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In Kentucky the Family Preservation Program (FPP) is a resource within the state's Department of Community Based Services (DCBS), a division of the Kentucky Cabinet for Families and Children. (22) The 120 Kentucky counties are grouped into 16 regions for purposes of FPP administration. There is a family services specialist in Frankfort who has responsibility for statewide coordination of family preservation services including program oversight of contracts, providing training and meeting program reporting requirements. Direct services are delivered by private providers under contract to the state.
Kentucky counties participating in the evaluation originally included Jefferson County (Louisville) and Fayette County (Lexington). Fayette County only participated in the data collection effort for eight months and referred 32 of the 349 net study cases. Therefore, this chapter highlights service delivery, family preservation services, and the implementation of the evaluation in Jefferson County. Study enrollment began in May 1996 and concluded in February 1998.
The sources of material for this chapter are reports and documents produced by the state and interviews with personnel at the DCBS and FPP programs. This information is presented to help understand the context in which services were provided, and to identify any changes that occurred during the implementation of the evaluation. The observations only reflect the perceptions of the individuals we interviewed.
This chapter begins with an overview of the characteristics of Kentucky's children and families. Details of the Kentucky family preservation program, service delivery in Jefferson County, implementation of the evaluation, and other organizational initiatives are then provided.
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This section provides demographic statistics on Kentucky's children and families. Child welfare statistics are presented for Jefferson County (Louisville), which was the focus of the family preservation study in Kentucky.
There are approximately 1,000,000 children under age 18 in Kentucky, with the majority being white (89 percent), and nearly two-thirds under twelve years old (Table 3-1).
| Total number of children under age 18 in 1997 | 961,200 |
| Age | Percent (%) |
|---|---|
| 0-5 years old | 32 |
| 6-11 years old | 32 |
| 12-14 years old | 18 |
| 15-17 years old | 18 |
| Race/Ethnicity 1997 | |
| White | 89 |
| African American | 9 |
| Hispanic | 1 |
| Other | 1 |
Indicators of child health, education, and social and economic welfare in Kentucky as compared to the nation are presented in Table 3-2. Data have been abstracted from the Kids Count Data Book, published by Annie E. Casey Foundation. With respect to most indicators, Kentucky's families and children are similar to the national average. The Casey Foundation developed a family risk index based on the following indicators: 1) number of children who are not living with two parents; 2) households in which the head of household did not have a high school degree; 3) family income below poverty level; 4) parents did not have steady employment; 5) the family was receiving welfare; and 6) no health insurance for the children. Using the Casey risk calculation, in Kentucky, 17 percent of the children are considered at risk as compared to 14 percent of children in the nation.
| Kentucky | Nation | |
|---|---|---|
| Health: | ||
| Percent low birth weight babies (1996) | 7.9% | 7.4% |
| Infant mortality rate (deaths per 1,000 live births, 1996) | 7.5 | 7.3 |
| Percent of 2 year olds immunized (1997) | 81.0% | 78.0% |
| Percent of children without health insurance (1996) | 14.0% | 14.0% |
| Percent of children covered by Medicaid or other public-sector health insurance (1996) | 31.0% | 25.0% |
| Child death rate (deaths per 100,000 ages 1-14 in 1996) | 27.0 | 26.0 |
| Teen violent death rates (deaths per 100,000 ages 15-19 in 1996) | 73.0 | 62.0 |
| Teen birth rate (Births per 1,000 15-17 females in 1996) | 37.0 | 34.0 |
| Education: | ||
| Percent of teens who are high school dropouts (1998) | 14.0% | 10.0% |
| Percent of 4th grade student scoring below basic reading level (1998) | 37.0% | 39.0% |
| Percent of 8th grade students scoring below basic math reading level (1998) | 26.0% | 28.0% |
| Welfare, Social, and Economic | ||
| Median income of families with children (1996) | $33,900 | $39,700 |
| Percent of children in poverty (1996) | 25.0% | 20.0% |
| Percent of children in extreme poverty (1996) | 16.0% | 9.0% |
| Percent of children living with parents who do not have full time employment (1996) | 33.0% | 30.0% |
| Percent of families with children headed by a single parent (1996) | 25.0% | 27.0% |
| Source: Kids Count Data Book, published by Annie E. Casey Foundation, 1999. | ||
Child Welfare Statistics for Louisville. To provide background for the findings from the evaluation, an overview of the number of child abuse and neglect reports and the percentage of substantiations for four years prior to the study and the first year of the study are presented (Table 3-3). For the calendar years 1992-1994, the number of children for whom there were abuse and neglect reports remained fairly stable, around 10,000. An increase of about 2,000 was seen in 1995. In 1996 there were 12,118 children reported and 49 percent substantiated, similar to the number of children reported in 1995. In 1998, the year the study ended, there were 11,797 children reported and 44 percent of those children substantiated.
Across all five years, approximately 50 percent of the children reported were substantiated victims. The percentage of cases substantiated by age remained fairly constant over the years, with children over ten having a slightly higher rate of substantiation than children under 5 years old. African American children had a consistently higher rate of substantiation than white children.
