Evaluation of Family Preservation and Reunification Programs: Final Report - Volume One. 6.3.2 In-home Services

12/01/2002

6.3.2.1 Services to Children in Their Own Homes (SCOH)

In 1978, state legislation mandated SCOH in all counties. These services were (and still are) intended to support intact families and protect victims of child abuse and neglect who remain at home. One of the early SCOH programs in Philadelphia was staffed by paraprofessional workers with caseloads of three families per worker. Workers served as advocates for families. Over time, teams of social workers and paraprofessionals were developed. Caseloads grew to about eight families per worker by 1990.

SCOH are provided by about 20 private agencies in Philadelphia. DHS contracts with a private agency to deliver a specific level of SCOH for each case. Initially there were three intensity levels of SCOH: Level I consisted of 1 hour of in-home service a week; Level II consisted of 2 hours of in-home service per week; and Level III consisted of 3 hours of in-home service per week. However, Level I is no longer in use as it was thought to be insufficient for a case. Level II and Level III continue to be provided.

SCOH are usually initiated by a joint meeting of family members, the FSR caseworker, and the private agency SCOH worker in the family's home. Because it is often difficult to arrange such meetings around FSR caseworkers' schedules (their protective service investigations and court appearances take precedence over SCOH meetings), delays in the start of SCOH are common. Some private SCOH agencies have bypassed the joint meeting and begun services without an initial meeting with the FSR caseworker.

Once in SCOH, cases move through the program quickly. DHS has tightened time frames in the program. After nine months of services, cases are automatically terminated from SCOH unless there is a new risk assessment and DHS agrees to a six-month extension. SCOH caseloads vary across agencies from approximately 8 to 14 cases per worker.

6.3.2.2 Family Preservation Services (FPS)

In response to the crack-cocaine epidemic, which hit Philadelphia in the mid-1980s, the state legislature allocated funds for a "Pennsylvania Free" (Penn Free) program to service crack cocaine-addicted women and their families. Funding for this program was channeled through county mental health departments and services were often provided through contracts with private agencies. Three of these programs were launched in Philadelphia. Although they were called family preservation services (FPS), the Penn Free programs were not nearly as intensive as current FPS and included a mix of in-home and office-based contact with clients.

From 1986 to 1989, a private service provider in Philadelphia, Youth Service, Inc., operated an in-home, family-based program funded by the Edna McConnell Clark Foundation. Initial referrals included some very difficult cases, the program was not able to achieve quick and substantial reductions in the risks to children, and placement rates were high in this early cohort. Referrals shifted to families with chronic problems in which children were not at risk of placement. By the end of the Clark-funded project, cases in the program were similar to those serviced in SCOH.

In the late 1980s, Pennsylvania state child welfare administrators were very impressed by presentations on family preservation services at national meetings of state governors. A strong commitment to family preservation developed at the state level and in some counties. The Pennsylvania Family Preservation Act of 1989 encouraged counties to establish family preservation programs, "enabling children who would otherwise be subject to out-of-home placement to remain at home" (P.L. 218, No. 35). The impetus for this law came from experience with local programs that were similar to family preservation services and the influence of the national family preservation movement. Because public programs in Pennsylvania are administered at the county level, the state had no way to force FPS on counties, and some were resistant. Therefore, the state sought county-level "buy-in" to the family preservation ideal by setting up grants to counties for FPS.

During an initial phase-in period, grants were provided to counties on a competitive basis, based on a review of proposals submitted by county children and youth agencies, with no county matching fund requirements. State law does provide some guidelines within which county-run programs operate, however counties were generally left to decide whether and how to provide FP services. There has been considerable variation across counties in the implementation of FP programs. Advocates hoped that FPS would eventually be available statewide, but that has never happened.

6.3.2.2.1 Philadelphia FPS

Philadelphia began providing FPS in 1991. Philadelphia did not apply for a state FPS grant the first year they were available (1989), but applied and received a grant to begin in 1990, and started services in 1991. Services began with one DHS FP unit. Tabor Children's Services coordinated with DHS on the grant, jointly planned the first FPS program, and was the first private agency to deliver FPS in the county. After the first year, administrators made note of families who did not benefit from the FPS provided. Based on that information, specialized FPS models were developed to meet the needs of various communities and clients. As a result, specialization became an important part of FPS in Philadelphia, and continues to be a hallmark of Philadelphia County FPS. Each private agency who received DHS FP grants served a specific target population such as teen parents or parents with drug and alcohol abuse problems. In the first few years, the FPS programs in Philadelphia were not at capacity. Referrals to the program were few and some referrals were inappropriate for the program. Efforts made to "market" FPS to intake workers were successful and the number of families entering the program grew.

