By Westat, Inc. in association with James Bell Associates, Inc., and The Chapin Hall Center for Children at the University of Chicago
May 30, 1995
For the Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
A. Background
B. Purpose of This Report
C. Approach
D. Relationship of Program Characteristics and Study Criteria
A. Overview
B. Analysis of Family Preservation Program Characteristics
A.Overview
B.Analysis of Reunification Programs
3Program Maturity
4.Program Size
5.Status of Child's Return Home
6.Referral Criteria
7.Service Providers
APPENDIX A:DESCRIPTION OF SELECTED PLACEMENT PREVENTION PROGRAMS
APPENDIX B:DESCRIPTION OF SELECTED REUNIFICATION PROGRAMS
Initially, the term "family preservation" was applied to Homebuilders, a foster care placement prevention program developed in 1974 in Tacoma, Washington. The Homebuilders model called for short-term, time-limited services provided to the entire family in their home. Services were provided to families with children who were at risk of an imminent placement into foster care.
The program was based, in part, on crisis intervention theory. This theory holds that families experiencing a crisis -- that is, about to have a child placed in foster care -- would be more amenable to receiving services and learning new behaviors. Early exponents of the theory also believed that crises were experienced for a short time (i.e., six weeks) before they disappear or are resolved.<1> Social learning theory also played a part in defining the Homebuilders model. Social learning theory rejects the belief that changes in thinking and feeling must precede changes in behavior. Instead, behavior, beliefs and expectations influence each other in a reciprocal manner.
Initially, the program was expected to serve families with older youth who were referred from mental health agencies. Subsequently, the program was used to serve families with children 0-18 who were referred from the child welfare agency. Key program characteristics included: contact with the family within 24 hours of the crisis; caseload sizes of one or two families per worker; service duration of four to six weeks; provision of both concrete services and counseling, with an emphasis on techniques that change behaviors and responses among family members; staff availability to families 24 hours per day/seven days per week; and an average of 20 hours of service per family per week. In addition, the program was characterized by a philosophy of treating families with respect, emphasizing the strengths of family members, and providing both counseling and concrete services.
Since the early 1970s, the term "family preservation" has been used to describe a variety of programs that are intended to provide services to children and families who are experiencing serious problems that may eventually lead to the placement of children in foster care or otherwise result in the dissolution of the family unit. Some of these programs differed in their theoretical underpinnings. For example, the FAMILIES program begun in Iowa in 1974 was based on family systems theory. Applications of this theory focused on the way family members interact with one another and attempted to change the way in which the family functions as a whole. Under the original program in Iowa, teams of workers carried a caseload of 10 to 12 families whom they saw in the families' homes for an average of four and one-half months. Both concrete and therapeutic services were provided and the principles of working with families in a respectful and positive manner were emphasized.<2> <3>
The Intensive Family Services Program which began in Oregon, was based upon a family treatment model. It relied less on the provision of concrete and supportive services and more on family therapy. Services were provided in an office as well as in the home and were less intensive than in the Homebuilders model. Workers carried a caseload of approximately 11 families. Services were provided for 90 days with weekly follow-up services provided for an average of three to five and one-half months.<4>
Over the years, other states adopted existing family preservation models. Some of these programs were slight variations on the basic Homebuilders model, while others adapted the Iowa or Oregon approach to family preservation. Although these programs differed in treatment theory, the level of intensity of services provided, and the length of services, they shared a common philosophy of family centered services including focusing on family strengths, involving families in determining their case plan goals, serving the entire family, and treating family members with respect.
In addition, some programs began to provide services to families whose children had been placed in foster care and had a case plan goal of reunification. Often these programs followed the same service model that was used for placement prevention -- the difference resting solely in the foster care status of the children served. Reunification efforts have received considerably less attention than the placement prevention programs in the documented literature; nevertheless, they represent a related effort to reduce the length of stay in foster care and to prevent re-entry into care in cases where prevention of placement was not initially possible.
In 1993, Congress passed legislation establishing title IV, part B-2 of the Social Security Act, creating funding for family preservation and family support programs. The legislation does not endorse any single program model for family preservation services. Instead, states are allowed to determine their own program models with the broad definition stated below:
Family Preservation Services -- services for children and families designed to help families (including adoptive and extended families) at risk or in crisis, including:
·services designed to help children -
-where appropriate, return to families from which they have been removed; or
-be placed for adoption, with legal guardian or in some other planned, permanent living arrangement;
·preplacement prevention services programs, such as intensive family preservation programs, designed to help children at risk of foster care placement remain with their families;
As evidenced in the above definition, the legislation further broadened the definition of family preservation services allowing states a variety of options in how new federal funds for family preservation would be utilized.
The National Evaluation of Family Preservation Programs is expected to help inform future decisions regarding federal and state policies concerning family preservation programs. Because of the intent to conduct a rigorous, outcome evaluation in a limited number of programs it will not be possible to examine the full range of programs that might be considered family preservation programs. The study began with the intent to select programs that met the following criteria:
The process of identifying site criteria and selecting candidate programs for the evaluation is an iterative one -- methodological and practical considerations impose certain limitations on the range of programs that would be suitable for the evaluation. However, the criteria must be consistent with the characteristics of a majority of programs currently in operation. In other words, while the evaluation cannot encompass all types of family preservation programs, it should not focus on aberrations in the family preservation field or models that the field appears to be abandoning.
With these issues in mind, we developed this paper, along with a companion paper that reviews the family preservation evaluation literature, to help inform the selection of candidate sites for evaluation. This paper describes the "state of the family preservation field" and examines in greater depth the characteristics and operations of programs that are potential sites for the evaluation. It also provides a reality check on the initial site selection criteria -- determining the feasibility of identifying sites that meet the initial criteria.
We identified programs for review through an examination of the existing literature on family preservation program models in various states, discussions with national experts about states and counties with program models that might be of interest, a review of the state applications for FP/FS funds and the knowledge of the study team about existing state programs. Whether or not they were identified through any of the above sources, the 20 states with the largest number of children (0-18 years old) were included in this review.<5>
We held telephone discussions with an individual in each state's child welfare agency who was responsible for, or could describe, family preservation programs in their state. Four of the 26 states providing information had no state-sponsored program model. In some instances states provided funding for county-operated programs that met very broad criteria. In other instances, programs were both funded and operated at the local level.
In states with no state-sponsored family preservation model, we asked the state official to identify counties with family preservation or reunification program models, particularly those in the three largest counties in the state.
For states with a state-sponsored program model or models, we obtained a description of the model(s). In addition, we identified contacts in large county child welfare agencies and/or the major private providers of family preservation services, depending upon the nature of the service delivery system in each state. We then held follow-up telephone discussions with officials in at least one agency within the state, in most instances.<6>
We obtained information about program characteristics relevant to most site selection criteria. However, site visits are planned to secure more detailed information on those sites that appear to be plausible candidates.
Discussions with state and local child welfare administrators included the following:
Although most of the administrators with whom we spoke were very cooperative, they could not always provide us with program statistics of interest. Family preservation program administrators could typically provide data on the number of families served by their program, but not on the number of abuse or neglect allegations or children entering foster care. We obtained some of these data through additional calls to other staff in the child welfare agency, but we still had difficulty identifying the number of children entering care. Also, even where we obtained program statistics in all areas of interest, the statistics did not necessarily cover the same time periods.
Overall, the information we obtained has enabled us to depict 38 placement prevention and 26 reunification programs and to make a preliminary assessment of the extent to which sites meet at least some of the key criteria for participating in the evaluation.
Chapters II and III present the findings from our review of placement prevention and reunification programs respectively. Within each chapter, we present an overview of the findings along key program dimensions for each of the states contacted. A more detailed description of each of the states that is a possible candidate for inclusion in this study is provided in Appendices A and B.
A summary of the study findings as they relate to the initial study criteria is provided below.
The telephone discussions with state and local administrators provide a preliminary indication of the extent to which sites meet most of the study criteria. We have identified 14 states in which there are one or more jurisdictions that might be reviewed in further detail. Nevertheless, it will be more problematic than initially anticipated to meet some of these criteria. Findings as they relate to each criterion are presented below.
a.Criterion #1: Programs should have a primary focus on a population served by the child welfare agency.
This criterion was established for several reasons. First, this evaluation focuses on programs that meet the intent of the new legislation, creating title IV-B, part 2 of the Social Security Act which is administered by the state child welfare agencies. Second, limiting the study to child welfare cases will create a more homogeneous sample making it possible to draw a smaller sample and gather data on a set of outcome measures relevant to the entire sample population. Finally, from a logistical and project resources perspective, it is more problematic to secure cooperation and collect the necessary case data from multiple agencies.
Although the majority of families served by a family preservation program in most states were referred by the child welfare agency, few family preservation programs limited their caseloads to child welfare referrals. Referrals from juvenile justice and mental health agencies sometimes accounted for a significant percentage (i.e., more than 25 percent) of the families served.
In sites that accept referrals from multiple sources, the study could still be limited to those families referred by the child welfare agency; however, this approach may affect the ability of sites to meet Criterion #5 (adequate sample size). A more detailed analysis of program referral practices and recent program statistics will be required to determine which sites can meet both criteria.
b. Criterion #2: Programs should be based on well-articulated theories.
Although early family preservation programs attempted to base their approach to service delivery on theoretical models -- crisis intervention, social learning theory, family systems theory, and family treatment -- the distinction between these theories and their application to family preservation service delivery models is somewhat ambiguous. As other states began developing family preservation models, they often adapted one of the program models previously described; however, in describing the models on which their program is based, administrators tend to focus on service delivery characteristics (most notably caseload size and service duration) rather than on the theoretical underpinnings of the service delivery model.
In short, while programs may not meet this criterion, it is possible to identify programs that have either replicated or adapted one of the early program models.
c.Criterion #3: Programs should have been in place long enough to operate in the way expected by program managers.
To fully determine whether or not programs are being implemented as managers expect will require an in-depth site visits to candidate programs. As a surrogate measure, we asked administrators about the year in which family preservation services began and whether or not the initial program model has undergone any substantial changes. Our intent was to eliminate programs that had not been in operation long enough for program managers to identify and resolve implementation problems.