Substitute care placements in Louisville, Kentucky for the year prior to the study (1995) and the first full year of data collection (1997) are presented below (Table 3-4). There were a greater number of children in care at the beginning of 1997 than 1995. This may reflect the increase in abuse and neglect cases in 1995 and 1996. However, there was a definite decrease in the number of new entrants and an increase in the number of discharges in 1997.
| 1992 | 1993 | 1994 | 1995 | |||||
|---|---|---|---|---|---|---|---|---|
| Number Reported |
Percentage Substantiated (%) |
Number Reported |
Percentage Substantiated (%) |
Number Reported |
Percentage Substantiated (%) |
Number Reported |
Percentage Substantiated (%) |
|
| Age: | ||||||||
| Total all ages | 10,170 | 48 | 9,940 | 51 | 10,660 | 50 | 12,621 | 48 |
| 0-5 Years Old | 4,857 | 42 | 4,526 | 47 | 4,697 | 46 | 5,810 | 44 |
| 6-10 Years Old | 2,807 | 50 | 2,623 | 56 | 2,912 | 47 | 3,606 | 51 |
| 11-15 Years Old | 2,287 | 52 | 2,286 | 56 | 2,477 | 54 | 2,576 | 54 |
| 16-17 Years Old | 536 | 50 | 505 | 58 | 574 | 49 | 629 | 52 |
| Race: | ||||||||
| White | 6,216 | 45 | 5,944 | 54 | 6,127 | 47 | 7,213 | 53 |
| Hispanic | 17 | 47 | 31 | 46 | 44 | 59 | 26 | 73 |
| African American | 3,534 | 53 | 3,556 | 66 | 4,082 | 56 | 4,785 | 61 |
| Asian | 44 | 45 | 51 | 55 | 34 | 47 | 51 | 31 |
| American Indian | 0 | -- | 2 | 100 | 4 | 54 | 5 | 0 |
| Bi-racial | 342 | 48 | 347 | 65 | 349 | 25 | 508 | 61 |
| 1995 | 1997 | |
|---|---|---|
| Children in care at beginning of year | 1534 | 1774 |
| New entrants | 943 | 591 |
| Discharge | 885 | 1458 |
| Total served | 2477 | 2365 |
| Includes children in foster homes, group homes, treatment facilities, and with relative foster parents. | ||
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Family preservation programs began in Kentucky in 1985 with pilot projects funded by the Edna McConnell Clark foundation. These pilot studies, initiated through local efforts, were the impetus for three 1989 state grants to pilot family preservation programs in Louisville, Lexington, and western Kentucky. The pilot projects were replications of the Homebuilders Model. In 1990 the Kentucky Family Preservation Act established the Family Preservation Program (FPP), "a short-term intensive, crisis-intervention resource intended to prevent the unnecessary placement of children at imminent risk of placement." According to legislation, family preservation programs were to "follow intensive, home-based service models with demonstrated effectiveness in reducing or avoiding the need for out-of-home placement." (23)
Initially the 1990 Kentucky Family Preservation Act provided for grants to 47 counties to establish family preservation programs. By 1992 the program expanded to 90 counties, and in April 1996 services were available in all 120 Kentucky counties.
By law, family preservation services can be provided by the Department of Community Based Services or through contracts with private, nonprofit social service agencies. Currently all services are purchased through contracts with private agencies.
Until 1994 family preservation programs were entirely state funded when the decision was made to use federal Title IV-A Emergency Assistance Funds (EAF). The purpose of this was to maximize available state and federal dollars by applying for Title IV-A emergency funds for families eligible for family preservation services. In 1997, with the inception of Temporary Assistance for Needy Families (TANF) and the block granting of IV-A funds, the state implemented an eight percent decrease in family preservation contracts. At that time, there was a short-term effort to draw down Medicaid Rehabilitation Funds for FPP. Presently TANF funds are being used to supplement state funding. In 1998 there was an increase in the budget due to an increase in funding for reunification services. The 1998 budget reflected a blending of funds for the two programs, family preservation and reunification.
The family preservation funds available through the 1993 Omnibus Budget Reconciliation Act (OBRA), Title IV subpart 2 of the Social Security Act were mainly used in the planning year to develop regional planning for service provision. A small proportion of the funds was used to pilot family reunification services in five sites for six months. In subsequent years, the funding was divided between family support programs and family preservation. The proportion of funds devoted to family preservation was used for the development of reunification programs rather than further expansion of family preservation programs. All regions were given funds to develop reunification programs. These funds could be used to expand reunification services provided through the pilot studies or new programs could be developed. New initiatives were developed to provide reunification services at the time a child entered foster care as well as targeting those children who were in foster care for extended periods of time.
According to Kentucky policy, "Family Preservation and Program Responsibilities," the Family Preservation Program (FPP) is a short-term, intensive, crisis-intervention resource intended to prevent the unnecessary placement of children at imminent risk of placement. (24) The program serves children and their families who are at risk of commitment as dependent, abused, or neglected; who are identified as needing juvenile services because families are unable to exercise reasonable control of the child; who are identified as having mental health problems; or who are receiving services through the Kentucky Impact program. (25) The purpose of the program is to make reasonable efforts by the Department to prevent the removal of children from their homes.
Programs are to:
Families referred to the FPP are expected to meet the following criteria:
Families not eligible for family preservation services include families in which there has been sexual abuse of a child and the perpetrator is still in the home or the child is at risk from recurring sexual abuse and families in which an adult is drug dependent and he or she is not in active treatment.
Direct services are provided by private providers under contract to the state. State policy dictates that caseload size, intensity and duration of services and accessibility of services are based on the Homebuilders model and are outlined in policy as summarized below:
Policy also specifies that the family preservation provider is to conduct a home visit within 24 hours of referral and make a determination of service provision within 72 hours of the referral.
