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Development of a family risk-factor measure that predicts imminent risk of placement and appropriateness for family-based, wrap -around services

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Development of a family risk-factor measure that predicts imminent risk of placement and appropriateness for family-based, wrap -around services

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Content DEVELOPMENT OF A FAMILY RISK-FACTOR MEASURE THAT
PREDICTS IMMINENT RISK OF PLACEMENT AND
APPROPRIATENESS FOR FAMILY-BASED,
WRAP-AROUND SERVICES
by
Robert Mayo Stovall
A Dissertation Presentated to the
FACULTY OF THE SCHOOL OF POLICY, PLANNING,
AND DEVELOPMENT
UNIVERSITY OF SOUTHERN CALIFORNIA
in Partial Fulfillm ent of the
Requirements for the Degree
DOCTOR OF PUBLIC ADMINISTRATION
May 2001
Copyright 2001 Robert Mayo Stovall
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UM1 Number: 3027783
Copyright 2001 by
Stovall, Robert Mayo
All rights reserved.
_ _ ®
IJM I
UMI Microform 3027783
Copyright 2002 by Bell & Howell Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
Bell & Howell Information and Learning Company
300 North Zeeb Road
P.O. Box 1346
Ann Arbor, Ml 48106-1346
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UNIVERSITY OF SOUTHERN CALIFORNIA
SCHOOL OF PUBLIC ADMINISTRATION
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90089
This dissertation, written by
Robert Mayo Stovall
under the direction of hJ§.... Dissertation
Committee, and approved by all its
members, has been presented to and
accepted by the Faculty of the School of
Public Administration in partial fulfillment
of requirements for the degree of
DOCTOR OF PUBLIC ADMINISTRATION
Dean
0
Date,
DISSERTATION C
rperson
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Dedication
At the dinner table, we have spoken of the concept, "The more
you know, the more you owe." I hope that readers turn their
knowledge into action through providing pro bono services to
the disadvantaged. While knowledge is power; shared knowledge
becomes powerful. This work is dedicated to those who share
knowledge through service.
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Acknowledgments
This research was made possible because of the values
that surrounded me in my family. My parents demonstrated
through action that learning is a life-long process.
I am most appreciative of those who took the time to
review and comment on the draft: Ross Clayton, Chet Newland
and Bob Caulk. I commend USC for providing a stimulating,
learning environment for practicing professionals in a format
which enables students to interchange vantage points and
encourages taking theory into action.
Special thanks to my wife, Ann, who, as a literature
teacher, assisted in the editing of this document and for her
continued support in my struggles through the dissertation
doldrums. As for my children, two of whom were placed into
foster care and were adopted by my wife and me, when asked,
"Where is Daddy?" they respond, "In front of the computer, as
usual." I thank them for giving the time that could have been
family time so that potentially other families may remain whole.
i i i
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Table of Contents Page
Dedication i i
Acknowledgment i i i
Tables vi
Figures v ii
T Introduction 1
1.1 Increase of Out-of-Home Care In California 9
1.2 Federal Definitions of Family Preservation 14
1.3 Importance of the Study 16
1.4 Content of the Chapters 19
2 Literature Review 27
2.1 Definitions of Concepts and Terms 28
2.2 Brief History of Foster Care ' 36
2.3 Federal Legislative History of Family
Preservation and Support Services 41
2.4 California Legislative History of Family
Preservation and Support Services 51
2.5 Models Used for Family Preservation Programs 63
2.6 Conclusion Regarding Family Preservation
Models 87
2.7 Evaluations of Family Preservation Programs 91
2.8 Conclusion: The Missing Criteria for "Imminent
Risk of Placement" 101
3 Problem Statement 106
3.1 Why This Study is Timely In Today's Political
Environment 107
3.2 Summary Argument 113
3.3 Hypothesis 119
iv
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4 Methods and Procedures
4.1 Restatement of Question
4.2 Formal Hypothesis
4.3 Method of Inquiry
4.4 Research Perspectives
4.5 Risk Assessment Tools and Actuarial
Assessment Methods
5 Interpretation of the Findings of Family
Preservation Research
5.1 Significant Findings of the Evaluations
5.2 Presentation of Summary Tables
5.3 Conclusions From the Survey of Evaluation
Data
5.4 Framing the Findings: Developing a Tool to
Assist in Determining Which Family-Based
Services are Most Appropriate or Whether
Out-of-Home Placement Should be Advocated
5.5 Implications for Family-Based Services:
Fast Lanes and Road Kills on the Bridge into
the Twenty-First Century
6 Summary and Conclusions
6.1 The Need For an Imminent-Risk Tool
6.2 Instructions for the Visual-Based, Two-
Dimensional Decision Tool to Assist in
Determining Imminent Risk of Placement
6.3 An Example of the Application of the Two-
Dimensional, Imminent-Risk Decision Tool
6.4 Outcome Measures as Feed-back Mechanisms
in Determining Public Policy
6.5 Suggestions for Additional Research
7 Bibliography
121
121
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124
128
133
135
148
154
162
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206
208
214
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Tables
Table 1.1
Average number of Children in Foster Care In California
per Month.
Table 12
Average Annual Expenditures for Children in California
for Foster Care.
Table 2.1
Changes in Numbers of Placements, Placement Costs,
and Average Monthly Cost of a Child in Foster Care in
California Between 1980 and 1997.
Table 5.2
Differences at Intake Between Children Placed and
Not Placed.
Table 5.3
Differences at Termination Between Children who
were placed and not placed.
Table 5.4
Differences in scores before and after fam ily
preservation services for children who were placed
and not placed with regard to changes in the Child
Well-Being Scale.
Table 5.5
Differences at intake between families whose children
were placed and those families that were not placed.
p. 10
p. 11
p. 46
3 . 148
3. 149
3. 150
3. 151
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Table 5.6 p. 152
Differences at termination between families whose
children were placed and those families that were
not placed.
Table 5.7 p. 153
Logit Analysis of risk factors identified at intake
associated with out-of-hom e placement for families
receiving services and for comparison group families.
Table 5.8 p. 167-168
Summary of findings: Scores on family risk factors
which were consistently lower for those families
whose children were placed out-of-home.
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Figures
Figure 5.1 p. 134
Two dimensional decision making tool to
determine imminent risk of placement.
Figure 5.9 p. 173-174
"Red Flag" risk factors that have been directly
associated with the placement of children into
out-of-home placement
Figure 5.10 p. 175-177
Risk factors to assist in placement decisions.
Figure 6.1 Case One p. 198-199
"Red Flag" risk factors that have been directly
associated with the placement of children into
out-of-home placement.
Figure 6.2 Case One p. 200-202
Risk factors to assist in placement decisions.
Figure 6.3 Case Two p. 204
"Red Flag" risk factors that have been directly
associated with the placement of children into
out-of-home placement.
Figure 6.4 Case Two p. 205
Risk factors to assist in placement decisions.
vi ii
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ABSTRACT
DEVELOPMENT OF A FAMILY RISK-FACTOR MEASURE THAT
PREDICTS IMMINENT RISK OF PLACEMENT AND APPROPRIATENESS
FOR FAMILY-BASED, WRAP-AROUND SERVICES
In July, 2000, over 1 0 5 ,0 0 0 children were living in out-of-
home care in California. A number of these children could have
remained in their homes with the provision of wrap-around
services. However, in order to obtain wrap-around services,
children need to be deemed at imminent risk of out-of-home
placement. To date, decisions of imminent risk of placement
have been subjective with little inter-agency agreement as to
definitions of this term .
This research utilizes data obtained from three studies in
California which evaluated family preservation programs by
utilizing family risk scales. Re-evaluation of that research is
used to determine which risk-factors are directly associated
with out-of-home placement. In addition, a summary of seven,
family-based services models is presented and discussed.
i x
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This research provides a visual-based, two-dimensional
decision-assisting tool to assess family risk factors that can be
used by child protection service workers in making complicated
and profound decisions as to whether or not to remove children
from birth families or provide wrap-around services. The two-
dimensional, decision tool is composed of seven clusters of issue
areas and vertical and horizontal scales. One cluster identifies
issues which are associated with children being removed from
their birth families. The other, six issue clusters identify risk
factors that have been used in agencies to exclude families from
receiving family-based services because of perceived, imminent
risk of out-of-home placement.
The horizontal scale is an objective-based scale that
identifies the extent of the risk in the family. The vertical
placement selected represents the decision-maker's subjective
opinion in determining if family-based service or out-of-hom e
placement is appropriate for each specific risk area examined.
Implications for future research are discussed.
x
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D ev e lo p m en t o f a Fam ily R isk-F acto r M easure T h a t
P red ic ts Im m in e n t Risk o f P lacem en t and
A p p ro p ria te n e s s fo r Fam ily-B ased
W raparound S ervices
R obert Mayo S to v a ll, 2 0 0 0
C h apter One In tro d u c tio n
Child protective service workers constantly make
decisions at the conclusion of a child abuse and neglect
investigation that are crucial to the future safety of children and
the well-being of the family. Workers must decide to: 1.) close
the case, 2.) open the case for intensive in-home family
preservation or wrap-around services or some other child
protective service intervention, or 3 .) remove the child or
children to out-of-home placement. The decision to place
children in out-of-home placement has tremendous consequences
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for the children and families given the emotional turbulence and
trauma resulting from a child's separation from his or her family
and the fiscal cost of placement. On the other hand, a decision to
leave children in a potentially abusive home can lead to
emotional, sexual or physical trauma, or, on rare occasions,
death.
The decision-making process occurs in arenas where the
stakes are measured in terms of the physical and emotional
health of children. Decisions must be made on a firm foundation
of theory, research, and practical experience. Additional
decision factors include: service options, the family's
environmental conditions and risk factors, contextual political
and fiscal issues, and the frontline worker’s estimation of the
potential of harm if the children remain in the home.
Unfortunately, those frontline workers who are responsible for
these decisions reflect a wide variety of backgrounds,
preconceived notions, professional experience, time on the job,
and education. The mix of conditions relevant to the decision to
2
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place a family in a family preservation or wrap-around program
or to place the children in out-of home care is varied. The
difficultly in assessing family situations and the range of
expertise of the workers combine to produce a near perfect
equation for widespread disparity and inconsistency in case
decision-making (Baird et al, p. 724, 1999).
This research provides a visual-based decision assisting
tool to assess family risk factors that can be utilized by child
protection service workers in making the complicated and
profound decision whether or not to remove children from birth
families or to provide family-based services. This study utilizes
research provided in evaluations of family preservation programs
which identify characteristics of families that have had children
removed and placed into out-of-home care.
During a juvenile court proceeding, a California Superior
Court Judge lamented that it cost the tax payer more to send a
youth to a group home than if the judge, as a parent, had sent his
son to Stanford and bought him a red sports car! i
3
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In a policy development arena in which options are
significantly weighted for fiscal impact, the ability to reduce
the costs associated with over 100,000 children in out-of-home
placem ents in California is gaining legislators' and California
State Department of Social Services's attention.2 Funding
mechanisms have been developed to transfer funds previously
used for foster care payments to family based services, which
include family preservation programs, and wrap-around
programs.
SB 163 (Chapter 795/S tatu tes of 1997) created a five year
p ilo t program known as the "Wraparound Services Project"
beginning January of 1998, which allowed California counties to
utilize Aid to Families with Dependent Children - Foster Care
dollars to provide family-based services to eligible children as
an alternative to the more expensive group home placements.
Wraparound is a planning process which emphasizes family-
centered, strength-based, needs and services planning and
delivery. Service delivery can include specific treatm ent and/or
4
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intervention approaches such as psycho-social, life-skill
development, individual and family therapy, or medication
services. The goals of this program are 1.) to allow children to
remain in, or return to their family environments, 2.) to utilize
resources traditionally targeted for residential treatm ent of
children for the needs of the family and children in the home
setting rather than in an out-of-home residential care, 3.) to
assist children and families to attain their needs and services
goals, 4.) to reduce the length of stay in expensive group homes,
5.) to strengthen families so that children with the highest need
can remain in the home permanently, and 6.) to reduce the costs
of placement of children in high-end groups. Eligibility for the
project was limited to children that are determined to be at
imminent risk of placement into a group home program with a
rate clarification level of twelve, thirteen, or fourteen. The
costs of these programs, as of July 1, 2000, are respectively
$5,057, $5,397, and $5,732 per month per child.
5
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In August of 2000, AB 2706, (Chapter 259), changed the
definition of eligible children to those who reside in or who are
at risk of being placed in group homes with a rate clarification
level of ten or eleven. The number of children placed in group
home with rate classification levels of ten to fourteen include
about seventy percent of the children in group home care in
California. Any cost savings that counties realize from the
Wraparounds must be reinvested in the expansion or enhancement
of services for children and families (California Departm ent of
Social Services, internet site Childsworld, p. SB 163 Wraparound
Services Pilot Questions and Answers, 1999).
Beginning in the late 1980's, experimental research
utilizing control groups examined how family-based services
could reduce the need for out-of-home placement. Numerous
studies utilizing rigorous control groups have shown that there
is little significant difference in placement rates between
families th a t have received family-based services and those that
have not. However, in examining the research, there are
6
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significant indicators that predict the need for out-of-hom e
placement regardless of the services that families receive. The
goal of this research is to reassess studies which evaluated
family preservation programs in California using child and
family risk scales 1.) to determ ine which risk-factors are
utilized in determining imminent risk of out-of-hom e placement,
2.) which risk-factors are directly associated with out-of-hom e
placement, and 3 .) to develop a tool to assist child care
professionals in determining which families may best benefit
from family-based services, and which may be b etter served by
out-of-home placement.
Senate Bill 370, which was approved by the Governor in
1989 and became law, required that the California State
Department develop and utilize an assessment tool for placement
workers to match the needs of children who are wards of the
court and their families with services that need to be provided in
out-of-home placement. This was to be accomplished by the
legislated deadline, July 1, 1990. To date, this has not occurred.
7
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Assembly Bill 933, which became law in 1999, again
addressed the need fo r a family and child assessments related to
decisions regarding out-of-home care. Assembly Bill 933,
repealed the previous requirement for the development and
implementation of a level of care assessment instrument and
process to determine appropriate placement for children in out-
of-home care. AB 933 instead requires development of a
strength-based assessment for provision of child welfare
services for foster children when it is necessary to place them
in out-of-home care. In addition, the Legislature requested that
a report be issued th at contained best practice guidelines for
assessments of families and children receiving foster care and
child welfare services. Currently, com mittees are addressing
this need.3
The focus of this research will be to provide an overview
of research on family-based, services programs in which a
primary outcome goal was a reduction in out-of-home placement.
The research will focus on the characteristics of those children
8
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and families th at are referred for out-of-home care. By
identifying those risk factors that exist in families that are
most likely to have children placed in out-of-home care,
decision-makers in county child welfare service departments can
b etter identify those families that could benefit most from
family preservation and wrap-around programs and those
children that may be better served in foster or kinship care.
1.1 In c re a s e o f O u t-o f-H o m e C are In C a lifo rn ia
According to the U. S. Department of Justice, the youth
population in the United States declined by eleven percent
between 1979 and 1989 while the number of juveniles in custody
increased by thirty-one percent. In California, which provided
care and supervision to tw enty percent of the nation's children in
foster care,4 the number of children in foster care increased
from 44,021 in 1988 to 7 8 ,7 5 6 in 1997, an increase of seventy-
nine percent over ten years (S tate of California Information
9
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Services Bureau, Aid to Families with Dependent Children Foster
Care, Fiscal Years Ending June 30, 1980 to 1997, Table 8, 1997).
(see Figure 1.1) By December 31, 1999 the number of children in
foster care in California had increased to 107,536 (Center for
Social Services Research, p. 1, 2 0 0 0 ).
Average number of Children in Foster Care In California per
Month
Year Number of Change Percent
Ending Children from Change fro
June 30 Placed Prior Year Prior Year
1997 78,756 4,814 6.50%
1996 73,942 4,727 6.80%
1995 69,215 2,518 3.80%
1994 66,697 3,135 4.90%
1993 63,562 1,165 1.90%
1992 62,397 1,982 3.30%
1991 60,415 3,757 6.60%
1990 56,658 6,484 12.90%
1989 50,174 6,153 14.00%
1988 44,021 4,449 11.20%
10 year average 62 ,5 8 4 3,918 7.00%
State of California Information Services Bureau October 1997
Table 1.1
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Average Annual Expenditures for Children in California for
Foster Care
Year Total Annual Amount Percent
Ending Expense for Change from Change from
June 30 Foster Care Prior Year Prior Year
1997 $1,095,678,227 $120,530,884 1 2.40%
1996 $975,147,343 $75,171,569 8.40%
1995 $899,975,774 $40,606,738 4.70%
1994 $859,369,036 $31,552,289 3.80%
1993 $827,816,747 $20,721,998 2.60%
1992 $807,094,749 $56,488,448 7.50%
1991 $750,606,301 $117,232,336 18.50%
1990 $633,373,965 $96,531,076 18.00%
1989 $536,842,889 $73,908,871 16.00%
1988 $462,934,018 $77,773,108 20.20%
10 year average $784,883,905 $71,051,732 11.21%
State of California Information Services Bureau October 1997
Aid to Families with Dependent Children - Foster Care
Fiscal Years Ending June 30, 1987 to 19971
Table 1.2
The cost of out-of-home, non-secure settings, including
formal kinship care, foster homes, and community-based
programs, has increased from $463 million in the fiscal year
1 9 8 7 -8 8 to $1.1 billion in the fiscal year 1 9 9 6 -9 7 , an average
increase of 11.2 percent per year, (see Figure 1.2) The number of
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children placed in out-of-hom e care in California increased from
5 0 ,0 0 0 in fiscal year 1 9 8 8 -8 9 to 105,756 in July 1999, more
than doubling over a ten year period (S tate of California
Information Services Bureau, Aid to Families with Dependent
Children Foster Care, Fiscal Years Ending June 30, 1980 to 1997,
Table 8, 1997).
Federal and State government expenditures and policies
are increasingly being driven by fiscal constraints and
demonstrated outcomes. The California Governor's 2 000-2001
budget recommended an expenditure of 1.478 billion dollars for
foster care based on an estimated monthly caseload of 79,800.
Of the funds expended for foster care, the State of California
provides for 26 percent of the costs, the counties pay for 41
percent, and the federal government covers 33 percent.6
Federal and state legislators and local decision-makers are
seeking effective and less costly alternatives to out-of-home
care. One tool th at can assist child protective service workers
in determining which children might most benefit from family
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based preservation or wrap-around services and which children
would be better served in out-of-home placement is a tool based
on research which identifies the risk factors present in families
that have children placed in out-of-home care regardless of
services provided to those families.
One alternative to out-of-hom e placement is family
preservation and support services. This program provides new
and redirected federal, state, and local funds to child welfare
agencies for preventive services which include designated family
support services, and service to families at risk or in crisis, or
family preservation services. Family preservation services are
designed to prevent the removal of neglected or abused children
from their families (Schuerman, Rzepnocki and Littell, p. 3,
1994).
Another alternative to out-of-home placement has recently
been identified as wrap-around services. Wrap-around services
target those foster youth that would be placed in settings that
would cost more than $ 4 ,5 0 0 per month. The services are
13
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similar to those described in family preservation services
without the 90 day limitation on duration of services.
1 .2 F e d e ra l D e fin itio n s o f Fam ily P re s e rv a tio n
Family support services are primarily
community-based preventive activities designed to
alleviate stress and promote parental competencies
and behaviors th at will increase the ability of
families to successfully nurture their children,
enable families to use other resources and
opportunities available in the community, and create
supportive networks to enhance child-rearing
abilities of parents and help compensate for the
increased social isolation and vulnerability of
families. ...
Family preservation services typically are
services designed to help families alleviate crises
that might lead to out-of-home placement of
children, maintain the safety of children in their
homes, support families preparing to reunify or
adopt, and assist families in obtaining services and
other support necessary to address their multiple
needs in a culturally sensitive manner. ...
Family support services and activities include
respite care for parents and other care-givers, early
development screening of children to assess the
needs of these children and assist in obtaining .
specific services to m eet their needs, mentoring,
tutoring, and health education for youth, and a range
of center-based activities (informal interactions in
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drop-in centers, parent support groups) and home
visiting programs. (OMB No. 0980-0258, p. 2, 1994)
Family-based services have several goals: 1.) to keep
families safe, 2 .) to improve family functioning so that the
behaviors that led to crisis within the family are reduced 3.) to
avoid unnecessary placement of children in out-of-home care,
and 4 .) to avoid the high fiscal and human cost of out-of-home
care.
Two, central evaluation questions have emerged at the
national level. First, are the family preservation and support
services models as effective as their supporters propose?
Second, is the heavy investment in family preservation and
support services programs as cost-effective as anticipated?
This dissertation utilizes data gleaned from controlled studies
in California (McDonald and Associates, 1990, Meezan and
McCroskey, 1997, and McDonald and Associates, 1997) and
answers the question: given the results of family preservation
research utilizing controlled experimental studies, what are the
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risk factors in families that lead to the imminent risk of
placement?
1 .3 Im p o rtan ce o f th e Study
Statistical information on child out-of-hom e placements
is im portant both nationally and specifically in California. In
California, the State Departm ent of Social Services is currently
revising the procedures utilized in making the judgm ent as to
whether to place a child in out-of home care. Senate Bill 9 3 3 ,
which was signed into law in California in 1 9 9 9 , requires that a
strength-based assessment for children be utilized when it is
necessary to place them in out-of-home care. The findings of
this dissertation can assist in the decision as to when it is
necessary to place children in out-of-hom e care. The timeliness
and importance of this information to current re-thinking of out-
of-home policy in California are discussed in depth In Chapter
Three.
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Many professionals are required to submit reports if they
have reason to believe that child abuse or neglect is or has taken
place. Nation-wide about 60 percent of the cases reported are
deemed "unfounded"; however, when cases are determined to
have taken place, public servants must decide what should be
done (Schuerman, Rzepnocki and Littell, p. 4, 1994). In Santa
Clara county California alone, for example, of the 2 2 ,7 0 0
children identified in child abuse reports in 1996, court
dependency petitions were filed for 1,082 children, 4.8 percent
of the total. In that year, 726 children or 3.2 percent of the
children identified in child abuse reports entered out-of-hom e
care (McDonald and Associates, p. 1.1, 1998).
