Evaluation of the New York City Home Rebuilders Demonstration

IMPLEMENTATION OF THE HOMEREBUILDERS DEMONSTRATION

Chapter 2

Contents

1. Background
2. The Planning Phase
3. Overview of Each Agency
   • Harlem Dowling
   • Little Flower
   • New York Foundling
   • Miracle Makers
   • St. Christopher-Jennie Clarkson
   • St. Christopher-Ottilie
   • Summary
4. Characteristics of the Families Served
5. Implementation Practices and Procedures
6. Other Initiatives During HomeRebuilders
7. Public and Private Agency Perspective on HomeRebuilders
8. Summary

The information presented in this chapter is based on interviews during four separate time intervals. The first set of interviews took place between January 1996 and June 1996. During this period, staff from Westat and James Bell Associates conducted site visits to each of the six agencies that participated in the project: Harlem Dowling, Little Flower, New York Foundling, Miracle Makers, St. Christopher-Jennie Clarkson, and St. Christopher-Ottilie. Both administrative staff and caseworkers were interviewed. The second set of interviews was held between December 1996 and February 1997. Chapin Hall conducted in-person and follow-up telephone interviews with public agency staff from New York City and New York State. The third set of interviews was held with one to three administrators at each agency via telephone from June through August 1997. Finally, in-person and telephone interviews were held with program and fiscal administrators in February 1998. These interviews were conducted to review and clarify study findings. This chapter documents the implementation of the HomeRebuilders Demonstration from the public and private agency participant perspective. Whenever possible, multiple sources were used to confirm information; however, it must be noted that this chapter represents the opinions voiced at each agency. In addition, the data were collected retrospectively. The study began approximately two and one-half years after the HomeRebuilders program was initiated, close to the time that funding for the program ceased. Therefore, all of the interviews were conducted after the program ended. The effect this had on the interviewees' comments is not known.

2.1 Background

As in other areas of the country, New York experienced an unprecedented growth in its foster care population during the last half of the 1980s. Poverty, lack of education, AIDS, and the effects of crack-cocaine were some of the primary causes for new cases entering the system. Growth was also due to an increase in the length of time children remained in foster care. Between 1986 and 1990, the number of children in foster care in New York State rose from 27,000 to 65,000 (an increase of 140 percent), placing stress on the foster care system. This surge in the foster care population brought a renewed sense of urgency to the ongoing debates within child welfare regarding the role, availability, and effectiveness of program, and about funding for foster care and preventive services. There was concern that not enough service emphasis was being placed on the "back end of the system," those children remaining in foster care.

In response to these needs, the New York State DSS began the HomeRebuilders Demonstration Project, a 3-year collaborative effort among the state, the City of New York CWA, and six voluntary (private) child care agencies. The project was scheduled to run from July 1993 to June 1996. However, the project ended in December 1995, 6 months early.

The demonstration tested an alternative to the per diem method of agency reimbursement. This alternative was tested because some critics of the child welfare system argued that the per diem reimbursement mechanism slowed the discharge of children. Under the HomeRebuilders program, agencies were paid a flat amount of money, or capitation payment, instead of being paid for each day in care. The state calculated a 3-year projection of care day utilization based on each agency's historic care day usage. Agencies could spend the money on a combination of placement and social services, depending on the needs of the child and his or her family. The capitation-like payment was designed to give the agencies flexibility and still maintain accountability for quality service delivery. This funding scheme could also stimulate agency investments in services that could lead to early discharge from placement, resulting in fewer days spent in care. In particular, the funding strategy was designed to allow agencies to increase their aftercare services.

It was hypothesized that the change in the payment system would achieve earlier permanency for children through intensified discharge planning and aftercare services. If the program was successful, children in the HomeRebuilders program would spend less time in foster care than a comparable group of children not in the program. A goal of reducing time in care by 10 percent was set. Besides reducing care days it was also expected that participants would experience a reduced rate of reentry when compared with historical patterns and a suitable comparison group.

The funding for the HomeRebuilders program was based on a 3-year projection of care day utilization. Funds were frontloaded, that is, money that would have been spent in the second and third years of the project was moved to the first year so that discharge planning and aftercare services could be intensified in years 1 and 2. Funding also included a feature that permitted agencies to carry cash deficits or cash surpluses from one year to the next during the 3-year period.