To aid in the implementation of family preservation services in each region, policy outlines the development of a Family Preservation Program Management Team. The team consists of the contract agency Executive Director, the Department's District Manager, a Department staff person who assumes responsibility for reviewing all referrals to the FPP, the central office family preservation program coordinator, and the FPP supervisor.
Jefferson County (Louisville) is the largest district of the Department. Jefferson County did not become part of the Department until 1989. Prior to that time, the Department contracted with Jefferson County to provide child protective services. In Jefferson County reports of child abuse and neglect are made to a state hot line. These reports are then investigated by the Intake and Investigation unit. After investigation, families needing further service are referred to Child Protective Service (CPS) ongoing treatment units. Transfers are to occur within 10 days of conducting the investigation.
During the evaluation, there were nine intake and investigation teams and nine ongoing treatment units. There were also special teams to serve the medically fragile, adolescents, adoption, recruitment, domestic violence cases, and provide court support. During the study period, approximately half way through data collection, the District Manager moved to a state office position, and a new District Manager was appointed.
Prior to beginning data collection for the study, interviews with public and private agency staff were conducted to understand how family preservation services were delivered and the relationship between FPP and DSS. (26) Comments from these interviews are included in the following description.
Presently, family preservation services are provided in Jefferson County by the private provider, Seven Counties Services, Inc. However, this was not always the case. Originally, family preservation services were provided through a unit within the county public child welfare agency and Seven Counties Services. Public agency staff who experienced both the internal family preservation program and the program provided by Seven Counties preferred the services provided by the public agency program. They felt that the public agency program was more successful, more accessible, there was better collaboration, and services were provided for a longer time period, (12 weeks as compared to 4-6 weeks). The family preservation unit had a screener who reviewed all cases referred for services. When the decision was made to contract for family preservation services, the screener position remained within the public agency.
Referral Procedures. Referrals to family preservation come from the intake, ongoing, and adolescent child welfare agency units. Workers are required to discuss all referrals with the team supervisor and then present the case to the family preservation screener. A family preservation referral form is completed (see Appendix D), and the worker must discuss with the family its interest in the service prior to referral. The screener is responsible for making sure the referral is appropriate and also acts as the liaison with the family preservation program.
The screener maintains a log of cases needing family preservation services that have not been referred because of the unavailability of slots. In the year prior to the study (1995), 195 child welfare cases were referred to family preservation services. Of these cases, 58 percent were from ongoing units and 42 percent were from intake and investigation units. (27)
As discussed earlier, state regulation stated that referrals should only be cases in which there was imminent risk of placement. In fact, during early negotiations with Louisville, the screener said she estimated about 80 percent of the referred cases were at "imminent risk" of placement. However, in subsequent conversations with workers, they indicated they referred cases that they felt really needed services, but were not necessarily facing imminent placement.
When intake and investigation (I&I) workers were asked specifically about the types of cases referred for family preservation services, they responded:
The I&I workers believed that family preservation helped families get organized and taught daily living and parenting skills.
FPP Program. Seven Counties, Inc. is the agency that provides family preservation services for Jefferson County. The FPP program is referred to as the "HELP" program and the workers are referred to as "therapists." Seven Counties is a community mental health agency with a staff of almost 1,000. The agency has a variety of programs for seriously mentally ill adults, including outpatient treatment, case management, day treatment, and medication management. Programs for children and families include services for violence problems -- outreach, office based, and in-home services for perpetrators and victims. Other programs include school outreach, a parent aide program, and Kentucky Impact, a program providing long- term wraparound services for severely emotionally disturbed children. The family preservation program also has a reunification component. Reunification services are provided to families just prior to returning the children home.
FPP cases are referred from Kentucky Impact as well as the courts and DCBS. Referrals from the courts and Kentucky Impact account for approximately one-third of all family preservation cases served each year by Seven Counties. However, family preservation service cases referred from Kentucky Impact focus on prevention of psychiatric hospitalization and last for six to eight weeks rather than the four weeks of the general family preservation program.
Each FPP therapist handles two cases at a time, and must complete 15 cases per year. The agency is budgeted at 124 cases per year (1000 face to face hours per worker/year). Since its inception in 1990-1991, the program has doubled in size. In 1992 the intervention was shortened from six to four weeks to meet the goal of serving 124 cases.
To provide family preservation services Seven Counties has one supervisor, ten therapists, one reunification therapist, and one therapist who works solely with cases serving severely emotionally disturbed children. Almost all therapists have Masters degrees (either MSW or M.Ed.). All therapists receive Homebuilders training, with some specific training provided on substance abuse. Twenty percent of the therapists in the program are African American and the remaining are white. Therapists were very adamant in their belief in the Homebuilders philosophy, particularly its emphasis on respecting clients, self-determination, and advocating for clients.
State policy required that the therapist contact the family within 24 hours of referral. If they were unable to reach the family within 48 hours they were to contact the public agency for assistance. By 72 hours a complete initial family contact was to occur, with a determination of whether the family would be active with FPP. If a family could not be contacted or was not willing to work with FPP, then DCBS was to be immediately notified. Therapists indicated they had an unwritten "three strikes" rule. A family was given three attempts to contact or visit, and if a therapist could not reach the family, the family was "out," and the referral was turned back to DCBS.
FPP provides an acceptance letter on each case, but CPS investigators rarely have direct contact with FPP therapists. Some FPP therapists said they liked to meet with ongoing workers while others did not. In some instances, case conferences were held. If there was no conference, at the closure of FPP case, the therapist would call the worker.
