1. Background Information
Ohio's child welfare system is administered at the county level with supervision provided by the state. Of Ohio's 88 counties, 25, including the major metropolitan areas of Cincinnati, Cleveland, and Toledo, have adopted the Annie E. Casey Foundation's reform initiative called Family to Family. Family to Family is a set of principles, strategies, and tools to confront problems that child welfare systems face. These include strengthening the network of families available to care for abused and neglected children in their own communities; building partnerships with at-risk neighborhoods toward that end; and tracking outcomes for children and families so that child welfare systems can better learn from their experiences. Lucas County Children Services' implementation of Family to Family reflects several important trends that are emerging in the provision of child welfare services. These trends include intensive home-based services, community-based services, and team decision-making. Because of the increasing prevalence of these practices in many public child welfare agencies, we selected Lucas County for a site visit to examine their application of a community-based model.(1)
2. Community Development Department (CDD) Services
Lucas County Children Services adopted Family to Family in December 1999 following a period of intense community criticism of the agency's family preservation efforts and concerns for children's safety. For several years prior to adopting Family to Family, the county had been overwhelmed by a surge in the number of children entering foster care and never returning to their parents. Moreover, the agency was concerned about the number of children who re-entered care after they had been returned to their parent's care. Concomitant to the steady influx of children into care, the agency had been reducing family support services to cope with a fiscal crisis. These conditions were highlighted in a study commissioned to review the agency following public criticism of family preservation.
In 1997, shortly before the study was released, a new agency director was appointed. One of the new director's first actions was to reorganize the agency, using Family to Family's set of value driven principles as a guide for delivering child welfare services. Family to Family was developed in 1992 and has been piloted in over half a dozen states. Its focus is to get "states and communities to reconceptualize, redesign, and reconstruct their foster care system" so that it is "neighborhood-based, culturally sensitive" and located in the client's community. Family to Family seeks to replace institutional settings with community settings and traditional care with kinship care.
In addition to the reorganization and policy changes, a new department -- the Community Development Department (CDD) -- was created within Children Services and charged with developing and providing family-centered, community-based services for families whose children entered, or were at risk of entering, foster care.
2.1 Referral and Department Functions
Families who receive services from CDD are referred from Children Services' Assessment or Family Services Departments and their cases are reviewed by the agency's Case Review Department. The relationship of these departments within Children Services is illustrated in Figure 1.
Figure 1.
Lucas County Children Services' Referral, Planning, and Review Processes
An overview of these Departments and their functions provides an understanding of how community-based services are provided within Lucas County Children Services.
Assessment Department. The Assessment Department, which investigates new cases and provides emergency services as needed, will refer a family to CDD for in-home services if minor or temporary problems have been identified that do not necessitate removing the child from the home. These families typically need only short-term concrete services such as household management or location assistance. Families with more complex difficulties whose children are removed from their care are referred to the Family Services Department and may also be referred to CDD.
Family Services Department. The Family Services Department is responsible for case planning and management and overseeing the provision of services for all ongoing cases. Once the Assessment Department has completed its investigation and opened a case, a family is assigned to 1 of 57 Family Services case managers. On average, case managers carry a caseload of 13.3 families.
After receiving an assignment, the case manager works with the family to develop a case plan. Development of the family's case plan is accomplished through team decision-making -- a practice that the agency has adopted to facilitate family participation in the decision process. Team decisionmaking is based on two key assumptions: first, that the family is often the proper unit for solving family problems and, second, that the extended family should be formally included in case decision-making. In general, case managers call for team meetings whenever placement, service, reunification, or other permanency decisions are to be made.
Aware that some parents could feel intimidated by the team meeting, the agency has taken several steps that are intended to increase families' comfort levels and encourage them to actively contribute to the planning process. In an effort to accommodate parents, whenever possible team meetings are held at neighborhood community centers instead of the agency's central office in downtown Toledo. Not only are the community centers more conveniently located, but it is hoped that the parents will feel that the centers provide a more neutral and friendly setting for the meeting. Furthermore, case managers encourage parents to invite their extended family, friends, and counselors and other professionals who will lend them support during the meeting.