The HomeRebuilders demonstration was intended to be cost-neutral for agencies, the city, and the state in regard to foster care payments for children. Funding for the comparison group used the traditional per diem mechanism, a payment for each day in care. Agencies were paid by the city, based on rates calculated by the state. A capitation rate was determined for the 3-year demonstration project based on a 3-year history of care day usage by the subpopulation in each agency. An allocation strategy was agreed upon to pay agencies up to 43 percent in the first year, 34 percent in the second year, and the balance in the third year.

Title IV-E of the Social Security Act provides for federal participation in the costs of foster care room and board and associated training and administrative costs. These funds may not be used for services to promote reunification or other outcomes. During the planning of HomeRebuilders, New York State officials worked with Congress to develop legislation that would authorize use of Title IV-E funds for the HomeRebuilders project. This legislation (included in the Urban Aid Bill) was passed by both houses but vetoed by President George Bush in November 1992. Despite this setback, the state determined to move forward, and the city and participating agencies were assured the project would proceed.

2.2  The Planning Phase

In September 1991 the state and city met with the directors of six selected agencies to propose the radically new funding mechanism that became HomeRebuilders. Subsequent talks were held and one of the agencies dropped out of further involvement. This agency was primarily involved in providing congregate care and determined that the proposed reimbursement structure would not be beneficial. Representatives from the remaining five agencies along with staff from the city and state became known as the Interagency Steering Committee. The committee met at least once a month during the planning stage, during which time the city and state officials involved (notably Claude Meyers and George Gabel from the city and Don Smith and Fred Wulczyn from the state) became convinced of the commitment of the agencies to the project. A sixth agency was added to the group after the planning process had begun. The six agencies were Harlem Dowling, Little Flower, Miracle Makers, New York Foundling Hospital, St Christopher-Ottilie, and St. Christopher-Jennie Clarkson. These agencies included both Catholic and Protestant affiliated organizations.

Executives or senior program managers represented the six agencies. The committee addressed policy and organizational issues. Major topics discussed included clarification of legal and programmatic aspects of aftercare, program evaluation, cash flow and fiscal risk, community-based service delivery, identification of target populations, and triaging of services to families. Initially, the HomeRebuilders program was conceptualized as a reunification program. In some of the agencies, there were not enough cases with a reunification goal and the program was expanded to include adoption cases. The inclusion of adoption cases broadened the scope of HomeRebuilders beyond reunification to permanency more broadly.

Planning meeting discussions frequently focused on service triaging. In the medical profession triaging refers to servicing cases based on the severity of the problem. Treatment is directed where it will do the most good. For the HomeRebuilders demonstration, triaging also meant sorting cases by severity of the problem, and the concept was used to identify those cases that would most likely be reunified or adopted if services were provided. Agencies were encouraged to develop a framework to (1) establish criteria for identifying children who were most likely to be reunified or adopted, (2) communicate the criteria to staff, and (3) support staff through developing new resource options. Historically, service provision was based on availability of service and eligibility of the child and his family. Coupled with the new options provided through flexible spending, triaging was introduced as a new way to prioritize and deliver services. Service decisions were not to be based on "categorical need," but on whether the service helped reunification occur faster and more securely.

The steering committee discussed the barriers related to reunification and struggled with identifying criteria that separated children who were "short stayers" from "long stayers." This concept was critical to identifying families that might benefit from quick intensive intervention versus those for whom intervention would unlikely produce reunification.

The committee discussed triage as the key component of budget planning within a capitation setting. Agencies were challenged to develop strategies to meet their overall goals of reduced care days. For example, agencies might triage by identifying a small number of families they felt could be discharged earlier if appropriate services were provided. Investment could be made to reunify families quickly and then work hard to avoid recidivism. Although agencies might expend extra money upfront, savings were to be accrued by having these families reunified throughout the 3-year project. Another option might be to put in place services that focused on reunifying more families by gradually trying to improve the timeliness of each discharge throughout the three years. This might entail targeting specific problems (e.g. housing) which create barriers to reunification rather than classifying families as short or long stayers. Each agency then designed implementation procedures around their decisions about how to prioritize cases. As discussed later, some agencies made broad changes while others changed only slightly.