Conversations with therapists revealed some tensions between the public agency ongoing workers and Seven Counties therapists. Therapists felt that some ongoing workers referred cases because they wanted a break from overwhelming cases so they could work on other cases. Seven Counties therapists felt that the workers should stay involved with the family while the case was receiving FPP services. In contrast to the therapists' reports, supervisors of ongoing workers indicated that their workers do keep visiting families during FPP, dealing with the child protection issues.
Seven Counties therapists worried that cases would be closed immediately after FPP was done, although this did not often actually happen. They felt that this was not appropriate as many families needed extended services.
There were generally positive views from the intake and investigation workers who wanted many more FPP slots. However, they were concerned about the short-term intervention because they felt that positive family changes were just beginning to happen at the end of service. They believed some of the therapists do good work, while others were not as good. When asked, workers described an inadequate therapist as one who was not flexible and did not really connect with the family. Supervisor comments stressed the positive value of FPP, but suggested several changes: they felt the program should have more slots, change the substance abuse policy, and have a longer period of intervention.
Overall, workers and supervisors indicated they had a mostly positive experience with the program. They believed FPP was timely in responding, took difficult cases, and shared information. One worker said, "even when placement occurs we still find out a lot about a family, and good joint decisions are made." Supervisors stressed that referrals were made based on crisis, immediate need, and risk of placement, not to assess a family. While assessment is not the "reason" for referrals, they noted that FPP may find out more about family problems such as drug abuse.
There were differing opinions about the rule that families with substance abuse problems can only be referred to family preservation if they are in or about to enter treatment. Supervisors felt that 70 percent of the cases involve some kind of substance abuse. They indicated that FPP can help to get parents into treatment and that FPP should change its focus in order to deal with these cases. The rule does not prohibit the referral of a family with an adolescent with substance abuse problems. Others felt that FPP is too short an intervention for dealing with substance abuse problems and parents need to admit to their problems first in order to make use of FPP.
Court System. The court system in Jefferson County is very supportive of family preservation programs. There is a strong commitment to families. At about the time family preservation programs were being piloted, a family court pilot project was implemented. Beginning with a Family Court Feasibility Task Force in 1988, the Kentucky General Assembly adopted Resolution Number 30. The resolution recognized that the courts were routinely required to make judicial determinations about families, the jurisdiction of the various courts overlapped, and the establishment of a court devoted to and specializing in family law might promote continuity of judicial decision-making. The Family Court Pilot Project was established. The jurisdiction of the family court includes divorce cases, adoptions and terminations of parental rights, dependency, neglect, and abuse cases, paternity status, and emergency protective order cases. The court also conducts the reviews of children in substitute care placement. A 1993 poll conducted by the Survey Research Center at the University of Kentucky found the concept of the court was strongly favored by attorneys and litigants. The majority of the people interviewed believed that family legal disputes should be adjudicated in a single court system, that it was an improvement for families, that the court's rulings met family needs, and that it created additional support mechanisms available to the judge. The family court concept is still functioning in Jefferson County, and the court continues to play an integral role in service delivery and in particular is a proponent of family preservation services.
The policy on involvement of the court was revised and strengthened in 1995 to aid in the protection of children. In substantiated cases of intrafamilial child abuse or neglect in which the alleged perpetrator has continued access to the victim, a juvenile abuse, neglect or dependency petition shall be filed on cases meeting the following guidelines.
Due to this policy there was a substantial rise in the number of petitions filed on cases. Workers indicated they were pleased to have the clout of the court when working with families. However, due to the increase in petitions, a deferred court process was also instituted, court proceedings could be deferred 90 days.
We met with judges and the court administrator prior to starting the study. Initially there was support for the evaluation and a strong belief that family preservation services were a good service. As discussed in Section 3.4, judges did become perturbed with the random assignment process, especially if it affected a case in which they wanted family preservation to be provided. The public agency administrator played a major role in working with the judges throughout the study. She talked with judges about their concerns, and while sympathetic to their concerns, helped maintain study procedures.
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Having a well-established statewide program, Kentucky was one of the original sites considered for study participation. This site was selected as it met all study selection criteria - a well-defined, mature program using a "relatively" pure version of the Homebuilders model that had more families to serve than slots available.
Site visits were conducted and state office administrators were very interested in participating in the study, with some trepidation about a randomized experiment. Additional meetings were held with state and local personnel to address concerns and to explain the dimensions of the study. To meet required study sample sizes, it was decided that the study would take place in Jefferson county (Louisville), Fayette county (Lexington), and ten Bluegrass counties. A two-day meeting was held with personnel from all these sites to work out the details of the study. At that time it was decided to drop the Bluegrass counties and concentrate efforts on Louisville and Lexington, even if it meant extending data collection past one year to achieve the necessary sample size. Meetings were set up with all of Louisville and Lexington supervisors and workers that would be affected by the study. As was expected, these meetings focused on staff concerns about random assignment. Their concerns are discussed in further detail in Section 3.4.3.
State and local personnel indicated that families currently being referred for family preservation were not necessarily those at imminent risk of placement and that there were many eligible families not being referred for services. Referral problems were particularly salient in Lexington. To address these concerns procedures were implemented to help tighten the screening and referral of families to family preservation. As described below, different procedures were designed for Louisville and Lexington in conjunction with central office DCBS staff.
Preparation and training for the experiment were conducted in the winter and early spring of 1996. Training sessions were held with both DCBS screeners and FPP program coordinators. During the one-day training sessions study procedures were reviewed including use of study forms, the screening protocol, random assignment procedures, and the role of the study site coordinator.