In addition to the case manager, the parents, and their invited supporters, a facilitator from the Case Review Department attends team meetings. The facilitator's job is to ensure that all of the relevant case information is brought up for discussion and that every participant is given an opportunity to speak and ask questions. In addition to facilitating communication, the facilitator is responsible for maintaining the integrity of the meeting and respect for the parents' rights.
Once a case plan is developed, the case manager makes appropriate referrals for services that are not already in place. Families are usually referred to private agencies for counseling, diagnostic assessments, and substance abuse treatment. If reunification is expected to occur within a short time, the family is referred to CDD's Community Advocate Unit. Usually, parents first complete drug treatment, domestic violence counseling, and parenting classes before they are referred for intensive services from the Community Advocate.
Case Review. The Case Review Department is responsible for ensuring that all cases are reviewed within the timeframes that have been established by the court and the state. The standard procedure is to hold an administrative review at 4 months and again 10½ months after a case is opened. The administrative review examines the case plan to assess whether the parent has made progress, and if necessary, the plan and permanency goal are revised. For children in substitute care, the initial permanency goal is almost always to return home. The only exceptions to this general rule are families whose case histories strongly suggest profound parenting difficulties.
Aside from reviewing the case plan and services that each family has received, reports from workers providing services and other professionals such as therapists and substance abuse counselors are considered in assessing the family's progress toward achieving goals listed in the case plan. In addition to these reports, agency workers assess the risk to child safety whenever an administrative review or permanency hearing is scheduled. The risk assessment considers a variety of factors that affect the level of risk to the child -- the age of the child; the extent of emotional harm and physical injuries; the level of medical care; the ability of the family to provide basic needs like food, clothing, and shelter; and the adequacy of supervision. After all of the case information is reviewed, a permanency recommendation is made to the court.
2.2 Services
Community Development Department. The CDD is made up of four units -- Community Resource Liaison, Parent Education, Day Care, and Community Advocate -- which provide a range of services that are intended to maintain or reunify families.
Community Resource Liaison Unit. The Community Resource Liaison Unit uses resources in the community to help support families to make reunification possible and keep families together. The unit consists of Community Resource Liaison workers who act as liaisons with community resource centers, and staff who specialize in housing. The community centers are multi-service agencies providing recreation, family counseling, health services, and after school programs.
At the time of our visit, two Community Resource Liaison workers were being assigned to work with six local community resource centers. Their role is to ensure that LCCS-referred families are linked with a variety of center services, including respite care, recreation, after-school, parenting, and family counseling.
The housing specialist in the unit assists parents with securing affordable housing--a major barrier to reunification for many families. The housing specialist helps parents locate housing resources in the public and private sectors. In addition, for those parents who need subsidized housing, Family Unification Program Section 8 housing certificates have been reserved for CDD-referred families.
Parents face not only financial obstacles to acquiring housing but also often have a history of delinquent rent and utility payments. Hence, they are unable to get needed references from previous landlords. Although CDD does not usually pay parents' delinquent bills, the housing specialist will work with parents, landlords, and utility companies to negotiate debt forbearance and payment arrangements.
Parent Education Unit. The CDD's Parent Education Unit manages the agency's parenting education program. This parent training program is available to any parents referred by their Children Services worker regardless of their children's placement status. However, many of the children whose parents are referred to the program are in foster care with a permanency goal of reunification. The parenting education program attempts to increase the effectiveness of traditional classroom parenting instruction by adding two components. First, parenting classes are held at two neighborhood community centers in order to facilitate parents' class attendance. From the parents' perspective, the community centers are conveniently located, the atmosphere is friendly, and recreational activities are offered for their children while they attend class.
Secondly, in addition to providing classroom training, the unit's parent educators visit with parents in their homes to reinforce the parenting techniques that are taught in class. During the home visit, parent educators model effective parenting behaviors and coach the parents as they practice the techniques with their children. Although teaching parenting skills is the major task that parent educators undertake, they also provide transportation and day care for parents who need it in order to attend classes.