Only five of the states examined did not have any family preservation model operating in at least one jurisdiction for five years or longer. Therefore, there are enough "mature" programs to expect that inconsistencies in implementation that occur during the formative stages of program development will not be a problem.
d. Criterion #4: Programs should be consistently implemented within a site.
This criterion was established to minimize variations in the treatment intervention at a given site. Variations in treatment intervention may occur when workers apply the treatment intervention differently to the cases they serve, when there are differences among staff in the way services are provided, or when agencies providing the same treatment model make formal or informal changes to the model. Differences may include the length or intensity of services, the type of services provided, and the experience and skills of staff providing services.
Although this review could not explore fully all the possible sources of inconsistency in delivering the treatment intervention, it did explore the number of providers responsible for service delivery. The presence of multiple service providers is not synonymous with inconsistency, but the possibility of inconsistency increases when multiple providers deliver services. In ideal circumstances a "program site" would consist of one child welfare agency and one family preservation service provider (either public or private).
Establishing a definition for a "program site with consistent implementation" appears to pose more problems than initially anticipated. The situation is complicated by two factors: (1) a small number of families served in all but the largest urban areas: and (2) service delivery by multiple private providers within counties and across counties (or child welfare agency jurisdictions). In order to achieve adequate sample sizes, it may be necessary to define "a family preservation program" as an entire state or a sub-section of the state that encompasses multiple child welfare agencies and/or multiple service providers. States that do not have a consistent program model or a single urban area providing family preservation services to at least 250 families were excluded from further consideration as potential sites.
For states that have a statewide family preservation model, it may be possible to "create" a program site for evaluation purposes by combining local child welfare agency jurisdictions and/or service delivery providers who are implementing the same model. However, even in states that indicate that there is a consistent model implemented in most or all jurisdictions, we expect that as the number of child welfare agencies and private providers increases, consistency will decrease. Also, there are practical issues concerning securing cooperation among a large number of local agencies and providers and establishing data collection procedures that are consistent with project resources that must be addressed. We will examine the question of program consistency in greater depth during subsequent site selection activities.
e.Criterion #5: Programs should have a sufficient number of families to reach adequate sample sizes.
Lack of data on entry rates into the placement prevention program and foster care make it difficult to determine the precise number of sites that serve enough families and have a sufficient number of cases entering foster care, to yield 250 families each in the experimental and control groups.
For those programs able to provide information, the number of families receiving placement prevention services appears to be relatively small in all but the largest urban areas. As discussed above, adequate sample sizes may be achieved by combining sites within a state that implement the same program model.
Additional statistical data on program size and foster care entry rates will be required before we can determine the number of programs serving a sufficient number of families for sampling purposes. Based on this information, we will further review the feasibility of combining program sites.
f.Criterion #6: Key policymakers, managers and line staff should be willing to allow an evaluation to be conducted.
We did not raise the question of whether or not programs will agree to an evaluation with program administrators during our initial contacts. Clearly, all relevant stakeholders in a site would require detailed information about our plans before determining whether or not they wanted to be part of this evaluation. Since the purpose of these telephone discussions with programs was to obtain preliminary program information, we did not undertake a detailed discussion of evaluation plans. Nevertheless, some administrators did indicate an interest in learning more about the study design and discussing their participation in the national evaluation.
The review of state and county reunification programs indicates that there are fewer reunification programs than placement prevention programs. Furthermore, existing re- unification programs tend to be extremely small and are often not clearly defined. Our review indicates that evaluation design and site selection criteria as they pertain to the reunification programs will need to be re-examined.
The relationship between the study criteria and the characteristics of reunification programs is described below.
a.Criterion #1: Programs should have a primary focus on a population served by the child welfare agency.
Like the placement prevention programs, reunification programs may serve families from the juvenile justice and mental health systems as well as the child welfare agency; however, twelve of the 20 reunification programs examined in depth serve only child welfare cases or primarily child welfare cases.
b.Criterion #2: Programs should be based on well-articulated theories.
Of the reunification programs examined, seven programs were an integral part of the placement prevention programs-- that is, reunification cases were served by the same staff and received the same types of services as placement prevention cases. Services were mostly provided after the child had been returned home. In these programs that were part of a placement prevention program, the reunification program was based on the same theories of behavior and treatment.
Like the placement prevention program administrators, reunification program administrators seldom described their programs in terms of theory. Rather they focused on the duration and intensity of their service model, and to some extent, on the types of cases they typically served (e.g., children recently entering foster care, children who have been in placement at least six months, or children who are in group care).
c.Criterion #3: Programs should have been in place long enough to operate in the way expected by program managers.
Unlike the placement prevention programs, the majority of reunification programs have been in place for only a short time. Thirteen of the 20 programs examined were established in 1990 or later.
Of the seven programs established before 1990, only two programs are distinct reunification programs. The others are an integral part of a placement prevention program.
The lack of a large number of mature programs will be of concern in selecting sites, although it is possible that some of the more recent programs will be operationally stable and consistent with the program design described by managers and policymakers.
d.Criterion #4: Programs should be consistently implemented within a site.
As discussed above, this criterion is intended to minimize variations in the treatment intervention in a given site. As was true of the placement prevention programs, the challenge in meeting this criterion is complicated by the small number of families served by most programs. Although the reunification programs in Los Angeles and New York City, serve a sufficient number of families to meet the sample size requirements, neither program defines a specific service delivery intervention. Instead, the service delivery providers are given considerable latitude in determining the nature of the service intervention.
It appears that it will be difficult to find sites that meet this criterion. Further consideration of the effect of studying sites that do not meet this criteria is required.
e.Criterion #5: Programs should serve a sufficient number of families to reach adequate sample sizes.
As noted above, only two programs -- Los Angeles and New York City -- meet this criterion. Other programs ranged in size from fewer than 25 families to approximately 150 families, considerably less than is necessary to have experimental and control groups with approximately 250 families in each group. Furthermore, the lack of statewide programs serving any sizeable number of families will make it difficult to achieve the necessary sample sizes by combining like programs within a state to form one evaluation site.
An inability to meet this criterion will require a re-examination of the study design.
f.Criterion #6: Key policymakers, managers and line staff should be willing to allow an evaluation to be conducted.
As described above, this question was not addressed during the initial telephone discussions with agency and program administrators. We do not expect, however, that it will be particularly problematic to secure consent for an evaluation of the reunification programs.
We contacted administrators in 26 states and asked them to describe the family preservation program models operating in their state. It was not a simple task to define the parameters of the family preservation programs included in this review. Many respondents focused on describing a single program model for intensive family preservation programs established by the child welfare agency in the state. However, some also included models that were operated by other agencies such as mental health and juvenile justice. Others described funding mechanisms for purchasing a range of services that may assist in placement prevention. Still others described managed care programs for severely emotionally disturbed children that use multi-disciplinary teams to prevent placement, reunify families, or arrange for placement in the least restrictive setting. For this review, we excluded programs operated by other agencies, specialized programs for emotionally disturbed and developmentally disabled children, and funding mechanisms for purchasing preventive services. Descriptions of selected placement prevention programs are provided in Appendix A.
Even when the programs from other agencies, specialized programs and general funding mechanisms are excluded from consideration, it is difficult to completely capture the diversity of family preservation programs. Both states and counties appear to be exploring new ways to better serve families. States that implemented one type of program for several years are now piloting alternative models. In other instances, counties may be simultaneously implementing both a state program model and other models suited to the needs of their families and available through the service providers in their area. Among those states that assert that there is a single model in operation throughout the state, many acknowledge that counties and private providers may vary in their implementation of the state model.
Of the 26 states we contacted, four -- California, Massachusetts, Ohio and Pennsylvania -- do not have a specific program model that guides program implementation. These states have made funds available to counties and have allowed them to determine their own model or models.
In three of these states; California, Ohio and Pennsylvania, we contacted large population centers with programs recommended by the state agency.<7> In California, we reviewed programs in Contra Costa, Los Angeles, Sacramento, San Diego, and Solano counties. Each of these counties has its own family preservation program model. In Pennsylvania, programs in Allegheny County (Pittsburgh) and Philadelphia County were reviewed. Pittsburgh operates two distinct family preservation models. Philadelphia contracts with a variety of providers, each of which may have a special program intended to meet the needs of a special population (e.g., pregnant and parenting teenagers), but all of which follow the same 12-week service delivery model. In Ohio, we contacted Cuyahoga (Cleveland) and Franklin (Columbus) counties. Three family preservation programs -- one in Cleveland and two in Columbus--were identified.
The remaining 22 states have one or more statewide models. Of these, Colorado, Florida, Iowa, New Hampshire and Oregon, have two family preservation program models.
Collectively, 38 statewide or countywide programs were identified. We analyzed these programs' characteristics, and the findings are presented in Section B.
In addition to these 38 fully-described programs, we identified other programs. For example, both Dallas and Houston have programs consistent with the family preservation model described by the state, but also have other program models in operation. In Connecticut, there is a statewide model operated by 11 service providers throughout the state and several small programs intended for special populations operated by the Yale Child Development Center. In instances where a statewide model exists, we did not include other small programs operated by the county in the analysis.
The 38 family preservation programs reviewed in this study vary along several dimensions, including: the type of program model, the sources of referral for family preservation, and the referral practices (including the way imminent risk is defined, the review of decisions to refer cases to family preservation, and the types of cases excluded from receiving services). Programs also differ in the length of time in operation and the number and type of providers who deliver family preservation services. Programs vary by size, but most are small in comparison to the number of abuse and neglect reports and children entering foster care each year. Exhibit II-5, which appears at the end of this section, provides a summary of each program along the dimensions listed above. A discussion of each dimension and the similarities and differences among programs is provided below.
Some of the earliest family preservation programs designed their programs based on theories about family dynamics. The Homebuilders program in Tacoma was based on theories about crisis intervention and social learning. Iowa's earlier models focused on family systems theory, and Oregon's program was designed to provide a family treatment intervention. The differences in theory translated to somewhat different service delivery characteristics. Homebuilders serves only two families per worker for a four to six week period. Iowa's earliest program, FAMILIES, used a two-person team with a caseload of 10 to 12 families and provided home-based services for up to seven months. The family treatment approach, as implemented in Oregon's Intensive Family Services (IFS) program, has a single therapist who provides three months of treatment for 10 to 12 families. Services are delivered in both office- and home-based settings.
