Evaluation of the New York City Home Rebuilders Demonstration

IMPLEMENTATION OF THE HOMEREBUILDERS DEMONSTRATION

Chapter 2 - Continued
2.5 Implementation Practices and Procedures

Contents of This Section

1. Fiscal Issues
2. Program Staffing
3. Caseloads
4. Training
5. Case Processing
6. Assessment and Prioritizing Cases
7. Roleof Foster Families and Kin
8. Discharge Planning
9. Aftercare

While the new funding mechanism was prescribed, the Interagency Steering Committee spent long hours discussing such practice issues as staffing, training, prioritizing cases, and caseload size. Agencies were encouraged to rethink service delivery and make decisions about how to achieve the HomeRebuilders objectives. It was incumbent upon each agency to develop its implementation plans.

2.5.1  Fiscal Issues

An inherent characteristic of the planning and implementation of HomeRebuilders was the coordination of program and fiscal staff in the agency. The flexibility of spending permitted agencies to individually determine a plan which balanced additional expenditures against savings from reduced care day usage. As one director describes it, this was a new "marriage" of budget and program staff. Virtually every program and budget administrator described the value of this new relationship. The following reflects how this relationship was operationalized.

Three Year Staffing Plan. The HomeRebuilders capitation funding required that agencies consider staffing, not in the context of static yearly caseloads, but in relationship to a fixed caseload of children moving in and out of care for the three year period. Under the traditional per diem rate, each agency budgets for a fixed level of children in care, expecting that children discharged each month will be replaced by new entrants. Minimal dollars are budgeted for aftercare for children who are in trial discharge. Under the capitation methodology, the agency was held responsible for its assigned fixed number of children for the three year period, for those in-care, and for preventing those out-of-care from returning.

Discussions with participants suggest that several upfront decisions had to be made in staffing the project to meet this new challenge. This included caseload sizes for in-care caseworkers, aftercare workers, hiring and designation of specialized staff such as substance abuse workers and housing specialists, and a plan for the adjustment of staffing ratios over the course of the demonstration period.

For example, Little Flower developed a staffing model for the three years based on expected discharge rates of children. The model included caseloads of eight families (15 children) per caseworker, one parent aide per two caseworkers, a supervisor per every four caseworkers, and increasing ratios of aftercare workers for up to 18 months after trial discharge. While they anticipated an immediate and gradual decline in the number of in-care caseworkers, there would be an increase in the need of aftercare workers. The total number of caseworkers would not begin to decline until the end of the first year.

In most agencies, the typical turnover and attrition rate was expected to make the necessary staff shrinkage palatable to staff during the last two years of the program. Little Flower replaced some staff during the first year and consolidated units as staff left during the last two years. At St. Christopher­Ottilie, an adoption worker was assigned to the project during the third year because of the unexpected shift of children to the adoption track. The executive director also felt that a higher supervisor ratio was needed for HomeRebuilders, but was unable to implement it. Further discussion about each agency's staffing decisions is provided in section 2.5.2.

Monitoring of Expenses Against Expected Length of Stay. The fiscal director at each agency used the expected rate of increased discharge each year (10 percent), to monitor their success in the demonstration and to monitor budget expenditure. Each agency developed periodic reporting to match expected number of discharges to actual number. At Little Flower, there appeared to be more intensive monitoring. They did not use the provided state CCRS data, but built an actuarial file of the children's length of stay from their own database. They monitored the expense and compared the number of actual discharges to the expected number and reviewed them case-by-case with program staff monthly. Unfortunately, they felt the monitoring process was hindered by the demands the city placed on the agencys' budget staff. Budget staff were required to provide detailed child-by-child expenditure data to reconcile the HomeRebuilders rates with the rates applied to the remainder of the agencies' children.

Three agencies spoke specifically about the need for better software and information tools to manage expectations about length of stay. Beyond the data provided by DSS, the information system must collect data on important characteristics of the children and their families that might affect length of stay. Suggested variables include substance abuse problems of the caregiver, death or incarceration of the caregiver, positive toxicology at birth for the child, and presence or severity of child abuse or neglect as reason for placement.

Flexible Spending. The demonstration allowed agencies to be more flexible in their expenditures for each case. They were not restricted to room and board, the primary categories of IV-E reimbursement, or the city's standards of payment. As stated by the fiscal director at Little Flower, "budget is usually the 'abominable no-man', but not in HomeRebuilders." For example, cars for visitation were made exclusively available to HomeRebuilders workers at this agency.