Some program staff were concerned that triaging could be interpreted as denying services to families who were not selected for specialized service. Also, agency staff questioned whether the differentiation of services for the experimental and comparison group could be considered negligence and lead to lawsuits. In fact, legal staff were drawn into the discussion and the conclusion was that HomeRebuilders was a demonstration and until evaluated, no one could be sure that the program was delivering better services.

Steering committee discussions also addressed issues of organizational culture. How do you help caseworkers and city case managers go from an environment of categorical funding to triage? Areas of training and need for supervision were emphasized. Most participants agreed that all the debates and discussions were vital training for executives planning to participate in a demonstration of any managed care principles.

Once the demonstration began, the steering committee continued to meet, although less frequently. In addition to the steering committee, a program directors committee was established. This committee also included direct service representation from each of the six agencies, the state, and the city. This group focused on operational issues of implementation. Special attention was given to training and interagency coordination. Several program directors described this committee as a unique experience that struggled with solving problems. In particular, the tension around meeting target goals pressed members to bring issues to the table and share recommendations for quick resolution. This committee continued to meet regularly during the entire project.

The steering committee established criteria for the characteristics of children to be included in the demonstration. For the most part, the agencies were allowed to choose which of their sub-populations would be sampled for the demonstration. Agencies made their population selections based on adequate population size and programmatic interest. The state required that each agency choose criteria to ensure that the population size was adequate to select a sample of 400 children.

During the planning stage, the state led discussions to help each agency understand the city's and each individual agency's historical pattern for discharges and readmissions. The impact on length of stay on age of children, whether the children were in relative care, and whether the children had a permanency planning goal of adoption were considered.

Table 2-1 depicts the final agreed upon criteria for each agency with respect to age, permanency goal, type of placement, time in care, and the number of children assigned to the control and experimental groups. Case characteristics of study populations varied by agency. Children's ages ranged from younger than 12 to 17 years old. Two agencies included only children in foster boarding homes, with a permanency goal of return to home, while the remaining agencies included children with the goal of adoption. These same four agencies included children in both foster boarding homes and approved relative placements. Four of the agencies included children who were in care for more than 90 days, while the remaining two agencies included all children.

Table 2-1.  Assignment of Children

* After 1 month of participation, the agency placed the remaining children in the experimental group.  This increased its total to 484.

Key:  RTH = Return to Home; ADP = Adoption; FBH = Foster Boarding Home; ARH = Approved Relative Home; IND. LV. = Independent Living.

The demonstration was originally designed with procedures for random assignment of children to either a comparison group that received the regular services offered at the agency or an experimental group that used the HomeRebuilders model. Every attempt was made to assign all siblings from one family to the same group. Three agencies, Miracle Makers, Little Flower, and Harlem Dowling, used random assignment procedures. Two agencies, St. Christopher-Ottilie and New York Foundling, divided the comparison and experimental groups based on agency sites. One agency, St. Christopher-Jennie Clarkson, placed all of its children in the experimental group.

From the beginning, HomeRebuilders was viewed by all state officials interviewed as a unique and creative example of managed care that provided new ways to think about planning, rate-setting, and practice. The model broadened people's thinking about program design and rate setting and the relationship between the two. HomeRebuilders was seen as an important initiative for the field of child welfare. Respondents clearly recognized the importance and potential cost saving of programs that addressed the back end of the system (i.e., rates of foster care discharges and reentry into the system) and length of stay.

City officials did not accept the concept with the same enthusiasm; their reaction was mixed. Some of the administrators liked and wanted to test HomeRebuilders as a financing strategy, and they noted that HomeRebuilders forced fiscal and program directors in the agencies to manage care together by looking at data on outcomes. Case management staff liked the new roles and responsibilities that were being created for case managers. This constituted a fundamental change in the role of case managers who previously monitored paperwork and did not go into the field. On the other hand, some city officials saw HomeRebuilders as a state initiative, one that was too expensive and did not save money.

Private agency administrators understood that the state's overall goal was a reduction in the number of children in foster care. They believed that the goals set by the state were appropriate and within reach. The state's goal for HomeRebuilders was seen as a positive step toward families and communities. Most of the agency administrators believed that the city's goals were never as clear as the state's. HomeRebuilders was seen as the state's idea. Initially, the administrators believed that the city showed much resistance to the program. Some administrators believed that the city accepted the state's goals while others believed the city did not.