As evidence of the changes that have occurred since these programs began, Oregon continues to operate its IFS treatment model, but has recently begun to implement the Homebuilders model as well, through its Intensive Home-Based Services (IHS) program. In Iowa, the Iowa Family Preservation Program (IFPP), provides services to an average of 3.5 families per worker for a maximum of eight weeks. Iowa also funds another family-centered service program whose implementation varies by provider, but is generally less intensive and of longer duration than the IFPP. Although Homebuilders is still the major family preservation model in Washington, recent efforts to decentralize child welfare service delivery may result in communities modifying or selecting different service delivery models.
The family preservation programs reviewed represent all of these models as well as various "hybrid" models. However, the programs tend not to describe themselves in terms of theoretical approaches. Instead, they describe their model in terms of caseload size, service duration, and whether they use one worker or a team approach in working with families.
Exhibit II-1 identifies each of the programs reviewed in terms of caseload size and duration. Programs using teams are noted. This exhibit shows the relationship between caseload size (which establishes the level of service intensity) and service duration. Simply stated, high intensity of service is associated with short service duration. As caseload sizes increase, duration increases.
The exhibit also indicates that the majority of programs have adopted or adapted the small caseload/short duration model originally developed by Homebuilders. Of the 37 programs providing complete data, 9 replicate the Homebuilders model in terms of both caseload size and duration (Alabama, Colorado-Model A, Kentucky, Michigan, Missouri, New Jersey, Oregon-Intensive Home-Based Services (IHS), Tennessee and Washington). An additional nine programs provide services for four to six weeks, but have allowed workers to serve up to four families at one time (California - Contra Costa and Solano; Florida - Intensive Crisis Counseling Program; Minnesota; New Hampshire - Crisis Intervention; New York; North Carolina; Ohio/Cuyahoga County; and Pennsylvania/Allegheny County - Crisis Model). Only seven programs occupy the other end of the spectrum. Of these, Los Angeles provides services for up to 52 weeks to caseloads of 5-8 families, Sacramento, California and Oregon-Intensive Services provide 12 weeks and 16 weeks of service respectively to caseloads ranging from 9 to 12 families. Colorado's Model B serves 9 to 12 families per worker and may extend services for up to 36 weeks. The Family Builders program in Florida and the statewide model in Texas provide 12 weeks of service for caseloads ranging from five to eight families. New Hampshire's Long-term service program serves an average of five families for 24 weeks. It is interesting to note that four of these programs have been implemented in states which also have short-term, more intensive service models.
[Exhibit II-1 here is a table showing caseload size and case duration for several programs.]
Only four programs indicated that they typically use a team approach rather than a single worker. As expected, these are some of the programs that have slightly larger caseloads (Arizona; Sacramento, California; Family Builders in Florida; and the Intensive Home-Based Program in Franklin, Ohio). San Diego and Cuyahoga, Ohio noted that some cases are staffed by a team, but that this decision is made on a case-by-case basis. Also, there may be other variations by program site. For example, although Florida indicated that its Intensive Crisis Counseling Program (ICCP) uses one worker per case, the provider in Hillsborough, Florida indicated that it staffs its ICCP cases with a team. In Arizona, where the state indicated a team approach to service delivery, one of the providers in Tucson indicated it uses one worker per caseload. Hence, variation in the use of teams may be greater than child welfare administrators believe.
These findings have some implications for selecting sites in which to conduct the evaluation. Initially, the evaluation was to be conducted in two sites that were modeled after the Homebuilders program, and in two sites that had a less intensive/longer duration approach to service delivery. However, these findings suggest that the choice of programs that are not modeled after Homebuilders is somewhat limited. Moreover, most of the programs with longer/less intensive services are in less populous states or counties (e.g., Arizona, New Hampshire) or in states and counties that have only recently developed programs (e.g., Colorado). This is not intended to suggest that programs not modeled after Homebuilders should be excluded from consideration; however, when all study criteria are combined, greater flexibility in selecting program models will be needed.
Although this program review was intended to focus on family preservation programs that served child welfare referrals, it is somewhat difficult to disentangle programs by referral sources. As previously noted, separate and distinct family preservation models established in agencies such as mental health or juvenile justice were not included in this study. However, many family preservation programs serve the child welfare agency as well as other agencies. Even when family preservation services are provided by the public child welfare agency (e.g., Alabama), cases referred from other agencies may be accepted. Exhibit II-2 provides a listing of programs that serve only the child welfare agency, programs that receive 50 percent or more of their referrals from the child welfare agency and programs receiving less than 50 percent of their referrals from child welfare. Information was available for 32 of the 38 programs. The remaining programs are presumed to serve primarily child welfare cases, but this information was not provided.
As noted in the exhibit, 11 programs receive referrals only from child welfare. Only one state, New Hampshire, receives less than half of its referrals from the child welfare agency. The remainder of cases come from juvenile justice and mental health agencies. Juvenile justice and mental health agencies represent the majority of other referrals in almost all programs. In Alabama, Florida, Iowa and New Jersey referrals from other agencies to family preservation are screened by the child welfare agency.
It is important to note, however, that because of the organizational structure of an agency and the way in which status offenders are treated, distinctions between cases referred from a child welfare agency and cases referred from juvenile justice may be ambiguous. For example, cases referred from the juvenile justice agency in Kentucky are status offenders. In New York, status offenders are served by the child welfare agency, which may refer them for family preservation services. Thus, although the sources of referral may differ from state to state, the types of cases referred may be similar.
One of the site selection criteria for the evaluation is that the program serve predominantly families referred from child welfare. Although most agencies accept referrals from multiple agencies, the types of cases referred may be similar. The inter-relationship between referral sources and case characteristics will have to be explored in greater depth with candidate sites in order to determine optimal procedures for identifying cases for inclusion in the study.
[Exhibit II-2 here shows referring agencies by State.]
In examining the way in which cases are referred to family preservation, we explored three issues:
The findings in each of these areas are discussed below.
Recent evaluations of family preservation programs have questioned whether the cases referred to family preservation were at risk of imminent placement. In many instances, the cases appeared to have serious, multiple problems which might eventually lead to foster care placement or further abuse or neglect; however, it did not appear that placement would have occurred immediately in these cases, in the absence of family preservation services.<8> <9> Data for the evaluations conducted in California, Illinois and New Jersey indicated relatively low placement rates for the control groups, as well as for the experimental groups. The control group placements rates were 20, 17 and 57 percent, respectively.<10> <11> <12>
Child welfare agencies and family preservation programs have been struggling to address this issue. Some programs have abandoned the use of the term, requiring only that cases referred have serious problems which cannot be addressed by less intensive services. In other instances, programs have an "imminent risk" criterion, but no definition is established to guide worker decisions about whether or not a case meets the criterion. Still other programs attempt to guide the worker by having the worker complete a risk assessment scale. These scales, however, generally assess the risk of danger and other serious problems to the child rather than the likelihood of placement, including such factors as a history of abuse and neglect and parental motivation to change (see Schuerman and Rossi, January 1994).<13>
Finally, some programs have attempted to provide a time limit during which placement would be expected to occur (e.g., a child will be placed in five days if family preservation services are not provided). Although this approach to defining imminent risk appears to address the issue of likelihood of placement, workers may have difficulty operationalizing this criterion. In essence, a CPS investigator or other worker with authority to seek placement, can decide at a given time whether or not to seek placement based on the information available to them at that time. It is almost impossible to ask a worker to predict what actions might be taken at a later date when more information may be available. Nevertheless, programs that have established such a criterion, at least appear to be reinforcing the concept that probable placement is an essential criterion in the decision-making process.
Exhibit II-3 provides a list of the programs employing each of the definitions described above. As noted in this Exhibit, five programs do not require that a case be at imminent risk of foster care placement in order to receive family preservation services. In the long-term programs in Iowa and Oregon and in the programs in Los Angeles and San Diego, California, there has been a specific decision not to employ this criterion.
[Exhibit II-3 here shows alternative definitions of imminent risk used by programs.]
Nine programs indicated that imminent risk was a referral criterion, but these programs had not developed a definition of imminent risk. Of these nine, North Carolina had recently reorganized its family preservation program and may be developing a definition in the near future. Texas also indicated that it was planning to improve consistency in the implementation of the state model across regions and may eventually develop such a definition. In Florida, Hillsborough County has developed its own definition.
Twelve programs do not define imminent risk, but expect that workers will make that judgment based on the findings of a uniform risk assessment protocol. However, only Utah described using the scale to establish a specific referral criterion. Families must score four or five (on scale of one to five) to be referred for family preservation services. All other programs indicate that the risk assessment protocol is used to guide worker decisions regarding referral.
For the 11 programs that defined imminent risk as a specified number of days before placement occurs, the time periods identified ranged from 3 to 14 days. Most programs cited a two- to five-day time period, with five programs citing a three-day period. Georgia was the only program using a 14-day time frame.
For programs that have imminent risk as a criterion, the lack of a clear definition that workers can operationalize suggests that programs are likely to serve families who may or may not have otherwise experienced a foster care placement. Since placement in foster care is a key outcome variable in the evaluation, these findings may pose problems that will need to be addressed in the evaluation design and selection of candidate sites.
The process used to decide which cases are referred for family preservation services will also affect the likelihood that such cases are at imminent risk of placement. The initial decision to refer a case for family preservation services is made by a CPS investigator or other worker making an assessment of the problem. In some programs, workers may refer cases directly to the family preservation program. In others, a supervisor may need to approve the referral; however, it is unclear if this approval involves a detailed review of the appropriateness of the referral or simply a perfunctory sign-off procedure. Some programs also may require a more formal review process involving other parties less intimately involved in the case to determine if the case meets program criteria.
A second level of review typically occurs after the family preservation worker has made an initial assessment of the family. The secondary review from the family preservation program tends to focus on whether child safety issues have been adequately assessed and whether there is at least one caretaker who is able to accept services. This review seldom involves a determination of whether the family is at imminent risk of placement. (One exception to this appears to be in Missouri, where program statistics indicate that some cases were rejected because they did not meet imminent risk criteria.)