At New York Foundling, to expedite reunification, special funding was budgeted for trainers, housing, adoption attorney time, family social activities for visitation, and emergency household funds for such items as furniture, clothing, and food. Miracle Makers reported that new streamlined procedures for obtaining emergency funds were instituted. St. Christopher­Jennie Clarkson used flexible funding to pay rent for families. Staff reported that the usual city housing subsidy often took an inordinate amount of time to access and HomeRebuilders allowed the agency to enter into individual contracts with landlords. Obtaining adequate housing for families was often cited as a barrier to reunification, and this flexibility allowed the agency to alleviate a problem that hindered children from returning home.

The flexible funding allowed agencies to be reimbursed for services to families, not specifically directed at the child in care. At Little Flower, the use of case aides and additional training for foster parents permitted the use of birth parent visitation at the home of the foster parent and not always at the agency office. St Christopher­Ottilie also used flexible funds to train foster parents as aides/mentors to birth parents.

Although each agency implemented the concept of flexible spending somewhat differently, all caseworkers had more flexibility in service provision. Some were allowed to request cash to help a family buy groceries, clothing, prescriptions, other necessities, transportation to see their children, or activities during visitation. The total amount of money was limited at each agency. Realizing that funds were being used too rapidly, some agencies tightened access to these funds as the demonstration progressed. Prior to the end of the demonstration, some agencies did run out of flexible funds.

Agency Consideration of Financial Risk. Agency financial risk depended upon the extent to which agencies invested money upfront to develop resources and whether the dollars expended were recouped through fewer care days. If an agency believed they could cut care days by 10 percent and this translated into expected availability of one-half million dollars for new services, anything less than a 10 percent reduction could be a financial loss. A board of directors governs each of the participating agencies. The financial risks of the demonstration had to be presented and approved by each agency's board. At Little Flower, the board was initially concerned that the city and state would not follow through on their commitments. They requested monthly reports on the project. They were more supportive after the success of the first year. The Board of Directors at St. Christopher-Otillie required that an independent auditor verify the actuarial baseline for the capitation. Once completed, the board felt the risk was acceptable and proposed care day reduction achievable. No other agencies reported any board hesitancy for support of the program.

Several agencies stated that they had not anticipated the shift in the number of cases to adoption. Little Flower identified two problems in the planning. First, the 1988-1992 historical data used by the state did not reflect the policy shift toward adoption in the 1990s in New York City. Second, in their budget modeling, they used their internal electronic data and did not account for the added time and expense for adoption. In fact, the agency comptroller suggested that the early ending of the program might have protected them from the adoption costs that were accrued after the project ended early. At New York Foundling, the Fiscal Director senses that adoption goal decisions were made more expeditiously under HomeRebuilders. He was concerned about the legal costs, additional days in care during the adoption process, and the extra caseworker time required for adoption cases. Miracle Makers was not as affected by adoption shifts, since they served many kinship families which had slower rates of adoption.

Per Diem versus Capitation Payment for Service. The DSS sets a maximum state aid rate for each private agency's foster care program. The city then determines whether it will pay a percentage or the full amount of the maximum state aid rate. Agencies were concerned that the city would change the payment rate and upset the capitation rate set for HomeRebuilders. The city developed an understanding with each agency to hold the agency harmless from any system-wide reductions during the demonstration. Also, each agency would benefit from a system-wide increase during the period. In fact, the 1994-1995 city budget initiative reduced the foster care rate paid by the city. Reimbursement for children in the HomeRebuilders program was held harmless from the reduction. However, the children in the control group and the rest of each agency had their rates reduced. Agencies experienced revenue reduction and several agencies reported agency cash flow problems.

Medicaid per diem. Plans for the demonstration also called for a capitation rate for Medicaid payments for children in the project. The state agreed to fund applicable Medicaid payments at the current rate for actual care day usage and provide additional Medicaid funding at 65 percent of the current rate for each day saved, compared to historical usage pattern. For example, if during HomeRebuilders, an agency used 200 fewer care days than expected, the agency was to be paid 65 percent of their current Medicaid rate for the 200 days. In discussions with fiscal directors, it was not clear that most agencies made modifications in their budgets to use this extra funding. Little Flower budgeted for a medical HomeRebuilders Team that enhanced mental health staffing for children and families in the HomeRebuilders group.

