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.7
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 control, 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.
7 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.