Intensive Foster Care Reunification Programs

06/30/1992

By Ariel Ahart, Ruth Bruer, Carolyn Rutsch, Richard Schmidt, and Susan Zaro.

Macro International, Inc.

 

For the Assistant Secretary for Planning and Evaluation

U.S. Department of Health and Human Services


EXECUTIVE SUMMARY

I. The Social and Policy Context

A. The Family Reunification Problem

Foster care is a substitute care service for children who need to be separated from their parents. One-half of these children are placed because of abuse and neglect and one-quarter because of parental condition or absence. The remainder are placed because of status offenses, parent-child conflicts, or because of a child's disability. Ideally, the placement is temporary and only used as a last resort.

It is widely presumed that the preferred course of action for most children in foster care is a quick reunification with the child's biological family, for several reasons. First, it is believed that a continuous caretaking relationship is important for the child's well-being and that this relationship most often involves the biological parent(s). Second, it is possible that the separation and lack of stability inherent in a temporary placement may psychologically harm the child. In addition, an incentive may exist to reunify the child because foster care is relatively expensive and adoptive placements can be difficult to find.

Although the vast majority of foster care children are eventually reunified, there is much room for improvement. Problems include the following: 1) few reunification services are provided to families that are reunified; 2) the child welfare system is overloaded so reunification may be delayed; and, 3) some children remain in foster care "drift", with little action taken to ensure their permanent placement.

Few reunification services available generally. The first failure involves the largest group of children, those who exit foster care quickly after placement and are returned home to their biological families. While this group represents the preferred foster care outcome, it also points to a major service gap. During the time that children are out of the home, their families often receive inadequate support services to remedy the problems that may have precipitated the initial placement. In addition, families rarely receive assistance with the often traumatic reunion when their children are returned home. It is widely believed that this lack of effective support services is partly responsible for a consistently large proportion of children re-entering the foster care system when family reunification attempts fail.

Delayed reunification for some children. The second failure involves the proportion of children who could be returned home quickly, but due to the overburdened state of the child welfare system, often wait for six months or more before a periodic review of their care is performed and any significant efforts are made to reunify them with their families. This is important given the fact that research indicates that there is an inverse correlation between the length of time in foster care and the chances of a successful reunification.

Foster care drift. The third and final problem concerns those children languishing in foster care for extended periods of time, in what is referred to as foster care "drift." This situation relates to the foster care system's inability either to (1) resolve the problems that led to placement or developed during placement and, thus, to reunify the family, or, (2) to recognize that reunification is unlikely and, thus, to arrange for an alternative permanent placement such as adoption.

B. The Program and Policy Response

Over the past two decades, there have been initiatives to correct these problems. In the mid-1970s, child welfare professionals joined forces to develop a permanency planning movement the goal of which was to address the problems of foster care drift. The idea of permanency planning was to create a plan for each child in the state's care. This plan was to be periodically reviewed and updated to reflect a permanent placement. Foster care was only to be used as a last resort after reasonable efforts at prevention had failed. Family reunification was the second preferred option, and adoption was the third. The 1980 Adoption Assistance and Child Welfare Act (P.L. 96-272) mandated permanency planning nationwide and instituted safeguards to discourage foster care drift through periodic judicial and department reviews.

While P.L. 96-272 codified many practices which appear to have bad initial success in reducing the number of children experiencing foster care drift, new social problems and the increased severity of existing social problems contributed to a reversal of the trend during the 1980s. Child abuse and neglect reports increased dramatically, the use of crack-cocaine proliferated, the AIDS epidemic hit, and communities across the country experienced an increase in the number of impoverished and homeless families. With these forces at work, the number of children in foster care again began to grow.

One attempt to respond to ongoing problems in the child welfare system is the family preservation movement. This movement, which began in the 1970s and fits into the goals of permanency planning, focuses on preventing the child's placement in foster care. The goal of family preservation is to keep families together, i.e., out of the foster care system, thereby reducing the need for foster care placement. Many states have funded these programs on the assumption that they lower costs associated with foster care placement. Across the country, family preservation efforts have gained significant attention at the Federal level; initiatives are currently in operation at the state and local level.