Reconciliation of Per Diem/Cash Flow. The city reimbursed agencies on a quarterly basis. Agencies considered the methods for HomeRebuilders reimbursement cumbersome and burdensome. They were paid in two components following bill submissions: the regular agency per diem for each day a HomeRebuilders child spent in care, and a HomeRebuilders add-on to bring the year's total up to the agreed capitation amount. Agencies spoke of delays and requests for expansive justification of amounts each quarter. Two agencies reported hiring additional budget staff just for this function.

One agency, Miracle Makers, reported that it experienced cash flow problems during the second year as a result of the delays in payment. They decided to suspend some of the HomeRebuilders features including real estate security deposits for families and emergency cash funds for birth families. In addition, they chose to not fill vacant staff slots, including the budgeted, but never filled slot for a housing specialist. The agency's comptroller suggested that morale problems began at this time, with the rumor of layoffs from the program.

At the end of the year, each agency had to reconcile yearly expenditures with the city and state. At Little Flower, there was a deficit during the first year in relation to the planned 43 percent of total budget.As agreed, the state did a reconciliation and adjustment of the 3-year expenditure plan. The other five agencies were more conservative in their approaches and underspent during the first year. Unfortunately, this artificial surplus resulted in confusion in the city's fiscal office and delayed payments for the five agencies, according to one agency fiscal director.

2.5.2  Program Staffing

A HomeRebuilders project director was identified for each of the experimental programs. Within each program there were units with approximately four to five caseworkers to one supervisor. Each caseworker was the primary person responsible for a set of clients.

Experimental Group Caseworkers. Four of the six agencies, St. Christopher­Ottilie, Little Flower, Harlem Dowling, and Miracle Makers, recruited caseworkers specifically for the experimental group. The criteria set for these caseworkers were at a higher level than for the comparison group. For example, some agencies stipulated that the caseworker have at least 1 year of experience and good writing and assessment skills. Some of the directors stated that they looked for "mature" staff. Little Flower and Harlem Dowling paid the experimental group staff higher salaries. In part, the higher salary was because the staff had either more credentials or were more experienced. Although the administrators at St. Christopher­Jennie Clarkson did not specifically hire new staff at the beginning of the HomeRebuilders program, staff were expected to adhere to the set of beliefs that were promoted through the HomeRebuilders program. Staff who weren't able to or didn't agree with the philosophy of the program were let go. At New York Foundling, because the agency assigned cases by location, the existing staff at each location served as the experimental and comparison group staff.

Specialists. Each agency hired a number of specialists for the experimental group. Table 2-2 summarizes the area of expertise of the staff that were hired specifically for the HomeRebuilders program. As shown, a wide variety of specialists were hired to implement the program; the number of specialists ranged from 4 at Miracle Makers and St. Christopher­Ottilie to approximately 22 at St. Christopher­Jennie Clarkson, excluding caseworkers and aftercare workers. The agencies assessed the needs of their clients in relation to the services already in place at the agency. Almost all of the agencies found a need to hire additional housing and substance abuse specialists. In addition, the six agencies mentioned 16 other specialists that were hired to implement the HomeRebuilders model.

Table 2-2.  Type and number of specialists hired for the HomeRebuilders Program

A.  This person provided support to the experimental caseworkers for cases in which the goal changed from return to home to adoption.
B.  This person served the experimental and the control group.
C.  During the study, these two positions were combined.
D.  23 were trained over the course of the program.

The comparison group, except as noted for Miracle Makers, did not have access to these specialists. In addition to the specialists, some of the agencies had individuals or clinics that served both the comparison and the experimental groups. Some examples of these services included in-house or affiliated medical and preventive health clinics and staff, social support groups, mental health staff, dentists, attorneys to work on case processing, visiting nurses, Healthy Start programs, and housing programs.

2.5.3  Caseloads

In some agencies, the caseworkers in the experimental group had lower caseloads with the expectation that families would receive more attention from the caseworker. Two methods were used by the agencies to count caseloads in the experimental group. During the study, some of the agencies began to count the number of families for each caseworker, while the remaining agencies continued to count the number of children served by a caseworker. The agencies tried to place all siblings in either one home or in the same neighborhood. This allowed the caseworker to get to know each child's foster parent and environment a little better and to reduce the amount of time traveling from home to home.