2.3  Overview of Each Agency

HomeRebuilders was implemented differently by each agency. To begin to understand how each agency embraced the intervention, we provide an overview of each agency's stated purpose for the demonstration; steps taken to implement the project; and a chart summarizing each agency's major initiatives, population, and general programming.

• Harlem Dowling
• Little Flower
• New York Foundling
• Miracle Makers
• St. Christopher-Jennie Clarkson
• St. Christopher-Ottilie
• Summary

2.3.1  Harlem Dowling

At the beginning of the program, the executive director of Harlem Dowling, Melba Butler, saw HomeRebuilders as an opportunity for change. She felt that the city and state were moving in a family-oriented direction and that was the direction she wanted her agency to take. Therefore, she and her staff looked at the various models that were being used internally at the agency and pulled together a model they thought was workable. Ms. Butler believed that if the agency chose a model that incorporated strategies already known to work at the agency, there was a greater chance to continue the model after HomeRebuilders ended.

Ms. Butler believed HomeRebuilders "changed the urgency with which we could or should treat reunification. We found ways to cut the red tape, creative ways to provide services, and have workers trained in the concepts behind HomeRebuilders." Early in the project, agency meetings were held to inform staff about its implementation and requirements. Procedures were established to help ensure that caseworkers adhered to the programmatic recommendations to move cases forward. These procedures included meetings between caseworkers and their supervisors and oversight by management.

According to Ms. Butler, the success of the program was to be realized through the number of children reunified and adopted. The original target for Harlem Dowling's experimental group was for 40 percent of the children to be adopted, 10 percent by kin. Ms. Butler indicated that there was a shift during the program to change some children from the goal of reunification to either adoption or kinship placement. By the end of the program, the permanency planning goals of children had shifted to 80 percent adoption. The shift occurred mainly in the second year. Ms. Butler believed that the goals changed to adoption at a quicker rate in the HomeRebuilders group (as opposed to the control group) because the HomeRebuilders group examined the families more intensively during the first year and therefore knew sooner which goal they believed was best. HomeRebuilders put adoption proceedings on a different track, attempting to overcome obstacles, and the agency moved swiftly toward final adoption. The goal was changed to adoption when "we felt we couldn't reunite with parent or kin." Under HomeRebuilders, the agency was less likely to extend the time the children spent in foster care. The goal was a move toward permanency. Finally, Ms. Butler stated that the HomeRebuilders model didn't change the agency's philosophy toward independent living or toward kinship placements. The agency had always looked at families as caretakers. However, the program may have intensified the delivery of services a little.

The director of the Harlem Dowling HomeRebuilders program stated "the HomeRebuilders model distinguished the experimental group from the control group by focusing on case management rather than casework." She also noted that HomeRebuilders focused on the whole family and kinship support instead of being child centered. For example, money toward living expenses was provided to the family rather than being limited to financial assistance for the child's needs. Other distinguishing factors included offering housing assistance and hiring a staff person to focus on drug rehabilitation. This administrator believed that services offered through HomeRebuilders shortened the process of meeting goals by approximately 3 months.

2.3.2  Little Flower

To implement the HomeRebuilders demonstration, Little Flower undertook a 6-month strategic planning process carried out by a task force comprising of supervisors from departments throughout the agency. The task force concentrated its efforts on developing a paradigm, organizing a vision, developing guidelines for needed training, and soliciting staff input.

The agency's philosophy for the HomeRebuilders program was based on three principles. These principles follow the general philosophy of HomeRebuilders, and, in general, staff were chosen for the program based on these criteria.

1. A belief that children should return home whenever possible. This involved taking a chance with families, returning children home on a trial basis, and monitoring closely through aftercare. Agency management reported that the few staff members drawn from the adoption unit had the most trouble adapting to this concept.
2. An understanding of cultural differences. Staff members needed to be adaptable to build on family strengths associated with different cultures or circumstances. Using extended families to make contact with birth families or returning families to kin were cited as examples.
3. Seniority and the ability to elicit respect from other staff were important. To be part of HomeRebuilders, staff were required to have been with the agency for at least 1 year.