It is clear th at some families lack knowledge of strategies
of parenting, and/or lack resources to provide for the basic needs
of their children; and/or the influence of drugs interferes with
parenting, and/or psychological problems circumvent the
parenting process. It is quite unclear which attributes or
combination of attributes predominantly lead to out-of-home
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placement. This analysis of recent research in the family
preservation field identifies characteristics of families in
which children are placed in substitute care regardless of the
services they receive.
Over the past decade, the number of children placed into
out-of home care in California has doubled. This, and the costs
associated with these placements, has spurred the interest of
policy makers. In this period, several policy agendas have been
implemented in California, such as permanency planning,
reasonable efforts, least restrictive environments, family
preservation, concurrent planning, encouraging adoptions,
promoting kinship care and wraparound services. Yet, there is no
accepted definition as to what it means for a child to be at
"imminent risk of placement."
It is not entirely clear what is meant by that
phrase, {imminent risk of placement} but it is evident
in a number of studies, including ours, that relatively
few families served would have had a child placed in
substitute care in the absence of services. ... This
major study has already sparked a lively debate in the
child welfare research community about the adequacy
and appropriateness of the design, the significance of
18
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the primary direct variable {placement prevention},
the quality of the interventions offered, and the
meaning of the findings. Notable was the relatively
low level of predictive validity of the primary intake
criterion: "imminent risk of placement." Simply put,
many children deemed as such never entered care.
(Schuerman, Rzepnocki and Littell, p. xii & 22, 1994)
Politically speaking, providing family preservation and
wrap-around services is the right thing to do. However, from the
public administrators' viewpoint, how to do the right thing s till
must be determined.
1 .4 O rg a n iz a tio n o f D is s e rta tio n
This dissertation traces the development of family
preservation programs in the United Sates, discusses some of the
evaluations that had been completed by the end of the year 2000,
and applies some of the findings of the research to the
development of a family risk factor scale th a t is associated with
out-of-home placement.
Chapter Two consists of a critical review of family
preservation literature. The historical and legislative history of
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family preservation is summarized briefly. Seven models for
providing family preservation are presented in detail to build a
foundation and context for further discussions of programs,
clients, and outcomes. Previous research that has not utilized
control groups is discussed briefly and dismissed. There is a
short discussion of experimental, family preservation research
studies that have utilized control groups. The concept of
imminent risk of placement is explored, and it is speculated that
it has been misapplied in the research.
Chapter Two continues laying a contextual foundation with
a discussion of policy developments in family preservation in
California. In addition, some specifics included in legislation
(SB 370, AB 933, and AB 163) related to avoiding substitute care
frame the groundwork for the timeliness and application of the
arguments and findings presented in this dissertation.
Chapter Two concludes with a summary argument proposing
that data from the experim ental family preservation research
studies that have utilized control groups can be re-analyzed to
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develop a scale that realistically defines the risk factors for
families that are indeed at imminent risk of placement.
Chapter Three discusses the problem that is being
addressed: how can data from controlled experimental research
on family preservation be applied to development of a family at-
risk scale th at identifies family attributes th a t typically result
in the placement of children into out-of-home placement. An in-
depth discussion is presented as to the timeliness and
importance of this information in the development of revised
California policy relating to the placement o f children in out-of-
home care. This discussion is framed by three environments, 1.)
a policy environment of fiscal constraints, 2.) a services
environment driven by litigation, and 3.) a political environment
driven by outcome measures.
Chapter Three concludes with a presentation of the
hypothesis o f this dissertation: The reassessment of the
findings o f family preservation research utilizing controlled
studies can lead to developm ent of a family well-being measure
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that assesses the degree of imminent risk of placement and
provides a policy tool for social service departments to be used
in determining which families may be best suited to benefit from
fam ily-based services.
The methods chapter, Chapter Four, begins by restating the
question, presenting the formal hypothesis, and presenting
research perspectives and data-analysis methods. Some
limitations of the methodology are discussed. This methods
chapter concludes with a discussion of process measures, output
measures, outcome measures, and evaluation conclusions. The
stage is set for an integrative analysis of three extensive family
preservation evaluations in California.
Chapter Five presents findings from several evaluations on
family preservation evaluations in California. Perspectives of
these family preservation evaluations are presented. The
findings are then re-fram ed in the context of predicting
placement rather than evaluating family preservation programs.
22
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Historical problems defining "imminent risk of placement" are
presented.
This research then examines three evaluations which
measured risk factors associated with the placement of children
from families th at were referred to California county Child
Protective Services offices. Tables presenting the findings of
various evaluations are presented. There is no consistency
between the risk factors associated with out-of-home placement
identified in the studies because each study utilized a different
child well-being scale. A list o f the family risk factors th at
were associated with imminent risk of placement is collated
from all of the programs evaluated. A decision-assisting tool i s
developed which identifies both the perceived imminent risk of
placement and the degree of risk factors involved. This
decision-assisting tool is visual based so that a child protective
services worker or supervisor can look at the results of the
assessment and quickly determine where strengths are present
in the family and what threats to safety may indicate that it is
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prudent to remove children from an unsafe family environment.
Chapter five concludes with a discussion of the findings from the
evaluations and their implications for future family-based
services.
Chapter six examines several issues that came to light in
the process of this research. First is an example of the
application of the visual based, two-dimensional decision
assisting tool. Another issue is the question, is it appropriate
for outcome measures to drive determination of whether social
services are successful and cost effective? The chapter
concludes with suggestions for additional research.
i The cost of the average group home placement in California in
July 2000 is $4,465 per month. The estimated cost of attending
Stanford University for one academic year of three quarters
(September to June) is approximately $ 3 4 ,6 4 2 for a single person
or about $ 3 ,8 5 0 per month that school is in session with three
months off per year. This leaves $ 2 2 ,1 4 0 over four years for the
red sports car.
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2 "As of July 1999, there were 105,756 welfare-supervised
children reported in out-of-home care, this number does not
include the 6,785 probation-supervised children reported in out-
of-home care. Of these, approximately 46 percent were placed
with relatives." "Current State law places responsibility and
authority for child welfare services, including out-of-hom e care,
with the California Department of Social Services and county
welfare, social services, children and family services, or human
service agencies. These county agencies administer the
continuum of child welfare services provided to children and
their families at the local level. Depending on the needs of the
child and the type of placement, monthly payments for out-of
home placement range from $365 to $513 for foster family
homes, $1,283 to $1,515 for Foster Family Agencies's, and up to
$5,732 for group homes." (California State Department of Social
Services web site: childsworld.org, 199 9 )
3"The California Department of Social Services (CDSS) is hosting
a series of public policy forums to explore the current issues and
trends in out-of-home care for children and families. ...The
participants include state and local government officials,
members of the Legislature, the judiciary, medical personnel,
foster parents, foster children and provider association
representatives. ...Forums will address innovative program
design, the vision for foster care in California and assessing the
various systems; impact (rate structure, court/legal,
administrative) on achieving positive outcomes.
A midterm summary report entitled 'Out of Home Care for
Children and Families: Public Policy Forums' has been issued that
cited the following recommendations:
- Examine and address the reasons children do not exit the
system when considering the growth of the foster care
population in California.
- Revise training for social workers, administrators and judges
to address neurodevelopment, family and community issues.
- Improve training for foster parents.
- Provide better payment and resources for foster parents.
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- Identify and coordinate public and private community
resources.
- Educate legislators and the media on the need to redirect
resources to help strengthen families and communities.
- Provide fam ily-centered services, including aftercare to
support biological families.
- Focus on outcome driven interventions and communicate
effective strategies.
- Expand assessment efforts in replacement and placement
situations to individualize services.
- Redefine success in the child welfare system to include
maintaining biological (including sibling) ties.
- Identify child development issues as well as protection issues
and focus on the emotional well-being of children as well as
their safety.
- Revise family interventions to be therapeutic rather than
punitive.
- Consider cultural differences between communities before
intervening.
- Simplify access to social services systems by individuals and
the community.
- Include prenatal care in family preservation programs."
(Childsworld. California Departm ent of Social Services.
http://w w w .childsw orld.org/w elfare/chfostc.htm , 2 0 0 0 )
4 According to the California Department of Social Services
there were 1 0 5 ,7 5 6 children in foster care in California, as of
July 1999. According to the National Resource Center for Youth
Services there were an estim ated 5 4 7 ,0 0 0 children in foster
care as of March 3 1 ,1 9 9 9 .
5 Extensive data is available through the Child Welfare Research
Group, University of California (Needell, et al, 2 0 0 0 ).
http://cssr.berkeley.edu/perform ance-htm l
6 California Departm ent of Social Services Budget Summary.
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C h a p te r Tw o L ite ra tu r e R eview
This chapter begins with a clarification of concepts and
terms through definitions and discussion. It then provides a
critical review of family preservation literature, including a
brief historical and legislative history of family preservation.
Seven models of family preservation are presented in detail,
1.) the crisis intervention model, 2.) the home based model, 3.)
the family treatm ent model, 4 .) the wrap-around model, 5.) the
family unity model, 6.) the fam ily-to-fam ily model, and 7,) the
community-based ecological model. Next is a discussion of
family preservation research studies. "Imminent risk of
placement" is discussed. This chapter concludes with a
summary argument proposing that data from the experimental
family preservation research studies th at have utilized control
groups can be re-analyzed to develop a scale th at realistically
defines the risk factors for families th at are indeed at imminent
risk of placement.
27
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2.1 D e fin itio n s o f C o ncepts and Term s
Definition of "Family Preservation and Support Services"
The Family Preservation and Support Services program was
enacted by the Omnibus Budget Reconciliation Act of 1993 (1 OS-
66). This program provided new federal funds to state child
welfare agencies for family support services and family
preservation services.
Family support services are primarily
community-based preventative activities designed to
alleviate stress and promote parental competencies
and behaviors that will increase the ability of
families to successfully nurture their children;
enable families to use other resources and
opportunities available in the community; and create
supportive networks to enhance child-rearing
abilities of parents and help compensate for the
increased social isolation and vulnerability of
families. ...
Examples of community-based family support
services and activities include respite care for
parents and other care-givers; early development
screening of children to assess the needs of these
children and assistance in obtaining specific services
to m eet their needs; mentoring, tutoring, and health
education for youth; and a range of center-based
activities [informal interactions in drop-in centers,
parent support groups] and home visiting programs....
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Family preservation services typically are
services designed to help families alleviate crises
that might lead to out-of-home placement of
children; maintain the safety of children in their
homes; support families preparing to reunify or
adopt; and assist families in obtaining services and
other supports necessary to address their multiple
needs in a culturally sensitive manner.
In addition to providing funds for expanding
services, this legislation offers States an
extraordinary opportunity to assess and make changes
in State and local services delivery in child welfare,
broadly defined. The purpose of these changes is to
achieve improved well-being for vulnerable children
and their families, particularly those experiencing or
at-risk for abuse and neglect. Because the multiple
needs of these vulnerable children and families
cannot be addressed adequately through categorical
programs and fragmented services delivery system,
we encourage States to use new programs as catalyst
for establishing a continuum of coordinated and
integrated culturally-relevant, fam ily-focused
services for children and families. Among the
elements that would ideally be a part of the
continuum, depending on family needs, are family
support and family preservation services; child
welfare services, including child abuse and neglect
prevention and treatm ent services and foster care;
services to support reunification, adoption, kinship
care, independent living, or other permanent
living arrangements; and linkages to services that
meet other needs, such as housing, employment, and
health. (OMB No. 0980-0258, 1994)
A central objective of family preservation services is to
help the family get through a crisis without separation of the
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children, and, in the process, learn new skills that will help the
family to solve impasses in the future. Family preservation
services have several goals: 1.) to keep families safe, 2.) to avoid
unnecessary placement of children in out-of-home care, 3 .) to
avoid the high fiscal and human cost of out-of-home care, and 4.)
to improve family functioning so that the behaviors that led to
crisis within the family are reduced.
Definition of "Wraparound"
Wraparound services have the same goals as family
preservation services, that is, to have children remain in or
return to family environments, but they are targeted for only
those youth that would be placed or have been placed in
expensive out-of-home group homes or treatm ent centers. As
needed, trained s ta ff are available to the family tw enty-four
hours per day. These staff, sometimes called benevolent
gorillas, will assist in getting the youth up in the morning, doing
planned activities, following the youth to assure that
30
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inappropriate activities do not take place, and going to school
with the youth.
A key principle of wrap-around services is to use pre
existing services in the community including both informal
family and religious-based and community-based organizations.
In addition, mental health services are provided. Wrap-around
services are significantly different from family preservation
services in their funding mechanism in that they can be funded
entirely through the costs that would have been experienced had
the youth been in placement.
In California, these costs could be over $ 5 ,0 0 0 per month;
in addition, mental health funding sources can be utilized. Also,
unlike family preservation services, wrap-around services are
not tim e-lim ited to a short, intensive period of ninety days but
are provided on an on-going as-needed basis. Cost neutrality of
the wrap-around program is to be determined over a five-year
period by compiling the aggregate costs of the program in each
county and comparing it with the costs that would have occurred
31
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by maintaining those same children for the same amount of time
in group homes. Any cost savings must be reinvested in the
wrap-around program to expand the program or to enhance
services and resources to the children and families.
Definition of "Foster Care"
Foster care is a substitute care service or out-of-home
placement for children who have been separated from their
parents as the result of a court order. About one-half of the
children in out- of-home care are placed there because of abuse
and neglect and about one-quarter because of absence of the
parent(s) or the medical or mental condition of the parent(s). The
remaining placements are the result of status offenses, parent-
child conflicts or relate to a child's disability (Ahart et a!., p. 1,
1 9 92 ). Of the 2 2 ,7 0 0 reported incidents of child abuse in Santa
Clara County, California in 1996, for example, only about three
percent were referred to out-of-home placement (McDonald and
Associates, p. 1.1, 1998).
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Definition of "Targeting"
Targeting is the decision-making procedure utilized in
determ ining which families are appropriate for family
preservation services. Criteria utilized in this decision-making
include, but are not limited to, several areas. While family
preservation services are considered a cost saving alternative to
out-of-hom e care, they are relatively costly compared to
traditional o ff site services available to families in need of
assistance (Yuan, 1990). Targeting assists case workers in
identifying which families may most benefit from family
preservation services. In the absence of targeting, families
could be served that don't need family preservation services. By
targeting, family preservation services can be provided in a more
precise and scientific way. (Walton and Denby, p. 54, 1997).
Definition of "Imminent risk of placement"
In general, all models of Intensive family preservation
services focus on improving the wellness of the family through
services lasting up to six months. These services usually
33
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consist of family therapy provided by licensed professionals in
the family home, education in strategies of positive parenting,
and assistance in addressing the family's basic needs in areas
such as housing, employment, substance abuse counseling, and
food. Services are generally provided during a crisis and can be
ongoing throughout the week. A key criterion for inclusion in
family preservation programs is th a t one or more children within
the family are at imminent risk of placement in out-of-hom e
care. (Walton and Denby, p. 54, 1997).
Imminent risk of placement is founded on the concept that
without significant intervention to improve family dynamics,
children in the family will be placed into out-of-hom e care.
Working definitions include 1.) "a child who is about to be placed
immediately," 2 .) "placement that occurs within 3-7 days," 3.)
"potential for placement, time frame unspecified," 4 .) "definition
of imminent risk is decided by referring agencies," and 5 .) "no
working definition," (Walton and Denby, p. 54, 1997).
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This research provides a foundation for a means to assess
family risk factors which can be utilized by child protection
service workers in determining when children are indeed in
imminent risk of placement.
Definition of "Child Well-Being Scales"
The "Child Well-Being Scales" is an extensive instrument
that social workers and probation officers can use to assess the
risk areas and strengths of children and families (Magura and
Moses, 1986). The scales were developed with the support of the
Child Welfare League of America and by a grant from the
Administration of Children, Youth and Families, Office of Human
Development, Department of Health and Human Services,
Washington, D.C. The purpose of the scales is to develop a
reliable research tool to document possible changes in the well
being and caretaking environment of children and families.
Although the scales were not designed to measure the
environmental risk for a child or family, they can be of
assistance in decision-making. The data presented by Walter R.
35
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McDonald and Associates, Inc., appear to point to several
distinguishing characteristics between those families requiring
out-of-hom e placement and those benefiting from family
preservation services (McDonald and Associates, 1990).
Extensive data were collected by this firm on 7 0 9 families and
1,7 40 children at imminent risk of placement.
2 .2 B rie f H is to ry o f F o s te r Care
Theodore Roosevelt convened the first White House
Conference on Dependent Children in 1909. Of the thirteen
recommendations made to the president, one focused on efforts
to keep families together. "Except in unusual circumstances, the
home should not be broken up for reasons of poverty, but only for
considerations o f inefficiency or immorality" (Bremmer, 1971, in
Cole and Duva, p. 12, 1990). A fter the conference, many states
passed legislation authorizing financial aid for "mother's
pensions." This assistance prevented placement and preserved
36
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the homes for a substantial number of children (McGowan, 1988,
in Cole and Duva, p. 12, 1990).
The "mother's pensions" movement at the state level
resulted in national enactment of the Social Security Act of
1935, Aid to Dependent Children provision. T itle IV-E federal
funds are available for the support and maintenance of children
in foster care; these were unlimited entitlem ent funds which
required a fifty percent match. As a result of this Aid to
Dependent Children in Foster Care, the use of foster care
expanded as a way to address abused and neglected children. In
the 1940's, some authors argued that this prompted agency
removal of children to out-of-home care rather than agency
assistance in keeping the family together (Hutchenson 1944;
Gordon 1941, in Cole and Duva, p. 13, 1990). Other authors
questioned if foster care was a benefit for all children.
One has only to have made a few close
observations of some of the problems connected with
boarding home care to know that there have been
times when every experienced and thinking child
welfare worker has been torm ented by some doubts
as to the efficacy of this method of caring for
37
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dependent and neglected children. In fact, there are
occasions when a worker viewing the end result of
long years in foster care for a particular child will
remark with both candor and discouragement that the
child could not have been much worse off if he [or
she] had remained in his [or her] home. (Jolowiczs,
1 946, in Cole and Duva, p. 13, 1990)
Through the decades of the 1940's, 1950’s and 1960’s,
White House conferences advocated for intervention programs to
provide support and treatm ent to assist families and to restrain
the use of foster care"* (McDonald and Associates, p. 6. 1992,
Cole and Duva, p. 13-15, 1990). In 1959, a large-scale, national
study o f foster care through the Child Welfare League of America
provided research data that identified specific weaknesses in
the foster care system. Some agencies had vague and indefinite
plans for the future of foster children. Sixty-six percent of the
children in long-term foster care w ere originally targeted for
temporary placement. Biological parents rarely visited their
children in foster care and there seemed to be no plans for the
reunification of foster children and parents in their natural
homes (Maas and Angler, 1959, in Cole and Duva, p. 14, 1990).
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Following the study, the Child Welfare League of America
recommended that children who would not be returning home
from foster care be considered for adoption (Shapiro, 1959, in
Cole and Duva, p. 13, 1990). Furthermore, they recommended
development of home-based services that prevented the need for
many out-of-home placements. "We cannot substitute platitudes
about strengthening family life, preventing delinquency or
promoting mental health for action. It is not enough to utter
pious sentiments about obligations to maintain children in their
own homes, if those serve only to ease our conscience and
relieve us of responsibility to do anything further" (Turitz, 1961,
in Cole and Duva, p. 13, 1990).
The decade of the 1960's brought more awareness of
physical child abuse. Henry Kempe's identification of the
"Battered Child Syndrome" in 1962 forever changed the child
welfare philosophy to the authoritative use of child protective
service intervention to protect children (Kempe and Heifer, 1972,
39
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in McDonald and Associates, p. 7, 1992). With the increased
recognition of the social service needs of children and families,
amendments to the Social Security Act in 1962 increased funds
for services for recipients of public assistance.
The 1974 Child Abuse Prevention and Treatment Act and
the implementation of state reporting statutes across the
country spawned new efforts to prevent, identify and provide
treatm ent to children and families where m altreatm ent existed.
In 1961, 1 7 7 ,0 0 0 children were in foster care nationwide. The
number increased to 503,000 by 1977. Reports of child abuse
and neglect rose 259 percent between 1976 and 1989, and more
than fifty percent of all out-of-hom e placements were for
children who needed protection from adults in their own home.
Fifty-five percent of children in foster care experience two or
more placements. (McDonald and Associates, p. 8, 1992).
"Despite these federal initiatives, continuous state
expansion and regulation of service, and increased
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professionalization of staff, no system atic efforts were made
until th e past two decades to implement the concept of family
preservation introduced at the first (1 9 0 9 ) White House
Gonference on Children" (McGowan, 1988, in Cole and Duva, p. 15,
1990).
2 .3 Fed eral L e g is la tiv e H is to ry o f Fam ily
P re s e rv a tio n
In the m id-1970s, child welfare professionals joined
forces to address the problems of foster care drift, a dramatic
increasing condition in which children in foster care stayed in
foster care and moved from placement to placement. There was
no concerted effort or policy to encourage that children be
returned to their birth families or relatives, or be permanently
adopted.
During the 1970's, several federal laws were enacted that
redirected and initiated new services for children and their
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families and increased the number of families served. The Child
Abuse Prevention and Treatment Act of 1974 required a s ta te
wide reporting system for child abuse and neglect complaints.
As a result, child welfare agencies saw an increase in caseloads.
The Juvenile Justice and Delinquency Prevention Act of 1974
stim ulated alternatives to incarceration.
The 1980 Adoption Assistance and Child Welfare Act (P.L.
9 6 -2 7 2 ) mandated permanency planning nationwide. The concept
of permanency planning required that each child in foster care
had a plan for his or her future that would be periodically
reviewed and updated. Foster care was perceived as a temporary
situation with birth family reunification as the primary focus
during the first nine months of placement. A fter the first nine
months, other permanent placement options could be considered
such as adoption, guardianship, or placement with relatives.
After eighteen months, the court had to agree to a permanent
plan. Continued foster care was perceived as a last resort after
42
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all other reasonable efforts at prevention had failed. A
disadvantage of this concept was that adoptions could not
become permanent until eighteen months after a child had been
placed into out-of-hom e care.