Table 2-3 shows the number of children or families served per caseworker for the experimental and comparison groups. At Harlem Dowling, the control group was divided into two units: a foster care unit and an adoption unit. Although each caseworker had the same caseload of 29-35 children, both units are listed because the units were programmatically different. The comparison group at St. Christopher­Ottilie also reported having a foster care and an adoption unit prior to July 1994, but assigned a different number of children per caseworker in each unit. Little Flower reported both the number of children and the number of families assigned per caseworker in the experimental group. Finally, New York Foundling reported assigning 18 children per caseworker and 15 children or 5 to 10 families per aftercare worker in the experimental group. In its comparison group, it reported assigning 18 children per caseworker during the study and increased that number to 22-24 children after the project ended.

Table 2-3.  Comparison of Average Caseloads of
Experimental Group and Comparison Group

* St. Christopher­Ottilie:  The staff ratio changed to 18 children to 1 caseworker 7/94; prior to that time the ratio was 18:1 for foster care and 21:1 for adoption.

In four of the agencies, the experimental group had lower caseloads than the comparison group. The caseloads for the caseworkers at New York Foundling appeared to be equal for the experimental and comparison groups during the demonstration. However, at all of the agencies, the experimental group had more support from other staff (e.g., housing specialists, aftercare workers, drug rehabilitation specialists, etc.).

Since 1994, there has been a significant drop in the number of children in foster care in the city, apparently due largely to a decrease in admissions to care. As a result, the non-HomeRebuilders caseloads of the agencies involved in HomeRebuilders declined. In addition, as agencies worked toward a shorter length of stay for clients, planned reductions in HomeRebuilders staff were supposed to occur as the cases were closed. In combination, these phenomena resulted in downsizing or displacement of workers. Downsizing did not occur smoothly at most of the agencies, and this was probably a major factor negatively affecting staff morale. For the most part, downsizing was accomplished by moving staff to other positions in the agency or not refilling positions that were vacated.

The director at Little Flower reported that one month the administration spoke to the staff about eliminating positions and moving people to different positions based on the number of reunifications that had occurred. That month the staff recommended no children for reunification. The administration attributed this lack of recommending reunification to the staff's fear of losing their jobs. At Miracle Makers, the administration anticipated this same problem. Therefore, the administration told the staff that the success of the demonstration would determine their future positions at the agency. Caseworkers were told that the least productive staff would be the first to be reassigned or eliminated from the agency. The administration believed that this was both an honest approach and that it provided an incentive for workers to achieve results with families.

The staff at St. Christopher­Jennie Clarkson seemed to tolerate the downsizing fairly well. During the second year of the program, the agency's revenue was reduced by 22 percent. To adjust to this reduction, many of the clerical staff were eliminated, and the staff were given computers. The housing specialist position was eliminated, and one of the administrators took on those tasks as an addition to his workload. This was done deliberately to show the staff that the administration would change its workload to compensate for the loss of revenue.

The interviews that were conducted after the demonstration ended revealed that the staff morale in three of the agencies was very low. For example, at one agency, the caseworkers said that they had been promised that if they worked hard during the first 2 years of the program, they would not be given new cases during the third year of the program. They were counting on having this reduced caseload in order to concentrate on the remaining cases (which were the most difficult) and to have a chance to work at an easier pace. However, these caseworkers stated that as a result of downsizing, cases were redistributed and therefore their caseloads did not decrease. At another agency, the morale of the experimental group staff seemed high, but the morale of the comparison group was low. Further questioning revealed that the comparison group had lost more staff through attrition. Administrative staff and caseworkers at a third agency also reported low morale. They believed that the combination of downsizing and the unexpected budget cuts in the entire agency in 1995 severely hurt staff morale.