The decision-making process used by the child welfare agency in each of the programs studied is described in Exhibit II-4. As noted in this Exhibit, 13 programs indicated that workers may refer cases directly to family preservation without further screening and 8 indicated that cases were referred after a supervisory review. Eleven programs had some other system in place. The most frequent approach was some type of review committee or monitoring team. Both Solano County and Contra Costa County in California; Cuyahoga County, Ohio; and Utah established screening committees to review referrals. Also, two counties in Washington experimented with formal review committees, but these procedures were not established on a permanent basis. Colorado plans to establish monitoring teams to review referrals for both of its programs. Similarly, Iowa has established regional Clinical Assessment and Consultation Teams that receive referrals from all county offices and determine whether or not family preservation services are needed.
In Franklin County, Ohio, referrals to both programs are reviewed jointly by the CPS investigator and the supervisor of a planning unit. New Jersey trains screeners to review referrals in each county. Typically, screeners are child welfare agency staff members; however, in three jurisdictions a screener is part of the provider's staff.
[Exhibit II-4 here describes the decision making processes used by programs.]
Although it is not possible to determine the precise relationship between the existence of a referral review process and the application of existing imminent risk criteria, it is plausible to assume that programs with external review procedures (beyond an investigative worker and supervisor) are more likely to refer cases that meet existing criteria for imminent risk of placement. We will seek more detailed information on the nature and extent of existing review procedures, and explore the feasibility of establishing additional review procedures for the evaluation with potential sites.
Some of the earliest family preservation programs excluded cases with certain characteristics. Most frequently, families in which the caretaker had a serious substance abuse problem, mental illness or other incapacity that severely limited to their ability to cooperate with a family preservation worker were excluded. In addition, families in which the caretaker was completely unwilling to accept family preservation services were also typically excluded.
As family preservation programs were implemented in more jurisdictions, particularly in major urban centers, the effects of such exclusion criteria were re-examined. In particular, there was a high correlation between serious substance abuse and cases at imminent risk of placement. Child welfare administrators would informally comment that programs with major exclusion criteria, especially criteria relating to substance abuse, would not serve the population that was most likely to be at risk of imminent placement. As a result, programs began to modify their criteria by more narrowly defining the types of cases to be excluded (e.g., chronic substance abusers who refuse to enter treatment) or abolishing such criteria entirely.
The programs reviewed for this study were asked to identify whether or not there were any exclusion criteria used to screen referrals to their program and, if so, to describe them. Twelve programs had no exclusion criteria (Colorado-both programs; Georgia; Iowa-both programs; New Hampshire-both programs; New Jersey; North Carolina; Franklin County, Ohio-both programs; and Utah.
The four most frequently cited exclusion criteria were sexual abuse, when the perpetrator has not left the home; substance abuse, when the caretaker refuses treatment; mental illness/mental retardation, when a caretaker is not taking prescribed medication or is actively psychotic; and family refusal of services. Within each category, programs varied in their exact statements of the criteria. For example, Sacramento, California excludes all sexual abuse cases and Minnesota excludes serious sexual abuse cases, whereas eight of the states listed exclude a sexual abuse case only if the perpetrator is still in the home. Los Angeles excludes if the perpetrator still has access to the child.
Similarly, six programs exclude substance abusers who are not receiving treatment (Arizona, Florida-both programs, Michigan, Minnesota, and Missouri-St. Louis only). In Cuyahoga County, Ohio, cases are not accepted until the caretaker completes treatment or has made substantial progress. Only Wisconsin indicated that it would not serve substance abusers.
Nine programs specifically cited lack of a caretaker willing to participate in the program as a reason for exclusion. Programs may also vary in the threshold applied for determining when a caretaker is unwilling to participate. For some, unwillingness may mean that the family is not motivated, while for others it means that the family indicated they preferred a child be placed in care or that they refused the worker entry into their home.
In addition to these major criteria, other exclusion criteria identified by more than one program included the following: homelessness (Solano and Contra Costa counties, California and Michigan); juvenile delinquency (Philadelphia, Pennsylvania and Tennessee); serious physical abuse (San Diego, California and Michigan); and domestic violence (Michigan and Suffolk County, New York).
Overall, family preservation programs appear to set few limits on the types of cases that they will accept. However, lack of categorical exclusion criteria does not mean that a cases cannot be screened out on an individual basis. Nevertheless, it does not appear that large numbers of families who may be at risk of experiencing placement are routinely excluded from services.
The earliest family preservation programs were developed in 1974. Homebuilders started in Washington with funding from Catholic Community Services and the National Institute for Mental Health for the purpose of providing an alternative to psychiatric hospitalization for adolescents. In Iowa, Families, Inc. was originated to serve children who had been referred for residential care. Both of these programs have been modified over time. The Homebuilders model, currently implemented by Behavioral Sciences Institute, began in 1982. Iowa's current Iowa Family Preservation Program began in 1987.
Family preservation programs proliferated in the 1980s. Four programs (Florida-ICCP, Texas, Oregon-IFS and Utah) began in 1982, and Solano County, California began in 1983. Kentucky, both programs in New Hampshire and North Carolina began operating in 1985. Eleven programs began between 1987 and 1989 (Alabama, Arizona, California-CC, Connecticut, Michigan, Missouri, New Jersey, New York, Ohio-FCCR, Pennsylvania-ACR and Tennessee). Of the remaining programs, 15 began in the 1990's, and 2 began at various times as different providers within a state were identified.
Some of the later programs also have been modified over time. In addition, the development of specific county programs within a state sometimes has occurred over several years. For example, although Texas began family preservation services in 1982, the programs in Harris, Dallas, and Bexar counties were initiated in 1984, 1987 and 1993 respectively.
When programs are in their early stages of development, they are likely to still be experimenting with the treatment intervention. Moreover, it takes time to iron out operational problems and ensure that the program is actually being implemented as intended. If an outcome evaluation is conducted during the early stages of program development, there will be considerable inconsistencies in the treatment intervention. The existence of 21 programs that have been in operation for at least five years will simplify the site selection process for this evaluation.
Family preservation programs are operated by both public and private agencies. In 25 programs, all services are provided by private agencies. In three programs, services are provided directly by the public child welfare agency only (Alabama; California-Sacramento; and Ohio-FCCR). Of the ten programs using a combination of public and private providers (California, San Diego; Colorado-Models A and B; Iowa-FCS; Minnesota; Missouri; New York; Texas<14>; Utah; and Wisconsin), New York relies primarily on private providers and Utah relies primarily on the public agency to directly deliver services.
Whether services are provided by private or by public agencies is not of concern for site selection purposes; however, the number of agencies delivering services in a defined program may affect the consistency of the service intervention. A large number of agencies will also complicate the processes of securing cooperation among all parties and collecting data.
Programs were asked to provide information on their annual rates of child abuse and neglect allegations, foster care entry and family preservation program entry. Programs were also asked whether they were operating at full capacity, had a backlog or waiting list of cases, or had vacancies in their program. These data were important for three reasons. First, a program had to be of sufficient size to permit an adequate sample to be drawn within a 12-month period (preferably 250 families served per year in the family preservation program). Second, in a random assignment experiment, some families who are otherwise eligible for services will be assigned to a control group. If the program cannot currently serve all eligible families, then establishing a control group is less problematic since all families would not have received the service even if the evaluation was not in effect. Thus, programs that have a backlog of families or turn families away are more likely candidates for evaluation.
Finally, there is a possibility that current referral practices may be modified to ensure that the families referred for service during the evaluation are at imminent risk of foster care placement. Under these circumstances, it is not possible to determine whether or not the program will be able to serve all families referred or whether there will be more families eligible than program space permits. However, higher ratios of foster care entry rates to family preservation slots increase the likelihood that a control group can be established without denying services to eligible families.
Most programs that could provide information on whether they operated at full capacity, indicated that they were at capacity. The exceptions were Michigan and Hennepin County, Minnesota. Sites were generally unable to identify whether there was a case backlog, since family preservation programs do not keep waiting lists (presumably families require immediate service to prevent placement). Only Missouri, New Jersey, and North Carolina provided data on cases turned away due to lack of space. In Missouri, 34 percent of the cases referred were rejected due to lack of space statewide. In New Jersey, the rejection rate due to lack of space was 37.4 percent, and in North Carolina it was 7 percent.
Unfortunately, the availability of consistent statistical data was limited, and a final determination of the most promising sites cannot yet be made, However, it was possible to eliminate some programs from further consideration because available information on the number of families receiving family preservation services indicated that it would not be possible to meet minimum sample size requirements, even if counties providing the same service intervention were combined. The programs included Connecticut, New Hampshire, both programs in Franklin County, Ohio, and both programs in Allegheny County, Pennsylvania.
In 1990, 60 percent of children in foster care had a case plan goal of returning to the home from which they were initially removed.<15> For most of these children, efforts to reunify them with their family are made by the foster care worker, a child welfare worker who is assigned to child's parent or caregiver, or both. However, high caseloads and other factors often prevent workers from spending the time and resources necessary to facilitate the reunification process. As a result children may remain in foster care longer than would otherwise be necessary, or they may be returned home without the factors initially leading to foster care placement having been adequately resolved.
To address this problem, special programs that focused solely on facilitating reunification and ensuring the child's safety upon return home began to emerge in the 1980s. The earliest reunification programs were often an integral part of an existing placement prevention program -- that is, families in the reunificaion program were provided with the same services, with the same level of intensity and for the same duration, and by the same staff as families in the preplacement program. These cases were typically referred when reunification was about to occur and services were provided to ensure the child's safety and prevent the need to place the child in foster care again. In other words, these programs focused on what happens after reunification occurs.
More recently, reunification programs have been developed to facilitate the goal of reunification. In these instances, services are provided to a parent or caregiver to resolve problems relating to their ability to care for their child. Services may include drug treatment, parent training, counseling, or behavior management. They may also include concrete services such as locating adequate housing or making home improvements that are necessary to a child's safety. Services may also be provided to the child to enable the child to remain in the home and community. In addition, reunification programs may facilitate parent and child visitation. Services provided by these programs may end once reunification occurs, or they may continue for a short period of time after the child has returned home.