In addition, initial group meetings were conducted with caseworkers and supervisors from each unit. Workers were very resistant to random assignment and concerned that it would deny services to families, cause extra tasks, and delays in referrals for their caseloads.
A site coordinator was hired locally and provided by the study to assist DCBS and FPP staff with case information needed for random assignment and the conduct of interviews.
Referral to FPP. Prior to implementing study procedures, workers identified families they felt were appropriate to receive family preservation services, got supervisor approval for the referral, and then made the referral to the public agency screener through a referral form. The screener was then responsible for determining whether or not the referral was appropriate and contacting the family preservation agency to see if there were any openings. If there were time periods when referrals were low, the screener was also responsible for working with caseworkers to identify appropriate new referrals. The plans for implementing the evaluation built upon these procedures. As almost equal numbers of referrals came from the intake and ongoing units, it was decided to maintain this practice. Procedures for the two types of units only varied in the definition of an eligible case. Procedures established to refer cases were:
It was expected that cases referred from intake were cases with recent abuse/neglect reports. Cases referred from ongoing were defined as: the family unit was maintained at home without family preservation service and a new situation emerged which indicated that without family preservation services, the children would be placed in out-of-home care.
Targeting. As discussed earlier, DCBS administrators were concerned that FPP was not always targeted at families in which placement for a child was imminent. The study implemented two new procedures to help improve targeting and identify those cases that were at "imminent risk of placement." The first procedure was to identify potentially "high risk" eligible family preservation cases that were not being referred for services. In Louisville, there was a Court Liaison who reviewed every case in which a petition to the court was being filed because there was concern for the child's safety or the case was being referred for foster care placement. Efforts were made to include these cases in the study as more "severe" cases that might not otherwise be referred for family preservation services. For each case in which a petition was filed, we asked that a Worker Safety Checklist be completed by the worker (see Appendix E). For all recently investigated cases in which a petition was being filed, the workers were asked to complete a checklist which covered such issues as: whether or not they were considering foster care, whether the location of the primary caretaker was known, whether the caretaker refused to care for the children, whether the caretaker was chemically dependent without a plan for treatment, whether there was potential for recurring risk of sexual abuse, whether the caretaker was willing to work with an agency, and whether the caretaker was the perpetrator of harm to the child. These questions were developed in conjunction with family preservation and public agency staff to identify potential foster care cases, yet screen out those cases that would not be eligible for family preservation.
The study Site Coordinator reviewed the checklists using established criteria to ascertain whether or not the case should be sent to the screener for family preservation eligibility determination. These criteria excluded cases where workers indicated they were not considering foster care placement, the caretaker could not be located, the caretaker refused to care for the children, the caretaker was chemically dependent without a current treatment plan, or there was potential for recurring risk of sexual abuse. To help ensure that previously referred cases were not re-referred for family preservation, the procedures also included a question about previous referrals.
Throughout the 22 months of data collection, the Site Coordinator reviewed 2103 petitions. Of those petitions, 177 (8 percent) were identified as potentially eligible for family preservation. Of those referred to the screener, 42 percent (74) were randomly assigned. For 51 percent (53) of the cases not enrolled, the reason was that there was no space available in family preservation. Insufficient information accounted for another 23 cases (Table 3-6).
| N | |
|---|---|
| Number of petitions reviewed | 2103 |
| Total petitions sent to FP screener | 177 |
| - Cases enrolled in experiment | 74 |
| - Cases not enrolled | 103 |
| Reasons cases not reviewed | |
| - No space | 53 |
| - Insufficient information | 23 |
| - Worker plans to enroll | 11 |
| - Other | 16 |
The second procedure to help tighten targeting had the screener use a protocol to review cases referred to her. Screening protocols were developed by the study team to aid the screener. The protocol provided the screener the opportunity to review his or her decision by using a risk index based on factual items such as previous substantiated complaints, more than one maltreated child in the family, previous foster care placements, and the presence of substance abuse. The instrument yielded a score, the midrange values of which were thought to suggest referral to family preservation. Guidelines provided to the screener stated that cases receiving a score greater than 2 and less than 5 fell within reasonable risk, and should be referred. Cases with a score of less than 2 might not be considered at risk. Cases with a score greater than 5 might have too high risk. Although cases outside the 2-5 range could be referred, the screener was asked to provide the reason she believed the case should receive family preservation services. The screener was asked to explain why she was still referring cases that fell below or above the midrange. The screener was told that the tool was not to be used to determine referral, but as a review of her decision. As indicated earlier, copy of the protocol is presented in Appendix B.
Although there were many cases referred to the screener that were not sent to family preservation, screening tools were only completed on those cases referred to family preservation. Table 3-7 presents a breakdown of item responses for each of the screening questions. A total of 327 protocols were completed, approximately 91 percent of the 358 cases randomly assigned. The majority (77%) of the screener's scores for the cases referred to family preservation fell in the midrange between 3 and 5, with an average score of 4.2. The screener's comments about why she referred cases with scores below 3 and above 5 focused on the above 5 scores. She did not provide comments when a case with a score below 3 was referred. However, for the cases with scores above 5, the comments indicated that family preservation was necessary to prevent placement and procedures were in place to ensure safety.
The screening protocol depicted the majority of children (85%) having previous abuse and neglect allegations, with 85 percent of the allegations within the last six months. About one-third of the families had a child previously placed in substitute care. The reader is reminded that these findings are based on the screener's knowledge of the case at the time of referral to FPP.