Parent educators typically begin making visits to the parent's home 2 weeks before the 12-week parenting class begins. These initial visits allow the educator to observe the parents' interactions with their child. At the first class session, additional baseline data are collected from the parent. The parent completes the Child Abuse Potential Inventory (a standardized instrument designed to determine the risk of child abuse), and the parent educator assesses the informal support system to identify people who may help the parent with parenting. Sometimes key members of the parent's support network--siblings, godparents, and boyfriends--attend parenting classes to both provide support and learn new skills themselves. These occasions provide educators an opportunity to assess the impact that these individuals may have on the parent and child. Depending on the parent's level of skill development, parent educators may make follow-up visits to parents' homes for up to six months after the final class. But all parents receive at least one in-home visit following their completion of the class.
Because of the labor-intensive nature of the work, the parent education unit recently expanded from three to six parent educators and each is assigned a caseload of eight to ten families. Parent educators are paraprofessionals and receive substantial training from the agency. Parent educators attend state training on identifying and understanding child abuse and neglect, the legal system and how to give court testimony, risk assessment training, and child development. In addition to this classroom training, the unit supervisor provides extensive on-the-job training.
Day Care Unit. The primary role of the Day Care Unit is to provide protective day care for children while their parents are attending substance abuse treatment, parenting classes, or counseling. The unit currently has a few contracts with community day care centers and approximately 55 family day care homes. Day care homes must meet the state's family day care regulatory requirements regarding health, safety, and capacity. Each family day care home can provide care for up to six children. Last year, family day care providers served 600 children from 300 families.
Although the primary purpose of family day care is to care for children in order for their parents to receive services, from the agency's perspective, the providers serve several additional purposes. Because day care providers have daily contact with the family, the agency trains and relies on them to watch for indications of child abuse or neglect. In fact, day care is often a part of the formal safety plan.
Community Advocate Unit. Although all four CDD units provide services to reunify families, community advocate workers are central to delivering services in families' homes. Families may be referred by the Assessment Department to community advocates for in-home services in an effort to prevent removal of the child from the home. In this section we focus on the unit's provision of reunification services that are delivered in families' homes to prepare for the child's return and then stabilize the reunited family. There are no educational requirements for community advocates. Experience in the department is emphasized, and most advocates in the unit moved into their positions from other service units in the department. Currently, the unit employs 10 community advocates. Each advocate is assigned 8 to 10 families at any point in time. The number of families that an advocate sees varies from day to day, but typically services are provided in each family's home once or twice a week. Last year, approximately 500 families were served.
At the outset, most families are expected to reunify eventually, but the timing of referrals to CDD for intensive services depends on the particular aspects of the case. In most cases, families are referred to the Community Advocate Unit approximately 30 days before the court issues a return home order. Occasionally the unit does not receive the referral until the children have been returned home. An exception to this general referral process is made for families receiving TANF benefits. In these cases, the Case Review Department tries to determine whether reunification is possible in less than 180 days. For these families, returning their children home within 180 days is particularly important because otherwise they will lose their TANF benefits. Once TANF benefits are terminated, parents' circumstances generally worsen and, as a result, reunification may be jeopardized. Hence, if the risk to child safety is moderate to high and the case review administrator believes that it can be addressed quickly, a 180-day reunification is planned and the Family Services case manager refers the case to CDD.
Services provided prior to reunification focus on preparing the parent and the home for the child's homecoming. During the pre-reunification period, community advocates may supervise parent-child visits in the home or community. Many parents have completed parent education classes, and the advocate uses the visitation to reinforce newly learned parenting skills. In addition to continuing to build parenting skills, the advocate assists parents with household and financial problems that need to be resolved before their children will be returned. Advocates will transport and accompany parents to public and private agencies to obtain housing, furniture, utilities, and food, income, and medical benefits. Parents frequently need the advocate's assistance with household management and repairs. In addition to ensuring that parents and their home are readied for the child's return, advocates use these hands-on activities to teach parents how to manage their household effectively and access community services.