John Courtney, the associate executive director during the program, but no longer with the agency, stated that HomeRebuilders did not change Little Flower's philosophy on permanency, it was always a major emphasis. Case goals were changed when the agency staff believed that placement with parents was no longer a viable option. With permanency the ultimate goal, the agency then moved toward adoption. He also stated, "There was no planned shift from the goal of reunification to either adoption or kinship placement, and it didn't happen to a large degree. The agency conducted a monthly comparison between the experimental and the control group, and found in the control group that more cases had changes in their goals than in the experimental group. At the end of the study, the experimental group caught up somewhat, in part because the caseworkers knew the project was coming to the end. A renewed emphasis was placed on closing cases and this pushed the experimental group to change some of their cases to the goal of adoption. Few children moved to kinship placement in either group." From the beginning, a concerted effort was made to include all levels of staff in planning, service delivery, and monitoring case progress.

* NOTE:  There were clusters of offices at each location in Brooklyn, NY and Wading River, Long Island.

2.3.3  New York Foundling

New York Foundling summed up its philosophy by saying it was committed to permanency. Staff defined the difference between the experimental and control groups as the extent to which they sought to speed up permanency. According to the administrators, on average, the experimental group finalized goals earlier than the comparison group, in part because parents' rights in the experimental group on average were terminated earlier.

The program director, Luisa Doyle, discussed how the HomeRebuilders model changed the agency's philosophy on permanency. She believed that the intensified services offered during the first few months of placement were a critical component for reunification. The agency promoted the belief that no obstacle was too big to overcome, and it could help families overcome obstacles and care for their children. Also, intensive aftercare services were seen as a key factor. Aftercare could continue for 3 months to 2 years after reunification. In many cases, the goal of independent living was not affected by HomeRebuilders. However, in other cases, because of the change in philosophy, caseworkers reevaluated whether the goal of independent living was appropriate and instead began reexploring families as discharge resources.

The adoption process was given as much priority as reunification. Caseworkers began to complete the adoption process requirements (e.g., homestudy, subsidy, etc.) as soon as the case goal was changed to adoption. Prior to HomeRebuilders, the agency would begin this process after the child was freed for adoption. During HomeRebuilders, the agency did not allow long-term care for kinship families. If return to parent was not an appropriate goal, the agency promoted adoption. If the kinship family did not want to adopt, then the agency promoted discharge to the custody of kin. The agency also negotiated more conditional surrenders for adoption for these cases. Conditional surrenders allow parents to maintain certain rights such as continuing visitation. This change was conducive to the agency's philosophy in that it helped shorten the length of stay for children in foster care.

2.3.4 Miracle Makers

According to William Wren, Executive Director, Miracle Makers' philosophy did not radically change as a result of its involvement in the HomeRebuilders' project. However, the philosophy was greatly enhanced. Miracle Makers is a community-based organization that emphasizes working with families and considers family reunification its fundamental objective. The HomeRebuilders project provided a great impetus and focus to pursue this goal in a more collaborative approach among management, supervisors, caseworkers, birth parents, and foster parents.

As in other agencies, Miracle Makers was keenly aware of the fragmentation of services for families within the community. The agency staff strongly believed that if the program were to prove successful, other policy initiatives would be necessary. For example, housing and employment were critical resources, and without them family reunification was difficult to achieve. The shortage of other resources and the quality of other programs such as day care, aftercare, and preventive services were also critically important to the success of the program.

In the initial stage, some cases with goals of adoption were changed to reunification. These were cases where the parents were considered marginally involved in planning toward reunification. The heightened focus on family reunification and the diligence of the caseworkers based on the HomeRebuilders philosophy resulted in a significant degree of optimism toward reunification. In some cases, however, this created problems with foster parents who were anticipating adoption. There were also problems engaging foster parents to work in partnership with birth parents. Foster parents were informed of the program changes, and many embraced the principle. However, they found it difficult to put these ideas into practice when the shift in focus became reunification. This was especially true for cases where the child or children had been in care for a considerable amount of time and the foster parents' expectation was adoption.

There was no significant philosophical shift with regard to kinship families because the agency had always viewed and engaged the extended family network as an important resource to achieve permanency. HomeRebuilders did have an effect on independent living. The program led to the realization that there were limited resources available to young people leaving care. Post HomeRebuilders' efforts are being made to address this problem. Miracle Makers is in the process of establishing permanent and short-term housing and related resources and in-home training and support to redress this problem.