Throughout the 22 months of data collection, approximately 683 cases were referred to the Louisville screener for family preservation. Of these cases, 323 were randomly assigned to FPP or the control group. A monthly breakdown of the number of cases referred to the screener and then referred for randomization for Louisville is provided in Table 3-8. Only DCBS referrals to family preservation were considered for random assignment. Excluded from the study were cases referred by non-DCBS sources, and family reunification cases.
The number of cases referred for random assignment stayed constant for the first year of the study. A slight decrease in referrals was experienced in the second year. There was not an immediate rise in referrals as the study ended. Referrals in March and April 1998 maintained at 28 and 29 per month respectively. Conversations with the screener indicated that it became more difficult to continue to get workers to refer cases for family preservation, as they experienced having more of their cases go control.
Based on Family Preservation yearly reports from Seven Counties, the number of referrals received from DCBS increased from 1996 - 1998. The number of referrals was 185 in 1996, 244 in FY 1997, and 294 in FY 1998. There was also a slight increase in the number of referrals accepted, 109 in FY 1996 as compared to 135 in FY 1998. For FY 1997 the referrals accepted were similar to FY 1996, 110. (28)
| Screening Protocol Questions | (%) |
|---|---|
| 1. Number of children in family at risk of placement | |
| One | 35 |
| Two | 31 |
| Three | 16 |
| Four | 9 |
| Five or more | 8 |
| Unknown | 1 |
| 2. Number of previous substantiated abuse and neglect reports: | |
| Two or more | 60 |
| One | 25 |
| None | 14 |
| Unknown | 1 |
| 3. Substantiated or confirmed allegation in last six months: | |
| Yes | 85 |
| No | 12 |
| Unknown | 3 |
| 4. Has a child in the family previously been removed and placed in substitute care because of maltreatment | |
| Yes | 33 |
| No | 49 |
| Unknown | 18 |
| 5. Perpetrator currently living in the home made threats of physical harm to the family in the last two weeks? | |
| Yes | 12 |
| No | 51 |
| Unknown | 37 |
| 6. Perpetrator currently living in the family ever been convicted of a crime against a person | |
| Yes | 3 |
| No | 37 |
| Unknown | 60 |
| 7. Perpetrator currently living in the family abuses drugs | |
| Yes | 3 |
| No | 54 |
| Unknown | 43 |
| 8. At least one of the victims 3 years old or less | |
| Yes | 43 |
| No | 57 |
| 9. Single-female-headed household | |
| Yes | 48 |
| No | 52 |
| 10. Any income from employment | |
| Yes | 27 |
| No | 37 |
| Unknown | 36 |
| 11. Protocol score | |
| 0 | <1 |
| 1 | 1 |
| 2 | 11 |
| 3 | 22 |
| 4 | 29 |
| 5 | 26 |
| 6 | 7 |
| 7 | 3 |
| 8 | <1 |
| Average Score | 4.2 |
| Month | Number of Cases Referred to Screener | Number of Cases Enrolled E C Total | ||
|---|---|---|---|---|
| May-96 | 43 | 6 | 9 | 15 |
| June-96 | 37 | 10 | 4 | 14 |
| July-96 | 37 | 8 | 8 | 16 |
| August-96 | Incomplete | 3 | 7 | 10 |
| September-96 | 46 | 5 | 2 | 7 |
| October-96 | 40 | 7 | 9 | 16 |
| November-96 | 52 | 9 | 7 | 16 |
| December-96 | 41 | 4 | 1 | 5 |
| January-97 | 42 | 9 | 3 | 12 |
| February-97 | 31 | 8 | 10 | 18 |
| March-97 | 34 | 3 | 7 | 10 |
| April-97 | 40 | 11 | 14 | 25 |
| May-97 | 24 | 8 | 6 | 14 |
| June-97 | 20 | 4 | 6 | 10 |
| July-97 | 37 | 9 | 9 | 18 |
| August-97 | 21 | 11 | 4 | 15 |
| September-97 | 22 | 11 | 4 | 15 |
| October-97 | 38 | 10 | 22 | 32 |
| November-97 | 26 | 8 | 15 | 23 |
| December-97 | Incomplete | 5 | 5 | 10 |
| January-98 | 29 | 9 | 11 | 20 |
| February-98 | 23 | 1 | 3 | 4 |
| March-98 | 29 | Random Assignment Over | ||
| April-98 | 28 | Random Assignment Over | ||
| Total | 740 | 159 | 166 | 325 |
| 317 Net study cases, 6 inappropriate referrals and 2 cases referred twice | ||||
Although negotiations for Louisville and Lexington started at the same time, the study did not begin in Lexington until the end of August 1996, almost four months after start-up in Louisville. Setting up the experiment in Lexington met with much resistance by the local agency staff. Prior to the study beginning, staff morale was low and referrals to family preservation were waning. State office and family preservation personnel (both local and state) were committed to implementing the study. They hoped that the study would increase referrals to the FPP program. It was decided that the study would go ahead, and the state family preservation coordinator became the family preservation screener. Prior to this, screening of cases was done by the supervisor of the family preservation program, Bluegrass Comp Care. Thirty-two net study cases were enrolled in Lexington over eight months. Resistance of local public agency staff was not overcome, and it was decided that it was best to discontinue the experiment in Lexington.
Throughout the course of data collection, meetings were held with supervisory and casework staff at the public agency and at the family preservation program. Initially group meetings were held to explain study procedures and identify staff concerns. Subsequent meetings were held to try to allay workers' worries and keep communication open. The study site
coordinator was housed at the Louisville public agency so that she was available to have individual meetings with workers as concerns about the study and its effect on operations and services to families came up. Concerns fell into two major categories: 1) the ethics of random assignment and denying services to clients; and 2) the disruption of service delivery caused by study procedures.