Finally, some child welfare professionals and policy makers have begun to focus their attention on what are broadly referred to as "intensive family reunification programs." The programs are much less clearly defined, largely because they seem to be a catch-all for addressing all of the leftover issues related to reunification that were outlined above. These initiatives have received much less attention than those relating to family preservation. Very little is known about what these intensive family reunification programs look like, what they are doing, how effective they are, and what role they play in the reunification and permanency planning processes.

II. Purpose and Goals of the Study

In August 1991, Macro International Inc., under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (DHHS), was commissioned to undertake an exploratory study of intensive family reunification programs for children in foster care.

The goal of this study is to fill the knowledge gaps on family reunification by pursuing the following four objectives:

  • Begin to identify and describe the range and variety of intensive family reunification programs.
  • Describe the role that family reunification programs play in the child welfare system.
  • Discuss how family reunification programs measure success.
  • Describe lessons learned by programs in implementing these special or intensive family reunification services.

To gather this information, the Macro study team conducted a thorough review of the literature on family reunification, foster care reentry and permanency planning; held telephone discussions with experts in the field; and conducted a series of site visits to nine programs identified as being particularly innovative. These visits were to programs in California, Connecticut, Michigan, Oregon, and Washington State.

Findings from these visits are presented in this report, including an overview and purpose of the study, a background discussion on the child welfare system and reunification, a discussion of the study methodology, the primary study findings, lessons learned from the family reunification programs included in this study, and a discussion of the major policy and study, and a discussion of the major policy and research issues in family reunification. This report also includes detailed case studies of each of the nine programs visited.

III. Primary Study Findings

The primary study findings fall into one of the following five areas: (1) defining family reunification; (2) noting similarities and differences between programs; (3) explaining how the programs fit into the child welfare system; (4) identifying factors affecting programs' ability to operate successfully; and (5) defining program success.

Before presenting the findings, the following summaries briefly describe the nine programs visited during the course of this study and highlight some of their innovative features.

Alternative Family Services Program (AFS) in San Francisco, California. The AFS Program is a community-based intervention that serves the residents of the Bay View-Hunter's Point neighborhood in San Francisco, a predominantly African American community. Innovative features of the AFS Program are its use of foster parents to serve as mentors to biological families; its focus on developing long-term community support networks for families by involving local churches, day care centers, and service providers in the intervention services; and the program's provision of in-home support services for biological parents. The intervention targets children under age six who are recent entrants to long-term foster care; it has the capacity to serve approximately eight children for up to one year. The goal of the AFS Program is to stabilize the family situation so that the child can be returned home successfully, or, if this is not possible, to find an alternative permanent placement for the child.

Full Circle Family Consulting Services Reunification Program in San Raphael, California. The Full Circle Program is operated by Full Circle Programs, Inc., an agency with over 20 years' experience providing a wide range of prevention and treatment services for at-risk children and families in the Bay Area. The family reunification program is unusual in that it avoids using a specific program model; rather, the program tailors services to the particular needs of each individual child and family. These services may include medical evaluations, diagnosis, and treatment; educational diagnosis and advocacy, psychological or psychosocial counseling; and referral and follow-through with other outside agencies and services. The intervention targets children who are recent entrants to foster care, but the focus of the services is the parent(s). The program offers parents three to six months of weekly counseling and intensive case management, both in the home and in the community, depending on the family's needs, and another 6 months of follow-up consultation after the initial intensive intervention. Full Circle can serve up to 40 families at one time.

Casey Family Services Reunification Program in Hartford, Connecticut. Casey Family Services is a private long-term foster care and permanency planning agency that serves almost 200 children in the New England area. The agency currently funds three family reunification programs, one of which is located in Hartford. Unique features of the Hartford program are its long length (up to two years); the referrals and transportation it offers families to outside services; the focus on facilitating visitation between the parent and child; the use of a parent support group; and the availability of up to $3,500 per family each year in contingency funds to help address families' emergency health and housing needs. The Casey Program is targeted to those families whose children have been in foster or residential care between six months and one year and who are considered unlikely to be reunited with the normal range of child welfare services. All program services are described as family-oriented, home-based, concrete, and clinical; intensive case management is the thread that joins them. In order to participate in the program, families must have at least one child under age six; the program can serve up to 24 families at any one time.