2.3.5  St. Christopher-Jennie Clarkson

Prior to the start of the demonstration project, Luis Medina became executive director of St. Christopher-Jennie Clarkson. His vision was to create a family-centered approach to rebuild families, and that biological parents are the pillars of the family. He strongly believes that the HomeRebuilders model was an appropriate vehicle for his vision. During an interview he stated, "Parents remain parents even while their child is in foster care." Parents were strongly encouraged to be responsible for maintaining regular contact with the agency, being active participants in identifying the issues that needed to be addressed, and demonstrating through their actions that reunification was their goal. For example, to promote this interaction, staff wore beepers so that parents had 24 hour a day access to staff. Also, much emphasis was placed on ensuring that staff treated families respectfully and that services were delivered as promptly as possible. Foster care parents were asked to serve as mentors and friends to the biological parents. This concept was stressed during a mandatory 6 week course that individuals took to become foster parents. Also, when feasible, the agency worked closely with the extended families. Finally, after children were discharged, families were encouraged to maintain regular contact with the agency. The caseworkers stated that they called families at least every other month to find out how they were doing. They would stop calling only when the parents made that request.

From the initiation of HomeRebuilders, caseworkers played an integral role in developing the project. In preparation for implementing HomeRebuilders, caseworkers were systematically surveyed to identify up to three reasons each of the children on their caseloads was placed in foster care. Substance abuse, lack of parenting skills, and housing problems were the three main reasons for placement. This became the basis for developing new service initiatives that included hiring new staff, developing a family services unit, and restructuring the traditional hierarchy of service delivery. The agency hired a number of staff, including a housing and substance abuse specialist. In addition, extending the hours of service provision expanded parent training and parental visitation opportunities.

Previously, service delivery was based on caseworkers identifying the needs of the children on their caseloads and then obtaining services for children outside of the agency. With the onset of HomeRebuilders, a family service unit was developed which consisted of workers who could provide services directly to families. This unit allowed the caseworker's role to change from the traditional one of identifying problems and finding outside services to becoming part of a team. Still responsible for conducting the initial assessment of the family's problems and service needs, the caseworker now had a team of people who could directly provide needed services. This arrangement provided the opportunity for workers to consider family needs rather than individual child needs.

Checks and balances were implemented to ensure that families ready for discharge were receiving the services necessary to expedite the process. The program director reviewed the progress of all cases monthly. In particular she asked supervisors to identify anticipated discharges. Barriers to discharge were identified, and it became incumbent upon the family services unit to contact the appropriate worker to offer services to help resolve problems that were impeding reunification or adoption. In addition, caseworkers completed tracking forms for each case. These forms played an integral role in case decision-making and were perceived as part of the planning process.

In a follow-up interview with Jeremy Kohomban, Assistant Program Director, the agency's philosophy toward permanency was discussed. He stated that the philosophy of permanency was started before HomeRebuilders; the administration at St. Christopher-Jennie Clarkson already believed that the length of stay was too high. Because staff felt so strongly about the concept of HomeRebuilders, all of the children in the agency were in the demonstration. At the start of the program, 50 percent of the children in foster care had a permanency plan of adoption, a percentage that the agency believed was too high. The philosophy of the agency was that not more than 25 percent of children should be placed through adoption. Although adoption may be the easier route, the philosophy at St Christopher-Jennie Clarkson was that it should be used only in extreme cases. For example, adoption was used in cases where the parents were dying from AIDS, the children were truly abandoned, or where multiple children in one family could stay together through adoption but not otherwise. To achieve this reduction in adoptive placements, more training on life skills, stress management, and other issues that kept families apart was given to the parents and extended families. Through HomeRebuilders, some of the children with the placement goal of adoption returned to their biological families.

The HomeRebuilders model also had an effect on young adults at this agency. Instead of allowing them to age-out of the program, they were placed into independent living. The rationale for this strategy was to enhance the agency's ability to monitor these teenagers. If the caseworker believed they were having a difficult time, they were put back into foster care. Before HomeRebuilders, the young adults were not monitored, and consequently, some teenagers became homeless or went to jail. The use of independent living situations created a buffer because the caseworkers were instructed to monitor this population group.

