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:
- 1. Low functioning parents with no parenting skills;
- 2. Young mothers who are overwhelmed and need help getting supportive services;
- 3. Dirty house cases, something very concrete that family preservation can work on and can see improvement if it is not a chronic problem;
- 4. Domestic violence cases, family preservation provides ongoing support to the mother, who needs to repeatedly hear that she is worthy in order to make the decision to move out; and
- 5. Psychiatric cases--parent is schizophrenic and won't take medication.
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.
- 1. Substantiated physical abuse of any child under five years old;
- 2. Any child with injuries to critical areas of the body (head, neck, face, abdomen, genitals, lower back) as a result of physical abuse or any unexplained or abuse-related serious physical injury;
- 3. Neglect resulting in significant risk of injury or harm;
- 4. Sexual abuse; or
- 5. Any case in which staff determine that the family will not cooperate with services or action by the court which is necessary for the protection of the child.
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.