Milford Mental Health Clinic Reunification Program in Milford, Connecticut. The Milford Program is one of two state-funded pilot projects in Connecticut that are providing in-home and community-based services to families whose children are in foster care but will soon be reunified with their biological families in the Milford, Bridgeport, and New Haven areas. The Milford Program applies a variation of the Homebuilders family preservation model to reunification: services begin two to four weeks prior to the child's return home and continue for up to 12 weeks afterward. The Milford Mental Health Clinic is one of the two private agency contractors operating the program. During the first two weeks of the intervention, the caseworker facilitates the child's transition home; after the reunification, the caseworker spends up to 1-2 weeks working with the family in the family home. Services provided in the home include crisis counseling, life skills, and linking families to their community support systems. Given the program's caseload maximum of four to six families per caseworker, the Milford program has the capacity to serve up to 24 families.

Mott Children's Health Center Families First Program in Flint, Michigan. Families First is a state funded family preservation/family reunification program currently operating in 38 counties in Michigan. All programs closely follow the service delivery model which is based on the Homebuilders model. At the Mott Children's Health Center, the contracting Families First agency in Flint, the model is applied to both family preservation and family reunification. For families where reunification is a possibility, the program offers up to two weeks of service prior to the child's return home and four weeks of service in the family home after the reunification for a six-week total intervention period. Signature features of the Families First program are a two family per caseworker maximum caseload; time-limited, intensive services provided in the family's home; the use of a holistic, strength-oriented approach when working with the family; and the provision of ongoing training and technical assistance by the state child welfare agency to all of the program sites. Mott Families First has the capacity to serve eight families at any one time.

Oakland Family Services (OFS) Partners in Permanency Program in Pontiac, Michigan. OFS, a large, multi-service family mental health agency in Pontiac, Michigan, operates a family reunification program for families whose children recently entered long-term foster care. The program focuses on meeting the needs of a client population that is particularly multi-problem, e.g., homeless, substance abusing, adolescent. OFS Program services are targeted to address these longer-term, complex needs; services are geared toward 'parenting the parent,' with psychological assessment, weekly group therapy, and weekly parent-child interaction groups serving as key program components. Services are available for up to three years if that is how long it takes to reunify the family or for the parent to decide to terminate parental rights. A unique feature of the OFS program is its extensive use of trained volunteers to provide direct services; volunteers work with the families in their homes, providing a friend and source of support for the families, and serving as eyes and ears for the program caseworkers.

Family Unity Model in Oregon. The Family Unity Model is unique among the programs visited in that it is not a program but a practice or "attitude." The model was developed at the state child welfare agency level, based on a survey of the views of front-line child welfare workers on "successful" practice strategies in working with families. The result was the Family Unity Model, which prescribes child welfare practices that engage families as active participants in service delivery, discover family strengths rather than weaknesses, and bring family resources to bear to resolve the situation that brought families into contact with the child welfare system in the first place. An important feature of the Family Unity Model is the Family Unity Meeting, which invites the family to gather its human and other resources in one room to develop a plan to resolve the family's problems. The child welfare caseworker might call a Family Unity Meeting to address the imminent break up of a family, possible family reunification, or some other issue that would benefit from a family- and community-based plan of action. Currently, the state staff who developed the model are traveling across the state, advertising and training county child welfare agency staff on the model The hope is to have the caseworkers adopt the model as "good child welfare practice." Staff who have adopted the model report that it is a very effective approach for working with foster care families. A positive feature for agency caseworkers is that the approach appears to lighten their workload; families rely on their own strengths and resources and those of their communities to resolve their problems, not just the caseworker.

Permanency Enhancement Project in the Tacoma, Washington Division of Children and Family Services Regional Office. The Permanency Enhancement Project (PEP) is the name given to several two-year child welfare "service enhancement" projects funded by the State of Washington and operated by regional and/or county child welfare offices. PEP follows on the coattails of earlier state-funded research demonstration efforts to discover how to reduce foster care expenditures by enhancing child welfare services. The focus of the current PEP projects is to explore strategies to improve child welfare services, particularly permanency planning efforts, in order to reduce the "backlog" of children in foster care for 90 days or longer. Each of the PEP projects is somewhat different. The Tacoma regional child welfare office operates special PEP units in two offices within the region. In these units, cases begin permanency planning soon after the initial CPS investigation is completed (i.e., much earlier than normal) and receive more intensive staff and other resources than are regularly available in the office in order to help the child find a permanent placement. The goal of the PEP unit is to achieve reunified on for the child with his or her family of origin, or, alternatively, to move toward termination of parental rights and adoption. The Tacoma PEP unit has been operating for less than a year and currently serves 70 children.

