Trauma-Informed Care in Child Welfare Practice

New research is demonstrating the effectiveness of trauma treatment models for families involved in the child welfare system.

Trauma Systems Therapy (TST) is an especially promising model for use in the child welfare system. It is a research-based, therapeutic model designed to improve functioning of children exposed to trauma. Child Trends conducted a research study in Kansas and found that children whose care teams had been trained in TST demonstrated significant improvements in well-being (behavioral and emotional regulation, functioning) and placement stability.

Child Trends also evaluated Trauma Systems Therapy for Foster Care. Resource parents receiving the training were more likely to keep their homes open to foster children, and children were less likely to experience a placement disruption.

Another model, ARC Reflections, teaches resource parents skills to enhance child well-being, stability, and permanency. It is based on Attachment, Self-Regulation, and Competency. Five North Carolina child welfare agencies tested the model. Resource parents showed significant increase in knowledge and skills about trauma-informed parenting and tolerance towards children’s misbehavior along with praise for positive behavior.

A summary of the Child Trends Evaluation of trauma-informed care for the child welfare system is available here: https://www.childtrends.org/trauma-informed-care-initiatives-show-promise-improving-practice-child-welfare-system/

Information on Trauma Systems Therapy is available here: https://med.nyu.edu/child-adolescent-psychiatry/research/institutes-and-programs/trauma-and-resilience-research-program/trauma-systems-therapy

The Trauma Systems Therapy manual is excellent training for both therapists and non-therapists as it is hands-on and interactive. Purchasing information is available here: https://www.guilford.com/books/Trauma-Systems-Therapy-for-Children-and-Teens/Saxe-Ellis-Brown/9781462521456

NFPN has an assessment tool for Trauma/Post-Trauma Well-Being with details here: http://www.nfpn.org/assessment-tools/trauma-assessment-tool

Posted by Priscilla Martens, NFPN Executive Director

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Federal Funding for Preserving Families

Following nearly two years of consideration, the Family First Prevention Services Act was passed by Congress as part of the Bipartisan Budget Act of 2018 (H.R. 1892).

Starting October 1, 2019, all states for the first time will have the option of using foster care funds (Title IV-E) to pay for prevention services, or, more precisely, keeping families together. Those eligible for the prevention services include children (and their parents/kin caregivers) 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. Funding is an entitlement meaning that it will be available for any services that are eligible for reimbursement.

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 must be trauma-informed
• services and programs that are evidence-based (promising, supported, or well-supported practice as defined in the legislation with a pre-approved list to be developed by the Dept. of
Health and Human Services)
• services provided for a maximum of 12 months
• states will be reimbursed for 50% of the cost of services, staff training, and the administrative costs for developing processes and procedures

Each child receiving services must have a written plan that identifies the strategy for keeping the child out of foster care and the services that are needed. States must include a well-designed evaluation for any practice used unless they receive a waiver based on compelling evidence of effectiveness. States must also document how they are tracking and preventing deaths from child abuse and neglect.

The legislation 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:
• allows children to receive unlimited reunification services while in foster care
• children returning home from foster care will have access to 15 months of reunification services

A detailed summary of the legislation prepared by Children’s Defense Fund is available here: http://www.childrensdefense.org/library/data/family-first-detailed-summary.pdf

Posted by Priscilla Martens, NFPN Executive Director

Resources for Preserving Families

The mission of the National Family Preservation Network (NFPN) is to serve as the primary national voice for the preservation of families. In fulfilling our mission, NFPN has conducted research studies on family preservation and has developed over 50 resources to assist those who work with families. Information on the research and resources is available on the website at http://www.nfpn.org.

The field of family preservation has evolved over the past decades through, for example, research findings being translated into best practice, the use of reliable and valid assessment tools to measure family functioning, and the addition of booster/step-down services. Statewide evaluations of Intensive Family Preservation Services (IFPS) and periodic national surveys of IFPS provide data on the components and outcomes of effective intensive services.

In addition to research and resources, NFPN offers training and technical assistance on family preservation and in-home services. In recent years, we have focused more on video and online training. NFPN’s newest offering is video training on substance abuse and in-home services, a timely training in the midst of the opioid epidemic. Highlights of the training include effective therapeutic techniques and an interview with a mother recovering from substance abuse and reunifying with her children.

Here are descriptions and links to a selection of resources offered by NFPN, including the most popular ones:
IFPS ToolKit : Comprehensive guide for the development and maintenance of strong and effective IFPS services http://www.nfpn.org/preservation/ifps-toolkit

IFPS Nationwide Survey (2014): Comparison of high-quality IFPS programs in 12 states http://www.nfpn.org/preservation/2014-ifps-survey

Reunification Model: NFPN’s recommended model for intensive family reunification services http://www.nfpn.org/Portals/0/Documents/ifpspaper.pdf, starting on p. 11.

Continuous Quality Improvement: CQI instrument to ensure ongoing quality of IFPS programs, http://www.nfpn.org/preservation/cqi-ifps-instrument

Video training: Training on substance abuse for in-home services practitioners http://www.nfpn.org/videos/substance-abuse-and-in-home-services

Reliable and valid assessment tools for use with families: http://www.nfpn.org/Portals/0/Documents/assessment_tools_overview.pdf

Please contact NFPN (director@nfpn.org, 888-498-9047) if you need assistance with resources, T/TA, or wish to place an order. Our doors are always open for family preservation!

Posted by Priscilla Martens, Executive Director

Milestone Year

The National Family Preservation Network (NFPN) is wrapping up its 25th year of operation. We’re happy and grateful to continue fulfilling our mission as the primary national voice for the preservation of families.

The Preserving Families Blog is a mouthpiece for our voice. This past year the Blog has focused on key elements of preserving families such as assessment, nationwide surveys of Intensive Family Preservation Services, model programs, gatekeeping, safety, reunification, and federal funding for family preservation.

In 2018 we will be studying the opioid epidemic and collaborating with agencies to do everything possible to strengthen and preserve families involved with substance abuse.

Thank you for everything that you do to help families.

Merry Christmas and Happy New Year!

Posted by Priscilla Martens, Executive Director

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

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