The family preservation movement, which began in the
1970's fit into the goals of permanency planning which focus on
preventing the child's placement in foster care. The goal of
family preservation was to keep at-risk of placement children
with their birth families, thereby reducing the need for foster
care. Several states funded pilot family preservation programs
based on the assumption that the programs would lower the
state's costs associated with foster care (McDonald and
Associates, p. 11, 1 992).
The Congress created a national mandate, through the
Adoption Assistance and Child Welfare Act of 1980, Public Law
96-272, to reduce out-of-hom e placements for physically or
sexually abused or severely neglected children. This law was
most significant in the creation of family preservation and
43
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support services nationwide. States could draw down limited,
matching federal funds if they had a plan that provided that a
"reasonable effort" be made to prevent or eliminate the need for
removal of children from their home or to make it possible for
them to return home. By maximizing federal fiscal participation
under Title IV-E of the Social Security A ct, states could draw
upon additional federal dollars. In this way, state funds used for
foster care maintenance could be redirected to fund family
preservation services. As a result, interest in fam ily
preservation and support services programs developed nationally.
In 1982, only tw enty family preservation and support
services programs were identified by the National Resource
Center on Family Based Services. By 1 9 8 6 , the list had grown to
238 programs across 45 states (McDonald and Associates, p. 17,
1 9 9 2 ). The concept of family preservation gained in popularity
because it both promoted keeping families together and
purported to be a cost-effective alternative to the placement of
children in foster care.
44
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During the 1980's, new social problems developed, such as
the use of crack-cocaine and the AIDS epidemic; existing social
problems, such as the dramatic increase in child abuse and
neglect reports and the increase in the number of impoverished
and homeless families, increased the need for foster care and
alternatives such as family preservation programs. The number
of children in foster care once again began to grow, (see Table
2.1)
Title IV-B funds of the Federal Child W elfare and Adoption
Assistance Act provided limited federal funding for prevention
and fam ily reunification services and family support services.
Title 1V-E of the same act provided entitlem ent funds to states
for out-of-home placement. Title IV-B funds were fixed at $ 2 6 6
million between 1977 and 1989 and grew only ten percent in
constant 1981 dollars over that period. In 1989, the
authorization was increased to $3 2 5 million, but in 1991,
Congress appropriated only $271 million.
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Changes in Numbers of Placements, Placement Costs, and
Average Monthly Cost of a Child in Foster Care in California
Between 1980 and 1997
Change in number Change in cost; Average
of placements of placement monthly
Year from the from the cost of
Ending prior year prior year a child in
June 30 Percent placement
1997 6.5% 12.4% $1,159.36
1996 6.8% 8.4% $1,099.00
1995 3.8% 4.7% $1,083.55
1994 4.9% 3.8% $1,073.72
1993 1.9% 2.6% $1,085.31
1992 3.3% 7.5% $1,077.90
1991 6.6% 18.5% $1,035.35
1990 12.9% 18.0% $931.57
1989 14.0% 16.0% $891.64
1988 11.2% 20.2% $876.35
1987 13.1% 16.2% $811.10
1986 11.6% 16.5% $789.43
1985 10.5% 21.9% $756.26
1984 0.4% 8.0% $685.48
1983 -0.1% 1.1% $637.21
1982 1.3% 13.4% $629.25
1981 9.2% 21.0% $562.48
1980 -1.5% 18.4% $508.04
Aid to Families with Dependent Children Foster Care
Fiscal Years Ending June 30, 1980 to 1997
State of California Information Services Bureau
Department of Social Services Updated: October 1997
Table 2.1
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In contrast, Title IV-E funds provided open-ended matching
funds to states for out-of-home placement. Between 1981 and
1991, administrative and program-related expenses for o u t-o f-
home placement increased from $ 3 0 million to $ 8 8 2 million. In
1991, Congress budgeted $1.8 billion for foster care services for
Federal FY 1991-92.
In 1992, the National Commission on Children recommended
a comprehensive community-based approach to strengthen
families and to provide essential services and support to
alleviate the need to place children in protective custody. The
commission advocated that services to children be restructured
to include three tiers of services; 1.) community-based, family
support networks offering access and referral to a broad range of
services to strengthen families and promote healthy child
development, 2.) comprehensive intervention to strengthen and
preserve troubled families who voluntarily seek help before their
problems become acute, and 3.) comprehensive child welfare
services for families in crisis to keep children in their homes
47
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whenever possible or to provide permanent placement for those
who must be removed from their families (National Commission
on Children, p. 282, 1992).
In response to deteriorating conditions for many American
children (Children's Defense Fund, 1 9 9 2 ) and to the increasing
number of children in out-of-hom e placement, federal legislation
was passed in August, 1992, to strengthen troubled families.
Hailed as the most significant reform of federally-funded child
welfare services since the Adoption Assistance and Child
Welfare Act of 1980 (P.L. 9 6 -2 7 2 ), the Omnibus Budget
Reconciliation Act of 1993 (P.L. 1 0 3 -6 6 ) provided $1.3 billion to
the states over a five-year period for early intervention,
prevention, and family support services (Binder, p. 2, 1993).
The Congressional Budget Office projected that $9.24
billion would be expended through Title IV-E related expenses
between FY 1991 and FY 1996. Including the one-to-one
matching funds provided by the states, the country expended an
average of $ 3 .4 billion per year for the placement of children in
48
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out-of-home care (National Commission on Children, p. 306,
1993).
A fter a number of years of discussion and experimentation
in family preservation, Congress enacted in 1993 the National
Family Preservation and Family Support Services Program (P.L.
103-66, The Omnibus Budget and Reconciliation Act of 1993,
Title IV-B, Subpart 2.) The Omnibus Budget Act of 1993 provided
to the states $1.3 billion over five years to provide family
preservation and family support services. One of the purposes of
this funding is to reduce the amount of tax-based fiscal
resources used for children in out-of-home placement. However,
the entitlem ent structure of Title IV-E funding still provided
strong fiscal incentives to states to place children in foster
care, rather than to provide intensive family preservation and
support services to keep families together.
In 1994, the federal government provided clearer
guidelines suggesting common principles for family preservation
and support programs.
49
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1.) The welfare and safety of children and of all
family members must be maintained while
strengthening and preserving the family whenever
possible. Supporting families is the best way of
promoting children's healthy development.
2.) Services are focused on the family as a
whole; family strengths are identified, enhanced, and
respected, as opposed to a focus on family deficits or
dysfunctions. Service providers work with families
as partners in identifying and meeting individual and
family needs.
3 .) Services are easily accessible (often
delivered in the home or in community-based
settings, convenient to parents' schedules), and are
delivered in a manner that respects cultural and
community differences.
4 .) Services are flexible and responsive to real
family needs. Linkage to a wide variety of support and
services outside the child welfare system (e. g.,
providers of housing, substance abuse treatm ent, job
training, and mental health, health, and child care)
are generally crucial to meeting families' and
children's needs.
5.) Services are community-based and involve
community organizations and residents (including
parents) in their design and delivery.
6 .) Services are intensive enough to m eet
family needs and keep children safe. The level of
intensity needed to achieve these goals may vary
greatly between preventive (family support) and
crisis services. (Adm inistration for Children and
Families, 19 9 4 , in Meezan and McCroskey p. 21, 1997).
If federal legislation regarding block grants is passed in
the future to include Title IV-E related entitlem ent expenses,
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states will be responsible for one hundred percent of out-of
home placement costs. If that occurs, and foster placement
funding is included in a capitated service provision concept like
managed health care, foster care costs would no longer come
from an entitlem ent fund. Foster care placement policy would
end up on the agendas of county boards of supervisors, and they
would decide how best to expend the funds.
2 .4 C a lifo rn ia L e g is la tiv e H is to ry o f Fam ily
P re s e rv a tio n and S u p p o rt S ervices
According to the U. S. Department of Justice, the youth
population in the United States declined by eleven percent
between 1979 and 1989 while the number of juveniles in custody
increased by thirty-one percent. In California, the cost of out-
of-home, non-secure settings such as foster homes and
community-based programs increased from $ 5 5 3 million in the
fiscal year 1 9 8 8 -8 9 to a budgeted $ 9 5 2 million in fiscal year
51
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1 9 9 2 -9 3 , an average increase of fourteen and a half percent per
year (State of California Information Services Bureau, Aid to
Families with Dependent Children Foster Care, Fiscal Years
Ending June 30, 1980 to 1997, Table 8, 1997).
The number of children placed in out-of-home care
increased from 7 0 ,5 2 7 in the fiscal year 1 9 8 8 -8 9 to an
estimated 8 1 ,4 5 9 in 1991-92, an average increase of four
percent per year (State of California Information Services
Bureau, Aid to Families with Dependent Children Foster Care,
Fiscal Years Ending June 30, 1980 to 1997, Table 8, 1997). In
1991, approximately one quarter of the children in foster care
were under the age of three. In California, the cost of out-of
home care has increased at a rate far greater than the number of
youth served; and more importantly, far greater than the increase
in the tax base.
According to a report by the Commission on California
State Government, Economy, and Efficiency, better known as the
Little Hoover Commission, the State of California is not focusing
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its effo rts on getting the best value for the $ 1 .4 billion that is
spent on child welfare services. The commission claimed that
more dollars should be devoted to family preservation services.
Commissioners believe that for every dollar spent on family
preservation, three to five dollars can be saved in foster care
costs. According to the Little Hoover Commission, experts have
estim ated that between thirty-five and seventy percent of foster
children should never have been put in placement (Little Hoover
Commission, p. 3, 1992).
In 1980, there were 2 5 ,5 7 3 children in foster care in
California. By 1990, the number of children in foster care more
than doubled to 56 ,6 5 8 children in foster care (State of
California Information Services Bureau, Aid to Families with
Dependent Children Foster Care, Fiscal Years Ending June 30,
1980 to 1997, Table 8, 1997). In the ten year period between
1988 and 1999, the number of children in foster care again
doubled to 1 0 7 ,5 3 6 (UC Berkeley, Center for Social Services
Research, Child Welfare Research Center, p. 1, 2 0 0 0 ).
53
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The increase in the numbers of children placed in out-of
home settings in California was partially the result of
misdirected federal and state funding incentives. The structure
of the federal Title IV-E funding provided a strong, fiscal
incentive to place children in foster care rather than to provide
intensive, family preservation and support services to keep
families together. Prior to 199 2 in California, Federal Title IV-
E entitlem ent funds covered fifty percent of all foster care
placem ent costs for the families th a t were federally eligible,
th at is, the families that were receiving welfare assistance at
the time of out-of-home placement.
The state general fund provided for ninety-five percent of
the non-federal cost of foster care placements. This left two
and a half percent of the cost responsibility to California
counties if the family was receiving welfare benefits and five
percent of the placement costs if the family was not previously
receiving federal benefits, th at is the family was not federally
eligible. For every $ 1 ,0 0 0 spent for foster care, the cost to the
54
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county general fund was tw enty-five dollars or fifty dollars,
depending if the family was federally eligible. For the many
children referred to the superior court due to delinquency,
neglect, or abuse, it was cost effective to the county to place
the children in out-of-home care utilizing the entitlem ent funds
available through Title IV-E and the matching state funds. In
addition in California, counties pay only $25 per month for a
youth placed in the California Youth Authority up to a certain
quota per county.
A fter the realignment act of 1993, counties in California
received a percentage of the state sales tax and vehicle licence
fees, and were given more fiscal responsibility for health,
mental health, and social services expenses. A county's
responsibility for foster care expenses increased to sixty
percent of the total non-federa! cost of placement. As can be
seen from the significant decrease in the rate of change of
placement in 19 9 2, this is an example of fiscally-driven policy,
(see Table 2.1)
55
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California was among the initial states to perceive the
potential of placement prevention and the savings in the costs of
placement resulting from family preservation programs.
California legislatively supported development of family
preservation programs. In 1986, the California Governor signed
into law Assembly Bill 1 562, as amended by Assembly Bill 366,
which provided funds for a pilot program in eight California
counties to provide demonstration projects of intensive family
preservation services targeting a reduction in the number of
children placed in foster care. The pilot program provided short
term , intensive, family preservation and support services to
avoid out-of-home placement of children. Services included
counseling, substance abuse treatm ent, respite care, parent
training, crisis intervention, and teaching and demonstrating
homemaking. The legislation required that an evaluation of the
pilot projects be provided to the legislature after the first three
years of the project.
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of the copyright owner. Further reproduction prohibited without permission.
Assembly Bill 558 of 1988 and Assembly Bill 236 5 of 1992
expanded the program to additional counties. In 1991, the
California legislature expanded, through Assembly Bill 546, this
opportunity to all counties to provide family preservation
services (Meezan and McCroskey, p. 17, 1997).
In 1995, California received $ 1 6 .6 million from the federal
government to expand family preservation and support programs.
Funds were distributed to counties based on the number of
children in poverty in each county. In order to draw down the
funds, county social service departments had to have a plan
approved by the State Department of Social Services. In federal
fiscal year 1996, the amount increased to $ 2 6 million, and by
1998, the amount provided to California reached almost $ 3 0
million. The Federal Adoptions and Safe Family Act of November,
1997, extended the federal funding for an additional three years
(Barth, p. 2, 2000).
In 1995, the California Departm ent of Social Services
provided assistance to counties in developing five year plans for
57
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developing family preservation and support programs. As of this
writing, fifty-six of the fifty-eig h t counties in California have
implemented family preservation and support programs (Barth, p.
1, 2000).
Beginning in 1 99 9 , after a court ruling and several pilot
programs, a portion of the placement costs for those foster
children needing the highest level of care could be drawn down to
provide family preservation-like services called wrap-around
services. This funding could be used to prevent children from
going into expensive placements and could be used to assist in
the reunification of children with their families after they had
been in treatm ent programs.
The California Departm ent of Social Services and
California Governor Wilson's office in 1 9 9 5 -9 6 promoted a
change in policy as it related to providing out-of-home care for
foster children.
Marjorie Kelly, Deputy Director of California State
Departm ent of Social Services Division of Children and Family
58
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Services during the Wilson Governorship, believed that the state
should refocus its resources on the front end of the problem
rather than concentrating on the back end where children are
incarcerated or placed in high cost group homes. Kelly claimed
that the foster care system, as it existed in California, was a
funding stream, not a service. Kelly believed that children
belong in families. Kelly believed that the demand for placement
could be reduced, by redirecting resources from group homes to
family preservation and support services, which focus on and
build on the strengths of families.
The California counties could use their general fund monies
for expanded family preservation and support services for those
youth and families at risk of placement and wrap-around and
aftercare services for those foster youth returning home after
placement. However, limited state funds were available for
county family preservation and support services.
At that time, the Governor's office promoted this change
because it contained costs and was less expensive. Under the
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Governor's FY 1 9 9 5-9 6 restructuring proposal, counties would
have been responsible for 100 percent of the non-federal costs
for foster care placement. This policy would have given counties
strong, fiscal incentives to focus on activities that were
designed to reduce the need for and cost to place children in
foster care. The Governor's proposed budget also called for an
increase in funding for family preservation programs. These, and
other changes, were proposed in exchange for a fixed percentage
of the state sales tax. The final approved budget maintained the
status quo in state and county shares for foster care and
provided no increase for family preservation.
Under the 2 0 0 0 family preservation and support services
program, counties are authorized to "draw down" a portion of the
state share of the projected costs for foster care in order to
fund family preservation and support services. If the counties
are successful in reducing the actual costs of placements by up
to twenty-five percent, the counties receive an equivalent share
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of the General Fund savings; if not, the counties pay for the
excess costs.
County Boards of Supervisors and County administrators
look toward family preservation and support services both as a
way to reduce current county expenditures and to prevent future
expenditures.
There has been a lack of federal, categorical funding
available for post foster care family reunification services.
Birth families rarely received additional assistance when their
children were returned home beyond community-based counseling
agencies. This lack of effective post-placement support
services could be significantly responsible for a consistently
large proportion of children re-entering the foster care system
when family reunification attem pts failed (Ahart et al., p. 2,
1992).
Using Federal waivers, counties in California are now
coordinating aftercare services through a program called wrap
around. Senate Bill 163 (Chapter 7 6 5 /S ta tu te s of 1 9 9 7 )
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addressed wrap-around services; it created a five-year pilot
project, beginning in January 1998, that allowed California
counties to use State foster care funds in flexible ways to
provide an alternative to group home placements that cost over
$ 4 ,5 0 0 per month. The goal of wrap-around services is to allow
children to remain in family environments or return to family
environments.
The conceptual foundation of wrap-around services is that
the wrap-around process can strengthen families so that out-of
home placement is not necessary. Each county is funded for a
limited number of slots for wrap-around services rather than
services for a specific number of children. A t the present time
(2 0 0 0 ) counties are in the developmental stage of providing
wrap-around services.
The State Department of Social Services provided
guidelines to counties about the number of slots that they could
request but stated that there were not a fixed number of slots
available. In making a determination of the number of slots that
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counties should request, it is suggested that counties consider
the number of children that are currently in group homes costing
over $ 4 ,5 0 0 per month and the number of children who could be
classified as at imminent risk of placement at these levels
(California Departm ent of Social Services, Internet site
Childsworld, p. SB 163 Wraparound Services Pilot Questions and
Answers, 1999).
2 .5 M odels fo r Fam ily P re s e rv a tio n and S u p p o rt
S e rv ic e s P ro g ram s
Several models of Family Preservation were developed
prior to 1993. These models led to inclusion of the Family
Support and Family Preservation project in the Omnibus Budget
Act of 1993. Prior to 1993, there were several evaluations of
Family Preservation programs. Some studies found that ninety-
five percent of the families served avoided the use of out-of
home placement (Goldstine, 1973; Kinney, Madsen, Fleming, and
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Haapala, 1 9 77 ). Other studies found there were no significant
differences between families th at were provided intensive
Family Preservation services and those families that received
traditional services one year after the delivery of services
(Hennepin County Community Services Department 1981;
Nebraska Department of Public Welfare 1981; Willems and
DeRubeis 1981; Szykula and Fleischman 1985; Yuan et al. 1990;
Meezan and McCroskey 1993; Schuerman, Rzepnicki, and Littell
1994; Mitchell, Tovar, and Knitzer, 1 9 8 9 ).
Initially, the goal of this chapter was to compare and
contrast various delivery systems of family preservation
services and ferret out those conditions that most often led to
success in keeping families together. Instead, what was found in
the literature review was that by having various models
available to family preservation practitioners, different
modalities could be provided to m eet the individual needs of
various families.
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In reviewing the literature, programs are described by
different geographic service delivery areas (McDonald and
Associates, 1992, Westat, 19 9 5 ). No consolidated description
of delivery models was found since the 1992 description of
three, basic models (Nelson and Landsman, 1992,) and the
comparison of two approaches (McDonald and Associates, 1992).
It is believed that this presentation of family preservation
models fills a significant gap in the literature by combining
differing perceptions of family preservation delivery modalities
in one publication. By providing this summary, child protection
workers can better serve the various needs of the client groups
they encounter.
To date, family preservation and support services programs
can be roughly classified into seven, different, general models,
1.) the crisis intervention model, 2 .) the home based model, 3.)
the family treatm ent model, 4 .) the wrap-around model, 5.) the
family unity model, 6.) the fam ily-to-fam ily model, and 7 ,) the
community-based ecological model. Individual programs may
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have rather fuzzy boundaries that cross between models;
however, the following model descriptions help to distinguish
primary program components. All models focus on providing
services primarily to families as opposed to individual-based
services; the programs advocate maintaining children in their
original homes as opposed to utilizing the foster care system. In
addition, all programs ta rg et families in which placing children
in out-of-home care is a possible outcome.
Program delivery mechanisms vary considerably in several
dimensions; they may be private or non-profit organizations
contracting with government entities to provide services, direct
government providers of services, or private, non-profit
organizations operating independently with no funds or
constraints from government entities. Theoretical orientations
of programs may focus on behavioral change methodologies,
crisis intervention, brief therapy models, and/or family systems
theory. Services may be provided primarily in the home, office,
or a combination of the two. Services may be directly provided
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by m asters’ level personnel and/or para-professionals, and
caseloads per worker vary from model to model. Target
populations may separate or blend identified problems based on
child neglect, abuse, juvenile offenses, and age. Programs vary
considerably in terms of length and intensity of services, and, of
course, cost.
In an attem pt to distinguish between major aspects of
family preservation and support services programs, authors have
identified several models. Frankel (1 9 8 8 ) divided fam ily
preservation and support services programs into two categories
as determined by their desired outcomes. One program objective
was primarily to provide significant services to families so that
the need for services would be significantly reduced or
eliminated. The other program objective was to assist the
family through a crisis period, to stabilize the family, and to
refer the family to other existing services.
Barth (1 9 8 8 ) divided family preservation and support
services programs by their theoretical foundation in delivery of
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services. Theoretical ideologies included crisis intervention,
family systems, social learning, and ecological theories.
Nelson and Landsman (1 9 9 0 ) divided family preservation
and support services in to three program models to better
understand their characteristics and theoretical foundation.
These models consisted of the crisis intervention model, the
home-based model, and the family treatm ent model.
T h e C risis In te rv e n tio n M odel
Brief historical foundation
The original intensive family crisis program was developed
by the Homebuilders program in Tacoma, Washington in 1974,
with funding from the National Institute of Mental Health and the
Catholic Community Services. The original intent of the
Homebuilders model, identified as the crisis intervention model
here, was to provide services to families in an attem pt to avoid
the use of expensive, psychiatric hospitalization or the
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placem ent of children in out-of-home care. As the program
became well known, funding increased and the service delivery
area expanded to include four counties in the state of
Washington. With the support of the Edna McConnell Clark
Foundation, the Homebuilders' crisis intervention model has been
disseminated widely throughout the United States.
Brief theoretical foundation
The theoretical foundation of the crisis intervention model
is based on crisis intervention theory which presumes that, when
families are in crisis and chaos, they are open to change.
Traditional family-coping mechanisms have proven not to be
effective. Within twenty-four hours of the crisis point, the
family is open to intervention. The crisis intervention model
seizes this opportunity to interject services into the family in
crisis. While this natural avenue of change is temporarily open,
the crisis intervention model proposes utilizing social learning
theory and many other counseling theories.
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B rief action foundation
Case workers are primarily professionally trained.