The Permanency Enhancement Project in the Vancouver, Washington Division of Children and Family Services Regional Office. The Vancouver PEP is similar to the Tacoma PEP in that it is one of several state-funded child welfare agency service enhancement projects. It differs in terms of its target population and some of the designated staff and resources provided by the special PEP unit. Operating only in the Vancouver regional office, the Vancouver PEP unit works with those families whose children have been in foster care for 90 days or longer. It specifically targets those children who are called "foster care lifers." The initial impetus for the Vancouver project stemmed from the realization that "front-end" preservation efforts were working, but that few "back-end services" were being provided to help children in long-term foster care find permanent placements. The PEP unit brings together a multi-disciplinary team to work with reach family, including an assistant attorney general to handle the PEP cases in court, a financial worker to coordinate the families' financial assistance needs, social work staff with lowered caseloads who work on an ongoing basis with the families, and paraprofessional home support specialists to work with the families in their homes. The Vancouver PEP unit serves 12 children.

Findings from the study are as follows:

1. Defining family reunification.

There is no common definition of family reunification programs, nor is there a common understanding of how these fit into the broader context of permanency planning in the child welfare system. Consequently, any discussion of "family reunification programs" requires a statement of the working definition used by the program and a review of the key program characteristics.

2. Program similarities and differences.

Based on the site visits to nine family reunification programs, the following common program characteristics were identified. The programs are new and small; most draw heavily from the experiences and components of family preservation programs; most are serving children and families with numerous and severe social and economic problems; they are serving a young clientele (pre-adolescent children); they include visitation as a key program component; they provide access to a flexible pool of funding to help address family emergencies that could hinder family reunification; they tend to employ a team staffing approach; they focus on the whole family and not just the child; they are particularly intensive in nature; and they take a permanency planning approach.

The programs differ in terms of their underlying program philosophy; the duration of the intervention (from 6 weeks up to 3 years); when the intervention is initiated vis-a-vis the placement process; the funding source; where services are delivered; whether or not foster parents are included in the intervention; and the extent to which they develop direct linkages with the community.

3. How programs fit into the child welfare system.

The nature of the relationship between the intensive family reunification programs and the public child welfare system is critical, but still evolving. Three of the nine programs visited operate directly out of a child welfare agency office; the other six operate out of private agencies which may or may not be administratively linked to the child welfare agency. Regardless, each of the programs works closely with the "regular" child-welfare service system in four critical areas: referral, case planning and monitoring, case closure, and follow-up.

4. Factors affecting program's ability to operate.

Intensive family reunification program staff identified several factors that have a significant impact on their ability to provide effective family reunification services. These are the availability of appropriate services within the community, the type and timing of program referrals, the role that the courts play in family reunification, and the availability of funding and/or a state or local policy mandate to make family reunification a priority.

5. Defining program success.

Intensive family reunification programs are not well enough articulated nor are there sufficient data to generate hypotheses regarding effective program components, practice strategies, or types of services that work better for certain populations. Most programs have a broad definition and view program success within a permanency planning context. Very little has been documented in the way of program outcomes. Only three of the nine programs can provide reunification rates; the others are too new or have not tracked this particular outcome. One program experienced an aggregate 38 percent rate of children reunified by the program in the first two years, a second had a reunification rate of 74 percent after the first year, and a third had a reunification rate of 68 percent after the first year.

Comparing the outcomes of family preservation programs and intensive reunification programs must be done carefully, keeping in mind that: 1) it is probably easier to keep a family intact than put one back together; 2) foster care placement places additional stress on families; 3) families that experience foster care placement may be the most dysfunctional and difficult to serve; and 4) once families enter a reunification program, they are put under a professional microscope. Given the focus of intensive reunification programs on permanency planning, program success should reflect a broad range of outcomes, including improved permanency planning, reduced foster care caseloads, decreased reentry, and reduced foster care expenditures.

