raise the issue of reasonable efforts. Thus, reasonable efforts is only being raised as a legal requirement when it’s too late!

For more details read Judge Len Edwards perspective on reasonable efforts at https://chronicleofsocialchange.org/top-stories/ignoring-reasonable-efforts-why-court-system-fail-promote-prevention

Read the ACF guidance on reasonable efforts here: file:///C:/Users/User/Documents/Reasonable%20Efforts–ACF.html

There will be a lot more to come next year on the Family First Act, reasonable efforts, and other critical issues. In the meantime, thank you for making “beyond reasonable efforts” in helping to preserve families!

Merry Christmas and Happy New Year!

Posted by Priscilla Martens, Executive Director

Where Can I Find An Assessment Tool For Trauma?

Most government funded programs now require trauma-informed care. Providing trauma-informed care requires assessing for trauma, and it can be challenging to find an assessment tool for trauma. So let’s take a look at a trauma assessment tool with established reliability and validity.

The Trauma and Post-Trauma Well-Being tool is a pre/post measure with two domains.

The Trauma domain assists workers to become aware of the symptoms and indicators of trauma and to assess for trauma and the degree of severity.
The Trauma domain comprises the following subscales:
• Traumatic Sexual Abuse of Child(ren)
• Traumatic Physical Abuse of Child(ren)
• Traumatic Neglect of Child(ren)
• Traumatic Emotional/Psychological Abuse of Child(ren)
• Parent/Caregiver Trauma
• Overall Trauma

The Post-Trauma Well-Being domain focuses specifically on recovery and healing of children after trauma has occurred, on the status of the parent/caregiver following trauma to the parent/caregiver and/or the child, and on the parent/caregiver’s ability to support the child during the recovery/healing period.

The Post-Trauma Well-Being domain comprises the following subscales:
• Post-Traumatic Cognitive and Physical Well-Being of Child(ren)
• Post-Traumatic Emotional/Psychological Well-Being of Child(ren)
• Post-Traumatic Social Functioning of Child(ren)
• Post-Trauma Parent/Caregiver Support of Child(ren)
• Post-Trauma Parent/Caregiver Well-Being
• Overall Post-Trauma Well-Being

Now let’s look at the Trauma tool in action. In a research study involving family preservation programs in three states, families made substantial progress following treatment for trauma symptomology.

About 80% of the families had one or more trauma indicators. Neglect of children, emotional/psychological abuse of children, and parent/caregiver trauma had the highest percentages of moderate and serious problem ratings.

Following treatment, at case closure there were significant improvements in all aspects of child well-being and in parent/caregiver well-being.

To read the complete report, visit:
http://nfpn.org/trauma-report

The Trauma tool was designed for use with complementary assessment tools that measure family functioning: The NCFAS-G is used with intact families and the NCFAS-G+R is used with reunifying families. If your agency is currently using one of these NCFAS tools, then you may purchase the Trauma tool separately. If not, you can purchase one of the NCFAS tools along with the Trauma tool.

For more information on the Trauma and NCFAS tools visit http://nfpn.org/assessment-tools

Posted by Priscilla Martens, NFPN Executive Director

IFPS as EBP

This month the federal Administration for Children and Families (ACF) announced that Abt Associates will serve as the clearinghouse that establishes the list of evidence-based programs approved for use under the Family First Prevention Services Act. The clearinghouse plays a critical role because federal matching funds of 50% will be available only to programs on the clearinghouse list. The Family First legislation defines three levels of evidence-based programs and each level requires that a comparison group be included in the research studies.

Let’s look at an example of a comparison group using Intensive Family Preservation Services (IFPS) as the program in a large-scale study that was conducted in the state of North Carolina.
The study employed a retrospective design meaning no one had prior knowledge of the study and thus no opportunity to influence the data or case practice that could interfere with the reliability of the findings.

The study included 1,265 children who received IFPS services compared to over 110,000 children who did not receive IFPS but did receive other services. The children receiving IFPS were at higher risk than the comparison group in terms of risk assessment, prior substantiated reports of child abuse/neglect, and prior out-of-home placement.

Despite the high-risk factors of the children receiving IFPS, these children had 20-30% fewer out-of-home placements than the comparison group throughout the entire measurement period.

The study did find that the treatment effect of IFPS may diminish post-treatment and recommended that follow-up services be offered 4 to 6 months post-intervention. Most exemplary IFPS programs now provide booster sessions or step-down services.

The Family First Prevention Services Act is ideally suited for IFPS programs because the children eligible for the Family First services must be at imminent risk of entering out-of-home placement, the same criteria used for IFPS services. It’s too early to know which IFPS programs will meet the criteria to be included in the list that the clearinghouse develops. But IFPS program administrators and contracted providers can anticipate that funders and policy makers will ask whether or not their IFPS program is evidence-based. A good starting point is to refer inquirers to the research literature on IFPS.