Caseloads per therapist are minimal, usually no more than three
to five families per therapist. Services are made available
tw enty-four hours per day. Services are primarily delivered
directly in the family's home to assist in modeling parenting
strategies directly in the family setting. Services are limited to
four to six weeks (Haapala & Kinney, p. 2 4 5 -2 5 9 , 1979, Kinney et
al., p. 37-68, 1988).
Families are perceived as having individual characteristics
and particular services needs. Therapists use their own
perceptions without a formal assessment and utilize treatm ent
modalities that may include behavior modification, Rogerian
principles, environmental controls, active listening, values
clarification, cognitive restructuring, parent effectiveness
training, paradox, reframing, and hypnosis. In addition, other
support services can be provided such as day care, job search
assistance, transportation, parenting classes, and financial aid
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(Haapala & Kinney, p. 245-259, 1979, Kinney et a!., p. 37-68,
1988).
The Hom e-B ased Model
Brief historical foundation
The home-based model was developed in 1975 by Families,
Inc. in West Branch, Iowa, under a contract from the Iowa
Department of Social Services. The goal of the Families. Inc.,
referred to here as the home-based model, was to avoid
placement of adolescents in out-of-home care. In 1981, as a
result of a grant from the Children's Bureau of the Department of
Health and Human Services, the University of Iowa Institute of
Child Behavior and Development provided the National Resource
Center on Family Based Services (Nelson and Landsman, p. 3 2 -34 ,
1992).
Brief theoretical foundation
The theoretical foundation of home-based model is based
on family systems theory, which in addition to focusing on the
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fam ily as a whole, centers on the inter-family subsystems and
intra-fam ily community environment. Significant attention is
paid to improving linkages with community-based services.
Families are included in setting treatm ent goals and assessing
problem areas.
Brief action foundation
Case workers are primarily professionally trained.
Caseloads per therapist are ten to twelve families. Annual case
loads range from eight to tw enty-eight families per therapist.
Services are primarily delivered directly in the family's home.
Services average about eighteen weeks. Treatm ent techniques
include modeling, communication skills, genograms (which assist
in clarifying inter-generational interaction patterns), paradox,
reframing, and behavioral-based parenting training which
requires practice in the home. In addition, other support
services provided or coordinated with other community-based
service providers include day care, advocacy, job search
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assistance, transportation, health care, housing, and financial
assistance (Nelson and Landsman, p. 32-34, 1992).
T h e Fam ily T re a tm e n t M odel
Brief historical foundation
The family treatm ent model was developed by the State of
Oregon's Children's Service Division in 1980. The state has
contracted with existing community-based, social service
providers and provided services directly in areas where there
were no appropriate community-based service providers. Similar
to the crisis intervention model and the home-based model, the
treatm ent model was developed to avoid out-of-home placement.
All contracting agencies are required to m eet similar
requirements, which include serving at least eleven families for
at least twelve weeks, and no more than tw enty-five percent of
the families may utilize out-of-hom e placement during the
treatment period (Nelson and Landsman, p. 34-37, 1992).
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Brief theoretical foundation
Similar to the home-based model, the family treatm ent
model is based on family systems theory. Roles th at individual
family members play are identified and individual behavioral
problems are placed in a familial context. The family treatm ent
model focuses more on therapeutic intervention than the home-
based model and the crisis intervention model.
Brief action foundation
Case workers are primarily professionally trained. About
two-thirds of the families are seen by multiple therapists.
Individual caseloads vary from five to tw en ty-five families per
therapist. Services are primarily delivered in the agency's
office. Families receive services from tw elve to tw enty-four
weeks. Treatm ent techniques are primarily based on brief
therapy, communications-based family therapy, and the
identification of roles individuals play in the family system.
Support services are limited to instruction in homemaking and
parenting. Other community-based service providers are
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generally not utilized due to the contractual nature of service
provisions (Nelson and Landsman, p. 34-37, 1992).
T h e W rap-A round Model
B rief historical foundation
The wrap-around model was developed by Kaleidoscope, Inc.
based in Chicago. Several of the founders realized that a
m ajority of the out-of-home care expenses was targeted for a
small minority of individuals. Many of the children in need of
this high-cost care were placed out of state. Kaleidoscope
developed a program to serve these high-cost children in their
own home or in therapeutic foster care by bringing all of the
services that would have been provided in expensive out-of-home
care directly into the home. Kaleidoscope, Inc. contracts directly
with the Illinois Departm ent of Children and Family Services, the
Department of Mental Health, and the Department of Corrections.
In addition, Kaleidoscope, Inc. received support from corporate
and foundation grants and individual contributions. There has
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been recent national interest in this model. Regional training
programs have been provided by Karl Dennis and Kathy Potter of
the Kaleidoscope Training Institute (Kaleidoscope, p. 1-12.
1992). The wraparound was implemented in California in 1999.
Brief theoretical foundation
The wrap-around model is an intensive, extended-term
technique which brings all the services required directly to the
family on a long-term basis with a continuity of case workers.
Family services are provided to prevent out-of-home placement
and to reunify families a fte r children return from residential
treatm ent. The model targets children who are most in need.
The wrap-around philosophy is built on two concepts,
normalization and unconditional care. The basic premise of
normalization is that children who live in a normal environment
learn to be productive citizens. Unconditional care presumes
that children need loving care from consistent parent models
regardless of their behavior (Kaleidoscope, 1992).
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Brief action foundation
Unlike all of the other models presented, case workers are
not necessarily professionally trained. The wrap-around model
is built on the principle that parents, child care workers, and
foster parents are the most significant treatm ent resources for
children. Twenty-four hour, on-call care givers are in charge of
the children's services. These individuals, sometimes called
benevolent gorillas, may live-in with the family and follow the
youth at all tim es so as to interfere with anti-social and
criminal activity. The ultim ate goal is to assist the family to
become self-sufficient by working within the family system.
Clinical professionals are available for specialized treatm ent
and consultation. The wrap-around model consists of 1.) a
satellite family and outreach programs to prevent unnecessary
out-of-hom e placement and successfully reunite children in
residential treatm ent with their families, 2 .) therapeutic foster
family homes, and 3 .) youth development programs which place
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and supervise older youth in apartments (Kaleidoscope, p. 1-12,
1992).
T h e Fam ily U n ity M odel
Brief historical foundation
Originally, the family unity model was developed in New
Zealand as a way to assist the children of the native Maori
population which were referred to the court system. Prior to the
court decision regarding the children, a family unity meeting was
convened and a plan was developed and submitted to the court.
Extended family members were subpoenaed and flown in to the
meeting from as far away as Australia. The family is given the
opportunity to bring their support systems to the family unity
meeting. As a result of utilizing this model, the New Zealand
juvenile justice calendar was reduced by ninety percent and
foster care placement dropped by ninety-two percent. The model
has been utilized in Oregon (Nice and Graber, p. 1-28, 1996).
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Brief theoretical foundation
The family unity model is a long-term, solution-based
approach to family preservation and support. The model is based
on the theory that enlisting the support, solutions, and strengths
of the extended family is integral to the family preservation
process. The model assumes that families and communities are
the best resources for change. The family unity model is based
on the belief that families have strengths and can change, that
strengths are what ultim ately resolve issues of concern, and
that strengths are discovered through listening, noticing, and
paying attention to all family members. Therapists believe that
listening is a most powerful tool, and the therapist's role is as a
consultant, not a boss (Nice and Graber, p. 1-28, 1996).
Brief action foundation
Case workers are primarily professionally trained.
Therapists scan the extended family for strengths and areas of .
concern and avoid identifying problems and giving advice.
Problems are not identified; rather, issues of concern are raised.
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Family sessions are set up to have the family show its strengths
and ability to address problems. Therapists assist the family in
utilizing the strengths of the child welfare system, community-
based, social service organizations, and individuals in the
community involved with the family's children (Nice and Graber,
p. 1-28, 1996).
The Family Unity Model is unique among the programs in
that it is more of a practice attitude. The model was refined in
Oregon at the state child welfare agency level; it is based on a
survey of the views of front-line child welfare workers on
"successful" practice strategies in working with families. The
Family Unity Model prescribes th at child welfare practices
engage families as active participants in service delivery, focus
on family strengths rather than weaknesses, and bring extended
family and community resources to bear to resolve the situation
that brought families to the attention of child protective
services. A key feature of the Family Unity Model is the Family
Unity Meeting, which is the gathering of the extended family and
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other community resources in one room to develop a plan to
resolve the family's problems (Ahart et a!., p. 6, 1992.)
T h e F am ily to Fam ily M odel
Brief historical foundation
Traditional foster care and residential treatm ent programs
have focused on the children while they are in care. The
objective of the Family to Family model is to support, preserve,
and reunify the family while the child is in placement and after a
child is returned from out-of-hom e care through after-care
services. Foster parents become advocates for the child and the
entire birth family. They become like an extended family
providing emotional ties, helping to maintain emotional bonds
within the birth family, and are mentors to the birth parents.
Due to regulatory constraints, no funding is available for
after-care services through traditional Title IV-E or Title IV-B
funds. The Child Welfare League of America received a two-year
grant from the Annie E. Casey foundation to pilot a Family to
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Family experiment in Maryland. The concept of foster parents
becoming mentors to birth parents has become a best practices
model in Maryland. The Annie E. Casey Foundation went on to
make $ 2 .5 million grants to five other states; Alabama, Maryland,
New Mexico, Ohio, and Pennsylvania (Green, p. 4, 2000).
Brief theoretical foundation
The Family to Family model is similar to the family
treatm ent model; it utilizes family systems theory. The
individual behavioral problems that led to out-of-home
placement are put in a familial context, and roles and behaviors
that individual family members exhibited th a t led to the need for
out-of-home placement are identified. Intervention techniques
focus on the families' strengths, empowerment, and family skills
to maintain family connections. But, in addition, the Family to
Family model focuses on a continued connection with the family
and community based resources so the children are anchored in
their neighborhood (Green, p. 5, 2000).
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While the child is in placement and in aftercare, the child
is assisted by a team of foster care-givers, birth parents, and
child welfare professionals to develop social and parenting
skills. There is continued therapeutic intervention with the
family a fte r children return home, and the family is assisted in
other basic family needs. Out-of-home placements are conceived
as part of a family-based, service-delivery package that includes
fluid, flexible and continuous services during placement and
aftercare (Gruenewald, p. 5, 10, 1 9 9 4 ).
Brief action foundation
The Family to Family model promotes shortened lengths of
placement and improved permanent outcomes for children in care
through providing services to parents while the children are in
placement. Parents are involved in the assessment, planning of
services, and case review processes. Parents participate in the
programming decisions for their children while the children are
in placement, including the administration of rewards,
consequences, discipline, and home visits. The agency
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responsible for the out-of-hom e care assumes a position of
advocacy for the parents and actively promotes family
involvement and progress in areas that will improve family
reunification such as housing, employment, child care,
transportation, and other basic needs (Gruenewald, p. 5, 1994,
Green, p. 5, 2000).
T h e C o m m u n ity -B a s ed E co log ical M odel
Brief historical foundation
Los Angeles County developed a family preservation plan
modeled on a variety of other models after reviewing the
evaluations of family preservation programs. Unlike any other
family preservation model, the primary goal is not the prevention
of out-of-home placement. The model is based on the following
assumptions; "1 .) that family preservation is not primarily a
cost-saving scheme but an approach to building communities that
can support families in rearing healthy children, 2 .) that services
have to be designed to m eet the comprehensive needs of families;
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integrating assistance with employment and housing; and child
care with counseling, substance abuse treatm ent, and home-
based services, and 3.) that prevention of family problems rather
than prevention of placement is the most important outcome of
effective family preservation." (Meezan and McCroskey, p. 20,
1997).
Brief theoretical foundation
The community-based ecological model is tailored to meet
the needs of different communities. The model promotes the
belief that children and families need to be perceived in the
context of their immediate environments and community, that
family interactions are transactional over tim e and are not
static and one-way, and that all families can benefit from
supportive environments. The primary goal is the promotion of
improved family functioning within the community and home;
additionally, parents would enhance their child-rearing abilities
and family problems would be m itigated thus the risk of abuse
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and neglect could be diminished (Meezan and McCroskey, p. 8-10,
1997).
Brief action foundation
Social workers are not constrained by the criterion of
"imminent risk of out-of-home placement" in the decision to
refer abusive and neglectful families for home-based family
preservation services. Caseloads remain low with ten to twelve
families per case worker. The average length of home-based
counseling is about three months, but the length o f services can
vary according to the needs of the family. Family response
workers have bachelor's degrees in social work or related fields
and are supervised by licensed clinical social workers or
licensed marriage, family, and child counselors. The primary
goal is not primarily the avoidance o f out-of-hom e placement
and the associated cost avoidance (Meezan and McCroskey, p 2, 8,
1997).
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2 .6 C onclusion R egarding Fam ily P re s e rv a tio n
M odels
As can be seen, family preservation programs and models
have developed along different tracks and have varied widely. In
addition, they have also developed within various organizational
cultures and structures. Some family preservation programs
have grown out of government-based social service systems
including mental health and juvenile justice programs. Others
have grown from private non- profit, community-based programs
with significant funding from foundations. The values and
beliefs about preserving families and out-of-hom e care can be
associated with the organizational culture of the different
agencies providing family preservation services. It is evident
that organizational context and culture can influence the
theoretical foundations and goals of programs, the orientation to
services and responses to problems, and beliefs regarding
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advocacy to keep neglectful and abusive families together (Dore,
1991, in Meezan and McCroskey, p. 23, 1997).
As a result of the varying organizational cultures,
contexts, and perceptions of family preservation programs, a
debate in professional arenas has developed regarding the goals
and definitions of family preservation, definitions, and
appropriate service methods. Terms used under the family
preservation and support funding umbrella have included family-
centered, family systems, in-home services, intensive family-
centered crisis intervention services, wrap-around services and
therapeutic behavior services. This has resulted in some major
divisions within the family preservation m ovement (Meezan and
McCroskey, p. 23, 1997).
The common goaf among all family preservation service
modalities is prevention of the removal of children from their
homes. Most programs are family-centered, rather short term in
duration (tw o to six months), and intensive. Family preservation
services can be implemented in a wide variety of manners, can be
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provided in a number of contexts, and can address a diverse
number of problems. While the goal of this research was
originally to compare and contrast family preservation models,
it has become apparent that family preservation practitioners
must become eclectic in their foundations. They must be able to
vary the provision of services and funding sources to meet the
needs of individual families. Family preservation models should
not be perceived in a one modality fits all mentality. Some
families may most benefit from the long term intensive wrap
around model; others need guidance in parenting skills within the
family unit; while others may need the children removed so the
parent or parents can concentrate on substance abuse treatment.
In conclusion, there are several principle-based practices
that can be key elements of success or failure in any human
services agency, these practices are founded on the agencies'
organizational cultures and values. These values include common
courtesy, meaningful participation of families, staff, and
volunteers; and ethical conduct. Premises guiding the
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adm inistration of principle-based practices social service
agencies include:
,B 1.) once the organization's values and principles are
defined and adopted, train, orient, and retrain so that values and
principles are fully understood by everyone involved.
2 .) Live and model the principles. Practice what you
preach.
3 .) Monitor the organization's mission, goals, and
objectives to ensure that they reflect the principles.
4 .) Develop a spirit of inquiry and engage in an ongoing
search for excellence.
5 .) Recruit, interview, hire, orient, train, recognize,
reward, and discipline (but also where necessary, term inate)
based on the principles.
6.) Discover the power in sharing power - including
knowledge, control, decisions, and resources.
7.) Institutionalize an organizational culture where trust,
quality, knowledge, improvement, difference, discovery, respect,
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and results are valued. Cultivate fun" (Meezan and McCroskey, p.
x, 1997).
These principle-based practices may be more related to
cost-effective services and improved outcomes for children and
families than the choice of model for family based services.
A critical item missing from both the models and
principle-based practices is a driving force that is associated
with child abuse and neglect; namely the abuse of alcohol and
other drugs by care givers. Given that none of the models stress
the treatm ent for substance abuse, a critical service area that is
related to program outcomes has been neglected.
2 .7 E v a lu a tio n s o f Fam ily P re s e rv a tio n P rog ram s
Research on family preservation and support service
programs has developed significantly over the last decade. Early
studies utilized internal evaluations; the primary purpose was to
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confirm that demonstration projects were providing a savings in
expenditures due to reductions in expensive out-of-home
placement. Conclusions were drawn from serving a small
numbers of families. In computing cost savings, evaluations
assumed that all of the families served would have utilized out-
of-home care had they not received family preservation and
support services. In determining if out-of-hom e placement was
avoided, the window of time assessed was limited to the tim e
that the family was directly receiving services, typically six to
eighteen weeks and not the year following services. The
evaluations did not compare the placement rate of similar
families with those families th at received family preservation
and support services (Cole and Duva, p. 89-93, 1990).
As funding for the evaluation of family preservation and
support service programs increased, so did the sophistication of
the evaluations. In 1985, the Children's Bureau of the United
States Department of Health and Human Services assisted two
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studies that evaluated programs in several states (Fraser,
Pecora, and Haapala, 1989, and Nelson et.al., 1988). Although
these studies were mostly descriptive, multiple output measures
were utilized and variances in the families served were
addressed. By 1990, evaluation procedures included the use of
randomly-assigned control groups.
D e s c rip tiv e E v a lu a tio n s o f F am ily P re s e rv a tio n
P rog ram s
Early, internal evaluations of the Homebuilders program
reported significant prevention of out-of-home placement both
during the service delivery segment and up to one year after the
conclusion of services. Evaluations concluded that ten percent of
the families served required out-of-hom e placement during the
delivery of services, and only three percent of the families
needed out-of-home placement within three months o f the
conclusion of services. Family preservation and support service
programs in Florida and Utah reported similar results. The
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Florida study reported that of 196 children served, five percent
were referred for out-of-home placement at the termination of
services (Paschal and Schwahn, 1986, in Nelson and Landsman, p.
23, 1 9 9 2 ). In the Utah study, fifteen percent of the children
were referred to out-of-home placement prior to the termination
of services (Callister, Mitchell, and Trolly, 1 9 8 6 , in Nelson and
Landsman, p. 23, 1992). A study of five programs in Maine found
that placement rates varied from five to eighteen percent
between programs (Hinckley and Ellis, 1985, in Nelson and
Landsman, p. 24, 1992).
The above evaluations did not utilize randomly-assigned
control groups and did not address the potential reduction in
placement rates from the creaming effect of the selection of
families receiving services. Also, they did not develop base line
data on the number of families referred for crises intervention
that did not receive services and did not have children placed in
out-of-hom e care. As a result, it is difficult to draw significant
conclusions about placement prevention rates. Given that there
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are no comparison rates for placement prevention, it is further
impossible to determine the cost effectiveness of the family
preservation and support service programs.
Q u a s i-E x p e rim e n t a I E v a lu a tio n s o f Fam ily
P re s e rv a tio n Program s
By 1988, additional funding became available for external
evaluators to assess the effectiveness of family preservation
and support services. One evaluation was of the Homebuilders
program; it utilized a control group made up of families that
were referred for services, but services were unavailable due to
full caseloads. The evaluation found that of the families served,
twenty-seven percent of the children were referred to out-of
home care as compared to seventy-tw o percent of the children of
families that did not receive the Homebuilder crisis intervention
services (Kinney et al., 1988, in Nelson and Landsman, p. 24,
1992).
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In a follow-up study which tracked the children that were
not placed at the end of the program, after twelve months, an
additional thirteen percent of the children were placed (Haappala
and Kinney, 1988, in Nelson and Landsman, p. 24, 1992). Another
evaluation of a Homebuilders program in Washington found that,
of the families that started the program, only six percent of the
children were referred for placement by the end of services. In a
twelve-m onth, follow-up study, an additional thirty percent of
the children were referred into out-of-home care (Fraser e t at.,
1989, in Nelson and Landsman, p. 24, 1992). In an evaluation of a
Homebuilders program in Utah, based on a twelve-month follow-
up study, nine percent of the children were placed prior to the
end of services and an additional forty-four percent after twelve
months, compared with a eighty-five percent placement rate for
overflow clients (Fraser et a!., 1989, in Nelson and Landsman, p.
24, 1992).
In contrast, an evaluation of a family preservation and
support services program in Minnesota found no differences in
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the number of placements between a group which received family
preservation and support services and a similar group that did
not (AuClaire and Schwartz, 1986, in Nelson and Landsman, p. 25,
1992). Another twelve-month, follow-up evaluation of a
Homebuilders program in New York found no difference in
placement rates between those families that received services
and those turned away because of full caseloads (Mitchell, Tovar,
and Knitzer, 1989, in Nelson and Landsman, p. 24, 1992).
Findings of the evaluations were incredibly mixed and
even contradictory. One evaluation of a family preservation and
support service program found that only five percent of the
children were referred to out-of-hom e placement prior to the
completion of the program. An evaluation of another program,
which utilized a control group, revealed there was no difference
in the numbers of families whose children were referred for out-
of-home placement between the control group and the group
receiving services.
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C o m p a ra tiv e E v a lu a tio n s U tiliz in g R andom ly
A ssign ed C o ntro l Groups
While the results of non-experimental studies suggested
that a high number of families remained intact as the result of
receiving family preservation services, the results from studies
utilizing control groups are mixed. In a 1995 review of family
preservation evaluations utilizing controlled studies, seven o f
the eleven randomized experiments (Hennepin County Community
Services Department 1981; Nebraska Department of Public
Welfare 1981; Willems and DeRubeis 1981; Szykula and
Fleischman 1985; Yuan et al. 1990; Meezan and McCroskey 1993;
Schuerman, Rzepnicki, and Littell 1 9 9 4 ) and one overflow group
study (Mitchell, Tovar, and Knitzer 1 9 8 9 ) found that no
significant reductions in out-of-hom e placements could be
attributed to families receiving family preservation services.
Four randomized experiments (Jones, Neuman, and Shyne
1976; Halper and Jones 1981; Lyle and Nelson 1983; Feldman
1991) and three overflow comparison studies (Wood, Barton, and
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Schroeder 1988; Schwartz, AuClaire, and Harris 1991; Pecora,
Fraser, and Haapala 1 9 9 2 ) found significant reductions in
placements in those families receiving family preservation
services but the differences between groups was relatively
small. More importantly, in those control groups where children
were deemed at imminent risk of out-of-home placement, less
than half were placed in out-of-home care. Unfortunately, when
a primary programmatic goal is to reduce placement when the
population served is not at imminent risk of placement, it is
unlikely that it can be experimentally verified th at significant
reductions in placement do indeed result. "It is not meaningful
to talk about preventing an event if the event wouldn't have
happened anyway" (Littell and Schuerman, p. 19, 1995).