As a result of FP expansion, in 1994 DHS began the Specialized Family Preservation/ Reunification Section, a centralized, specialized section made up of five units. This model made sense for practice and practical reasons, to maintain necessary support, training, and reinforcement, while at the same time encouraging cohesion in practice, and enforcing accountability.

In 1994-95 the Philadelphia FP programs served 341 families with 888 children. In 1995-96 FPS were provided to 462 families with 1,452 children. In 1996-97, the figures were 616 families with 1,642 children. By 1999, there were approximately 16 FPS programs provided by 12 private agencies across the county. Plans to expand the program continue. In 2000, the county had the capacity to serve 1,000 families per year in family preservation and reunification programs.

FPS in Philadelphia County has focused on serving families with substance abuse problems, a focus that has its roots in the Penn Free programs. Substance abuse is the primary emphasis of the FPS program operated by the Abraxas Foundation, and to a lesser extent, by Tabor Children's Services, two agencies serving both experimental and control group families in our study. As mentioned earlier, specialization of services is a hallmark of Philadelphia FPS. Other private agencies provide FPS to specific populations in need.

The Abraxas Foundation focuses on substance abuse among young parents. Many of these clients need in-patient treatment. Some are status offenders or are classified as "pre-delinquent." Abraxas operates treatment and rehabilitation programs for delinquent and dependent youth with substance abuse problems, drug sellers, sex offenders, and youth with emotional and behavioral disorders. Other than FPS, most of Abraxas's programs serve youth referred through the juvenile justice system.

The FP programs at Tabor Children's Services focus on substance abuse, child maltreatment, family conflict, life skills, parenting needs, and parent education. Most of the families in these programs have children under 12, although families with older children are sometimes referred. Tabor Children's Services is a multi-service child welfare agency with adoption, foster care, and supervised independent living programs. Its parent agency, Tabor Services, also has mental health and day care divisions.

The FP programs at Youth Service, Inc., focus on family conflict, most often in three-generational households with young parents. Conflict resolution and parenting skills training are emphasized, and crisis nursery and day care services are available. Carson Valley School specializes in serving status offenders, teenage victims of abuse, cases of parent-teen conflict, and some teenagers with mental health and mental retardation problems; group treatment is provided for teens and parents. Congreso de Latinos Unidos is a bi-lingual, bi-cultural, multi-service program for families in North Philadelphia; its FP program services include life skills training, parenting training, family conflict resolution, and substance abuse intervention.

Target Population. Philadelphia County defines the target population and goals of family preservation in somewhat more expansive terms than the traditional FPS Homebuilders-type model. The FPS program is focused more broadly by serving children who are at intermediate risk of removal from the home, as opposed to serving only children at imminent risk, and provides 12 weeks of services. The caseload size of five families per caseworker, set by the 1989 Act, has generally been adhered to.

When the FP program began in Philadelphia, most of the referrals involved drug and alcohol abuse in families with young children. As the program progressed, families with older children were also referred, as were parents with mental health problems and other needs. Little systematic information is available about the characteristics of families served by Philadelphia's family preservation and SCOH programs. However, data available from one FPS program indicate that of the first 40 cases served by the one FP program, 70 percent were receiving AFDC, 78 percent had at least one family member with a serious drug or alcohol addiction, and 8 percent involved children who were born addicted to drugs. Three-quarters of the families were African American, 23 percent were Caucasian, and 3 percent were Hispanic. More than half (55%) of the mothers served by the program were never married, 28 percent were divorced, and 3 percent were widowed. (69)

Referral. Referrals to the FP program usually come from central intake. In Philadelphia, the public agency's specialized FPS section develops selection criteria, approves families to receive FPS, and works closely with the private providers. The decision to refer a case is made by intake or a family service region worker. The referral is assigned to a DHS FP worker, by the DHS FPS receiving supervisor, for assessment. Ideally, the referring DHS worker and FP worker would go out together to meet and assess the family for FPS. However, sometimes the DHS worker cannot attend the meeting and the DHS FP worker and a private FP supervisor and/or worker will go out to help assess the family. Criteria used to make a determination on a referral include: 1) can the family identify at least one achievable goal?, and 2) is the family willing to accept intensive services from an agency? (70) A family service plan is drawn up by the DHS FP worker at the time of assessment. If a case appears feasible for FPS, the DHS FP supervisor will assign the case to a private provider FP worker, if one has not been assigned at that point, to begin the ongoing work with the family.

The DHS FP worker generally performs all the public-sector mandated functions and activities such as the family service plan, any court petitions or appearances, CPS interventions, mental health and/or placement planning if necessary, and attends all mid-point and ending meetings with the family. The DHS FP worker may also assist the FP provider worker in identifying resources or responding to emergencies.

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