2.5.4  Training

Training was most prevalent during the first year of the demonstration. To orient the staff to the HomeRebuilders program, in June 1993 a training conference was held at Fordham University to kickoff the project. Individuals from each of the six agencies attended. A general session was held to teach staff members how to complete the assessment tool that was to be completed for each family in the experimental and comparison group. Also, a variety of workshops were offered at the conference including:

• Quality Management
• Family Network Intervention
• Family Centered Empowerment
• Family Practice
• How to Identify and Locate Community Resources
• Involving Foster Parents in Building Partnerships To Reunify Families
• Visitation-A Central Theme in HomeRebuilders
• When is a Family Ready for Reunification?
• The Effective Use of Self To Empower Families

Approximately one year later, there was a second joint training session for all of the agencies. This training session was designed to boost morale and to emphasize important constructs of the HomeRebuilders model. In addition, each agency held training sessions for its staff and in conjunction with other agencies involved in the project. Some of the topics included cultural diversity and impact on multicultural families, conflict resolution and team building, working with disorganized families, separation and loss, and working with medically fragile children.

During the interviews, one agency administrator spoke about the importance of time management skills for his administrative staff.Another agency gave a detailed description of the types of training sessions that it held at the beginning of the program. The administrator stated that individuals from the Annie E. Casey Foundation led some of the training sessions and that information from the book Teaching Family Reunification:  A Sourcebook (Child Welfare League of America) was used. Another agency received training from the Child Welfare Institute (CWI) in Georgia.

The following list contains the topics mentioned by all of the participants. It demonstrates the breadth of topics covered and reflects an emphasis on improving a wide variety of staff skills. The topics were taken from several different family service models (e.g., Oregon Model, CWI).

• The importance of visitation
• The belief that children could go home
• Defined family reunification
• Review of family therapy techniques
• How to provide good casework by utilizing local resources
• Techniques that promote trust between the family and caseworker
• Assessment and interviewing techniques
• How to conduct a family service plan review
• How to provide aftercare
• What permanency planning means to children
• Visitation as a training tool
• How to involve foster parents
• How to interview substance abusers
• Time management skills
• HomeRebuilders philosophy
• Team building
• Access to entitlements
• Case management
• Case planning
• Stress management
• Family consciousness training based on the Oregon Model

Table 2-4 describes the level and type of training that was held at each agency. As shown, two of the agencies held mainly joint training sessions for their administrators and caseworkers. Among the other agencies, the proportion of training time administrators spent on administrative issues was approximately one-third to three-fourths of the session time, while caseworkers spent the majority of their training session time on client issues (approximately 65 to 85 percent of their training time).

Table 2-4.  Frequency and focus of HomeRebuilders training sessions

2.5.5  Case Processing

All of the agencies had similar case processing procedures, following those set forth by the city and state. All cases were placed into care by the New York City CWA and CWA had case management responsibility.

A CWA worker was assigned as the case manager to each case to provide authority for the case planning developed at each agency. Case planning included service assessment, provision, arrangement, coordination and evaluation. For the HomeRebuilders group, the caseworkers were required to work closely with CWA. The CWA workers generally visited the agency once or twice a month and participated in case review and planning. When there was a good relationship between the caseworker and CWA worker, the process went fairly smoothly. Usually a positive relationship was the result of the same individuals having an opportunity to work on a series of cases together. Sometimes one or two CWA workers would be assigned to a particular agency. This allowed agency staff and CWA workers to get to know each other and to get to know each others' philosophy on HomeRebuilders and views of when it was safe to return a child to the parent.

2.5.6  Assessment and Prioritizing Cases

At the beginning of the project in 1993, provider agency workers completed an assessment form on cases in the experimental and comparison groups. The assessment form contained information on family composition, the child's foster care placement, and court actions. It contained information on the child's physical and mental health, development, and education. Each agency was to administer the demonstration-wide assessment to every case in the experimental and comparison groups. The assessment revealed inadequate access to substance abuse counseling, housing and housing assistance programs, lengthy processing requirements associated with finalizing adoptions, and a lack of aftercare resources for children returned home. However, most of the agencies did not find the assessment particularly helpful; a common complaint was that it was too long. Some of the agencies reported that caseworkers in both the experimental group and comparison group were to be paid $25 for completing the assessment; however, in most agencies the comparison group money was not funded. Some of the agencies also developed their own assessment instruments or used other standardized assessments.