Programs vary on the type of cases that are referred to a reunification program, most notably on the length of time that a child was in foster care prior to referral. Some programs focus on children recently placed in foster care, expecting that intensive efforts to work with parents immediately or shortly after a child is placed will prevent children from languishing in foster care. This approach is consistent with research that indicates that the longer a child remains in foster care (particularly longer than two years), the less likely the child is to return home at all.
Other programs focus on children for whom past efforts of child welfare workers have not succeeded in returning the children home. Often these programs are considered a last resort for children who have remained in foster care for long periods of time without specialized intervention. Because these programs often be serve more difficult cases, they may experience lower rates of reunification or require a longer period of service to achieve specified goals.
In addition to the length of time in foster care prior to referral, programs may also use other criteria for accepting referrals, such as the age of the child or the type of placement in which the child currently resides. Younger children and those with disabilities may have special vulnerabilities. When cost is considered, reunification programs may focus on serving children whose out-of-home care is most expensive (those in group care or institutions or those whose age or special needs results in higher foster care payments).
The variability in scope of reunification programs and the target populations that they serve pose some distinct problems for the evaluation. Initially, it was expected that all reunification programs were intended to facilitate the reunification of children who might otherwise remain in foster care for a considerable period of time. Under these circumstances, the major outcome variables used in the evaluation would be the percentage of children reunified and the length of time spent in foster care before reunification occurred. However, if some programs are serving children who, at the time of referral, have already returned home or are about to return home, then the appropriate outcome measures must be reconsidered. Outcome measures such as re-allegation of abuse and neglect and re-entry into foster care would need to be examined.
In the 26 states we contacted as part of this review, we asked about the existence of reunification programs. We identified reunification program models using a process similar to the process we used to identify placement prevention programs. Both statewide and county reunification program models were identified with some states and counties identifying more than one program model. In general, the states that had a statewide model for placement prevention also had a statewide model for reunification; however, there were considerably fewer reunification programs. States and counties with multiple placement prevention models also had multiple reunification programs.
We identified twenty-six programs in 15 states. A summary chart appears at the end of this chapter, (Exhibit III-7), that provides available information on all 26 programs. We note that some of these programs were very recent, and policies regarding eligibility and service delivery had not been established (e.g., both programs in Colorado).
Programs that were an integral part of the family preservation program indicated that only a small percentage of cases served were reunification cases. These programs typically provided aftercare services. Because these programs provided identical services to reunification cases and placement prevention cases, they often did not keep data that differentiated between these cases, nor did they have explicit referral criteria for reunification cases. These programs include both programs in Oregon and the statewide program in Minnesota. In Utah, there was a reunification program in place for several years that was currently undergoing a complete reorganization. Since there was little information available on the characteristics of these programs or the families that they served, they are not included in the analysis provided in Section B (below) that focuses on the 20 programs identified in Exhibit III-1.
It is important to distinguish between reunification programs that are an integral part of the placement prevention program and reunification programs that stand alone. A stand alone program is defined as one which has a distinct service delivery model and/or separate staff, units or providers that serve reunification services and referral practices. As shown in Exhibit III-1, these included eight programs that are part of the placement prevention program, 11 programs that have distinct reunification programs, and one program that is a mixture of combined and distinct programs depending upon the service provider.
[Exhibit II-1 here is a list of reunification programs.]
It is somewhat questionable whether all of the programs that are an integral part of a placement prevention program can truly be considered reunification programs. As described later in this section, most of these programs serve children who have already returned home. Their goal is to ensure the child's safety and prevent the need for another foster care placement.
Although the state and county child welfare officials described these efforts as reunification programs, we might consider an alternative description. These programs serve cases that might be considered placement prevention cases that are referred for services through a different process. Instead of being referred by CPS investigative staff because a child is at risk of imminent placement, they are referred by foster care workers when the child's return home is imminent, but there is a high risk that the child may re-enter foster care. An evaluation of such cases would be based on examining subsequent abuse or neglect allegations and rates of replacement in foster care.
Like the placement prevention programs, most reunification programs provide a mixture of concrete services and counseling, primarily in a family's home or where the child is currently residing. Programs differ, however, on the intensity and duration of service. Although most programs specify an average caseload size and service duration, some programs make case specific decisions regarding length of service and determine the number of cases assigned to a specific worker based on the characteristics and complexity of his or her caseload. Exhibit III-2 indicates the relationship of caseload size and service duration and identifies those programs which vary along one or both of these dimensions.
The findings presented in this exhibit resemble those described for the placement prevention programs. As service intensity decreases, length of service increases. However, the reunification programs are likely to provide services for a longer time than the placement prevention programs. The programs that provide a very brief period of service are those that provide reunification services as part of their placement prevention program.
[Exhibit III-2 here describes caseload size and duration for programs.]
It is important to note that the program in New York City departs from the other reunification programs examined in one respect. Rather than identifying a specific caseload, service duration, or set of services, decisions regarding service delivery are made by the private agencies and public agency staff who have responsibility for the child's placement in foster care. They are given a fixed amount of funding and are expected to use it to deliver, arrange or provide the services necessary to effect reunification. In other words, the New York City program is a managed care program. As a result, there is no single service intervention to evaluate. Rather than determining the efficacy of a specific intervention, the New York evaluation would examine whether or not a managed care system is a cost effective approach to serving children who are in foster care.
The date programs began operation is shown in Exhibit III-1. There appears to be a relationship between the maturity of the reunification program and whether it is a distinct program or part of a placement prevention program. Of the 20 programs with available data, only 7 programs were in operation before 1990. Five of these programs are an integral part of the placement prevention program. Only two programs, both operating in Bexar County, Texas, were established as independent reunification programs in the 1980s.
In contrast, seven programs were established in 1993 or 1994, and six of these are distinct reunification programs (Montgomery County, Alabama; Michigan; Missouri; New York City; Allegheny County, Pennsylvania - long-term; and Philadelphia County, Pennsylvania). The remaining six programs for which we have start dates, were established between 1990 and 1992. Three of these have a distinct reunification program.
As discussed in Chapter I, program maturity was one of the initial site selection criteria. While the majority of placement prevention programs meet this criterion, most reunification programs do not. When the programs that are an integral part of the placement prevention program are excluded from consideration, only five reunification programs remain in operation for more than two years.
From an evaluation standpoint, program size is the characteristic that is of greatest concern. As shown in Exhibit III-3, of the 16 programs providing data, only five served more than 100 families (Los Angeles, Sacremento, and San Diego California; New York City, New York; and Allegheny County, Pennsylvania). Sacramento, New York City and Allegheny County serve primarily child welfare cases, Los Angeles and San Diego serve cases referred from other agencies as well. Only New York City and Los Angeles serve enough cases to meet the estimated sample size of 250 cases in the experimental group.
The question of program size is further complicated by the fact that four programs accept cases from multiple sources. An additional four programs serve primarily child welfare cases, but may accept cases from other sources. If cases referred from other agencies are excluded from the study, then the potential sample sizes would be even smaller in several sites.
Since most programs do not even come close to achieving the necessary sample sizes, the implications of this finding for site selection will require further review.
[Exhibit III-3 here describes the number of families served by programs and referral sources.]
As previously discussed, some of the reunification programs serve families for whom reunification has already occurred or is expected to occur in a matter of days or weeks. Exhibit III-4 provides information on the status of the child's return home at the time of case referral. For two programs (Florida-FB and Allegheny County, Pennsylvania's Crisis Program), services begin immediately after the child has returned home.
For nine programs, the child is expected to return home within a specified time period, ranging from 1 to 12 weeks. Child welfare administrators indicated that for programs serving families on the brink of reunification (scheduled to occur in one to three weeks), the decision to reunify has been made, and reunification is almost certain to occur irrespective of the outcomes of the services provided.
For seven of the programs, the status of the case at the time of referral may vary. These programs serve cases in which the case plan goal is reunification; however, in some instances the decision to return the child home within a few weeks has been made, while for others, a date for reunification has not been determined.
The differences among programs concerning the likelihood of reunification affect the nature of the services delivered. As shown in Exhibit III-5, programs in which reunification is almost certain to occur primarily provide aftercare services to the child and family. As previously noted, the goal of such programs is to ensure the child's safety and prevent the need to place the child in foster care again.
Although some programs do not specify a time period in which children will be reunified, and they provide services both prior to and after reunification occurs, they have other case referral criteria that may also affect the likelihood or reunification. Most notably these criteria relate to the length of time a child must have been in foster care before referral to the reunification program.
[Exhibit III-4 here describes the status of child's return home at time of referral for reunification services.]
[Exhibit III-5 here describes the extent to which aftercare services are provided.]
Programs fall into three categories: (1) those that target children who have recently entered foster care; (2) those that target children who have been in foster care for a specified minimum period of time (ranging from at least three months to at least one year) and, (3) those that do not specify a foster care length of stay. Exhibit III-6 provides information concerning this variable.
Although the majority of programs do not specify a minimum period of time in foster care before referral, those that do are likely to be serving different subpopulations. These
differences are likely to result in different service delivery patterns as well as differences in the likelihood of reunification. Again, this raises the question of determining the appropriate outcome measures.
For the six programs that begin reunification services virtually at the time of entry, the intent is to begin services before allowing "foster care drift" to occur. Early onset of services can also ensure that a parent and child do not lose contact with one another. In the absence of other criteria that specify referral of cases that are identified as particularly problematic, caseloads in these programs will include families whose problems vary in severity.
In contrast, two programs target children who have been in care for at least three months. The New York City program specifies a minimum of three months, but notes that most children have been in care much longer. This program initially served children who had been in care at least two years. Bexar County (Long term), expects that cases referred will have been in foster care at least six months. Children referred to these programs are likely to have already experienced foster care drift, and the ties to their parents may have been somewhat eroded. Such cases are likely to be more problematic and, in the absence of other referral criteria, may have a lower probability of reunification or may require services for a longer period of time to reach that goal. Bexar County's Long-term program allows for services for up to nine months. The New York City program varies the length of service, based on family needs.
[Exhibit III-6 here describes children's length of time in foster care prior to referral to reunification services.]