IV. Lessons Learned by the Intensive Family Reunification Programs

Through the course of conducting the nine program site visits, the study team gathered a great deal of information on what worked and what did not work in operating the programs. The lessons learned relate to program start-up and planning; staff recruitment, retention, and training; the client referral process; working with families; and developing collaborative relationships with community service providers.

1. The start-up and planning phase.

Programs found that the start-up period is more often fraught with difficulties than expected. Attention to two factors proved helpful: promoting community awareness around the agency and its services, and conducting initial staff orientation and training.

2. Staff recruitment, retention, and training.

Program staff indicated that the success or failure of their program hinged, to a large extent, on the quality of their staff. One of the staffing features cited as particularly successful is the team staffing approach, which in its simplest form involves team reviews of cases and in its more complex form involves the use of a multi disciplinary staff team available to deliver services to any one family. Program staff also described the characteristics of "successful" family reunification program caseworkers. These staff have an accepting attitude towards client, and their lifestyles; ethnic and cultural competence; compassion; prior work experience in the child welfare system; and residence or knowledge of the community in which clients live. Family reunification programs did not report any major problems with staff retention, largely because the intensive family reunification programs allow staff to work much more closely with individual families than is possible in most child welfare agencies. In addition, staff in many of the programs are supported by the team approach that removes the decision making burden from any one staff person, and by ongoing training and technical assistance that is provided to staff as needed.

3. The client referral process.

The major lessons learned with regard to the client referral process are to establish a close relationship with the referring child welfare agency at the staff, supervisory, and agency level; arrive at mutually agreed-upon expectations about the purpose and goals of the program; develop written eligibility criteria for the program and then follow-up with child welfare agency staff on a one-to-one basis to ensure that these are understood; and develop some formal means of announcing program openings.

4. Working with families.

Many of the client families for the family reunification programs are "fragile"; in other words, they are inundated with multiple and severe social and economic problems such as poverty, substance abuse, low literacy, a personal history of abuse and neglect, and homelessness. In working with these families, program staff identified some key strategies that relate to the needs of these clients; many relate to working with any family involved in the family reunification process. First, the facilitation of frequent and structured visitation between the child and family is critical. Second, working with families from a "family strength" perspective is more successful than the traditional "family deficit" model; the former empowers the family to make changes in their situation, while the latter leads to a posture of family compliance with the child welfare system's needs but not necessarily making "real" changes. Third, some programs target fathers and/or significant others in their program interventions, recognizing that they are an important, but often ignored, resource in the family reunification process. Fourth, some programs sponsor family support groups or use family therapy groups in their interventions to provide both parent education and parent support. And finally, many of the programs recognize the importance of connecting families to long-term community supports that will continue to assist the family long after the intervention ends.

5. Working collaboratively with other community service providers.

The study team found that both the courts and foster parents are key players in the family reunification process. When program staff enlist their assistance, they can play an important supportive role in working with families; however, most of the programs are only working with them indirectly. Innovative ways that the programs work with the courts include providing training to judges on the intensive family reunification program model, and arranging to have consistent representation from the district attorney's office for all children served by the special programs. While the majority of programs only work with foster parents if the foster parents expressed an interest, one program enlists foster parents in a lead role in the program intervention. This program uses foster parents as "mentors" to biological families. Thus the foster parents play two roles -- they provide foster care to the children and they teach effective parenting and life skills to the parents.

V. The Major Policy and Research Issues In Family Reunification

The primary purpose of this study is to provide descriptive information about intensive family reunification programs. However, the study also captures policy-related information that can contribute to the debate on budgetary, legislative, and program modification decisions, as well decisions regarding the overall organization and allocation of child welfare resources. These issues include (1) the link between the family reunification research and practice, (2) the impact of family reunification programs, (3) the prospects for the continuation of these programs, and (4) future research and evaluation needs and considerations.