The study referenced in this post is available here: http://www.nfpn.org/preservation/effectiveness-study

The author of the study, Ray Kirk, also has a PowerPoint summary of 4 IFPS studies that he presented at the National Child Welfare Evaluation Summit: https://www.acf.hhs.gov/cb/capacity/program-evaluation/summit-2011/session3

Posted by Priscilla Martens
NFPN Executive Director

A Quick Guide to IFPS

With the arrival of the new fiscal year for the federal government and many state governments, agencies are implementing new programs.  One of the most effective programs is Intensive Family Preservation Services (IFPS).  Here’s a quick guide to IFPS that includes online references and resources.

Intensive Family Preservation Services are concentrated, in-home services designed to prevent placement of children at imminent risk of removal.  For a detailed description of these services, visit http://www.intensivefamilypreservation.org/about/

While IFPS programs may vary to some extent, high-quality programs have these components in common:

  • Immediate response within 24 hours
  • Accessibility of staff 24 hours a day, 7 days a week
  • Small caseloads (2 to 4 families)
  • Intensive interventions (8 to 10 hours per week)
  • Service delivery in the family’s home and community
  • Short-term services (4 to 8 weeks), to be followed by other support services
  • Hard & soft services delivered by the same worker
  • Focused on teaching skills

 

States with exemplary IFPS programs incorporate the IFPS components into their RFPs and standards.  To compare 12 states with exemplary IFPS programs see http://www.nfpn.org/preservation/2014-ifps-survey

After reviewing the exemplary state programs, agencies can move to establishing their own IFPS program. The IFPS ToolKit is a comprehensive guide that covers over a dozen issues addressing implementation:  http://www.nfpn.org/preservation/ifps-toolkit

After implementing an IFPS program, it’s important to assure continuous quality.  Here’s a tool to do that: http://www.nfpn.org/preservation/cqi-ifps-instrument

Also critical to assure quality is an annual program evaluation and Missouri provides an example of a statewide IFPS evaluation: http://www.nfpn.org/preservation/state-resources

There is a substantial body of research on IFPS.  The gold standard for research is a randomized control trial (RCT).  Everyone interested in IFPS should be familiar with the RCT on IFPS conducted in Michigan:   https://www.michigan.gov/mdhhs/0,5885,7-339-73970_61179_8366-21887–,00.html

IFPS is also used for reunification services.  The IFPS ToolKit has a section on this issue and a recommended model of service: http://www.nfpn.org/preservation/ifps-toolkit

Every IFPS program needs a reliable and valid assessment tool to assist with determining needs, setting goals, selecting services, and assuring good outcomes.  The NCFAS assessment tools were specifically designed for use with IFPS. For more information visit http://www.nfpn.org/assessment-tools

The majority of families in the child welfare system are involved in substance misuse.  NFPN has a video training to assist working with these families: http://www.nfpn.org/videos/substance-abuse-and-in-home-services

 

Posted by Priscilla Martens

NFPN Executive Director

Kinship Care–Best Practice

The increase in kinship care in recent years means that those who provide services to kin caregivers will need training and other support. The Child Welfare Information Gateway Bulletin, “Working with Kinship Caregivers” (June, 2018), provides a good starting place: https://www.childwelfare.gov/pubPDFs/kinship.pdf.

Federal law requires agencies to consider placement with kin when a child is removed from the home. About 2.6 million children in the U.S. are in some form of kinship care. Kinship care ranges from an informal arrangement between the parent and the relative to a formal placement by a child welfare agency that has legal custody of the child. Kinship foster homes may be either unlicensed or licensed. If licensed, the relative must meet foster home licensing and training standards and is paid the same as a nonrelative foster home.

Kinship care has the following benefits:
• Ongoing connections with a child’s birth family, extended family, siblings, and community—bonds that are essential to well-being
• Preservation of cultural identity (Generations United, 2016)
• Higher likelihood siblings will remain together
• Greater placement stability than for children in other out-of-home care arrangements

In order to help kinship caregivers make good decisions regarding the child, kin workers need to provide information about licensing options, the court process and the kin’s role, and resources. An assessment opens the door to determine the strengths and needs of the kin caregiver. It’s especially critical to explore family dynamics in terms of the kin caregiver’s relationship with the child’s parent and how to resolve safety and compliance issues. A family-centered practice approach to working with kin empowers them and gives them ownership of their issues.

Model programs for kin placements have these features in common:
• Presumption that placement of the child will be with kin
• Immediate and diligent search for family members
• Licensing waivers for kin homes for nonsafety issues
• Connection of kin to any needed services (frequently requested are financial assistance, day care, behavioral intervention, crisis management)
• Referral to support groups

The Annie E. Casey Foundation, in cooperation with Joseph Trumbley, has developed a five-part video training series to build skills specific to working with kin families. It’s available here: https://www.aecf.org/blog/engaging-kinship-caregivers-with-joseph-crumbley/

Helping kin understand the impact of their caregiving in terms of health, stress, and emotional stability is essential. Here is a list of resources addressing those issues: https://www.childwelfare.gov/topics/outofhome/kinship/resourcesforcaregivers/impact/

Here are details on an upcoming training on kinship care offered by CWLA: https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=CWLA&WebCode=EventDetail&evt_key=67b14325-ac1d-46d8-a2fb-d0c79f7ca7aa.

Posted by Priscilla Martens
NFPN Executive Director