Available evidence sheds little light on whether
family preservation programs have differential
effects on placement for different kinds of families
or on the relative effectiveness of different
approaches to placement prevention. Evidence of the
effects of family preservation programs for specific
subgroups of clients is scant and the results of
available studies are somewhat contradictory.
Although it is correlational in nature, the best
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available evidence suggests that features of services
th a t are often considered among the hallmarks of
fam ily preservation programs—brevity and
intensity of services and the provision of an array of
concrete and specialized services—may not be
critical. (Littell and Schuerman, p. 19, 19 9 5 )
California Assembly Bill 1562 of 1986 which authorized
funding for family preservation programs for three years in eight
California counties also required an evaluation of the project.
Walter R. McDonald and Associates, Inc. collected data on over
70 0 families receiving intensive family preservation services.
The sample included 1,185 adults and 1,740 children. Each
family received an average of sixty hours of service over a
seven-week period. A licensed therapist was involved in ninety-
five percent of all services. About a third of the therapy
sessions took place in the family home. A comparison study was
designed to determine the rate of placement prevention. The
comparison included 152 families and 3 5 6 children randomly
assigned to receive intensive family preservation services and
152 families and 3 5 7 children randomly assigned to receive
other child welfare services.
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There were no significant s tatis tic a l differences between
the placement rates of the group receiving intensive family
preservation services and the group that did not. Also, there was
little difference in the placement costs associated with each
group. However, significant differences were found in the Child
Well-Being Scores between the tw enty percent of families and
children that were placed in out-of-home care and the eighty
percent of families that did not require placement. These
differences are discussed in Chapter five.
2 .8 C onclusion: T h e M issing C rite ria fo r
"Im m in e n t Risk o f P la c e m en t"
The findings of nonexperimental studies in the late 1980's
and early 1990's have been used to suggest that family
preservation programs significantly reduced the need for out-of
home placement of children. Many of the early non-experimental
studies of family preservation suggested that 7 0 to 90 percent
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of families served remained intact after being provided intensive
family preservation services (McCroskey and Meezan, p. 277,
1 9 9 7 ). Because ail of the families served were deemed to have
children at immediate risk of placement, these studies assumed
that if the families had not been served, the children would have
been placed in out-of-home placement. These results of non-
experimental studies fueled the expansion of funding of family
preservation programs because of the perceived potential to
reduce public expenditures via placement prevention and the
family values of keeping families together.
"The field believed that it had found the answer to
preventing growth in the out-of-home care system, and schools
of social work and agencies started to train students and staff
members in the philosophy, theory base, practice methods, and
supporting information thought to be necessary to achieve these
goals" (McCroskey and Meezan, p. 278, 1997).
However, as nonexperimental studies demonstrated, no
convincing evidence exists of program effects, since no clear
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evidence shows that families would have had children placed in
out-of-hom e care in the absence of these services. Claims that
children of the families served were at "imminent risk of
placement" at the time of referral have not been supported by
evidence. Child protective service workers may have maintained
that placement is imminent in order for families to obtain
family preservation services (Littell and Schuerman, p. 278,
1995).
Claims that family preservation programs
result in substantial reductions in the placement of
children are based largely on non-experimental
studies. Such studies do not provide solid evidence of
program effects. Evidence from controlled studies of
placement prevention effects is much weaker. The
results of controlled studies suggest that
difficulties in targ eting services to families at risk
of placement contribute to the lack of effects on
likelihood of placement. The small amount of
evidence on outcomes other than placement suggests
that these programs have little effect on the
recurrence of child m altreatm ent, although they may
produce modest, short term improvements in some
aspects of child and family functioning....In
particular, it is not clear w hether intensive service
programs increase the rates at which children return
home, reduce the risk of foster care re-entry, or
lessen the chance of subsequent child m altreatment.
(Littell and Schuerman, p. 2, 1 9 9 5 )
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Problems with the foster care system in California that
have been addressed by major policy changes over the past
tw enty years include; 1.) lack of specialized services for
families to prevent placement, 2.) birth families often receive
inadequate support services to remedy the problems that may
have precipitated the initial placement, 3.) the child welfare
system is so overloaded that reunification may be delayed
resulting in foster care "drift," 4 .) the need for training of foster
parents, and 5.) the fact that families often face traum atic
reunions when children are returned home. Also a set of criteria
is lacking to assist social workers in determining which
families may be most appropriate for family preservation
services or when out-of-home placement should be used. By
examining the results of recent controlled experiments in family
preservation, family risk factors th a t are associated with out-
of-home placement can be determined.
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1 Preliminary Statements to the White House Conference on
Children in a Democracy. January 18-20, 1940. Midcenturv
Conference On Children .and. Youth. December 3-7, 1950.
Conference Proceeding Golden Anniversary WhiteHouse
Conference on Chifcjreo.. . and Youth, March 27-April 2, 1960.
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C hapter Three Problem S ta te m e n t
This chapter begins by emphasizing how the development of
an imminent risk scale is tim ely in California. It then discusses
how data from controlled experimental research on family
preservation can be applied to develop a family at-risk scale
which identifies family risk-factors th a t are associated with
the placement of children into out-of-home placement. This
chapter concludes with a presentation of the hypothesis of this
dissertation: The reassessment of the findings of family
preservation research utilizing controlled studies can lead to
development of a family well-being measure that assesses the
degree of imminent risk of placement and provides a policy tool
for social service departm ents to use in determining which
families may be best suited to benefit from family-based
services.
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3.1 W hy This S tud y is T im e ly In T o d a y 's P o litic a l
E n viro n m en t
For numerous reasons, concerns for children in out-of-
home placement have been drawn into the political arena. First,
public expenditures for out-of-hom e care increased dramatically
during the fifteen years, 1 8 = 9 8 5 -2 0 0 0 .. In 1985, the total cost
of out-of-home care in California was $ 2 8 4 ,6 4 2 ,5 5 0 . By 1997,
the cost had increased to $ 1 ,0 9 5 ,6 7 8 ,2 2 7 (California Department
of Social Services, Public Assistance selected Statistics FY
1980 - 1997, Table 8, P. 10, 1997). For fiscal year 2 0 0 0 -2 0 0 1 ,
$ 1 ,4 7 8 million was budgeted in California for foster carei
(California Departm ent of Social Services, Highlights of the
2000-01 Governor's Budget, p. 13, 2 0 0 0 ).
Over the fifteen year period 1 9 8 5 -2 0 0 0 , the cost of foster
care in California had increased over five fold. During the same
period, the number of children in foster care in California had
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increased over three fold from 31,365 to 105,756 (California
Departm ent of Social Services, Aid to Families with Dependent
Children Foster Care Fiscal Years ending June 30, 1980 to 1997,
Table 8 , 1998, and UC Berkeley, Child W elfare Research Center,
Intern et p. fac8899b, 2000).
Second, the political correctness of promoting family
values by strengthening families and reducing the neglect and
abuse o f children is a given. From a politician's viewpoint,
anything that promotes keeping families whole is the right thing
to do. This issue was addressed in both the Republican and
Democratic convention speeches in 2000.
Third, the number of reports of child abuse and neglect has
continued to increase. In the period from 1985 and 1989, reports
of abuse and neglect in California increased 70 percent, from 41
per 1,000 children to 71 per 1,000 children. The increase in
children born to drug-exposed mothers may have significantly led
to this increase. A fter 1 9 9 0 , legislation restricted the
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conditions necessary for reporting child abuse. By 1993,
reported incidents of child abuse increased to 76 per 1,000
children.
In terms of the number of reports between 1985 and 1993,
the number of reports increased 124 percent, from 2 9 6 ,0 0 0 to
6 6 4 ,0 0 0 , an average annual increase of ten percent. This
increase has been attributed to 1.) increased economic pressures
on families, 2.) increased illegal drug use, and 3 .) increased
awareness regarding reporting of child abuse (Hill, p. 1 3 -1 4 ,
1996).
Another reason that concern for children in foster care is
entering the political arena is that the concept of investment in
prevention is being promoted as more cost-beneficial than
treatm ent. Since a significant amount of public funds for social
services are tied to outcomes and evaluations, it has been
postulated that family preservation, wrap-around and other
community-based programs can result in positive outcomes,
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providing that services are provided to families that can benefit
from the services.
In 1999, the Little Hoover Commission's report on the
foster care system in California, "Now In Our Hands: Caring For
California's Abused and Neglected Children", made the following
finding:
The State lacks an accurate and dynamic
assessment tool to measure the risk to vulnerable
children and determine the best approach to promote
their well-being. Perhaps the most critical link in
the government’ s response to child abuse is how it
assesses a family in crisis. In some counties, the
decision to remove children from parents is driven
largely by a zero tolerance toward parents with drug
abuse problems. In other counties, more emphasis is
placed on keeping families intact. On a day-to-day
basis, these decisions are influenced by the
availability of foster care, the number of incoming
abused children, and shifting sensitivity to removing
children based on yesterday’s headlines. A t the same
time, researchers have found that it is common for
authorities to receive several reports of abuse before
children are removed from the home, suggesting that
in some cases abuses are repeated before that step is
taken. ... The best assessment tools are a
combination of instinct, experience and science, and
the State is trying to improve the ability to
determine risk. This effort should not be a one-time
task, but an ongoing effort to improve the ability of
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caseworkers to make one of the hardest decisions
public employees are required to make. ...
Specifically, the department should: Develop accurate
safety assessment tools. The State should expedite
efforts to develop tools that accurately assess the
risk in maintaining children with their families or
returning them to their families. (Little Hoover
Commission, p. 19, 1999)
In the year 2 0 0 0 , the California Department of Social
Services hosted a number of policy forums attended by key
stakeholders and policy makers in the foster care arena. In
addition to other recommendations, the following were
presented; 1.) "Expand assessment efforts in replacement and
placement situations to individualize services," 2 .) "Identify
child development issues as well as protection issues and focus
on the emotional well-being of children as well as their safety,"
and 3.) "Educate legislators and the media on the need to redirect
resources to help strengthen families and communities"
(California Departm ent o f Social Services, Childsworld, Foster
Care Public Policy Forums, p. 2, 2000).
With the improving economy of the late nineties, there are
slack resources in the tax base to focus on areas in the welfare
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state th at traditionally have not gained much recognition due to
their under-representation in the political arena. Also, with the
focus on outcomes as identified in the Government Performance
and Results Act of 1993, the program outcomes of family
preservation, wrap-around services, and foster care have been
thrust into the political spotlight.
Finally, recent legislation has led foster care issues into
the policy development arena. California Assembly Bill 2 7 0 6 of
2000, changes the definition of children eligible fo r fam ily-
based, wrap-around programs to children that reside in or are at
imminent risk of being placed in group homes with a rate
classification level of ten or higher. In 1997, sixty-seven
percent of the children placed in group homes were placed within
homes with a rate classification level o f ten or higher
(California Alliance of Child and Family Services, Personal
communication). In addition, federal funding for providing
independent living services to foster youth has doubled.2
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3.2 Summary Argument
The Center for the Study of Social Policy (1 9 8 8 ) found that
in reviewing family preservation programs in six states
(California, Florida, Iowa, Maryland, New Jersey, and
Washington), seventy-five percent of the families that received
family preservation services avoided out-of-hom e placement of
at-risk children. These programs did not utilize a control group.
In contrast, a 1990 study of six, intensive family preservation
service programs in California th at utilized a control group that
received no family preservation services, found that the control
group avoided out-of-hom e placem ent o f at-risk children in
eighty percent of the families (McDonald and Associates, p. v,
1990).
By 1 9 95 , at least five evaluations using randomly mixed
control groups had been conducted for family-based programs
utilizing the imminent risk of placem ent criteria (AuClaire and
Schwartz, 1986; Feldman, 1990; Fraser et al., 1991; Scheurman
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et al., 1992; and Yuan et al., 1990). To determine imminent risk
of placement, three of the studies relied on worker judgments
and tw o used an external review. In all five studies, about eighty
percent of the children in the control samples remained at home;
therefore, those families were not at imminent risk of
placement (Pecora et al., p. 49, 1995).
In each of these studies the concept of imminent risk was
used to target the families that could benefit from placement. It
is this concept, imminent risk of placement, as brought to light
through these studies that warrants further investigation. In the
conclusion of a 1997 study of family preservation services in
California, the authors stated; "A reliable and valid method for
determining when placement is the appropriate outcome needs to
be developed, as do measures of the appropriateness of other
outcomes including retaining the child with the family,
reunification, and permanent placement" (Yuan et al., p. 5.8,
1997).
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As of July 1999, there were over 10 5 ,0 00 children in
foster care in California.3 An unknown number of these could
have been served by family preservation, wrap-around services,
or community- based services; and the emotional trauma and
fiscal costs of placement could have been avoided. At-risk
children and families of California and, indeed, the nation, can
benefit from development of a tool for county social workers to
assist them in determining which children may best be served by
out-of-home placement and which families may be served by
family preservation, wrap-around services, or other community
based services.
By re-examining the data from evaluations utilizing control
groups of family preservation programs in California, specific
risk factors that are associated with out-of-hom e placement can
be identified. A tool can be developed based on existing research
to determine the family and environmental risk factors most
associated with imminent risk of placement. Thereby, the
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number of children in foster care could be reduced or the initial
removal of a child from his or her home could be avoided entirely.
. In a study to assess the use of the concept of imminent
risk of placement, working definitions have included 1.) "a child
who is about to be placed immediately," 2.) "placement that
occurs within 3-7 days," 3.) "potential for placement, time frame
unspecified," 4 .) "definition of imminent risk is decided by
referring agencies," and 5.) "no working definition" (Walton and
Denby, p. 58, 1997).
The question then remains, "Which troubled
families are likely to benefit most from these
services?" The answer may be elusive because of the
way in which practitioners, adm inistrators, and
researchers conceptualize the question. For some
decision-makers, selecting families for special
services is an issue of dividing up a limited resource
- a little bit like the process of selecting only a few
of the starving masses to receive an adequate diet
rather than equally distributing a few crumbs to
everyone. Perhaps a more appropriate model for
conceptualizing the decision-making would be to
compare it to the process of identifying the specific
natural needs of each person - given their unique
strengths, deficiencies, and set of circumstances.
Then treatm ents would be designed to match the
specific needs - acknowledging that some
treatm ents would be more intensive or costly than
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others. Although Intensive Family Preservation
Services may not be measured and analyzed as simply
as vitamins and minerals, it appears at times that
th e families in need o f child welfare services are
much like the 'starving masses.' In fact, service
providers may feel so overwhelmed by the needs that
th e y lose motivation for designing a rational,
decision-making process for determining which
families get help. The challenge for future research
is to accurately measure families' 'nutritional'
deficiencies along with their strengths and resources
so that specific treatm ents can be tailored to fit.
When we have accomplished th a t task, we will know
what Intensive Family Preservation Service programs
are good for. (Walton and Denby, p. 68, 1997)
The study concluded; "It seems disheartening, if not
strange, that a fte r there is so much emphasis in the literature,
so few agencies have defined imminent risk for them selves—let
alone used it" (Walton and Denby, p. 68, 1997).
A recent study o f family preservation and family
functioning in Los Angeles county concluded; "Meaningful
practice-relevant instruments should be used to assess family
functioning in order to determ ine whether family-based services
are appropriate, and to guide service planning and service
provision. Since very few instruments exist now, development,
testing, and refinem ent of multiple approaches will be necessary
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to make sure that instruments fit the various assumptions and
goals o f family-based services programs" (McCroskey and
Meezan, p. 305, 1997).
By examining recent research on family preservation
programs in California that have utilized control groups, one can
identify the characteristics of families whose children were
placed in out-of-hom e care regardless of the services they
received. By developing risk scales based on research, county
social workers who make the recommendations for out-of-home
placement will be b etter able to make decisions regarding which
families could most benefit from family preservation services,
wrap-around services, or community-based services and which
children may be better served by out-of-home placement.
A need exists for a survey of existing research of family
preservation and support service evaluations to help both state
and local policy makers to make informed choices about how act
to cost-effectively and efficiently to serve families whose
children may best benefit from family-based services and under
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what conditions it would be best for the children to become
wards o f the court.
3 .3 H yp othesis
The reassessment of the findings of family preservation
research utilizing controlled studies can lead to development of
a family well-being measure that helps assess the degree of
imminent risk of placement and provides a practice tool for
social service departments to use in determ ining which families
may be best suited to benefit from family-based services.
1 Of the $ 1,4 7 8 million budgeted in FY 2 0 0 0 -2 0 0 1 for foster care
expenditures in California, $601 million, or 41% , was budgeted
as county expenses, $389 million, or 26% , was budgeted as state
expenses, and $488 million, or 33%, was budgeted as federal
expenses.
2 Known as the Chaffee Bill, public law 1 0 6 -1 6 9 doubles the
amount from $ 7 0 million per year in federal expenditures to
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$ 1 4 0 million per year. These funds are to assist foster youth
between the ages of 16 and 21 in independent living.
3 This number represents the number of children in dependent
foster care in California and excludes probation wards and
severely emotionally disturbed children (UC Berkeley, Child
W elfare Research Center, p. fac8899b, 2000).
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Chapter Four Methods and Procedures
This chapter begins by restating the question, presenting
the formal hypothesis, and presenting research perspectives and
data-analysis methods. Limitations of the methodology are
discussed. The methods chapter concludes with a discussion of
risk assessment tools and actuarial assessment methods.
4.1 R e s tate m e n t o f Q uestion
By examining the results of three recent, controlled
experiments with family preservation in California, can family
risk factors associated with out-of-hom e placement of children
in those families be determined?
The data gathered from evaluations of family preservation
demonstration projects in California can be re-evaluated to
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determine the spectrum of family risk factors for those fam ilies
with children at risk of placement that are associated with the
placement of those children into out-of-home care, regardless of
what services are provided. Speculations regarding causal
relationships are avoided. Potential associative relationships
are stipulated.
4 .2 Formal H yp othesis
The reassessment of the findings of family
preservation research utilizing controlled studies can lead to
development of a family well-being measure that helps assess
the degree of imminent risk of placement and provides a practice
tool for social service departm ents to use in determining which
families may be best suited to benefit from family-based
services.
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4 .3 M ethod o f Inquiry
This inquiry tests the hypothesis by analysis of a survey of
findings from three evaluations of family preservation programs
in California. Risk factors were reviewed for those families
that received family preservation services and those families in
a control group that received other community-based services.
Rather than focusing on the differences between these two
groups, this analysis focuses on the differences between those
families that had children placed in out-of-hom e care regardless
of the services they received. The reassessment of the findings
of family preservation research utilizing controlled studies can
support the development of a family well-being measure that
predicts out-of-home placement and provides a policy tool for
social service departments.
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4 .4 Research P ersp ectives
Programs that provide intensive Family
Preservation Services generally focus on family
preservation through the short-term application of
family therapy, communication skills training, and
assistance in addressing basic needs such as food,
employment, and housing. The elements common to
most programs based on this approach are that case
workers; (a) accept only families at immediate risk
o f child placement; (b) meet with families as soon as
possible after referral; (c) provide services 24 hours
a day, 7 days a week; (d) deal with the family as a
unit; (e) provide services primarily in the home; (f)
provide services based on need rather than on
categories; and (g) provide intensive services on a
short term basis. (Walton and Denby, p. 54, 1997)
In 1980, Congress created a national mandate, the Adoption
Assistance and Child Welfare Act, to promote prevention of out-
of-home placement for physically or sexually abused or severely
neglected children. The primary goal of this mandate was to
keep children and families together and to avoid the costs
associated with out-of-home placement. In 1982, the National
Resource Center on Family Based Services identified tw en ty
family preservation and support services programs. By 1986, the
directory included 2 3 8 programs across the United States. In
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1 9 9 1 , 24 states had legislative initiatives relating to family
preservation (McDonald and Associates, p. 1 7, 1992).
The Omnibus Budget Act of 1993 provided $1.3 billion over
five years to the states to provide family preservation and
family support services. As a result of expansion of federal
support and program models, two central evaluation questions
have emerged at the national level. First, are fam ily
preservation and support services models as effective as their
supporters propose? Second, is the heavy investment in fam ily
preservation and support services as cost-effective as
anticipated?
As mentioned in the summary argument of Chapter Three,
the findings of research answer these questions in significantly
different ways. The 1988 Center for the Study of Social Policy
study o f family preservation across six states found that o u t-o f
home placement of at-risk children was avoided in seventy-five
percent of the families. In contrast, a 1 9 9 0 study of six family
preservation programs in California found no significant
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differences in placement rates between the project group and
comparison group. Eighty percent of the families in the control
group avoided out-of-home placement of at-risk children. This
compared with seventy-five percent of the project families
(McDonald and Associates, p. v, 1990).
Yet, a 1991 study of six family preservation programs that
utilized a control group found that the group which received
family preservation services avoided placem ent in fifty-six
percent of the families as compared to placement avoidance in
only fifteen percent of the control group families (Pecora,
Fraser, and Haapala 1991,in Wells, pp. 4 7 5 -4 8 0 , 1994).
Regardless of the services that families received, there
are several differences that seem to emerge between families
where children were placed and those families where children
were not placed. For example, in the Walter R. McDonald and
Associates 199 0 study, all families were assessed using the
Child Well Being Scales. These scales consist of forty-three
rating scales. Each risk factor is scored on a continuum of four
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to six levels that range from adequate, marginal, moderately
inadequate, seriously inadequate to severely inadequate. Each
level is explicitly defined in observable terms (Magura et al., p.
1-55, 1987). The study found that families experiencing
placem ent were significantly different from families that did
not experience placement in thirteen items (see Table 5.4)
(W alter R. McDonald and Associates, Inc., p. 5.20, 1990).
Given that the attributes of families whose children are
at-risk of out-of-home placement can be consistently assessed,
it can be estim ated which families are most likely to have their
children placed in out-of-hom e care regardless of whether
family preservation, wrap-around or other community support
services are provided or not.