Advocates typically provide services for at least 6 weeks after families are reunified. Post-reunification services continue to focus on household management (e.g., budgeting, shopping, and scheduling), and parenting (e.g., appropriate bed and meal times for children). In addition, building the parents' network of community supports is particularly emphasized during the post-reunification period. Advocates will assist parents with enrolling their children in day care, school, summer camp, and after-school programs. Whenever necessary, advocates meet with school personnel and other community professionals on the family's behalf. Advocates also attempt to build the family's relationships with extended family, foster parents, and neighborhood community centers.
Generally, advocates rely on parents to identify extended family members who will provide ongoing support. Grandparents, aunts, and uncles often give parents support during the reunification process. From the child welfare agency's perspective, reliable extended family members who have frequent contact with the parent and child can help to ensure the child's safety.
Although many parents receive a substantial amount of support from their extended families, other parents' familial relationships are strained. Whenever extended family cannot be relied on to support parents, advocates search for alternative supports in the community. For example, community agencies offer parent partners to parents with children under 4 years of age. Parent partners offer parenting and child development education to parents in their homes.
Advocates report that reunification seems to work best when foster parents are included in the process. Shortly before the child returns home, team meetings are held with the foster and birth parents to discuss the child's needs and reunification plans. Foster parents are asked to work with the team to facilitate the child's return home. Although some foster parents are initially hesitant, after they become acquainted with the biological parents through meetings at the agency, they usually very willingly share their knowledge of the child and successful parenting strategies.
Advocates also link parents with one of six community resource centers, multi-service agencies providing recreation, family counseling, health services, and after school programs throughout the county. CDD has contracts with these private, nonprofit agencies to provide space for worker-supervised family visitation, parenting classes, and team meetings. After advocates or other CDD workers have introduced a family to a community center, it is hoped that they will continue to use its services for ongoing support once CDD community advocate services have ended. For example, one young mother living in a rural area with her four children and no access to transportation was connected with a community center that provided transportation, parenting classes, family counseling, parent-child playgroups, and child immunizations. Although the centers offer a range of services, many families are most interested in the centers' recreational programs for children. Other families are less easily engaged in any of the programs that the centers offer. For those families, the community centers' outreach workers will sometimes visit the families' homes and encourage them to participate in one or another program.
Advocates cite parents' mental health and substance abuse issues, and inadequate income, transportation, and day care as the most common barriers to reunifying families. Rarely do parents have sufficient income to comfortably support their family, and many have difficulty finding someone to care for their children while they work. Even though the Department of Jobs and Human Services assists them with day care, parents who work evening shifts have difficulty securing day care.
Another hurdle to be overcome is parents' lack of transportation. Many families rely solely on public transportation and hence have difficulty getting to supermarkets and commercial centers to obtain basic services. Advocates look to parents' relatives and friends to provide transportation, but they are not always reliable. In one instance, a mother cancelled a cab believing that a relative was going to take her child to an immunization appointment. The relative cancelled at the last minute.
Throughout the time that advocates are providing services, weekly case notes and parent interaction forms are completed and given to the Family Services case manager who retains overall responsibility for the case. Although case managers are primarily responsible for case decisions, they rely heavily upon the advocate's assessments of the family's problems, needs for service, and stability. Generally, case managers value the advocates' opinions because they are in more frequent contact with the family, get to know the family better, and are most familiar with resources in the community. In fact, because of the advocates' greater access to information about the family, their input into the decision-making process may determine the case outcome.
In two case examples that advocates provided, their work with and assessment of the family substantially influenced the case outcome. In one instance, the advocate worked with a mother who had a long history of mental illness and substance abuse. The mother's first child had died at birth from substance exposure, and her second child was taken into custody from the hospital at birth. When the advocate received the case referral, the mother had given birth to a third child. It was the advocate's assessment that other professionals on the case tended to overemphasize the mother's mental health history without giving sufficient consideration to her ability to parent. Through her work with the advocate, the mother secured community mental health services, obtained income assistance, and received ongoing support from a parent partner. Largely as a result of the advocate's intense work with the mother and the implementation of ongoing community supports, the family was reunified, and the case closed.