In addition to targeting children who have either just been placed or those who have already spent some time in foster care, some programs have targeted children of a certain age or those who are in more expensive placements. Programs in Florida and Allegheny County (crisis), Pennsylvania generally serve younger children (under 5 years in Florida); however, the programs do not mandate that the children be under a certain age. In Bexar County Texas, the families in the crisis intervention program tend to be parents with young children, while families served in the long-term program are more likely to have older children. Iowa targets children in group care, and New York City targets children in foster boarding homes, including relatives' homes. These criteria or referral practices are likely to effect both the nature of the service delivery and the outcomes achieved.
For programs that did not specify referral criteria, it is difficult to determine whether the population they serve is heterogenous, or whether there are informal referral practices that limit the nature of the cases served. We will require a more detailed understanding of referral criteria and population characteristics for site selection.
Reunification services are provided by private and public agencies. In five programs, services are provided by the public agency. In 14 programs, services are provided by private agencies. In two programs, both public and private agencies provide reunification services. (Program-by-program breakdowns are provided in Exhibit III-7.)
As noted in the previous chapter, public or private sector service provision is not of concern for site selection purposes. However, the number of providers within a program area may have an effect on the consistency with which services are delivered and the ease with which data can be collected. Of the county-wide programs operated by private providers, five have three or more agencies that provide reunification services. In Los Angeles, 18 networks, each including multiple providers, deliver reunification services. In New York City, 6 agencies are involved in the managed care reunification program. Among the statewide programs, Connecticut contracts with 11 providers, Iowa with 10, Missouri with 10, New York with 24, and Tennessee with 15 providers.
Because most programs serve such a small number of families, there will be a need to include multiple providers, where appropriate, in order to achieve the necessary sample sizes.
This Appendix presents more detailed information on the following states: Alabama, Arizona, California, Florida, Iowa, Kentucky, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, Tennessee, Texas, Utah and Washington. At least one program in each state is a potential candidate for site selection. These states were selected because they met most of the criteria previously described. The criterion most programs had difficulty meeting concerns sample size; however, to the extent that all of the selected states except California and Ohio have statewide programs, it may be possible to combine local programs implementing the same model to achieve necessary sample sizes. The counties described in California serve enough families to meet the sample size criterion.
The family preservation program in Alabama, Family Options, began in 1989. Since 1991, the state has operated under a consent decree that, by 1999, will guarantee to all children in foster care and at risk of entering care the right to treatment and services. As a result, groups of counties comprising 15 percent of the child welfare population begin each year the process of converting their child welfare programs to emphasize family-based services. Each successive group of counties has one and one-half years to complete their conversion process before they are held accountable by the state's quality assurance system and the federal court monitor for operating according to the consent decree.
The conversion includes an enhanced emphasis on preventive services aimed at both preserving families and avoiding unnecessary foster care placement. For example, social workers now must receive the Alabama Certification Training (ACT). According to the state representative, the training teaches workers to work "aggressively" to keep families safely together. Under the consent decree, counties also have been allocated new flexible funds available at the local level to be used for individual families' needs.
Currently, there are seven family preservation programs that serve 19 of Alabama's 67 counties, (Several of the programs operate regionally). A state-funded Family Options Unit in the Family and Children's service program of the County Department of Human Resources provides the services. Among the largest programs are the Family Options programs in Madison, Montgomery, and Jefferson counties.
According to state officials, the seven programs serve 50 percent of the children who have a chance to enter the foster care system statewide. The State plans to expand the services this year by funding two additional programs that will serve two counties. These new programs will be served by a team of private community providers based on the Family Option model.
The Family Options program follows the Homebuilders model. Workers serve caseloads of two families for four-six weeks. According to the state, the programs usually stick to a four-week intervention. Jefferson County reported that during the intervention period, an average of 40 face-to-face hours of counseling and services are provided. Flexible funds are available, although they are minimal: Montgomery County reported having $30 per family; Jefferson County was not specific, but also said it was a small fund. However, all families served through these two counties, because they are converting their operations to achieve the terms of the consent decree, may have additional flexible funds spent to prevent unnecessary placement in care.
In FY 94, Jefferson County's Family Options served 55 families (operating at capacity), and Montgomery County's program served 75 families. According to the state, in the fourth quarter of FY 94, Montgomery County had 70 abuse neglect reports and 181 children in foster care; Madison County had 240 reports and 283 children in care. Jefferson County reported that for FY 94, there were 2,587 reports of abuse and neglect. New admissions into foster care totaled 258, there were 90 re-admissions, and 266 children left care. At the end of the year in Jefferson County, there were 596 children in foster care in Jefferson County.
Alabama's counties are going to great lengths to reduce the need for court proceedings or placement of children. Reports of child abuse and/or neglect are referred to the Child Abuse and Neglect Assessment Unit for assessment (investigation). Following the assessment, the case may be unfounded and closed, opened for ongoing protective or preservation services, or the child may be brought into foster care, if he or she cannot safely remain at home. If the Assessment Unit worker determines that the child can be left in the home, he/she develops a short term Individualized Service Plan (ISP) together with the family and with the help of a supervisor. This plan may include an immediate referral to family preservation or a referral to any other ongoing services.
Families referred for ongoing services may later be assigned to Family Options. Families initially assigned to foster care also may be referred later to Family Options, so long as the child has not been in care for more than 30 days. A permanent Individual Service Plan is developed for each family in the program after the family has stabilized, and in conjunction with the family, the family workers, and any others whom the family requests.
Currently the target population for the Family Options program is children (0-18) at-risk of removal or at-risk of entering state-paid care within 5 days. While clients from the juvenile justice and mental health systems may be served, they must enter through an abuse and neglect report, a judge's court order, or by a parent attempting to voluntarily place a child in foster care.
Imminent risk is determined by the worker and is based on the worker's assessment of the family's history and current situation, and on the family's willingness to participate in the program.
There is county variation in the populations served and types of cases excluded from services. For example:
Each month, each county Family Options Unit reports service utilization and case data to the State Coordinator who oversees the Family Options program. In addition, children and families served through Family Options are tracked at three, six, nine, and twelve month intervals after the service intervention to determine whether the children have successfully remained safely in the home. The criterion for determining success is based on the number of children served who have not entered state paid care for a period greater than fourteen days any time over the past three, six, nine, and twelve month intervals. For Fiscal Year 1994, data is available for six of the seven county programs which indicates that, 84 percent of the children served for the twelve months in the calendar year safely remained with their families. Of those served, the programs have a success rate that ranges from 73.8 to 88 percent for the year.
Arizona has been operating its family preservation programs since 1989. Services for CPS clients are provided through the state's Department of Economic Security (DES), Division of Social Services by private contractors. Currently, there are family preservation programs in each of the state's six districts, but not in every county. By the end of FY 95, there will be a total of 25 family preservation services teams across the state. There are also family preservation programs provided through the state mental health and juvenile justice agencies by private contractors.
Currently, there are nine private providers of family preservation services to CPS clients. Of these, three serve the Phoenix area, and two serve the Tucson area. Together, these two areas contain the majority of the state's general and child welfare populations. Statewide, in 1993 approximately 195 families received services. The statewide model of family preservation prescribes six-eight weeks of service with a possible extension of four weeks. There is some variation in how private providers structure their family preservation programs. For example, in Tucson, the two providers, Arizona Children's Home Association (ACHA) and Our Town each have a different program model.
·Arizona Children's Home Association. The ACHA program established in 1989, is an eight-week program that uses two-person teams (therapist and parent aide) and has a caseload of six families per team. The model provides structural strategic therapy in addition to concrete services. Flexible funding of $300 is available per family. In FY 93, ACHA served 34 families.<16>
ACHA is the largest provider of family preservation services in Arizona. In addition to the DES program, it has two other family preservation contracts. The agency contracts with mental health in Phoenix to provide a five-week intensive program established in 1992. This program uses three-person teams which include a special education teacher and focuses particularly on behavior management. These teams carry a caseload of 10 families. The Association also has a contract with juvenile court to provide Renewing Arizona's Family Traditions (RAFT) to probation clients. RAFT uses a four-week, two cases per worker, Homebuilders model.
·Our Town. Our Town provides a Homebuilders model (four weeks, two families per worker). In FY 93, Our Town served 35 families.
Referrals to the family preservation program are made by CPS intake workers, in consultation with their supervisors. Currently, the state's child welfare program serves only CPS families. However, as mentioned earlier, several of the providers, such as Arizona Children's Home, have contracts with other agencies (such as probation and mental health) to provide family preservation services to their clients.
No imminent risk criteria are provided by the state. The workers use their own judgment concerning risk of placement.
State program definition prohibits the program from serving: substance abusers when an abuser was unwilling to seek treatment, severely retarded parents, and parents exhibiting psychotic behavior. The Arizona Children's Home Association reports that it is dealing more often with sexual abuse cases and is beginning to focus more on cases involving chronic chemical dependency. The respondents noted that the criteria are looser in rural areas. The Association will take referrals there that they might refuse in Phoenix or Tucson, where there are more available resources.
The state completed an analysis of Arizona's family preservation services in FY 93.<17> This evaluation focused on three areas:
The evaluation found that a total of 195 families with 567 children were accepted to the program during FY 93. Most of the children who entered the program (67 percent) were age ten or younger. The average family was enrolled in the program for 56 days, and received an average of 45 direct service hours. Follow-up services were provided to 57 percent of the families after they exited the program, usually community-based services.
Outcomes were based on before-and-after comparisons conducted in three areas: the risk levels of families, the number of substantiated reports of maltreatment, and the number of out-of-home placements. No control group was used for this comparison. The evaluation reports that the program enjoyed a high degree of success based on these criteria.
The average program cost per family was calculated at $2,901. Emergency grants provided to 38 percent of the families by the program averaged $123. Families spent these grants on car and household repairs, rent, food, and utilities.
California has had family preservation programs in place for over a decade. Original authorizing legislation funded a number of demonstration sites to provide preplacement prevention services. Subsequent legislation provided funding through a competitive process to four pilot counties. Beginning in 1993, state authorizing legislation opened up the potential for program funding to any county that wishes to apply. Currently, California has state-subsidized family preservation programs available in 16 counties.