1. The link between the research and practice.

Intensive family reunification programs are addressing some of the factors that are related to children reentering the foster care system after their initial reunification with their biological families. Findings from research show a correlation between reentry and such factors as parental problems precipitating placement, parental ambivalence about their role and reunification, unplanned discharges, and inappropriate case management. To address these factors, intensive programs provide counseling, parenting and life skills training, and link families to community support systems. In addition, many of the intensive programs provide a more rational, planned reunification process for their client families than does the traditional child welfare services system. This is accomplished, largely, through careful case planning and bringing additional staff and special resources to bear on each family's situation. Additional program or agency staff and resources are not the only answer, however. Many of the programs focus on how the family is approached in the intervention as the critical factor. They focus on making the family a partner in the planning process, relying on the family to take a major role in identifying its needs and the resources on which to build a successful reunification effort.

Programs are not able to address all the issues identified by research as contributing to foster care reunification. For example, most of these programs are serving younger children even though older children are more prone to reentry. Also, the degree to which programs can serve multi-problem families and fragile families depends, in some cases, on the health of the community infrastructure and the availability and accessibility of community resources.

2. The impact of family reunification programs.

The following findings relate to the current and potential impact of intensive family reunification programs:

  • Because the programs are so new, little information exists regarding the short- and long-term outcomes of children and families participating in these programs or the overall impact of these programs on foster care caseloads or foster care expenditures.
  • Collectively and individually, these programs are serving only a small number of children and families. This is due largely to limited program capacity and the intensive (i.e., low staff-client ratio) nature of the services provided.
  • Programs are not able to match family risk status to a particular package of program services. Consequently, it is not possible to determine which type of program is most appropriate for which type of client. It appears, however, that a continuum of different types of programs are needed to address the full range of foster care family reunification needs in a community.
  • Programs are having a positive effect on the permanency planning process in the "general" child welfare system. For most of the programs, when family reunification does not appear possible, termination of parental rights becomes the case goal, eventually leading to an adoptive placement for the child. In addition, the two programs operating as special units within the child welfare agency itself are able to begin permanent placement much earlier than in the "regular" system, and have had a significant impact on reducing foster care drift.

3. The prospect for the continuation of these programs.

The key issues that policy makers and program administrators must consider when making decisions regarding program continuation and replication are (1) whether or not the program has a proven track record, (2) the factors that facilitate successful program development, (3) how program innovations are disseminated, and (4) the potential for future funding. Given the current climate of state fiscal crisis and budgetary cutbacks, it is likely that a program's ability to demonstrate positive client outcomes and foster care savings will weigh most heavily. However, even a proven track record is no guarantee of continued funding, as several of the program sites can attest. Consequently, it is even more important that family reunification program innovations be disseminated to the child welfare field and to Federal policy makers, who may find these efforts worth replicating on a larger scale.

4. Future research and evaluation needs and considerations.

Based on the experiences of nine intensive family reunification programs, future evaluation efforts should consider:

  • involving program practitioners and client families in selecting evaluation goals, outcomes, or measures most appropriate to their program;
  • using a self-assessment guide to assist program staff in developing their evaluation;
  • examining the similarities and differences between evaluating family preservation programs and family reunification programs (especially focusing on the different contexts for providing these services);
  • including both process- and outcome-oriented evaluation measures.

In addition, research is needed to address following questions:

Process Evaluation

System level

  • why was the program established?
  • what role/goals is it expected to fulfill?
  • what reunification and other child welfare services were available locally before the program was established?

Service level

  • what types of services are provided?
  • What staffing patterns are utilized?
  • how are case decisions made?
  • what systems are involved and how are they coordinated (courts, treatment programs, etc.)?
  • what practice strategies are applied?
  • how long are services delivered?
  • how are services funded?
  • what types of families agree to participate in the program?

Outcome Evaluation

System level

  • is permanency planning improved and streamlined (decreased length of time in foster care, facilitation of TPR and improved rates of adoption)?
  • is there an improvement in the reunification rate?
  • is there a reduction in the foster care reentry rate?
  • are there decreases in foster care expenditures?

Case specific

  • is there improved case planning?
  • is there improved parent-child interaction?
  • is there improved application of social work expertise?

Over the next few years, it is expected that the nine programs visited as well as other fledgling programs, will provide additional information regarding their program outcomes. The research questions outlined above will contribute significantly to the knowledge base necessary for making informed policy decisions regarding family reunification in the future.