Introduction
Reform of the policies and systems that provide services to families and children is underway throughout the nation (Fraser, Pecora, & Haapala, 1991). Public agencies, not-for-profit agencies, for-profit companies, and grassroots organizations are developing new service approaches, integrating services across traditionally separate domains, and collaborating with new partners to demonstrate the potential of reform and to better serve families. While the terminology differs by area—in education the watchword is “restructuring,” in health care it is “managed care,” in mental health “systems of care,” and in social services “family-centered” or “family-based services”—the underlying themes of these reform efforts are remarkably similar: meeting changing family needs, maximizing limited resources, and increasing program effectiveness.
Various forms of family-centered services (FCS), such as family support services, wraparound services, family-based services (FBS), and intensive family preservation services (IFPS), represent some of the fastest growing program areas in child welfare, mental health, and juvenile justice. These services are designed to strengthen family functioning in order to achieve a number of outcomes. For some families the desired outcome is prevention of child maltreatment, for others it is a reduction in parent-adolescent conflict, and for some families the goal is to improve some aspect of a child’s behavior. In still other cases the goal is to improve the family situation to a point where child placement can be prevented or the child can be returned from substitute care (e.g., family foster care, residential treatment).
Various terms are used to describe different program models in the area of family-centered services. Within the broad framework of family-centered, or family-based, services, there is wide variation across the nation in the kind of interventions, duration of services, size of caseloads, and components of service that characterize such programs. Perhaps this variation is inherent in all service innovations, but it is one of the reasons research findings on family-centered service programs have been confusing. Despite a growing body of literature, it is not clear what these services are, how much service is provided, and who benefits from them. As a result of the enormous variation in the service characteristics of the new programs, the programs themselves are often described using more specific terms, such as “family preservation,” “family support,” “home-based,” and “placement prevention services.”
In all family-centered services the family is not seen as deficient but as having many strengths and resources (Kagan, Powell, Weissbourd, & Zigler, 1987). One term, family support, has been used to encompass a broad range of family-strengthening programs. Although family-based and family preservation services have both been cited as family support programs, these programs (family based and family preservation) are distinct from primary prevention and child development–oriented family support programs such as prenatal care, home visiting, early childhood education, parent education, home-school-community linkage, child care, and other family-focused services that tend to provide one type of service (e.g., education, housing, financial assistance, or counseling), work with clients exclusively in an office or classroom, provide treatment over a long period of time (one year or more), or plan and monitor client services delivered by other agencies.
The Child Welfare League of America further clarifies family-centered services by means of a three-part typology of programs including (a) family resource, support, and education services; (b) family-centered services; and (c) intensive family-centered services.
These community-based services assist and support adults in their role as parents. Services are available to all families with children and do not impose criteria for participation that might separate or stigmatize certain parents.
These services encompass a range of activities, such as case management, counseling/therapy, education, skill building, advocacy, and provision of concrete services (such as housing, food, and clothing) for families with problems that threaten their stability. As mentioned earlier, the philosophy of these programs differs from the more traditional child welfare services in the role of parents, use of concrete and clinical services, and other areas.
The more common term is family-based services, although in some states programs are referred to as family preservation services. Most of these programs are currently found in child welfare agencies, although a number have been initiated by mental health centers. FBS programs have recently been started in a number of new service arenas, including juvenile justice, developmental disability, adoption, and foster care reunification programs. An example of an FBS program with a broad public health and family-centered focus is Hawaii’s Healthy Start program, which provides a comprehensive array of health care, counseling, and concrete services to families judged to be at moderate to high risk of child maltreatment (Breakey & Pratt, 1991).Although program designs and specific interventions differ, most of the programs fitting the broader name of family-based services share some or all of the following characteristics: • A primary worker or case manager establishes and maintains a supportive, empowering relationship with the family.
• A wide variety of helping options are used (e.g., concrete forms of supportive services such as food and transportation may be provided along with clinical services).
• Caseloads of two to twelve families are maintained.
• One or more associates serve as team members or provide backup for the primary worker.
• Workers (or their backup) are available twenty-four hours a day for crisis calls or emergencies.
• The home is the primary service setting, and maximum utilization is made of natural helping resources, including the family, the extended family, the neighborhood, and the community.
• The parents remain in charge of and responsible for their family as the primary caregivers, nurturers, and educators.