2.3.6  St. Christopher-Ottilie

St. Christopher-Ottilie has had a deep-rooted family focus that was established long before the HomeRebuilders model was developed. Its model is based on providing:

an integrated and full range of personal and social services to sustain children, families, and individuals in their own homes, to provide out of home placement to those who need it in the least restrictive setting, and to do so in an atmosphere of care, concern, acceptance and the dignity of the person through love, service, and respect.

This statement describes a philosophy rooted in empowerment of the birth parent, using the premise that a child remains the child of the birth parents, even while in foster care. This philosophy has long been held by the agency and is based on the agency's participation in a demonstration headed by Salvador Minuchin that took place 1986. Participation in that 2 year demonstration involved intense training of foster parents and agency staff on how to work together to empower the birth parents of children in care. Participation in that project seems to have had a lasting effect on the administrators and staff.

The agency has always maintained the philosophy that foster homes are temporary homes for children. Consequently, as part of their training, all foster parents are told that they are an important part of the reunification process and are expected to take an active role in assisting the agency in reuniting the families.

HomeRebuilders was viewed as a chance to demonstrate the type of model the agency desired, a neighborhood-based approach to services. St. Christopher-Ottilie believed in the concepts of intensified counseling and aftercare. Its philosophy toward permanency included reunification with parents or kin as well as adoption. The process of making good decisions about placement was also seen as a way to expedite permanency. The foster family was the first choice for adoption or permanent placement after establishing that placement with the biological parents was not a viable option. Robert J. McMahon, the Executive Director, emphasized the importance of HomeRebuilders as a service delivery philosophy rather than a mere fiscal mechanism. He believes, "The demonstration showed what directors already know, decision-making is the hard part of the field. The risk in HomeRebuilders was not the money, but how you support workers to make tough decisions." He believes that focusing on length of stay and discharges is a good starting point for a decision-making framework.

2.3.7  Summary

This section provided an overview of each agency's plan for implementing the HomeRebuilders demonstration. The six agencies shared common elements in their plans for changing service provision. They reported that HomeRebuilders permitted service delivery to be family-focused rather than child-focused and it reemphasized the importance of achieving permanency for children. A project wide perspective of families served, and the implementation of practices and procedures is presented in the following sections of this chapter.

2.4  Characteristics of the Families Served

In part, the outcomes of the project are dependent on the families served. As shown in the previous section, the agencies were located in diverse sections of New York City and Long Island. However, the agencies reported similarities in the characteristics of families served.

All of the agencies reported that most of the families served were either Black or Hispanic and that most of the "families" consisted of single mothers ages 20 to 40. Miracle Makers reported serving a significant number of teen mothers who caseworkers indicated were one of the most resistant groups to serve. New York Foundling reported serving teen mothers through a program outside of the HomeRebuilders demonstration. The majority of families had at least two children. Although the agencies were unable to quote an average age for the children in care, several of the agencies reported a decline in the number of newborns served. The agencies reporting a decrease attributed it to a change in New York City policy regarding babies born with positive toxicology reports. In 1992, a clarification of state policy regarding children reported by hospitals with positive toxicology for cocaine was issued. Up to this time, children in allegations with a confirmed positive toxicology report were routinely placed into foster care based solely on that evidence. The clarification emphasized that the medical report alone was not credible evidence of child abuse or neglect. The new state policy required that other credible evidence was necessary to substantiate an allegation of abuse or neglect and place the child into the care of the state.

All of the agencies reported that parental substance abuse played a role in the majority of cases. Crack cocaine, alcohol, and to a lesser extent heroin (one agency reported a rise in the use of heroin during the study) were used by many of the parents. AIDS was another factor reported. Several of the administrators stated that during the period of the study, the number of families with AIDS may have been at its peak, which therefore had an effect on the number of children orphaned. All of the agencies reported that some of their parents were mentally ill, depressed, or were abused by other family members or significant others. Some of the agencies emphasized that a percentage of the parents had only a grade-school education. Lack of adequate housing plagued families in all of the agencies.

Although the majority of the parents lived in the borough or county in which the agency was located, all of the agencies reported serving families living in all five boroughs. Two of the agencies, Harlem Dowling and St. Christopher-Jennie Clarkson, reported that they were serving families that had relocated either upstate or out-of-state. In some cases, the parent moved for better drug rehabilitation programs and decided to stay instead of returning to the drug-infested areas in which he or she lived. Other families moved to be closer to family members.