Random Assignment. Implementing random assignment procedures met with much resistance by caseworkers and family preservation therapists. They were concerned about the ethics of random assignment and what they perceived as denying services to families who needed them. The study design was based on the assumption that each participating county had a higher demand for service than the existing slots permitted. This was true in Louisville where nearly twice as many cases were referred to the screener as were entered into the study. However, as workers noted, in the past when services were not available, a worker might patch services together for a family until there was an available FPP slot. This made it particularly difficult for workers to accept a case being assigned to the control group, because control cases could not be referred again at a later date.
Workers' beliefs that random assignment denied services to families were fueled by the fact that random assignment removed worker control over decisions about their cases. This was complicated by the fact that workers who were good advocates for their families could not get the system to provide the service they believed the family should have. A good example of this tension was one worker's experience with the study. Apparently there had been some confusion between the screener and worker about being able to re-refer a case that went control. Initially the worker told the family that they could be re-referred after going control. The worker was very concerned that this was a child with Attention Deficit Hyperactive Disorder and the mother needed immediate help in controlling the child's behavior. The worker found other services for the child that the family had to pay for. The worker blamed random assignment for denying a service to a family and forcing them to pay for a service that they were entitled to receive for free. Workers were particularly galled by not being able to have control over their decisions and giving that decision up to a computer.
Another worker reported that random assignment denied services to families in his opinion, because appropriate cases did not necessarily come in on a regular basis. There were times when there were more cases referred than slots available. However, there were also times when there were fewer appropriate cases than openings in FPP.
It was often difficult to differentiate workers' angst about the ethics of random assignment and their discomfort over changing service delivery procedures. Both were realities for them and they identified a number of service delivery issues they felt would be affected by the experiment.
Service Delivery. Workers' concerns about how study procedures and random assignment affected service delivery to families were varied. While some of these concerns did materialize, other anticipated concerns did not come to fruition.
One of the more problematic issues concerned the procedures for obtaining IV-A eligibility for families. To obtain IV-A funding for family preservation services, workers were required to have families sign a form. This form also served the purpose of obtaining a family's commitment to FPP, if services were available. Policy required workers to tell families that services might not be available, and the form only showed their interest in receiving services. Signing the form did not mean that the family would get FPP. However, in practice, the workers did not use the form in this way. Workers expected that eventually, families would get FPP, even if there was not a current opening, there would be a future opening. Therefore, they did not tell families they would get the service only if it was available. Instead, they used the form as the family's acknowledgement of accepting services. This procedure became a major hurdle in the implementation of random assignment. Caseworkers could not refer a case to family preservation without the signed eligibility Title IV-A form. Because of random assignment, workers could not promise a family that they would get services. This often required the worker to make two trips to a family's home. (29)
Workers also feared that the study would create a higher turnover of workers. They believed that FPP helped relieve workers of difficult cases so they could concentrate on other cases. By having to keep difficult cases they would not spend time on other cases, become frustrated and quit. Interviews with caseworkers and supervisors indicated that this did not happen.
Caseworkers indicated that family preservation was often used to show "reasonable efforts" prior to placing a child in foster care to meet the P.L.96-272 requirements. Workers were concerned that if a family became a control case, and could not receive family preservation services, it could be interpreted by the family's attorney that workers had not tried every possible option to keep a child from going into foster care. In turn, they thought this would prolong termination of parental rights as a case could not be made that everything had been done to prevent termination. While these were legitimate concerns, there were no reports of this actually occurring.
Caseworkers were upset with the study's disruption of court procedures. There were instances in which a judge would order a family to have FPP. It was incumbent upon a worker to remind the judge that a study was in process, and families were being randomly assigned to the program. Workers were very upset about having to tell judges that a case could not get family preservation services because of the study. In Kentucky, the judge can order services, but not a particular service. But as a number of workers said, "tell that to the judge."
Many workers indicated that there were simply no alternatives to FPP and "when a case is appropriate for the HELP team, that is what is needed, not something else." Investigation and intake workers complained that random assignment forced them to patch services together when a case went into the control group, further evidence that FPP was not always used to deter foster care placement, but as an alternative to other services.
Caseworkers were also interviewed after the study was over. Not surprisingly, many of the issues they raised during earlier conversations remained as concerns. They were never comfortable with random assignment. When queried about how the families they referred during the study differed from families that would usually be referred, they indicated that they felt there was a difference. The study caused them to refer families they wouldn't ordinarily refer because more referrals were necessary to meet study demands. Supervisors did not agree with this assessment. They felt that workers often had to be encouraged to refer a case, especially if many of their cases went control. However, there was not a difference in the type of family that was referred. Both Seven Counties and CPS workers stated that it was hard to find foster care placements and the motive to provide alternative services lessened the risk of placement of the control group cases.
Violations and Exceptions. As part of our negotiations with DCBS, it was agreed that a limited number of eligible cases could be excluded from the study. DCBS administrators felt it was important that they not deny services to families that local agency staff identified as having an unacceptably high level of risk. It was agreed that eight cases could be considered exceptions prior to random assignment. There were six post random assignment exceptions (called violations in this report) to be used for cases that were assigned into the control group, but later, due to new circumstances, were determined to require FPP. All exclusions and violations had to be approved by the District Manager. In Kentucky a total of five exceptions and nine violations occurred. Interviews with caretakers and caseworkers were conducted on all cases randomly assigned, except for inappropriate referrals.