Being able to identify the critical attributes in families
whose children are at risk of placement can provide a research-
based predictor of imminent risk of out-of-home placement. An
analysis of recent research and evaluations of California fam ily
preservation models targeting families whose children are at-
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risk o f out-of-home placement could determine what types of
family attributes are correlated with out-of-hom e placement
both with groups receiving services and control groups. This
dissertation will survey the data collected by three evaluations
of California family preservation programs and seek to
determ ine which family risk factors predict out-of-hom e
placement.
4 .5 Risk A s s e s s m e n t Tools and A c tu a r ia l
A ssessm en t M ethods
While the use of family risk-assessment tools is relatively
recent, experts in the field are concerned that the theoretical
and empirical support for these systems is inadequate (Baird et
al, p. 725, 1 9 9 9 ). "Historically, case workers have used the case
study method, relying almost entirely upon clinical experience,
intuition, and interviewing skills to assess the future risk of
abuse or neglect to a child. ... These instruments may be helpful
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to CPS workers in conducting a comprehensive ease assessment,
but they are typically not constructed from an empirical analysis
of case outcomes in the jurisdiction in which they are used. In
other words, these instruments may help organize the case
worker's clinical assessment of risk, but they are not based on
research specific to the jurisdiction" (Baird et al., p. 726, 1999).
There are two, basic types of family risk-assessment
tools: consensus-based systems and actuarial systems. In
consensus-based systems, specific family characteristics are
identified, and case workers individually assess the risk of
future abuse or neglect based upon their own judgment. With
actuarial systems, empirical study of fam ilies1 characteristics
and associated outcomes identify risk factors which have
significant associations with future abuse or neglect (Baird et
al., p. 725, 1999).
■ Actuarial assessment methods require longitudinal
research which identifies risk factors and chances, or odds, of
associated outcomes. By utilizing the results from research on
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family preservation which include control group data,
empirically-based instruments can be developed to assess the
chances of out-of-home placement based on identified risk
factors present in the family.
The Child Well-Being Scales provide an assessment tool
that can be used to determine the severity of problems and risk
factors facing children and families involved with county social
services (Magura and Moses, 1986). By utilizing the Child W ell-
Being Scales, county social services case workers can
potentially determ ine those families which most likely can
benefit from family preservation services, wrap-around
services, or other community-based services and identify
characteristics of those families where out-of-hom e placement
may be most appropriate.
The purpose of the scales is to provide a reliable research
tool to document possible changes in the well-being and
caretaking environment of children and families. Although the
scales were not designed as measures of environmental risk for
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children and families to assist in decision-making, the data
presented by Walter R. McDonald and Associates, Inc. appears to
point to several distinguishing characteristics between those
families requiring out-of-home placement and those benefiting
from family preservation services.!
Several variables influence a decision to place a child or
not. Many variables are virtually unmeasurable and may
significantly influence whether a child is placed or not.
Sometimes, placem ent decisions are judicially and/or politically
driven. For example, placements may be required by law for the
protection of the child, placements may be made to protect the
community, and placements may not have been made due to fiscal
constraints placed on the county.
In surveying research over the past decade on family
preservation in California, an attem pt was made 1.) to make use
of studies that utilized control groups and presented findings
related to family risk and protective factors, 2.) to identify
different assumptions, and 3.) to identify the characteristic of
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families whose children were placed into out-of-hom e care.
Studies that lacked the utilization of comparison or control
groups were used only to identify characteristics of families
whose children were in out-of-home placement to assist in
identifying the spectrum of family risk and protective factors.
i These distinguishing characteristics are presented in Table 5.4.
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C h a p te r Five In te rp re ta tio n o f th e Findings o f
F am ily P re s e rv a tio n R esearch
This chapter presents findings from three evaluations of
family preservation evaluations in California. These findings are
framed in the context of predicting placement rather than
evaluating change in family dynamics.
Tables present a list of the family risk factors that were
associated with imminent risk of placement collated from all of
the programs evaluated. There is no consistency among the risk
factors associated with out-of-hom e placement identified in the
studies because each study utilized a different family well
being scale. A tw o-by-tw o, decision-assisting tool is presented
which identifies both perceived imminent risk of placement and
the degree of risk factors involved, (see Figure 5.1) This
decision-assisting tool is visual based so that a child protective
services worker or supervisor can look at the results of the
assessment and quickly determine strengths in the family and
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what threats these are to safety that may indicate that it is
prudent to remove children from an unsafe family environment.
The chapter concludes with implications for future, fam ily-
based services.
Vertical axis: Appropriateness
of Out-of-home placement vs.
Family based services
Horizontal axis: Risk and
safety factors present in
the home.
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Vertical axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Figure 5.1
Two dimensional decision making tool to
determine imminent risk of placement
134
FS
c s
FA
M P N
Nl
PB
PA
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5.1 S ig n ific a n t Findings o f th e E v a lu a tio n s
The findings of the controlled studies that have been
reviewed in states other than California are mixed. Seven of the
eleven randomized experiments reviewed found no significant
reductions in placement resulting from families receiving family
preservation services. While the remaining four randomized
experiments found significant reductions in placement in favor
of the experimental groups, differences between groups were
relatively small, and small sample sizes raised concerns (L itte ll
and Schuerman, p. 18, 1995).
A number of early studies found associations between
characteristics of families and placement of children during or
soon after family preservation services have been provided.
While no specific data are presented, these studies set the stage
for further investigation.
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In a review of eleven programs, it was found that risk of
placement was associated with: (Nelson, Emlen, Landsman, and
Hutchinson, 1988, in Little and Schuerman, p. 14, 1995)
• families with more severe problems,
• if problems that families were facing were related to
adolescents,
• families were not m otivated to receive services, and
• children in the family had been placed out-of-home
previously.
Another study reported that the placement rates were
higher for the following characteristics: (Fraser, Pecora, and
Haapala, 1991, in Little and Schuerman, p. 15, 1995)
• parents th at were hostile towards their children,
• families th a t had poor discipline skills,
• parents that requested that their children be placed in
out-of-home care, and
• children that had drug involvement, truancy, delinquency,
oppositional behaviors, mental illness, or intervention histories.
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Y et another study broadened the foundation for placement
potential to: (Feldman, 1991, in Little and Schuerman, p. 15,
1995)
• single-parent families,
• families with poor parenting skills,
• children with behavioral or emotional problems,
• delinquent children, and
• minorities.
In the above-mentioned studies there was no assignment of
risk to the various attributes, merely recognition of an unknown
association between some of the characteristics of fam ilies-at-
risk and imminent risk of placement. The studies only lead to
generalizations to assist caseworkers in determining which
families might be b etter served by family preservation services
and which might better be served by out-of-home placement. For
families referred through child abuse reports, a child protective
service worker would be hard pressed to find a family that did
not present at least tw enty-five percent of the above-mentioned
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characteristics. The above studies set the stage for further
research to b etter identify the characteristics associated with
placement of children in out-of-home settings.
Findings From th e 1 9 9 0 W a lte r R. McDonald and
A s s o c ia te s , Inc. E v a lu a tio n o f Fam ily P re s e rv a tio n
Assembly Bill 1 562 of 1986 authorized funding for family
preservation programs for three years in eight California
counties. The legislation required an evaluation of the project.
Walter R. McDonald and Associates, Inc. collected data on over
7 00 families receiving intensive family preservation services
which included 1,185 adults and 1,740 children. Each family
received an average of 60 hours of service over a seven-week
period. A licensed therapist was involved in 95 percent of all
services, about a third of these services took place in the family
home. A comparison study was designed to determine the rate of
placement prevention. The comparison study included 152
families and 3 5 6 children randomly assigned to receive intensive
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family preservation services and 1 52 families and 3 5 7 children
randomly assigned to receive other child welfare services.
There were no significant statis tic a l differences between
the placement rates of the group receiving intensive family
preservation services and the group that did not. Also, there was
little difference in the placement costs associated with each
group. However, significant differences were found in Child
Well-Being Scores between the 20 percent of families and
children that were placed in out-of-home care and the 80 percent
of families that did not require placement (W alter R. McDonald
and Associates, p. v, 1990).
Findings From th e 1 9 9 7 M eezan and McCroskey
E va lu a tio n o f th e F am ily P re s e rv a tio n Program
Provided by th e Los A n g eles D e p a rtm e n t o f Children
and Fam ily S e rv ic e s
In the Los Angeles Department of Children and Family
Services research study of two family preservation programs
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serving 108 families and comparison groups serving 123
families, about one in every three families (n = 3 7 ) in the family
preservation group, and one in every four families (n = 3 0 ) of the
control group had children placed in out-of-home care prior to
the beginning of the study. During the study period, some of the
children previously in placement returned home. About one in
every four of the service group (n =29) families and one in every
seven control group families (n = 1 7) had children in out-of-home
care during the 15 months of the study. During the study, about
one in every ten serviced families (n = 12) and one in every ten
control group families (n = 1 2 ) entered out-of-home care (Meezan
and McCroskey, p. 281-2, 1997).
Findings From th e 1 9 9 7 W a lte r R. M cDonald and
A s s o c ia te s , Inc. E v a lu a tio n o f Fam ily P re s e rv a tio n
The California Office of Child Abuse Prevention Contracted
w ith Walter R. McDonald and Associates, Inc. in 1991 to evaluate
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family preservation programs in Alameda, Contra Costa,
Mendocino, Riverside, Sacramento, San Diego, Santa Clara,
Solano, and Stanislaus counties. Unlike the participants in the
study funded by the Assembly Bill 1562 of 1986, who came from
counties required to follow a prescribed service model, AB 558
of 19 8 8, allowed counties flexibility in providing whatever
services were necessary to families that had children that were
deemed to be at imminent risk of being placed out-of-home. The
goal of the legislation was to have seventy-five percent of the
children remain placem ent-free within six months of the
services and sixty percent of the children remain home within a
two-year period after services were provided. AB 776 of 1993
allowed additional populations of eligible children to be served.
AB 776 defined family preservation services as any intensive
services for families whose children 1.) were at imminent risk
of out-of-home placement, 2.) who were in placement and might
remain in placement for longer periods, or 3 .) who might be
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placed in more restrictive settings. The evaluation did not
utilize a control group (Yuan et ah, p. 1.3-1.11, 1997).
A total of 2 ,1 4 2 children received family preservation
services across the nine counties during the study period. Of
that group, 423 were in out-of-home placement at the beginning
of the study and 1,719 children were living at home. Of the 423
children in out-of-home placement at the beginning of family
preservation services, only 171, or 4 0 .4 percent, were reunified
during the time that family preservation services were provided.
Of the 171 that were reunified, five returned to placement during
the delivery of family preservation services. A fter two years,
154 of the 166 remained placement-free. Of the 1,719 children
served with family preservation services, 194 or 11.3 percent
of the children experienced out-of-hom e placement within two
years (Yuan et a!., p. 2.1-2.9, 1997). The program seemed to have
prevented the placement of children who were immediately at
risk of placement.
142
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The Family Assessment Form was used to assess family
functioning at both intake and termination of services. The scale
was modified to include only those items that the developers
deemed reliable. The items consisted of 1.) care-giver
interaction, 2.) developmental stimulation, 3 .) financial
conditions, 4 .) parent-child interactions, 5.) living conditions,
and 6.) support to parents. The Family Assessment Form was
utilized to measure changes in family functioning resulting from
delivery of family-based services. A total of 272 Family
Assessment Forms were com pleted for families, slightly less
than 30 percent of the total of 953 families served (McDonald &
Associates, p. 4.1-4.6, 1996). There was a slight improvement in
family functioning as measured by the Family Assessment Form
for families th a t received family-based services. However, it
was stated that the improvements could not be credited only to
the services but could have been the result of the families, the
staff who assessed the families, or a function of the instrument,
143
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the services, or a combination of items (McDonald & Associates,
p. 4.8, 1996).
It is indeed interesting that each county used differing
criteria to screen the population to target and select families
prior to receiving services. The findings suggest that families
with children at imminent risk of placement were selected, but
these families were also sufficiently functional to have children
remain safely at home. Referrals were generally made by
probation officers and social service placement workers.
In Alameda County, the program targeted those families
that had a commitment to cooperate with the program, and a
priority was given to those families that were not receiving
public assistance. In Mendocino County, many of the families
referred had substance abuse as a primary or secondary issue.
Prior to being accepted for family preservation services,
families with substance abuse issues had to complete a two
week assessment to determine the appropriateness of services.
144
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In Riverside County, families with long standing substance
abuse problems or persistent neglect were seldom referred for
family preservation services.
In San Diego County, family preservation services were not
provided to families where there had been physical abuse to a
child under the age of three, the perpetrator resided in the house
at the time and the spouse had demonstrated a pattern of having
an abusive partner or partners. In addition, services were not
provided to families with children with a severe mental health
diagnosis or children that ran away frequently.
In Santa Clara County, the following family characteristics
precluded the delivery of family preservation services 1.) sexual
abuse cases where the perpetrator was still in the home, 2.)
severe physical abuse cases, 3.) hard-core drug or alcohol abuse,
4 .) severe psychiatric problems, or 5.) if there was an ongoing
Dependency investigation that could lead to the removal of
children from the home.
145
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In Solano County, referrals for family preservation
services were made by a committee, (McDonald & Associates, p.
A.3, A.1 5, A.17, A.27, A .31, A.48, 1996).
The issue of screening clients has been a concern in other
evaluations. For example, in a recent study of family
preservation programs to determine causal relationships
between interventions and outcomes utilizing 5 0 0 families in
each of five sites throughout the country, families were
randomly assigned either to a treatm ent group that received
family preservation services or to a control group th a t received
other community based social services. The evaluators
presented the caseworkers with vignettes drawn from actual
cases. The decision-making process the case workers used to
determine if the families served had children that were at
imminent risk of placement into out-of-hom e care was examined.
The evaluators found that, contrary to the stated intentions of
family preservation programs, a majority of the referrals to
146
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those programs involved children that would not have been placed
into out-of-home care had any service not been offered
(Schuerman and Rossi, p. xii, 2000).
O f the county programs evaluated, eight of nine met the
goal th at seventy-five percent of the children served remained
home for six months and all counties met the goal of having sixty
percent of the children remain home within two years of
services rendered. The programs seemed to benefit children that
had been identified to be at risk of placement. However, of the
1,719 children that were served and were not in placement when
services began, only 155 (9% ) were placed by the end of the year
(Yuan et al., p. 2.1-2.9, 1997). Without a comparison group, it is
difficult to make conclusive judgments about the benefit of the
services provided. With the data provided, significant
associations with common risk factors in families whose
children were placed into out-of-hom e care cannot be identified.
147
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5 .2 Presentation o f Summary Tables
Differences at Intake Between Children Placed and Not
Placed
Mean Mean
Child Well-Being Scale Score Score p< D iff.
Indicator
Placed
Not
Placed
Abusive Physical Discipline 82.9 73.5 0.001 9.4
Deprivation of Food/W ater 99.1 98.5 ns 0.6
Physical Confinement 95.9 95.7 ns 0.2
Deliberate Locking Out 99.1 98.5 ns 0.6
Sexual Abuse 83.3 87.4 ns -4.1
Threat of Abuse 74.3 78.6 0.05 -4.3
Economic Exploitation 95.1 97.8 0.01 -2 .7
Protection from Abuse 72.2 75.3 ns -3.1
Adequacy of Education 88.7 93.2 0.001 -4 .5
Academic Performance 83 89.8 0.001 -6 .8
School Attendance 83.5 92.2 0.001 -8 .7
Family Relations 76 82.7 0.001 -6 .7
Child's Misconduct 74.8 80.3 0.01 -5 .5
Coping Behavior of Child 71.3 75.6 0.01 -4 .3
Child's Impairment 84.1 86.4 ns -2 .3
Although several items are statistically significant, only
two items were scored below marginal: abusive physical
discipline and child's impairment.
A t intake, children who were not placed had significantly
higher overall scores than children who were placed.
Table 5.2
Data courtesy of Walter R. McDonald and Associates, Inc.,
Evaluation of AB 1562 In-Home Care Demonstration Projects, p.
5.24, 1990.
148
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Differences at Termination Between Children who were
placed and not placed
Difference
-3.1
0.2
- 2.2
0.0
- 6.0
-11.0
-2.5
0.3
-5.1
- 6.0
- 10.8
- 6.1
-9 .7
-5 .0
- 2.6
Mean Mean
Child Well-Being Scale Score Score
Indicator Not
Placed Placed
Abusive Physical Discipline 91.6 94.7
Deprivation of Food/W ater 99.3 99.1
Physical Confinement 96.9 99.1
Deliberate Locking Out 99.1 99.1
Sexual Abuse 88.1 94.1
Threat of Abuse 77.6 88.6
Economic Exploitation 96.4 98.9
Protection from Abuse 91.4 91.1
Adequacy of Education 90.2 95.3
Academic Performance 85.7 91.7
School Attendance 84.1 94.9
Family Relations 82.5 88.6
Child’s Misconduct 76.5 86.2
Coping Behavior of Child 73.6 78.6
Child's Impairment 83.8 86.4
Data shows significant differences between children
placed and not placed after intensive family preservation
services in the areas of threat of abuse, school attendance, and
child's misconduct.
Table 5.3
Data courtesy of Walter R. McDonald and Associates, Inc.,
Evaluation of AB 1562 In-Home Care Demonstration Projects, p.
5.25, 1990.
149
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Differences in scores before and after family preservation
services for children who were placed and not placed with regard
to changes in the Child Well-Being Scale.
Mean amount of change
Child Well-Being Scale A t Intake A t Termination
Indicator Not Not
Placed Placed Diff.PlacedPlaced D iff.
Abusive Physical Discipline82.9 91.6 -8 .7 73.5 94.7--21.2
Deprivation of Food/W ater 99.1 99.3 -0 .2 98.5 99.1 -0 .6
Physical Confinement 95.9 96.9 -1 .0 95.7 99.1 -3 .4
Deliberate Locking Out 99.1 99.1 0 98.5 99.1 -0 .6
Sexual Abuse 83.3 88.1 -4 .8 87.4 94.1 -6 .7
Threat of Abuse 74.3 77.6 -3 .3 78.6 88.6--10.0
Economic Exploitation 95.1 96.4 -1 .3 97.8 98.9 -1.1
Protection from Abuse 72.2 91.4-■19.2 75.3 91.1 ■ -15.8
Adequacy of Education 88.7 90.2 -1 .5 93.2 95.3 -2.1
Academic Performance 83 85.7 -2 .7 89.8 91.7 -1 .9
School Attendance 83.5 84.1 -0 .6 92.2 94.9 -2 .7
Family Relations 76 82.5 -6 .5 82.7 88.6 -5 .9
Child's Misconduct 74.8 76.5 -1 .7 80.3 86.2 -5 .9
Coping Behavior of Child 71.3 73.6 -2 .3 75.6 78.6 -3 .0
Child's Impairment 84.1 83.8 0.3 86.4 86.4 0.0
Data shows significant differences between children
placed and not placed after intensive family preservation
services in the areas of abusive physical discipline, threat of
abuse, and child's misconduct. The average improvement in the
area of abusive physical discipline a fte r experiencing family
preservation for those children not placed was 20.8 points
Table 5.4
Data courtesy of Walter R. McDonald and Associates, Inc.,
Evaluation of AB 1562 In-Home Care Demonstration Projects, p.
5.24-5.25, 1990.
150
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Differences at intake between families whose children
were placed and those families that were not placed
Child Well-Being Scale Score Score
Indicator Placed Not Placed
P<
Diff.
Physical Health Care 85.8 89.8 0.05 -4 .0
N u tritio n/D iet 81.5 87.4 0.01 -5 .9
Clothing 91.8 94.5 0.01 -2 .7
Personal Hygiene 90.6 94.3 0.01 -3 .7
Household Furnishings 88.4 91.7 0.01 -3 .3
Overcrowding 85.4 88.8 0.05 -3 .4
Household Sanitation 83.9 89.8 0.01 -5 .9
Security of Residence 93.6 96.3 0.001 -2 .7
Physical Safety 81.6 88.7 0.001 -7.1
Mental Health Care 65.2 73.7 0.001 -8.5
Supervision of Young 79.2 84.8 0.01 -5 .6
Arrangement for Subs. Care 83.2 88.7 0.01 -5.5
Money Management 86.2 90.7 0.001 -4.5
Capacity for Child Care 63.8 73.1 0.001 -9.3
Parental Relations 52.8 61.3 0.001 -8 .5
Continuity of Parenting 75.7 82.4 0.001 -6 .7
Recognition of Problems 52.3 56.4 0.01 -4.1
Motivation to Solve Problems 67.2 72.8 0.001 -5 .6
Cooperation with Case Plan 69.2 76.4 0.001 -7 .2
Support for Primary Caretaker 83.1 87.7 0.001 -4 .6
Availability of Services 82.4 84.8 0.05 -2 .4
Acceptance of Child 67 74.5 0.001 -7.5
Approval of Child 75 78.8 0.001 -3.8
Expectation of Child 72.2 76 0.01 -3 .8
Consistency of Discipline 76 79.3 0.05 -3.3
Stimulation of Child 74.8 82.1 0.001 -7.3
Families with placem ent scored below families w ithout
placement on all scores. Families experiencing placement scored
below marginal on 13 items, (*).
Table 5.5
Data courtesy of Walter R. McDonald and Associates, Inc.,
Evaluation of AB 1 562 In-Home Care Demonstration Projects, p.
5.21, 1990.
151
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Mean differences at termination between families whose
children were placed and those families that were not placed.
Child Well-Being Scale Score Score
Indicator Placed Not Placed difference
Physical Health Care 92 95.6 -3 .6
N u tritio n /D iet 86 92.1 -6.1
Personal Hygiene 93.5 96.2 -2 .7
* Household Furnishings 90.6 93.6 -3 .0
Overcrowding 88.5 90.3 -1 .8
Household Sanitation 87.6 92.7 -5.1
Security of Residence 95.4 97.9 -2 .5
Physical Safety 86.9 91.6 -4 .7
Mental Health Care 78.8 84.5 -5 .7
Supervision of Young 85.9 91.3 -5 .4
* Supervision of Teenagers 89.9 91.5 -1 .6
Arrangement for Subs. Care 89.5 94.6 -5.1
Money Management 87.5 94.5 -7 .0
Capacity for Child Care 70.9 79.7 -8 .8
* Parental Relations 59.3 70.6 -1 1 .3
Continuity of Parenting 85.6 92 -6 .4
Recognition of Problems 62.1 74.8 -1 2 .7
Motivation to Solve Problems 74.5 82.8 -8 .3
Cooperation with Case Plan 72.9 84 -11.1
* Support for Primary Caretaker 87.5 97.1 -9 .6
Availability of Services 84.2 87.5 -3 .3
Acceptance of Child 73.9 83.3 -9 .4
Approval of Child 79.9 83.6 -3 .7
* Expectation of Child 77.4 83.8 -6 .4
* Consistency of Discipline 81.5 87.2 -5 .7
* Stimulation of Child 80.2 87.3 -7.1
On the average, both groups improved after receiving
services. Families experiencing placement remained below
marginal in 7 of the original 14 items, (*).