Any county that wishes to receive state funding for a family preservation program must submit a plan for services that specifies how foster care placements will be redirected. Subject to state approval of the county's plan, each county can design and provide its own continuum of services, including reunification services. Savings in foster care dollars are also projected by the county. Counties that do not meet these projections in out-years can lose part of their state contribution.
Following are details of the programs in Contra Costa, Los Angeles, Sacramento, San Diego and Solano counties. According to the state representative and others, these are among the largest and best-established programs in California.
Family preservation services in Contra Costa County are provided by FamiliesFirst, a private, non-profit agency under contract to the county. The program includes the usual range of concrete and support services.
In addition to the Families First program, Contra Costa County has contracted with five community agencies to provide after-care, such as parent education, parent aides, and counseling. Service may be provided for up to one year after the intensive program ends.
FamiliesFirst is the only provider of intensive crisis-oriented services in the county.
In 1994, 774 children entered foster care in Contra Costa County. Of these, 589 were referred by DSS and 185 by Probation.
1) Structure
The Contra Costa County program was established in 1988. It follows a modified Homebuilders model. The caseload for the program is two to three families per worker. Service is provided for four to six weeks, except for cases referred by the mental health agency, which receive service for eight weeks. Flexible funds are available to provide less intense, longer term services to families through specialized contracts. Third party and private pay contracts are also accepted for individualized Family Preservation Services.
The objectives of the program are to ensure safety, negotiate outcomes, achieve those outcomes, and prevent placement. Success is defined case by case and involves assessing the family's behavior and acquisition of skills.
The program operates at capacity. It served 178 families in 1994.
Families in Contra Costa are eligible for aftercare services by five designated agencies within the three county regions. The services range from individual and family services to in-home support services. All services are available for a minimum of six months and a maximum of one year.
2) Operation
FamiliesFirst serves children age 0-18 at risk of placement. Referrals come from CPS (60%) and Probation (40%), and under a separate contract, from the county mental health agency (15-20 families per year).
There are no guidelines for determining risk of imminent placement: the determination is made by the referring worker and, according to the county contact, interpretation varies widely. Referrals from Probation follow a suspended court order for placement. Referrals from CPS follow the filing of an abuse/neglect petition.
Contra Costa County has a Review Committee that screens worker referrals. Occasionally, in an emergency, a case is referred directly, but it is later referred to the Committee for review. FamiliesFirst may screen referrals also, but usually only to determine whether the referral is timely.
Criteria for acceptance into the program are broadly defined. The program includes substance abusing parents. It excludes families in which there has been a death caused by a parent; homeless families; psychotics who refuse medication; and sexual abuse cases if the perpetrator (other than a sibling perpetrator) is still in the home.
The Los Angeles County Family Preservation Program (FPP) has been in operation since 1991. It is operated by the County under contracts with lead agencies for Community Family Preservation Networks. Funding for the FPP comes from state funds administered by the county Department of Children and Family Services. A citizen's advisory group helps to set policy and direction and oversees the operation of the program. The Family Preservation Program began with nine networks in the six Los Angeles County Community areas with the highest number of foster care placements. In 1994, three more communities and networks were added, and three additional networks were added to the original nine in the initial six community areas. FPP currently comprises 18 separate programs, including 15 community family preservation networks and 3 special county programs for Black and Latino families. Each of the networks is led by a different community agency (which sub-contracts with other local agencies). The overall program includes placement prevention, reunification, and juvenile diversions.
Since January 1993, FPP has served 7,000 children, one-third of these with reunification services, and two-thirds with placement prevention services. In 1994, 13,359 children entered foster care in Los Angeles County. Of these, 11,881 were referred by child welfare and 1,478 by Probation.
1) Structure
The Los Angeles program has developed its own service model, having rejected the Homebuilders model in favor of a program that provides Homebuilder-type services coupled with 21 other services that include accessing health, education and social services at the community level.
The program defines family preservation as "an integrated, comprehensive approach to strengthening and preserving families who are at risk of or already experiencing problems in family functioning with the goal of assuring the physical, emotional, social, educational, cultural and spiritual development of children in a safe, secure and nurturing environment." The program goals are to assure the safety of children; empower families to resolve their own problems; build on family strengths; identify problems early and solve them; involve the community in family support; decrease the need for public resources over time; and break multi-generational dependency upon public services.
The community network outreach workers carry a caseload of 5-8 families. Services are usually provided for 3-12 months, average 4.9 months, and must be reauthorized every 3 months. Services can extend beyond one year, with the approval of the Deputy Director of the Department of Children and Family Services. Cases are closed when the child is no longer at risk. DCFS workers serve as case managers and carry a caseload of about 38 children.
2) Operation
Cases are referred from Probation and CPS and are assigned to the appropriate community network for services. These networks provide both direct services and linkages to other agencies. The direct services include in-home/outreach service and several types of counseling; homemakers; emergency caretakers; parent training; transportation; mental health treatment matched with Medi-Cal; therapeutic day treatment; auxiliary funds; and self-help groups. The linkages are made to a range of agencies providing such services as substance abuse testing and treatment, housing, employment support, health care, child care, education and developmental services.
The program began with a focus on imminent risk of placement, but it found that local agencies had to broaden their referral criteria to include cases in which there is a problem with family functioning in order to receive adequate funding. The family rate per month payment mechanism resembles an HMO arrangement with flexibility in use of the capitated funding. The program does not screen out cases referred to it, however, referral sources exclude cases involving sex offenders with uncontrolled access to children and families that refuse services.
Family preservation services have been provided in Sacramento County since 1991. The program began with two units and expanded by two additional units in 1992 and 1993. The program, called Family Preservation and Child Protection (FPCP), is one of five divisions within the Department of Health and Human Services. Public staff from the FPCP division provide all case management activities, and the program contracts with nine partner agencies to provide client services such as drug counseling, service centers, homeless family shelters, anger control counseling, family support, and housing assistance. Other services, such as mental health services, nursing, and drug and alcohol counseling are provided by public employees from within the Department.
Annually, the county receives about 3,000 reports of child abuse and neglect per month, and responds to approximately 500 of these. Currently in the county, 3,000 children are in foster care, with 633 entering in 1994.
1) Structure
Family preservation services in Sacramento County are provided by a team of a social worker and a family support worker who serve 8-10 families each. Services are provided for 90 days, with extensions possible. Clients are involved for approximately 5-20 hours per week (including services provided by contract agencies), and families are able to access a program social worker via the 24 hours a day, seven days a week emergency response line.
The Family Preservation/Emergency Response Unit targets multiple referral cases and pregnant adolescents. With the latter group, services are provided pre-birth and 90 days post delivery. The Family Preservation units in Family Maintenance and Family Reunification target imminent risk cases. The Family Preservation/Emergency Response Program is considered a primary prevention program.
2) Operation
The program keeps accumulative statistics on the number of children served since 1991. It is estimated that approximately 65 family cases were referred and accepted each month (or approximately 1,000 children per year). The majority of these referrals originate following a child placed in protective custody and involve neglect and drugs. In addition, approximately one percent of referrals originate from mental health, and the program is required to accept 200 female juvenile justice referrals per year. The program accepts all cases (including substance abuse) with the exception of those involving sexual abuse. However, the program will continue to serve such cases if sexual abuse comes to light after the case has been accepted.
The average age of the parent served is 31, and the average age of the child is six. Most of those referred are poor and live in urban areas; the majority of those served live in the eight highest poverty areas in the city.
CPS cases enter family preservation through either the 24-hour emergency response line or the Dependent Intake Unit. Cases that enter through the emergency response line are assessed for imminent risk and referred by the Assessment worker and his or her supervisor. Cases that enter through the Dependent Intake Unit are assessed for imminent risk and referred by the Assessment worker and supervisor and by a family preservation worker and supervisor. After the assessment is completed, a decision is made to: screen the case out, refer to child welfare services (Family Maintenance), refer the child to family preservation services, or place the child in foster care on an emergency basis.
San Diego's Intensive Family Preservation program has been in existence since January 1991. The program operates as a division within the county CPS office and is staffed by CPS employees. It serves high-risk families, using both child welfare staff and private providers. Moderate and low-risk families are served by private providers who are under contract to the agency. A case manager oversees these cases and controls the services provided and their intensity.
In 1994, the intensive family preservation program estimates they served approximately 230 families. The program operates at capacity. That year, there were an average of 6,390 reports of child abuse and neglect per month in San Diego county. The average monthly number of children in foster care totaled 5,481. An average of 2,400 children enter foster care each year.
1) Structure
Services in the intensive program are flexible and designed to meet the needs of the individual family. Some cases are teamed, others are served by a single caseworker. Service duration varies from two weeks to 90 days, with extensions permissible up to nine months. Caseworkers are assigned no more than four cases (most have three on average). A maximum of $500 per month in flexible funds is available.
Services provided include traditional family preservation services such as counseling and also include public health, mental health, substance abuse treatment, transitional residential, and international liaison services for recent immigrants. All of these services are provided by program staff. Additional services are furnished by private providers on a contractual basis.
2) Operation
There are multiple referral sources for the San Diego family preservation program, including CPS, child welfare services, juvenile justice, courts, developmental disabilities, mental retardation, mental health, and children in residential care. In addition, program staff routinely track cases in foster care and advocate that they be referred for intensive services. Imminent risk is not a criteria for referral, although the program contact stresses that many of these cases are served. During November 1994, 49 cases were referred, 23 were rejected, and 19 were opened.
The program contact also stresses that the program serves many types of families and problems, including sexual and substance abuse cases. The program does not accept cases in which there is a high probability of a child's death. The program defines these cases as cases involving psychotic parents, parents with IQs below 70, cases of sadistic abuse, and cases in which a child has sustained serious blows to the head, burns, or bone breaks. The program also excludes parents whom a psychiatric evaluation has found incapable of parenting.
Family preservation services in Solano county are provided by FamiliesFirst, a private, non-profit agency under contract to the county. The program provides both family preservation and reunification services. It includes the usual range of concrete and support services.
FamiliesFirst is the only provider of intensive crisis-oriented services in the county. Solano County Department of Social Services has some family preservation workers who provide ongoing services.
In 1994, 300 children entered foster care in Solano County. Of these, 148 were referred by DSS and 152 by Probation.