Inappropriate Referrals. The family preservation program has a reunification component for families whose children are in foster care but are to be returned home within two weeks. These cases were not supposed to be enrolled in the study. However, circumstances of cases were not always clearly understood at the time of referral. Therefore, some cases that were referred to the study were identified as having children in foster care for over seven days at the time of referral. These cases were later removed from the study. There were a total of nine inappropriate referrals in Kentucky.
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Near the end of the study period, the Department underwent a reorganization and welfare reform activities were implemented.
In 1998 the Cabinet for Families and Children began a major restructuring. Two Departments, the Department for Social Insurance and the Department for Social Services were combined to form the Department for Community-Based Services. The separate regions of these two Departments were combined into common regions. According to Cabinet Secretary Viola Miller, "Welfare reform, the need for a more community-minded approach to human services, and the demands of our own employees have been the driving forces behind this decision." The goals of the restructuring were to:
The seeds of the restructuring began in 1996 with the EMPOWER Kentucky initiative. The goal of the initiative was to save taxpayer money, improve the efficiency of services, and better equip state employees with the tools they need to perform their jobs. With the advent of welfare reform it was felt that the Department for Social Insurance had to expand its operations from merely getting benefits out in a timely and efficient manner. There had to be programs in place to help recipients get back to work. The state believed that the best way to accomplish this was to collaborate with the community and other agencies. The Cabinet also wanted to use a community-oriented approach to more effectively fight child abuse by building partnerships with churches, neighborhood groups, and other individuals and groups using preventive techniques. It was intended that increased decision making authority be given to the regions, with the central office in Frankfort providing training, technology, and technical assistance.
With the passage of the 1996 Welfare Reform Act, the Cabinet for Families and Children was concerned about the impact that the new time limits and work requirements would have on the Kentucky welfare population. Questions to be answered included: Would there be adequate resources to train people within the five year limit and would homelessness and poverty become endemic? Could the hard-core unemployable go to work and would clients keep jobs and become self-sufficient? The Cabinet contracted with the University of Louisville's Urban Studies Institute (USI) to conduct a longitudinal, outcome-based evaluation of the effects of welfare reform. The evaluation had two components. The first was to work with Cabinet Departments to develop a database to track the trends and impact of reform on individual clients, and enable the Cabinet to meet the research and evaluation mandates accompanying welfare reform. USI also conducted a panel study of current and former clients to measure their quality of life for up to five years, with additional cohorts added each consecutive year. Recipients, prior to welfare reform, were also included in the study. Administrative data files summarizing client activity in 1994, 1995, and 1996 were included. The data from years prior to the establishment of TANF were used as a source of baseline data.
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Kentucky has offered family preservation services since 1985, when it served as one of the original pilot projects funded by the Edna McConnell Clark Foundation. The state funded three sites in 1989 and by 1996 family preservation programs were available in all 120 Kentucky counties. Over the years state policy and procedures have remained consistent, based on the Homebuilders model. The program has remained focused on identifying children at imminent risk of foster care placement and preventing that placement from occurring. Although policy has been consistent, caseworkers acknowledged that their definition of imminent risk was varied. Often caseworkers perceived family preservation services as an alternative service, which might aid in preventing future placement, but not necessarily targeting children at imminent risk of placement.
State and local administrators recognized the targeting problem and worked with the study staff to implement more stringent procedures. A screening protocol was used by the local screener to review all cases referred for FPP. Also, a procedure was implemented to review all cases in which a worker was filing a court petition for foster care placement or for the court's involvement in protecting the safety of the child.
In Louisville, the main study site, the family preservation program was well regarded by both caseworkers and the courts. There were some suggestions for improvement in communication between family preservation therapists and caseworkers. Some caseworkers believed that therapists needed more flexibility when working with families, while some therapists felt that caseworkers needed to stay more involved with families once they were referred for family preservation services. A major concern of both the public and private agencies was services for families in which drug abuse was a problem. While all staff agreed that this was a prevalent problem, there was not consensus as to whether FPP was the appropriate resource to address the issue. Overall, the courts, therapists, and caseworkers believed that family preservation services were a needed resource for families.
Kentucky random assignment for the evaluation was conducted from May 1996 through February 1998. The study mainly took place in Jefferson County (Louisville), with Fayette County (Lexington) participating for eight months. A net sample of 349 cases was assigned, 317 cases from Louisville and 32 cases from Lexington. Interviews with caretakers and caseworkers were conducted. Administrative data were also collected. The analyses of these interview and administrative data are presented in Volume Two.
While Kentucky staff were frustrated with study procedures and could not wait for random assignment to end, all levels of staff -- administrators, screeners, supervisors, caseworkers, and therapists put forth a tremendous effort and helped to maintain study integrity.
22. At study inception the Department was known as the Department of Social Services (DSS).
23. Kentucky Family Preservation Act, 1990.
24. Department for Social Services Program Manual, Family Preservation Section
25. The Kentucky Impact program works to prevent psychiatric placement of children.
26. At the beginning of the study, the Department was DSS.
27. The ongoing case total includes adolescent service units.
28. Fiscal years go from July to June.
29. We considered changing the study procedure, but local management wanted workers to follow the policy as it was written. It was believed that by shortcutting the policy, workers were not necessarily using family preservation for imminent risk cases. Study procedures did allow workers to call for an assignment from a family's home, but they never used this procedure.
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