Another intended use for the assessments was as a tool to prioritize cases and, at the start of the study, at least half of the agencies developed prioritization procedures. As discussed earlier, all agencies were encouraged to develop triaging plans to prioritize service delivery (see Section 2.2). The rationale behind the priority system was to determine which cases had been languishing in the system with problems that could be solved relatively quickly. Little Flower divided its cases into two categories, fast movers and slow movers, and worked on the fast moving cases first. Harlem Dowling categorized families by the number of problems they had: red flag families had six problems, yellow flag families had four to six problems, and green flag families had two or three remaining problems. The plan was to first provide services to those with fewer problems. St. Christopher­Jennie Clarkson determined which families needed housing and established a goal of finding a family a home within 4 weeks. Staff indicated that this helped to discharge many families during the first year of the study. Miracle Makers indicated that it attempted to look at cases with one pending situation (needed housing or completion of parenting program) and worked to rectify that problem to move toward reunification. However, interviews revealed that this prioritization was not implemented consistently. St. Christopher­Ottilie and New York Foundling said they did not prioritize cases. Instead, New York Foundling implemented a rigorous case review process for each case, and St. Christopher­Ottilie used the city's required service plan reviews augmented by administrative review.

2.5.7  Role of Foster Families and Kin

Foster parents and kin who assume responsibility for the children are an important permanency resource for children in New York City. Many foster parents enter the program with the intention of adoption or long-term placement. At the beginning of the demonstration, letters were sent to the foster parents (and to the biological parents) explaining that one of the main goals of the HomeRebuilders program was to reunite children with their biological parents, and this concept was expressed throughout the course of the study. However, when reunification was not possible and the goal was changed to adoption, in most cases, the foster family or the kin who had primary responsibility for the child became the adoptive parent. In some cases, the foster parent became the adoptive parent because of failed intervention with the families prior to HomeRebuilders. In these cases, it was not feasible to reverse the legal efforts already under way to free the child for adoption.

Many of the agencies indicated that some of the foster parents had difficulty accepting the goal of returning the child to his/her home. This concept was most difficult for foster parents who had already had the children in their care for a considerable period before the start of the study. For example, one administrator related a story of a father offering his child a piece of candy in the presence of the foster parent. The foster parent admonished the father in front of the child for giving the child candy. The administrator quickly stepped in and reminded the foster parent of her role in the situation. Another administrator stated that as a group, the foster parents in their Long Island locations were less willing to trust the biological parents than the foster parents in Brooklyn. This administrator believed that cultural values played a role in this mistrust. Other foster parents enjoyed a close working relationship with the birth parents and caseworkers and felt more valued working as part of a team. In fact, in some cases after the child returned to the birth parent, the foster family continued to support the family by babysitting and being a mentor. There are even cases where the birth parent asked the foster parent to serve as the child's godparent. At one agency in particular, there appeared to be a great difference between the experimental group and the comparison group in the relationship between the foster parents and birth parents. In the experimental group, interaction was actively promoted, with the opposite happening in the comparison group.

All of the agencies required foster parents in the experimental group to take a mandated 6 week training course. However, the agencies also offered additional training. Some agencies offered the foster parents and biological parents in the experimental group joint training sessions that focused primarily on birth parent issues. Other agencies invited both comparison and experimental groups to the sessions.

2.5.8  Discharge Planning

The HomeRebuilders program guidelines allowed a mix of services to achieve permanency, including counseling, day care, homemakers, or any other service needed to stabilize the family immediately before or after reunification. In short, agencies were given greater flexibility concerning how money that would otherwise be used to purchase space in the foster care system was spent on services to the family.

Each agency was allowed to design its own discharge planning and aftercare program. However, all of the programs were required to contain certain elements. For example, families were required to actively participate with the provider to plan discharge and coordinate post-discharge services. In general, the agencies followed the guidelines prescribed in city and state rules and regulations regarding case management. Family readiness was evaluated (see each agency's description below) and when the timing was appropriate, the family met with the caseworker, the CWA worker, and other staff members such as supervisors and other support staff to write a discharge plan. Families progressed from weekend visits to extended visits. The final discharge was usually preceded by a trial discharge period of up to 3 months. The case would close at this point, depending on whether other children were still in foster care or if contracted or court-ordered in-home services were still being provided to the family.

Miracle Makers stated it enhanced the HomeRebuilders program with guidelines from the HomeBuilders family preservation model. The agency followed the guidelines very closely and believed that this aided in the reunification of families. These guidelines included more "hands on" management with the parents. For example, workers would go into the homes of the parents and determine if there was a need for cleaning or budgeting skills. In the process, the caseworkers would wash dishes, help paint a room, show parents how to do laundry, assist parents with budgetary matters, and teach them how to shop more cost-effectively. The administrator stated that the process reduced the return to care rate in the experimental group to approximately 2 percent and believed that the rate was higher in the control group.