• Services are time limited, usually one to four months. (Bryce & Lloyd, 1981)
These services are designed for families “in crisis,” at a time when removal of a child is perceived as imminent or the return of a child from out-of home care is being considered. Yet the reality is that this service model is also being applied to chronic family situations, involving child neglect or abuse, which does not involve crises. These programs often share the same philosophical orientation and characteristics as family-centered services but are delivered with more intensity, so they are often referred to as intensive family preservation services, or IFPS, programs. Caseloads generally vary between two and six families per worker. Families are typically seen between six and ten hours per week, and the time period of intervention is generally between four and twelve weeks. The emphasis of these services is to provide intensive counseling, education, skills training, and supportive services to families, with the goal of protecting the child, strengthening and preserving the family, and preventing the unnecessary placement of children (Whittaker, Kinney, Tracy, & Booth, 1990). In some cases, however, the primary case goal is to reunite children with their families (Child Welfare League of America, 1989). We will refer to these programs as IFPS—intensive family preservation services—and they include programs such as Homebuilders in Washington, Intensive Family Services in Maryland, and certain types of Families First programs in various states. Although such programs may share core features, there exists much diversity in treatment models.
Intensive family-centered crisis services have been described as “family-based services,” “home-based services,” “services to children in their own homes,” and “family preservation services.”
The target population for family-centered services varies greatly. For example, both FBS and IFPS programs are generally targeted to families in serious trouble, including families no longer able to cope with problems that threaten family stability, families in which a decision has been made by an authorized public social service agency to place a child outside the home, and families whose children are in temporary out-of-home care. Although some programs may emphasize a “crisis orientation,” many families who are served by these agencies are not in crisis and have for some time been trying to cope with an abusive or neglectful family member, child mental illness, juvenile delinquency, or other problem. Thus these services may be appropriate for families seen by the child welfare, juvenile justice, or mental health systems, as well as for adoptive or foster families facing potential disruption.
The distinction between the various program categories is not definitive, but the CWLA taxonomy helps to clarify some distinguishing features of the three types of programs and to suggest some of the program design features highlighted by practitioners and administrators in the field. When referring specifically to programs that deliver both concrete and clinical services primarily in the home on an intensive basis, we will use the term intensive family-preservation services (IFPS).
A number of other program advocates are promoting the use of the term intensive family preservation services to designate programs that deliver both clinical and concrete services in the home setting and provide a more intensive service than do other programs (Whittaker et al., 1990). Recent home-based forms of family-centered services are most directly attributable to concerns that in the United States, traditional child welfare services were not meeting the needs of children and their families. More specifically, the field of child welfare was criticized during the 1960s and 1970s in the following areas:
• Children who could have remained at home were placed in substitute care, with disproportionate rates of placement occurring among ethnic minority families.
• Children in substitute care lacked clearly specified case plans.
• “Foster care drift” occurred in some situations, resulting in long-term placements, multiple placements, and no sense of permanence for many children.
• Parental involvement and visitation were discouraged by some workers.
• Termination procedures and adoption practices constrained the use of adoption as a bona fide case goal.
• Categorical federal funding policies encouraged foster care maintenance services (i.e., placement) and did not adequately fund preventive or restorative services.
• Most state agencies did not have adequate management information systems in place; consequently, program administrators did not know how many children were currently placed in substitute care, their average length of placement, or other essential planning information.
Expose´s of the quality of child welfare services, and of foster care in particular, were written and widely publicized by both child welfare experts and investigative reporters. In addition, the growing incidence and costs of foster care, concern about the harmful effects of substitute care, the belief that some placements could be prevented, and the trend toward deinstitutionalization all prompted the development of a variety of foster care preventive programs. Further, in child welfare it was thought that some children were placed in foster care, juvenile justice facilities, or residential treatment centers that could have remained at home or in less restrictive settings. Children in the substitute care settings usually lacked clearly specified case plans. This resulted in foster care drift, with unnecessarily long-term placements, multiple placements, and a sense of impermanence for many children.
When children were in foster care or other substitute arrangements, parental involvement and visitation were not encouraged (Fanshel & Shinn, 1978). In addition, substitute care arrangements, termination procedures, and adoption practices constrained the use of adoption as a realistic case goal. Furthermore, federal funding policies encouraged foster care maintenance services (i.e., placement) and did not adequately fund preventive or restorative services. Finally, most state agencies did not have adequate management information systems in place; consequently, program administrators did not know how many children were currently placed in substitute care, average lengths of placement, or other essential planning information.
One of the principal assumptions underlying foster care prevention and planning efforts for children at risk of child maltreatment is that in most cases, a child’s development and emotional well-being are best ensured through efforts to maintain the child in the home of her or his biological parents or extended. Most practitioners and researchers agree with this assumption, while realizing that child placement in some situations may be the more beneficial and necessary option.