Table 5.6
Data courtesy of Walter J R . McDonald and Associates, Inc.,
Evaluation of AB 1562 In-Home Care Demonstration Projects, p.
5.22, 1990.
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Logit Analysis of risk factors identified at intake
associated with out-of-hom e placement for families receiving
services.
Variable Standard Significance Odds
Error Ratio
Previous involvement
w ith Social Services .59 .10 2.8
Adult member of
fam ily is incarcerated 1.58 .01 102.3
Unexpected case closing 1.68 .01 72.4
Case worker reports
aggression .33 .05 2.0
Logit Analysis of risk factors identified at intake
associated with out-of-home placement for comparison group
fam ilies.
Variable Standard Significance Odds
Error Ratio
Previous involvement
with Social Services .76 .01 8.6
Low-cost living
conditions .53 .001 6.18
Low emotional stability .42 .01 2.99
Passive in the
interviewer's judgm ent .63 .01 .18
As can be seen, the only variable common to both groups
was previous involvement with social services.
Table 5.7
Data courtesy of Meezan and McCroskey, Family
Preservation and Family Functioning, p. 288, 290, 1997.
153
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5 .3 Conclusions From the Survey of Evaluation
D ata
Conclusions From th e W a lte r R. M cDonald and
A s s o c ia te s , Inc. 1 9 9 0 D a ta
Several significant differences were found in the Child
Well-Being Scores between families in which children were
placed and those families where children were not placed. In
general, at intake, children who were placed scored higher
overall than children who were not placed. (See Table 5.2) A fte r
intensive family preservation services were provided, the scores
of children who were placed were lower in the areas of threat of
abuse, school attendance, and child's misconduct. (See Table 5.3)
In comparing the differences between children placed and not
placed after intensive family preservation services, children
who were not placed showed significant improvement in the
areas of abusive physical discipline, threat of abuse, and child's
misconduct. The average improvement in the area of abusive
physical discipline a fte r experiencing family preservation for
those children not placed was 2 0 .8 points. (See Table 5.4)
154
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In general, the families of children that were placed scored
higher than the families that were not placed. (See Table 5.5)
On the average, both groups improved after receiving services.
Families experiencing placement remained below marginal in 7
of the original 14 items: household furnishings, supervision of
teenager, parental relations, support for primary caretakers,
expectations of child, consistency of discipline, and stimulation
of child.
Family preservation services were especially beneficial to
those families experiencing placement in problem areas such as
mental health care, security of residence, continuity of
parenting, recognition of problems, motivation to solve
problems, and acceptance of children. In the eighty percent of
families in imminent danger of having their children placed that
did not experience placement, intensive family preservation
services provided significant improvement in areas such as
parental relations, expectations of child, consistency of
discipline, and stim ulation o f child. (See Table 5.6)
155
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O f the tw enty-eight items in the Child Well-Being Scale
that were addressed to families at the intake phase of the family
preservation services, four were cited as having a significant
difference between those families whose children were placed
regardless of whether they received intensive family
preservation services or not: (Walter R. McDonald and Associates,
Inc., p.5.16, 1990)
• the primary caregiver was reported as having one or more
disabilities,
• the family was receiving public assistance,
• the family had experienced prior placements, and
• additional investigations for abuse or neglect of a child
were conducted.
C onclusions From th e M eezan and M cCroskey 1 9 9 7
D ata
It appeared that a family's risk factors were related to
having children placed into out-of-hom e care. To understand
156
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fu rth e r which variables would be the best predictors of
placem ent, a stepwise logit analysis was performed.! The
following four variables remained as being related to children
being placed out-of-home: (see Figure 5.7) (Meezan and
McCroskey, p. 288, 1997)
• incarceration of an adult family member,
• previous, unplanned case closings,
• previous, serious involvement with the county social
services agency, and
• aggressive behavior as assessed by the worker.
Thus, for example, the incarceration of an adult family
member was the primary predictor of children in the family
being placed in out-of-hom e care. In a family in which one
member was in prison or jail, there is a 102 times greater
likelihood that a child would be placed in care than a family
without an incarcerated family member (Meezan and McCroskey,
p. 2 8 8 ,1 9 9 7 ).
157
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A stepwise logit analysis was also run with the variables
identified with the control group.2 Four variables remained in
the model: (see Table 5.7 ) (Meezan and McCroskey, p. 288, 1997)
• previous involvement with the county social service
agency,
• living conditions as observed and reported,
• lack of emotional stability, and
• passive in the interviewer's judgment.
As with the findings of the group of families receiving
family preservation services, this model was statistically
significant and further analysis (which was not identified)
showed that the model positively predicted one-half of the
families whose children entered placement during the study.
When the model was utilized on the characteristics of all of the
families served, it predicted nonplacement for ninety-four
percent of the families (Meezan and McCroskey, p. 290, 1997).
Interestingly, the researchers found no relationship
between family or case worker reported Family Assessment
158
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Form scales at intake and later out-of-home placement. This is
indeed puzzling in that there were direct correlations with
findings of family functioning utilizing the Child and Family
Well-Being Scale but not the Family Assessment Form. Also,
these approaches found that no significant difference between
the group receiving home-based services and the comparison
group in the number of placements that occurred; however, it
appeared that the placement process may have been delayed for
the families receiving services (Meezan and McCroskey, p. 287,
1997).
C onclusions From th e W a lte r R. M cDonald and
A s s o c ia te s , Inc. 1 9 9 7 D a ta
In the McDonald and Associates, 1997 study of nine
California counties, family diversity was addressed by using a
multivariate approach which provided mathematical controls for
the variations among families and children. Successful outcome
was defined as the child not being placed in out-of-home care
159
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within one year after family preservation services were
provided. Data were collected for 2,142 children.
Multivariate analyses are useful because they can control
for the effects of other variables while isolating the effects of a
particular characteristic. For example, if one increases the
presence of a characteristic, such as a parent or significant
adult being involved in hard-core substance abuse in a child's
environment, as compared to other children that have the same
other environmental factors, such as income, age, and previous
involvement in out-of-home care, without the exposure to hard
core drugs, and there is a significant difference in placement
rates, then there is an increase in the likelihood that placement
will result.
When results are identified by individual risk factors while
all other factors remain constant, it is beneficial for discussion,
but in abusive families, other factors are not constant. For the
child protective service practitioner who has a perception of a
large number of environmental factors, those characteristics
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that influence the placement decision need to be separated from
others, even when other factors are not controlled. Bivariate
analysis can be used to identify those significant characteristics
that identify placement risk regardless of whether other factors
are not controlled. The evaluation found that significant risk
factors (p <.05) associated with out-of-home placement included:
(Yuan et al., p. 3.4-S.8, 1997)
• reported alcohol or drug abuse by the primary caretaker,
• prior placement history,
• younger children at risk of severe neglect, and
• living in a shelter.
Like the Meezan and McCroskey 1997 study, the Family
Assessment Form was used to assess family circumstances both
at intake and termination. However, the form was modified and
only completed for 272 of the 9 5 3 families in the study. The
changes in family functioning were quite small. The mean score
at the intake of the services suggested that the families, in
general, had only moderate problems to begin with and were
161
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functioning adequately. No data was presented that related the
Family Assessment Form and out-of-home placement (McDonald
and Associates, p. 4.7, 1996).
5 .4 Fram ing th e Findings: D eveloping a Tool to
A s s is t in D e te rm in in g W hich F a m ily -B a s e d S e rv ic es are
M ost A p p ro p ria te or W h e th e r O u t-o f-H o m e P lacem en t
Should be A d vo cated
Several issues persistently arise. One has to do with the
target population; how many of the children served were actually
im m inently at risk of placement? Another has to do with who
made the decision and how it was determined that the children
were im m inently at risk of placem ent. Finally, what research-
based findings can assist those in decision-making
responsibility areas. What are family risk factors that most
often are associated with children th a t are referred for out-of-
home placement?
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It appears that the concept "imminent risk of placement" is
not clearly operationally defined due to numerous reasons. First,
the criteria in determining risk factors are not agreed upon. In
the previously-mentioned 1997 Walter R. McDonald and
Associates, Inc. evaluation of family preservation, inconsistent
criteria were used to screen out families that appeared to be at
risk o f imminent placement.
Second, there is no standardized timeframe developed in
which to determine imminent risk of placement. Often, families
in crisis are families of changing and unpredictable
circumstances. Decisions regarding placing a child into
protective custody may be made too early or too late.
Third, different contexts in different counties may drive
decisions to place children. For example, a county that has just
opened an assessment center for youth at-risk may place
children more often than a county that has a lack of foster
parents.
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A fourth circumstance affecting the placement of children
is the availability of relatives who can take their kin into their
home. Of all placements, the placement of children with kin has
increased more than any other placement type. In California,
fifty -fiv e percent of formal placements are with relative
providers. In these cases, placement decisions may be driven by
availability as opposed to care characteristics.
Finally, in that there are few consistent indicators o f
imminent risk o f placement, the determination of whether a
child is to be placed is based on the subjective judgments and
experiential foundations of workers assigned to assess the need
for out-of-home placement (Pecora et al., 1995, Walter R.
McDonald and Associates, 1996, Meezan and McCroskey, 1997).
It appears that, by using existing research which
associates risk factors present in families with placement of
children in out-of-hom e placement, no conclusions based on
statistical analysis can be drawn. This is primarily because
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well-being scales and definitions used in each study were
d ifferen t. However, by drawing on the risk factors utilized to
exclude families from family-based services, a decision-
assisting tool based upon assumptions underlying those risk
factors can be presented. Such a tool should include the many
individual variables that enter into placement decisions of the
person making a recommendation which do not have consistent
applications across families.
It cannot be assumed that relationships that develop
between the family being served, the worker and the quality of
the hours of services provided to the family are of equal value to
each family being served. Most likely, the relationship between
the worker and the family is a significant influence on service
outcomes.
"Certainly, this relationship between family and
worker influences the success of the service. The
field as a whole must pay much more attention to the
characteristics and dynamics of those relationships,
the capacities of workers to develop meaningful
relationships with different kinds of caregivers, the
165
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professional preparation and training needed by
workers to develop effective relationships, and the
support that organizations should provide to workers
to make these relationships possible and productive"
(Meezan and McCroskey, p. 308, 1997).
It was hoped that, by surveying research of family
preservation programs that identified risk factors associated
with out-of-hom e placement, the benefits of blind studies would
be present. By targeting research which provided information on
reasons for placement as a by-product, it was hoped that the
"Hawthorne Effect" could be minimized.
It has been suggested that data should be collected to
identify specific behavioral characteristics of children and
!
families th at place children at-risk of out-of-hom e placement,
rather than relying on legal labels (Yuan et al., p. 5.9, 1997). A
summary of the findings from all of the studies surveyed which
associate lower family risk factors scores on selected variables
with the children in those families being placed out of home is
provided, (see Table 5.8)
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Summary of findings: Scores on family risk factors which were
consistently lower for those families whose children were
placed out-of-home.
abusive physical discipline
acceptance of child
additional investigations for abuse or neglect of a child
adult member of family is incarcerated
aggressive behavior as assessed by the worker
child with significant health or mental health problem
child's misconduct
children that ran away frequently
consistency of discipline
coping behavior of child
economic exploitation
family had experienced prior placements
fam ily was receiving public assistance
greater involvement in the judicial system members
hard-core drug or alcohol abuse
history of children placed in placement in the past
household furnishings
incarceration of an adult family member
lack o f emotional stability
living in a shelter
long-standing substance abuse problems
longer and more troublesome history
low em otional stability
low-cost living conditions
motivation to solve problems
not a commitment to cooperate with the program
ongoing dependency investigation that could lead to the
removal of children from the home
parent involvement in drugs or alcohol
passive in the interviewer's judgm ent
persistent neglect
physical abuse to a child under the age of three
Table 5.8, Part 1
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Summ ary of findings: Scores on family risk factors which were
consistently lower for those families whose children were
placed out-of-home (continued).
poorer work history
previous history of children in placement
previous involvement with Social Services
previous serious involvement with the county social
services agency
previous unplanned case closings,
primary caregiver was reported as having disabilities
problems with housing
prostitution,
protection from abuse
recognition of problems
reported alcohol abuse by the primary caretaker
reported drug abuse by the primary caretaker
school attendance
security of residence
severe mental health diagnosis
severe physical abuse cases
severe presenting problems with minimal services
sexual abuse
sexual abuse cases where the perpetrator is in the home
spouse had demonstrated a pattern of having an abusive
partner or partners
stim ulation of child
supervision of teenagers
support for primary caretaker
threat of abuse
unexpected case closing
younger age of parents
There is no predictive value assigned to any of the
variables, nor are they listed in any rank order associated with
risk.
Table 5.8, Part 2
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These risk and safety factors have been sorted into seven
areas. The first area is a "Red Flag" issue area that combines the
eleven factors directly associated with out-of-home placement
in the three studies reviewed. Research has shown that if
families have just one of these risk factors it usually indicates
that the family's children will be placed into out-of-hom e care
regardless if family-based services are provided or not. When
any of the eleven factors indicate that a serious risk or safety
problem exists or that the child is in danger, a child protective
service worker or probation officer should consider that the
family may not be suitable for family-based services.
A decision-assisting tool has been developed which frames
case workers' decisions into two dimensions. The tw o-by-tw o
matrix has been developed so that the foundation of the decision
to place a child in out-of-hom e care or to provide family based
services can be seen and the critical elements easily identified.
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A horizontal scale represents the degree of risk in a family
from "C" for a critical environment where the child is in danger
to "N" for no perceived problem. A vertical scale allows for
subjective judgments as to whether out-of-home placement is
advocated, a score of "PA," or if family-based services are
advocated and a family strength exists in the area, a score of
"f s :
First, risk factors are defined along a horizontal, linear
representation of risk and safety factors. The "Red Flag" risk and
safety factors include: 1.) the primary caregiver was reported as
having one or more disabilities, 2.) there has been previous,
serious involvement with county social services agency, 3.) there
have been previous, unplanned case closings, 4 .) in the worker's
judgment, there is aggressive behavior in the family, 5.) there is
a history of investigations for abuse or neglect, 6.) children in
the family have been previously placed into out- of-home care,
7.) an adult family member is currently incarcerated, 8.)
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current, living conditions put children at-risk, 9 .) in the worker's
judgm ent, there is a lack of emotional stability in the home, 10.)
in the worker's judgment, the primary caregiver is passive, and
11.) the family is currently receiving public assistance.
A score of "C" represents the worker's opinion that the
child is in critical danger. A score of "S" represents that a
serious risk or safety problem exists. A score of "M" represents
that a moderate problem exists. A score of "P" denotes that a
possible problem exists, and a score of "N" denotes that no risk
or safety factor exists in the area identified.
A second, vertical dimension is provided in the decision-
assisting tool. This dimension allows the case worker to
identify on a spectrum for each risk and safety factor a range of
action from advocacy for out-of-hom e placement, "PA", to
appropriateness for family-based services, "FS". A score of "PA"
would indicate placement is advocated given the issue or
condition. A score of "PB" denotes that out-of-home placement
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may be beneficial. A score of "MI" denotes that the issue is
neutral on the spectrum. A score of "FA" would indicate that
family-based services are advocated, and a score of "FS" would
indicate that a fam ily strength exists in the area. (See Figure
5.9)
All of the risk factors are then divided into issue clusters
that have been identified by previous decision-makers to exclude
families from receiving family-based services. These include;
1.) child-related issues that have been used to exclude families
from family-based services, 2 .) fam ily-related issues, 3 .)
income-related issues, 4 .) mental health of caregiver(s), 5.)
parenting-related issues, and 6.) neglect and abuse issues. Each
issue area is scored on its own two-dimensional matrix. As with
the above description, the risk factors are defined along a
horizontal axis and the appropriateness of placement versus
family-based services spectrum is represented along the
vertical axis. (See Figure 5.10)
172
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Red Flag risk factors
V ertical axis: Appropriateness of
Out-of-hom e placement vs.
Family based services
Horizontal axis: Risk and
safety factors present in
the home.
Horizontal axis: Risk and safety factors
No information on these issues____________________________
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Vertical axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Figure 5.9, Part 1
Red Flag risk factors that have been directly associated with the
placement of children into out-of-hom e placement.
173
FS
c s
FA
M P N
Nl
PB
PA
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RF-1.) The primary caregiver was reported as having one or more
disabilities.
R F-2.) There has been previous, serious involvement with the
county social services agency.
R F-3.) There have been previous, unplanned case closings.
RF-4.) In the worker's judgment, there is aggressive behavior in
th e family.
R F-5.) There is a history of investigations for abuse or neglect.
RF-6.) Children in the family have been previously placed in to
out-of-home care.
RF-7.) An adult family member is currently incarcerated.
RF-8.) Current living conditions put children at-risk.
RF-9.) In the worker's judgm ent, there is a lack of emotional
stability in the home.
RF-10 .) In the worker's judgm ent, the primary caregiver is
passive.
R F -11.) The family is currently receiving public assistance.
Figure 5.9 part 2
Red Flag risk factors that have been directly associated with the
placement of children into out-of-hom e placement
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Risk factors to assist in placement decisions
C hild-related issues Fam ily-related issues
FS FS
c S
FA
M P N C s
FA
M
P N
Nl Nl
PB
PA
PB
PA
No Info
Nn Infn
Incom e-related issues Mental health of caregiver
FS FS
C
S
FA
M
P N
c s
FA
M P N
Nl Nl
PB
PA
PB
PA
No Info.
No Info.
Parenting-related issues
Neglect and abuse issues
FS FS
C
S
FA
M P N
C S
FA
M P N
Nl Nl
PB PB
PA PA
No Info. No Info.
Figure 5 .1 0 , Part 1
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C-1.) Child's misconduct
C-2.) Child has significant health or mental health problem
C-3.) Coping behavior of child
C-4.) The child attends school minimally
Fam ily-related issues
F-1.) There is only one primary caregiver.
F-2.) Household furnishings
F-3.) Security of residence
F-4.) Problems with housing
F-5.) Living in a shelter
F-6.) Low-cost living conditions
F-7.) Family relations
F-8.) Aggressive behavior as assessed by the worker
F-9.) Motivation to solve problems
F-10.)N ot a commitment to cooperate with the program
Incom e-related issues
1-1.) Economic exploitation
1-2.) Family was receiving public assistance
1-3.) Poor work history
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N * No perceived problem.
Horizontal axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Risk factors to assist in placem ent decisions
Figure 5.10, Part 2
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Mental health of caregiver(s)
M-1.) Low emotional stability
M-2.) Severe mental health diagnosis
M-3.) Lack of emotional stability
Parenting related issues
P-1.) Consistency of discipline
P-2.) Acceptance of child
P-3.) Approval o f child
P-4.) Stim ulation of child
P-5.) Recognition of problems
P-6.) Passive in the interviewer's judgm ent
P-7.) Abusive physical discipline
Neglect and abuse issues
N-1.) Persistent neglect
N-2.) Protection from abuse
N-3.) Spouse having a pattern of an abusive partner or partners
N-4.) Severe physical abuse cases
N-5.) Perpetrator resides in the house
N-6.) Threat of abuse
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M * Moderate problem,
P a * Possible problem, and
N = No perceived problem.
Horizontal axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Risk factors to assist in placement decisions
Figure 5.10, Part 3
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Specific instructions for the use of the tool are provided in
Chapter Six. This instrument is not intended to be used to assess
changes in families over time.3 It is the intent of this
instrument to be a practice driven instrument; not a static,
research-driven instrument. A practice-driven instrument is a
tool that can be adapted to meet various situations that
professionals in the child protection services field need. It is
hoped that this instrument will be reinvented over time and
shared among professionals at wrap-around conferences as best
practices in the field change and develop.
5 .5 Im p lic a tio n s fo r F a m ily -B a s e d S e rv ic e s :
Fast Lanes and Road Kills on th e B ridge in to th e
T w e n ty F irs t C e n tu ry
The promotion o f family preservation programs, family-
based services, and wrap-around services is based on two
assumptions. One is th at the costs of services would be less
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compared to estimated costs of placement. The second
assumption is that placements would be reduced. To date, the
evidence provided by family preservation programs is that
financial savings are minimal and mixed. As has been shown in
the review of findings of experimental evaluations, the
assumption that placement would have occurred in the absence of
services is not supportable. If evaluations cannot show that
family preservation programs indeed reduce placement, then cost
reductions cannot be inferred (Littell and Schuerman, p. 22,
1995).
In California, in the fifteen years to 2000, the costs of
foster care increased over four-fold, and the number of children
in placement increased just under three fold. There is clearly a
state-level fiscal motivation to reduce increased costs of out-
of-home placement. A clear need exists to encourage innovation
in meeting the continuously changing needs of this diverse
population of children.
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Politically speaking, providing family preservation and
wrap-around services is the right thing to do. However, from the
public administrators' viewpoint, how to do the right thing must
still be determined. As a result of non-conclusive findings
regarding the success of family preservation programs, a lack of
increased federal funding has resulted; and this, in turn, has led
to stagnation in funding of family preservation programs. These
family preservation programs have become road kills on the
bridge to the tw enty first century.
On the other hand, wrap-around services are expanding
significantly. While the founding concepts of wrap-around
services are similar to family preservation programs, wrap
around services are targeted only to those children that are in
expensive placements or have the potential of being placed in
expensive placements. While there are no evaluations of wrap
around services to date in California, there has been a court
finding that they must be provided in order to m eet the law
requiring that children receive services in the least restrictive
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environment. As a result of legal action, wrap-around services
are in the fast lane on the bridge to the tw enty-first century.