A St. Christopher­Ottilie administrator stated that there was no difference in guidelines for discharge planning for the experimental and comparison groups. As reported in Chapter 3, this agency's comparison group actually had more case closings during the first two years, but by the end of the experiment, proportions of closings were similar. The administrator attributed the difference that was found in the first year to the fact that the comparison group families remained with the same caseworkers, while the experimental group was assigned new caseworkers specifically for the project.

A St. Christopher­Jennie Clarkson administrator stated that family readiness for reunification was determined by the level and quality of involvement exhibited by the families. The agency held readiness classes and gave the following example to describe how it measured readiness. "If a family showed up to the Saturday family days that was step one. If they showed up on the Saturdays in between family days, we took it as a sign that they were more interested. If they showed up with food for their child it meant even more." Before a child was returned to the parent, a discharge plan was made. Part of the plan included an "ABC Plan" with A representing a plan for everything working out well; B, the parent relapses; and C, the parent relapses and returns to an abusive partner. Scenarios for all the plans were worked out ahead of time with the parent. The administrator acknowledged a degree of risk in this alternative planning but valued reunification as worth taking a certain amount of risk.

An administrator from Little Flower stated that during HomeRebuilders good case planning took place. As at all of the agencies, the staff considered the safety of the child first. During the case conference, they reviewed the reasons for initial placement and ensured that those issues were no longer barriers for reunification. Then outcome statements were written. Since HomeRebuilders ended, this level of case planning is no longer occurring.

A New York Foundling administrator reported that specific guidelines on case closing were not developed. Case reviews were initiated on an as-needed basis, and parenting skills and readiness to reunite were evaluated on an individual basis. Case reviews were conducted monthly and attended by the program director, supervisor, caseworker, and any specialist involved in the case.

Harlem Dowling also stated that families were assessed for their ability to provide a safe and nurturing environment. The guidelines were the same for the experimental and control group; however, they were followed more intensely for the experimental group. In general, bonds with the foster care workers were stronger, and there was more teaching and modeling for the families in the experimental group. While working with the families, administrators said that caseworkers were informally measuring progress. Also, the staff evaluated families' linkages to family and community supports, their progress in addressing problems such as substance and alcohol abuse, the interactions between the parent and child, and the child's progress in school. During the first 2 years of the program, children in aftercare were closely followed. However, during the third year almost no aftercare took place.

2.5.9  Aftercare

Continuing support to families after they had been reunited was another key component of the HomeRebuilders program. The goal of this component was to empower families so they were able to access resources available within their communities and thereby promote less dependence on the agency and more support from the community. A hypothesis of HomeRebuilders was that stronger aftercare would allow earlier discharge of children from foster care. The frequency of visits by a caseworker during aftercare varied from family to family (Table 2-5). Some agencies reported that some families had contact with the agency several times per week, while others only spoke with agency personnel occasionally. At all agencies except Miracle Makers, families determined the frequency unless the caseworker believed that the situation was dangerous (this is reflected in Table 5 as "as needed"). Also, many families went through periods of needing more attention. At Miracle Makers, for both the control and the experimental group, the caseworkers who provided services while the child was in foster care visited the family at home during the first 2 months of aftercare. If the family continued making satisfactory progress, during the third month the family was contacted by phone. Three agencies reported providing aftercare services to the comparison group for 3 months. However, it is unclear whether these were truly aftercare services or whether they were normal services provided during the 90 day trial discharge period.

In three of the agencies -- Harlem Dowling, New York Foundling, and St. Christopher­Jennie Clarkson -- a separate caseworker provided aftercare services. At Miracle Makers, the philosophy was that the caseworkers were already invested in these families and had gained the trust of the parents. For the families, this eliminated the need to confide in yet another person. In other agencies, using a different caseworker during the aftercare period allowed each set of caseworkers to work on different issues to reduce caseworkers' loads and thereby allow them to concentrate more on their assigned cases. When the method worked well, caseworkers discussed the cases with each other and the transition went smoothly. However, at least one agency reported serious personal conflicts between the aftercare worker and the other caseworkers. This conflict led to a breakdown in services to families.

Table 2-5.  Provision of aftercare during HomeRebuilders