Permanency planning refers first to efforts to prevent unnecessary child placement and second to efforts to return children in foster care to their biological families or to some other form of permanent placement, such as an adoptive home or long-term foster care family with guardianship. This emphasis took hold in child welfare agencies in the late 1970s and 1980s with the leadership of the Oregon Permanency Planning Project and other training efforts. Permanency planning has been helpful in reducing the numbers of children lingering in family foster care: as of September 30, 1999, 37 percent of the children who left substitute care had been there for five months or less; 50 percent of the children were in placement less than twelve months. There is, however, a remaining concern about the lack of program alternatives for family reunification and foster care reentry (Goerge, 1990).
Criticism of the child welfare service delivery system has been brought to public attention by the numerous class action suits filed by the American Civil Liberties Union and other advocacy groups. In fact, many would argue that the focus on permanency planning, creating service alternatives, and child stability has not been supported through staff training, supervision, or provision of the necessary resources (Fanshel, 1992). Although the child population in substitute care had fallen from 502,000 in 1977 to 276,000 in 1985, as of March 31, 1998, 520,000 children were residing in foster homes in the United States. Some of this increase in placements is no doubt due to increased substance abuse among parents. A number of studies have found that various forms of child maltreatment are associated with abuse of alcohol or other drugs. There have been large increases in the number of drug-exposed infants coming into foster care. In addition, increasing rates of teen parenthood, a rise in never married parents, AIDS, urban poverty, a growing shortage of affordable housing, and significant rates of unemployment among certain groups have all contributed to the rise in child placement rates.
Some experts believe that state child welfare agencies have improved their efforts to reduce the number of unnecessary placements. Although in many states the percentage of children placed in relation to the number of child protective service cases being reported appears to have decreased, this may be due to a lack of emergency placement resources. Child advocates, therefore, remain concerned that essential preventive services are not being provided. They maintain that it is possible to identify families with a sufficiently high risk of maltreatment or harm to justify an intensive intervention to prevent further family deterioration or child placement. Consequently, many children have been placed outside their homes not once but multiple times in different family, group home, residential treatment, juvenile justice, and psychiatric hospital settings (Fanshel & Shinn, 1978).
The current difficulties evident in the child welfare system and in the development of the current FCS and IFPS programs have a long and varied history in the United States. Following a description of the history of family-based service programs, the authors discuss some of the major program implementation and evaluation issues for such programs.
Conclusion
The foregoing represent some of the major challenges that FCS and IFPS administrators and evaluators need to overcome. To date, the field lacks conclusive evidence that FBS programs prevent child placement and information about which types of FBS programs are most effective with different client subpopulations, including those involved in physical abuse, neglect, parent-child conflict, or other problems. We also need a better understanding of effectiveness with different age groups of children and of program components that contribute to success with different families. Studies are beginning to look at subpopulations and to estimate the value of different intervention components. These are all-important evaluation goals, along with the fundamental need for FCS and IFPS programs to assess effectiveness, refine interventions, and be accountable to funding agencies. These are just a few of the program implementation challenges that remain to be fully addressed.
Family-centered services represent an enduring and valuable approach to working with families at a time when “orphanages” and quick termination of parental rights are being touted as easy solutions to complex problems. Evaluation data from well-constructed research studies can help guide service reform efforts.
Reference:
Breakey, G., & Pratt, B. (1991). Healthy growth for Hawaii’s “healthy start”: Toward a systematic statewide approach to the prevention of child abuse and neglect. Zero to Three, 9 (4), 16–22.
Child Welfare League of America. (1989). Standards for services to strengthen and preserve families with children. Washington, DC: Author.
Fraser, M. W., Pecora, P. J., & Haapala, D. A. (1991). Families in crisis: The impact of intensive family preservation services (pp. 17–47).
Fanshel, D., & Shinn, E. (1978). Children in foster care: A longitudinal investigation. New York: Columbia University Press.
Goerge, R. M. (1990). The reunification process in substitute care. Social Service Review, 64, 422–57.
Kagan, S., Powell, D., Weissbourd, B., & Zigler, E. (Eds.). (1987). America’s family support programs: Perspectives and prospects. New Haven: Yale University Press.
Whittaker, J. K., Kinney, J., Tracy, E. M., & Booth, C. (Eds.). (1990). Reaching high-risk families: Intensive family preservation in human services. New York: Aldine de Gruyter.