1) Structure
The Solano County program was established in 1983. It follows a modified Homebuilders model. The caseload for the program is two to three families per worker. Service is provided for four to six weeks. Flexible funds are available to provide less intense, longer term services to families through specialized contracts. Third party and private pay contracts are also accepted for individualized Family Preservation Services.
The objectives of the program are to ensure safety, negotiate outcomes, achieve those outcomes, and prevent placement. Success is defined case by case and involves assessing the family's behavior and acquisition of skills.
The program operates at capacity. It served 92 families in 1994.
2) Operation
FamiliesFirst serves children age 0-18 at risk of placement. Referrals come from CPS (60%) and Probation (40%).
There are no guidelines for determining risk of imminent placement: the determination is made by the referring worker and, according to the county contact, interpretation varies widely. Referrals from Probation follow a suspended court order for placement.
Solano County has a Review Committee that screens worker referrals. Occasionally, in an emergency, a case is referred directly, but it is later referred to the Committee for review. FamiliesFirst may screen referrals also, but usually only to determine whether the referral is timely.
Criteria for acceptance into the program are broadly defined. The program includes substance abusing parents. It excludes families in which there has been a death caused by a parent; homeless families; psychotics who refuse medication; and sexual abuse cases if the perpetrator (other than a sibling perpetrator) is still in the home.
Statewide evaluation. Walter R. McDonald and Associates (WRMA) has conducted several evaluations of California's effort to impact foster care placement. These evaluations are funded through the state authorizing legislation.
Currently, ten sites are being evaluated. Nine of these sites are providing case-specific data through mini-automated systems. The tenth, Los Angeles County, is undergoing a separate process evaluation. This evaluation is entering its second year. For a previous evaluation, completed in 1990, WRMA collected data on over 700 families that were referred to family preservation services. These data included:
In addition, during the third year of this evaluation, five programs participated in a comparison study in which data were collected on a group of families and children referred for services. These referrals were assigned to either receive intensive in-home services or other child welfare services.
No significant differences in placement rates were observed between these two groups. Eighty-two percent of the project's children in the treatment group were not subsequently placed in foster care compared to 83 percent of those in the control group. Approximately one-quarter of the families in each group had a subsequent investigation for child abuse and neglect. In addition, no significant differences between the two groups were found in terms of placement incidents, length of time in placement, and overall placement costs.
Contra Costa and Solano Counties. Families First, the family preservation program in Contra Costa and Solano Counties, has been evaluated several times. In 1987-88, the University of California-Davis conducted an extensive evaluation of the program, using an experimental design. This research found that children whose families received family preservation services did not require outside placement at the rate of those in the conventional group, who received only traditional counseling services. Families First also was part of the WRMA evaluation and is currently being evaluated by the State.
Los Angeles County. The Los Angeles County Family Preservation Program has recently undergone a process evaluation by Walter R. McDonald and Associates.
In the three months since February 1992, the increase in the number of foster care placements has risen 3 percent in the initial 6 communities as compared to 36 percent in all other communities in Los Angeles.
Sacramento and San Diego Counties. Sacramento County (like the other 16 Family Preservation counties) was involved in a year long comprehensive evaluation by Walter McDonald, whose report is due in December 1995. Since its inception, Family Preservations' fiscal success and foster care avoidance have been evaluated by the State. County statistics indicate over 90 percent of the children in Family Preservation/Family Maintenance are home two years after termination of Family Preservation services. One hundred percent of the children served by Emergency Response/Family Preservation are home 1 year after termination of services.
In Florida, the Department of Health and Rehabilitative Services (DHRS) is responsible for the administration of family preservation programs. There are two statewide programs offered in all 15 DHR districts: Intensive Crisis Counseling Program (ICCP) and Family Builders (FB). There is variation in implementation among the districts. Both programs exist in all of the large population centers, but some of the geographic areas are too large and not densely populated enough to support one or the other program. Services are delivered by private providers contracting with the 15 state districts.
Recent legislation establishing a "family response system," has had an impact on who receives family preservation services. When a child abuse and neglect report is received at the District level, families are prioritized and placed into two groups: 1) Family Services Response (FSR) or 2) Investigation. Families that are sent to FSR receive any type of family preservation service (home maker, child care and intensive in-home services), without entering the child welfare system. Investigation families enter the child welfare system and are investigated. Some of these families may later be referred for family preservation services. The Office of Alcohol, Drug Abuse and Mental Health also has developed a family preservation model called SEDNET, which works to stabilize severely emotionally disturbed (SED) children in their families, through a variety of community supports.
According to the state contact, Hillsborough County (the Tampa area) has one of the oldest and best-established family preservation programs in Florida, and it has a reunification program as well. Details of the Hillsborough County program are included in the following description.
The two major family preservation programs in Florida are ICCP and Family Builders (FB).
ICCP. ICCP, which began as a pilot program 1982, is the older and larger of the two Florida family preservation models. Staff of this program provide a basic Homebuilders model, serving caseloads of two-four families for service durations of four--six weeks. While the program itself does not have any flexible funds attached, new legislation allows districts to use leftover emergency assistance funds or foster care funds to help preserve families. ICCP workers use these dollars as flexible funds. In FY 94, ICCP served 2,418 families statewide.
In Hillsborough County, ICCP services have been somewhat modified. Family preservation services are provided by a single private agency. Service is provided by two-person teams comprising a professional and a para-professional. The caseload is six families per team. The duration of service is six weeks, with a possible two-week extension.
Hillsborough's ICCP serves about 225 families per year. In 1994, 423 children entered foster care in the county. In December 1994 there were 1,075 children in foster care in the county. In November 1994, 1,072 families, representing 2,283 children, received protective services.
Family Builders. Family Builders was established in 1990. The program pairs a professional with a para-professional to provide services to four-six families at a time. The teams serve families for three-four months. There is also up to $500 of flexible funding available per family. Florida officials consider this the more intensive of their two programs. It is possible that a family that "failed in ICCP," might be referred to Family Builders, but for the most part these programs are mutually exclusive.
In FY 94, Family Builders served 1,397 families statewide. Discussions with the program contact revealed that this underrepresented the actual number, since only 11 of the 15 districts had reported for the last quarter. He estimated the number should be 25 percent higher.
Some districts have modified the basic Family Builders program. In Jacksonville, for example, there is a well-defined follow-up program which includes pairing families with more functional community families for six months after they leave the program.
Hillsborough County's Family Builders program sticks to the model and uses two-person teams who carry a caseload of six families per team. Services are provided for 90 days and may be extended for an additional month. Family Builders serves about 175 families per year.
ICCP. Referrals to ICCP can come from juvenile justice or child welfare, but they cannot be court ordered. Ninety percent of the referrals come from child welfare. According to the state contact, this is partly because juvenile justice is developing its own program. Referrals generally come from investigators (75 percent), but can also come from any other DHRS workers, (protective supervision, adoption, foster care, or Voluntary Family Services worker).
Imminent risk is required for entry into ICCP, but the state has not defined the term. According to the state representative, workers use their own judgment to make the determination. To receive family preservation services there must be a parent who is willing to work with the program and substance abusers must be willing to accept treatment. Policy also states that there must be the knowledge that with services, risk can be reduced.
The state representative noted that ICCP seems to be serving families with older children. There is some district to district variation in target populations because certain providers have contracted to serve special populations, such as substance abusers, teen parents or Spanish speaking populations.
In Hillsborough County, the referring caseworker uses a risk assessment tool to assess risk of imminent placement. Workers have to determine that the child will be placed within 24 hours to meet the imminent risk criterion. The program excludes families who are not willing to participate in the program and substance abusers who are not willing to accept treatment services.
Family Builders. The Family Builders target population is similar to ICCP, but the program tends to serve the more complex cases and younger children. In most cases, these children are under seven years old, and they are more likely to be under five years old. Imminent risk is required for entry into Family Builders.
In Hillsborough County, Family Builders excludes the same types of families excluded from ICCP.
The state has just completed a two and a half year evaluation of its family preservation programs. The evaluation was conducted with Florida State University in the first four districts of Family Builders. Hillsborough County was among the sites studied.
Although family preservation services have been available since 1974, the Iowa Family Preservation Program (IFPP) began on a demonstration basis in 1987 and became available statewide in the Fall of 1990. Home-based preventive services are available throughout the state through a number of public and private providers, some of which operate multiple sites across the state. Among the largest of these providers are: Lutheran Social Services, Gerard Treatment Program, Alternative Treatment Associates and Boys Town.
Throughout the state, two home-based preventive services programs are available: 1) Iowa's Family Preservation Program (IFPP) and 2) Family-Centered Services.
IFPP. IFPP is housed within the Department of Human Services in Des Moines and five regional offices. Services are provided by ten agencies, some with multiple sites across the state. The basic outline of the program is proscribed, including caseload size, service duration, and core services to be provided.
The worker providing family preservation services is in contact with the family every day at the start of the intervention and is available to the family on a 24-hour basis. Caseload size averages 3.5 families per worker; however, service standards for FY 95 shall reduce caseloads to three families. Services can be provided for up to 60 days, but the average length of service is about 45 days. The services are geared toward providing immediate services in order to relieve a crisis situation and include restorative living skills, social skills, therapy and counseling, psychological/social evaluations, and family skills development. Family preservation providers have access to flexible family assistance funds to meet concrete family needs.
Polk County (Des Moines) is the largest catchment area in Iowa. In Polk, approximately 33 families are served during a month. With an average length of service delivery of 45 days, approximately 297 families are served in a year. The majority of the families in Polk are served through one private agency.
In FY 94, there were 2,097 incidents of abuse or neglect involving 3,264 children reported in Polk County. Of these, 669 reports involving 919 children were substantiated. The average monthly number of children in foster care was 425. In 1993, statewide, 2,415 families were provided intensive family preservation services; over 2,450 were served in 1994.
Family-Centered Services. Iowa's Family-Centered Services program is statewide and is also targeted at families in crisis. However, it is implemented differently in every site. Services are provided by a combination of private providers and Department of Human Services (DHS) staff.
Most family-centered services are court-ordered. The services usually begin with contact with the family approximately three times per week, although no caseload size is prescribed. The major components of family-centered services are: pa