In a second case, an advocate worked with a father whose case history indicated that he had previously been uncooperative and hostile toward agency workers. The advocate's experience with the father, however, was quite the opposite. After the advocate built a relationship with the father, the father made every effort to remedy substandard and hazardous housing conditions--repairing loose flooring and installing protective barriers around the heating source. The father also followed through on referrals the advocate made to mental health and substance abuse services. In addition, he formed a very positive relationship with his children's foster parent and relied upon her for parenting guidance following reunification.
3. Conclusion
Central to Lucas County Children Services reunification process is the quantity of intensive services that its parent educators and community advocates provide in families' homes. Depending on the course that a case takes, it is possible for a family to receive at-home services from a parent educator at least once a week for 15 weeks, then from a community advocate for another 6 to 10 weeks. The primary focus of these services is to help parents increase their parenting and family management skills to a level that will allow them to prevent the need for placement or regain custody of their children. In addition to teaching these skills, CDD workers help parents obtain housing and furniture, assist them with household management and repairs, and link families to ongoing community services. These services help get parents on their feet and stabilize the reunified family. In the process of providing services in the home, workers have many opportunities to observe parent-child interactions and assess family functioning. To the extent that frequent observations provide higher quality information about parents' progress, these intensive home-based services may contribute to better case decisionmaking.
Perhaps one of the most novel aspects of Lucas County Children Services community-based model is the way that it has arranged for its workers to deliver services to families in community settings. Prior to adopting Family to Family, Children Services, like most public child welfare agencies, had contracted with private community agencies for many of the services that were provided to families. Children Services still relies on community agency staff to provide diagnostic services, therapy, and substance abuse treatment. However, LCCS's staff deliver parenting classes and family visitation services and only space is leased from the community centers. This arrangement allows Children Services to offer services to families in their own communities and still remain directly accountable for the services that their employees provide.
Across the country, many ways of including families in decision making are currently in use. Children's Services' team decision-making, however, is distinctive in its extensive inclusion of families in all crucial decisions that are made throughout the course of the case. Agency staff report that through frequent team meetings, they get to know the parents better, gain better information about the family, and as a result make better decisions. It has also been asserted that team-decision making improves the quality of case plans, increases parents' investment in the plan, reduces children's length of stay in foster care, and increases reunification rates.
Administrators and workers suggest that the model may influence the staff's perceptions and decisions regarding family reunification. As has already been mentioned, team decision-making and intensive home-based services allow agency staff to become better acquainted with families and provides them with direct access to information about the parents' perceptions, motivations, and functioning. In addition to greater access to this information, families' contacts with the agency's workers, day care providers, and contracted community centers allows the agency to better monitor children's safety. To the extent that staff have greater confidence that children's safety is adequately monitored, they may be more likely to proceed with reunification efforts earlier in a case and with families who have more complex difficulties.
This report has described the status of Lucas County's efforts to develop community-based child welfare services along the lines of the Family to Family model. The agency appears to have made substantial progress toward implementing components of the model over which it has the most control, such as the delivery of services by its own workers and contracted agencies, yet much remains to be done before the envisioned model is fully implemented. For example, the agency plans to develop a more comprehensive neighborhood-based system of care. These plans include securing foster parents and day care providers in the neighborhoods where most of the families served by the agency live. It is hoped that the provision of these services within families' neighborhoods will reduce the level of trauma that children may currently experience when they are removed from not only their parents' homes but also from their schools and communities.
In addition to these services, the agency works with community schools, churches, and citizens groups to identify ways that these organizations can contribute to the prevention of child abuse and neglect in their neighborhoods. The agency's efforts depend on the establishment of a comprehensive neighborhood-based system to both prevent abuse and neglect and to facilitate family reunification. Success may also depend upon the level of resources in communities that are available for the effort.
Endnotes
1. Of the 691 children in Lucas County who entered out-of-home care in 1999 (519 entering agency custody and 172 entering relative custody), 410 (almost 60%) were placed with an extended family member. The ethnic distribution of children in substitute care in 1999 was 45 percent African-American, 41 percent Caucasian, 11 percent Bi-Racial, 2 percent Hispanic, 1 percent other. Site visits for Lucas County were conducted in November 2000.