California's AB 2706, which was signed into law in the fail
of 2 0 0 0 , permits the use of federal, state, and county foster care
funds to be diverted from group home rates to wrap-around
services for children when it is determined the children are at
imminent risk of placement into group homes w ith rate
classification levels of ten or greater. The monthly placement
costs for a rate classification level of ten is $ 4 ,6 3 3 , and the
cost for classification level fourteen is $ 6 ,0 7 6 , effective
January of 2001. According to the California Alliance of
Children and Family Services, in 1997, sixty-seven percent of all
of the children placed in group home care were placed in group
homes with rate classification levels of ten or greater (personal
communication). Until this presentation of a tool to assist in the
determination of imminent risk of placem ent, imminent risk of
placement decisions were based in the past fifteen years on the
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subjective judgments of social workers and probation officers
(Cole and Duva, p. 88-89, 1990, and personal survey).
In 1995 the following observation was made;
The makers and analysts of poverty policy have
largely ignored the foster care program, even though
it is a direct programmatic out growth of AFDC {Aid
to Families with Dependent Children} and about half
of the children in care come from families th at are
eligible for receiving AFDC. This lack of attention to
foster care is a serious and potentially costly
oversite. In light of the troubling trends in the foster
care case load, welfare reform plans currently under
discussion may well reap unanticipated - and
expensive - consequences. (Courtney, p. 27, 199 5 )
Between 1981 and 1993, federal expenditures for foster
care maintenance payments and administration increased by 825
percent from $3 0 9 million to $ 2 .5 5 billion. Estimated federal
expenditures for foster expenditures in 1999 increased another
172 percent to $ 4 .3 8 billion. The ratio of federal costs of Aid to
Families with Dependent Children over federal expenditures for
foster care maintenance payments and administration has been
changing dramatically. The ratio was 25 to 1 in 1981. By 1999,
it has been estim ated that the ratio will decline to 4 to 1
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(Courtney, p. 27, 1995). Unfortunately, while federal costs of
foster care have increased drastically, federal expenditures for
case workers has increased minimally. A fter adjusting for
inflation, federal funding for casework services grew by about
fourteen percent while federal foster care spending grew by over
400 percent between 1981 and 1993 (Courtney, p. 30, 1995).
"If foster care is intended to be the life raft for
children who can no longer remain safely at home,
then the boat is being swamped, not only by the sheer
number of its passengers, but also by their numerous
and expensive needs." (Courtney, p. 30, 1995)
It is hoped that in constructing the bridge into the twenty-
first century, policy makers will go beyond the symptoms of a
problem, children in foster care, and tackle the causes, poverty
and abuse of alcohol and other drugs in families, in a
preventative manner by providing flexible funding and waivers
for family-based services. Failure to do so can contribute to the
careers of young criminal adults at an estim ated cost of $1.1
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million to taxpayers for each young criminal(Kumpfer, p. 10,
1998).
As a society, we have a long tradition of
coming to the aid o f families only when parents have
"failed" in some significant way to care adequately
for their children. Even then, we do so grudgingly,
and our efforts are feeble at best. As long as this is
our approach, we will likely find ourselves paying
’strangers' - or, even more ironically, relatives -
much more to care for children than we will pay to
support parents to care for their own. (Courtney, p.
32, 1995)
There is no doubt that reconstituting a family after foster
care is much more difficult than keeping a family together (Kelly
and Blythe, p. 31, 2 0 0 0 ). By identifying families that are at risk
of having their children removed into out-of-home care and
carefully targeting those families that can best be served by
family-based, wrap-around services unless children require the
safety of out-of-home placement, the prevention dollar can be
wisely invested. The return on the dollar could be measured by
the value of breaking the cycle of child neglect and abuse for
generations.
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Family preservation programs became road kills on the
bridge into the tw enty-first century because the outcomes
expected by policy makers were unmet. Wrap-around services
are currently in the fast lane because of both legislative and
legal action. Public administrators, in their mission to support
the welfare state as advocates for client groups, and in their
role as knowledgeable sources for policy development, may need
to pursue issues into the legal arena when the political arena is
slow to act. For wrap-around services to remain in the fast lane,
outcomes must be based on documentation of improvements in
children's well being, family functioning, cost savings resulting
from the avoidance of traditional residential treatm ent, and
reduction of unnecessary out-of-hom e placements. It is
anticipated that, with the utilization of the two-dimensional,
imminent-risk tool provided here, those families that can best
be served by wrap-around services can be identified and not be
confused with families whose children must be removed.
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1 Logit analysis is a logistic regression analysis technique
where the dependent variable is nominal. As with multivariate
analyses, the reader is cautioned to views these findings as
ten tative given the assumptions of the statistical technique used
and the nature of the data in the study. These data are presented
to suggest potential trends in the data and to offer directions for
further study.
2 See the previous note.
3 A summary of assessment instruments and practices is
provided by Pecora et al. (1 9 9 5 ). More recent family assessment
instruments include the North Carolina Family Assessment Scale,
Version 2.0, Kirk, R. S., and Reed Ashcraft, K, (June 1998) and the
Colorado Safety and Assessment/Plan (August, 2000).
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Chapter Six Summary and Conclusions
This chapter provides an example of the two^by-two
decision assisting tool. This chapter also questions the
applicability of outcome measures to drive determination of
whether social services are successful and cost effective. The
chapter concludes with suggestions for additional research.
Evaluations, such as those performed on family
preservation demonstration project evaluations, are rare and
expensive. Given that the data has already been gathered,
regardless of its limitations, it is im portant to draw as much
information from it as possible. As mentioned earlier, it was
postulated that a m eta-evaluation of the findings of family
preservation research could lead to development of family well
being measures that could predict outcomes regarding out-of-
home placement based on family-risk factors and, thus, provide
policy tool for social service departm ents.
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No statistically-based conclusions could be supported
based on a literature review that included three experimental
studies because no consistency was found in the family risk
factors that were measured. However, a two-dim ensional,
imminent-risk tool has been developed to assist child protective
service professionals in determining whether a child should be
removed from his/her home.
6.1 A p p lyin g th e T w o -D im e n s io n a l, Im m in e n t-R is k
T ool
California's policy has shifted from placing children in high
cost residential tre a tm e n t to utilizing fam ily-based, wrap
around services (SB 163 and AB 2 6 0 7 ). It would be appropriate
to evaluate the outcomes of this movement not only in terms of
placement prevention and cost/benefit implications but also in
terms of improvement o f family functioning. As a provider of
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residential treatm ent to juvenile youth in California over the
past tw enty years, this writer often perceived that the provided
services primarily targeted the symptoms of the problem, the
youth; and minimally addressed the causes of the symptom, that
is, working to enhance the family dynamics and building on the
strengths existing in the family. It seems intuitive that, with
the average cost of group home placement rising to close to
$ 4 ,5 0 0 per month per child, a family with two children at
imminent risk of placement could be served for less than $ 9 ,0 0 0
per month.
Both service providers and policy makers agree that the
intent of providing family-based, wrap-around services is to
reduce unnecessary out-of-home placements, enhance the child's
well being, improve family functioning, avoid the costs of high-
end residential treatm ent, and provide services in least
restrictive settings. If research on wrap-around services were
to show that placement was not significantly reduced, as has
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been th e finding in some of the family preservation studies
identified above, it is important to determine that family
functioning has changed so that the potential exists for
avoidance of future placements and family dynamics through the
next generation are improved. Regardless, it is important to
address the outcomes of interest to policy makers.
The population served consists of families referred to
California county child protective services offices and all
families deemed to be at imminent risk of out-of-home
placement. It was expected that basic measures of variables
such as a birth parent being incarcerated and/or criminal
activity taking place in the home, and/or habitual use of alcohol
and other drugs by the primary caretaker, and/or mental
instability of the primary caretaker would be common fam ily
risk factors utilized among the studies. Specifically, it was
expected that a common variable among imminent at-risk or
placement factors associated with out-of-hom e placement would
be children born to crack addicted mothers.
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Crack cocaine is the most insidious enemy that the
black community has faced in its perilous history.
It's a different kind o f beast. Like five-hundred-
pound termites, crack gnaws away at the
superstructure of a community, destroying values,
people, and families. So powerful are the jaws of
crack cocaine that they have chewed through the
steel cords binding black mothers and their children.
Crack is the only thing in our history, chemical or
whatever, that has been able to come between black
women and the mothering process. The KKK couldn't
do that. Jim Crow couldn't do that. The Old South
couldn’t even do that. (Marshall, p. 207, 1996)
6 .2 In s tru c tio n s fo r th e V is u a l-B a s e d , T w o -
D im en sion al D ecision Tool D esig n ed to A s s is t in
D e te rm in in g Im m in e n t Risk o f P la c e m e n t
The two-dimensional, imminent-risk tool is intended to
assist in decision-making. It is not to be used as a sole
determinant. Like a doctor's stethoscope, "vital signs" of
children can be quickly assessed. If, while using the
stethoscope, questions are raised, further investigation is
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warranted. In diagnosing patients more than a simple tool is
utilized; likewise, with the imminent-risk tool. It is only one of
the tools that can be used in the extensive process of
determining if children should be removed from their birth
family.
The two-dimensional, decision tool is composed of seven
parts, or clusters of issue areas, and two scales: an objective
scale identifying risk areas, and a subjective scale to assist in
determining if family-based services or out-of-hom e placement
is appropriate. Only one family at a time should be assessed on
the two-dimensional decision tool. If no information exists for a
specific issue area, the number of the issue should be listed on
the "no info." line ju st below each two-dimensional issue cluster.
The first issue cluster is on an individual page identified
as "Red Flag risk factors." These risk factors have been directly
associated with placement of children into out-of-hom e care.
The other six clusters are scored on one other page titled; "Risk
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factors utilized by family preservation programs to exclude
families from services." These clusters include issues that
individual county programs identified to exclude families from
taking part in famify-preservation programs and issues that have
been associated with families that have had children placed in
out-of home care regardless of whether they received family
preservation services or not. These issue clusters include; 1.)
child-related issues, 2 .) fam ily-related issues, 3 .) income-
related issues, 4 .) mental health issues related to caregiver(s),
5.) parenting-related issues, and 6.) neglect and abuse issues.
Each issue area is scored on its own individual two-dimensional
matrix.
Each specific risk within an issue cluster is scored
individually on the tw o-by-tw o m atrix. Horizontal placement
represents the extent of risk in the family. Vertical placement
represents the decision-maker's opinion on a spectrum related to
whether family-based service or out-of-hom e placement is
recommended as a result of each specific risk area examined.
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The horizontal scale is an objective based scale that
identifies information about the risk factors in a family. The
left end of the scale represents an environment in which a child
is in critical danger of being neglected and/or abused. A "C"
represents the left end of the scale. The right end of the scale is
indicated by an "N" which represents that there is no perceived
problem. Between the "critical danger'1 and "no perceived
problem" extremes, the decision-maker can select a score around
"S" which represents that a serious risk or safety problem may
exist, a score around "M" that represents a moderate problem may
exist, or score around "P" which denotes that a possible problem
exists. The decision-maker can select any point along the scale.
Each risk factor is scored individually on the specific matrix
that represents the particular cluster of risk factors.
The vertical scale allows for subjective judgm ents as to
whether out-of-hom e placement is advocated; this option is
represented by scores on the lower end of the scale. If family-
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based services are judged to be more appropriate, this will be
represented by scores on the upper end of the scale. This
vertical axis allows the decision-maker to identify each risk and
safety factor on a spectrum. The top area of the matrix
represents that it may be most appropriate for a family to
receive family-based services because there is a family
strength. This is represented by an "FS" at the top of the scale.
A score of "FA" would indicate that family-based services are
advocated. A score of "Nl" denotes that the issue is neutral. A
score near "PB" denotes that out-of-home placement may be
beneficial. A score of "PA" at the bottom of the axis would
indicate placement is advocated given the issue or condition.
By scoring using the assessment tool, a two-dimesional,
visual-based diagram, (Figure 5.8 and 5 .9 ) the professional and
his/her supervisor can immediately identify risk areas th at may
warrant further investigation. While there may be a
predominance of scores in the upper right quadrant, a significant
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risk facto r can be identified in the lower left quadrant that may
lead th e social worker to advocate that the child be removed
from the home.
This tool for assessment of family issues is not intended
to be used by itself to determine changes in families or to assist
in determining outcomes.
6 .3 An Exam ple o f th e A p p lic a tio n o f th e Tw o -
D im e n s io n a l, Im m in e n t-R is k D ec is io n T o o l
The following are scenarios for two families and how they
might be rated using the visual-based, two-dimensional
decision-assisting tool.
Case One Vignette
The Mendoza family originally referred by the
elementary school for behavioral problems of the son
enrolled in first grade, had been seen by the agency at
least three times previous to this case opening. The
family income, for two parents and three children
ages nine, seven, and two, was less than $ 10,000
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annually, derived primarily from AFDC {Aid to
Famifies with Dependent Children}. All three children
were assessed as having developmental problems: the
nine-year-old daughter was aggressive and threw
tantrum s, the two-year-old daughter had verbal
delays, and the seven-year-old was oppositional,
assaultive, and had speech problems.
The worker noted many family strengths,
including evidence that the home was kept clean and
neat, that the mother was very willing to learn, and
the father tolerated the mother's help-seeking and
was willing to follow through on referrals. Serious
concerns were also noted, including the evidence that
the family kept a pit-bull dog chained at the front of
the house, that the father refused to participate in
sessions himself, th a t he did not believe in discipline
at all, and that he would often sabotage the mother's
effo rts
Having knowledge of the family and a
relationship with the mother, the worker was able to
provide brief service focused on the changing
development needs of the children, sibling
interactions, and discipline. (McCroskey and Meezan,
page 244, 1997)
As can been seen in this example, the case worker
could use this tool to validate other methods which would
suggest that family-based services would be appropriate.
197
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Red Flag risk factors
Vertical axis: Appropriateness of
Out-of-home placement vs.
Family based services
Horizontal axis: Risk and
safety factors present in
the home.
No information on these issues____________________________
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Vertical axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Figure 6.1, Case One, Part 1
Red Flag risk factors th at have been directly associated with the
placement of children into out-of-hom e placement.
198
10
FS
2
6 1
7 3
11
C
9
s
FA
M 5
8
P N
Nl
4
PB
PA
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
RF-1.) The primary caregiver was reported as having one or more
disabilities.
R F-2.) There has been previous, serious involvement with the
county social services agency.
R F-3.) There have been previous, unplanned case closings.
R F-4.) In the worker's judgment, there is aggressive behavior in
the family.
R F-5.) There is a history of investigations for abuse or neglect.
R F-6.) Children in the family have been previously placed in to
out-of-home care.
RF-7.) An adult family member is currently incarcerated.
R F-8.) Current living conditions put children at-risk.
R F-9.) In the worker's judgm ent, there is a lack of emotional
stability in the home.
R F-10.) In the worker's judgm ent, the primary caregiver is
passive.
R F -1 1.) The family is currently receiving public assistance.
Figure 6.1 Case One, Part 2
Red Flag risk factors th a t have been directly associated with the
placement of children into out-of home placement.
199
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Risk factors to assist in placement decisions
C hild-related issues
FS
4
2
c S
FA
M P N
1
Nl
3
PB
PA
No Info
Incom e-related issues
2
FS
C s
FA
M
P N
Nl
PB
PA
No Info 1
3
Parenting-related issues
2
FS
3 FA
c s M P N
5
4
Nl
1 PB
PA
Fam ily -related issues
FS
1
8
2
7
FA
c s M
p N
Nl
9
PB
PA
No Info 3 4 5 6 10 __
Mental health of caregiver(s)
FS
C S
FA
M P N
Nl
PB
PA
No Info 1
2 3
Neglect and abuse issues
FS
C S
FA
M P N
Nl
PB
PA
No Info 6 7_________ No Info 12 3 4 5 6
Figure 6.2, Case One, Part 1
200
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C-1.) Child's misconduct
C-2.) Child has significant health or mental health problem
C-3.) Coping behavior of child
C-4.) The child attends school minimally
Fam ily-related issues
F-1.) There is only one primary caregiver.
F-2.) Household furnishings
F-3.) Security of residence
F-4.) Problems with housing
F-5.) Living in a shelter
F-6.) Low-cost living conditions
F-7.) Family relations
F-8.) Aggressive behavior as assessed by the worker
F-9.) Motivation to solve problems
F -1 0 .)N o t a commitment to cooperate with the program
Incom e-related issues
1-1.) Economic exploitation
1-2.) Family was receiving public assistance
1-3.) Poor work history
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Horizontal axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Risk factors to assist in placement decisions
Figure 6.2, Case One, Part 2
201
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M ental health of caregiver(s)
M-1.) Low emotional stability
M-2.) Severe mental health diagnosis
M-3.) Lack of emotional stability
Parenting related issues
p -1 .) Consistency of discipline
P-2.) Acceptance of child
P-3.) Approval o f child
P-4.) Stim ulation of child
P-5.) Recognition of problems
P-6.) Passive in the interviewer's judgm ent
P-7.) Abusive physical discipline
Neglect and abuse issues
N-1.) Persistent neglect
N-2.) Protection from abuse
N-3.) Spouse having a pattern of an abusive partner or partners
N-4.) Severe physical abuse cases
N-5.) Perpetrator resides in the house
N-6.) Threat of abuse
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Horizontal axis: O ut-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl - Neutral issue,
FA = Family-based services advocated, and
FS = Family strength.
Risk factors to assist in placem ent decisions
Figure 6.2, Case One, Part 3
202
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Case Two Vignette
The Smithson family, including 27-year-old
Mrs. Smithson, two-year-old David, and stepfather Mr.
Smithson, were referred to DCFS {Department of
Children and Family Services} for suspected neglect.
The family had two previous contacts with DCFS, and
tw o older children were living in out-of-hom e care.
Mrs Smithson, diagnosed as mildly retarded by the
Regional Center (which provides services for
developmentally disabled children and adults), had
herself been abandoned as an infant and reared by
neighbors who found her on their doorstep. Mrs.
Smithson was easily exploited by others and reported
many incidents of being verbally abused, pushed, and
threatened by friends and neighbors. She had little
knowledge of child development and inappropriate
expectations of her two-year-old, but the family saw
money as its primary problem. Mr. Smithson was not
working and Mrs. Smithson recieved AFDC {Aid to
Families with Dependant Children}.
Family preservation workers spent a great deal
of time with the mother, taking her to the Regional
Center, the welfare office, and social security
offices where they helped translate and complete
forms. The agency also provided toys and clothing.
Mrs. Smithson appeared to respond well to services,
but dropped out before services were complete.
(McCroskey and Meezan, page 242, 1997)
In Case Two, the case worker could use this tool to
validate other methods which would suggest that out-of-home
placement could be appropriate. It is suggested that in any case,
it is agreed upon by a supervisor.
203
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Red Flag risk factors
V ertical axis: Appropriateness of
Out-of-home placement vs.
Family based services
FS
c s
FA
M
(
4
P N
2
Nl
10
1 8
5 6
11
3 9
PB
PA
Horizontal axis: Risk and
safety factors present in
the home.
No information on these issues____________________________
Horizontal axis: Risk and safety factors
C = Critical, Child is in danger,
S = Serious problem,
M = Moderate problem,
P = Possible problem, and
N = No perceived problem.
Vertical axis: Out-of-hom e versus family-based services
PA = Placement advocated as a result of Issue/condition,
PB = Out-of-home placement may be beneficial,
Nl = Neutral issue,
FA - Family-based services advocated, and
FS = Family strength.
Figure 6.3, Case Two, Part One
Red Flag risk factors that have been directly associated with the
placement of children into out-of-hom e placement.
204
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Risk factors to assist in placement decisions
Child-related issues
FS
c S
FA
M P N
Nl
PB
PA
No Info
2 3 4
Incom e-related issues
FS
c s
FA
M N
Nl
1
PB
PA
Fam ily-related issues
FS
i 9
FA
c S M P N
Nl
10
3
PB
PA
No Info 2 4 5 6 7 8__
Mental health of caregiver(s)
FS
C S
FA
M P N
Nl
PB
PA
No ln fo „i L
No Info 1 2 3
Parenting-related issues
FS
C S
FA
M
P N
Nl
PB
PA
No Info 1 2 3 4 5 6 7 ..
Neglect and abuse issues
FS
C S
FA
M
P N
i
Nl
2
PB
PA
No Info
3 4 5 6
Figure 6.4, Case Two, Part Two
205
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6 .4 O utcom e M easures as Feed -b ack M echanism s in
D e te rm in in g P ublic Policy
It has been speculated in conversations with individuals in
the placement arena that the more a caseworker finds out about
a family referred to be at imminent risk of placement, the higher
the chance that the children will be moved into out-of-home
placement. This process has been called "case finding." Simply
put, the more intensive services that are provided to a
dysfunctional family, the more opportunity there is for a social
service worker to observe unsafe conditions within the home and
the higher chance that out-of-home placement will be
recommended (Yuan, p. 3.15, 1997). Concern has been raised that
if a checklist of family risk factors were to be introduced into
placement decisions, it could be misused. If fam ilies did not
meet a preconceived threshold of scores, children could be left in
the home and subjected to unnecessary abuse and neglect.
206
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Consider what would happen if another major institution in
addition to raising children in the nuclear family, for example in
marriage, were to be based on risk factors and statistically
significant outcomes In marriage, the odds of a married couple
filing for divorce are 50:50. From a statistical significance
viewpoint, marriage is not an activity that should be pursued. It
is not appropriate for out-of-home placement decisions to be
based entirely upon significant family risk factors.
There is speculation in the social services arena that if
outcomes of services cannot be measured or that if measurable
outcomes are not met, then funding stagnation or cuts can be
expected. This is probably the case for federal funding of family
preservation programs. If the condition of measurable outcomes
driving public expenditures were to gain a foothold in the
placement arena, the very foundation of the welfare state could
be weakened.! The welfare state encompasses the majority of
the population through its emphasis on quality of life and social
rights, and it acts both as a buffer between the capitalistic
207
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impact of market forces and as a vehicle of those interests. The
welfare state has become a government-induced balancing
mechanism for a m arket-oriented system. If market dynamics
were to be introduced to drive the social services arena, the
resulting outcomes could be catastrophic to the foundations of
the welfare state.
6 .5 S u g g es tio n s fo r A d d itio n a l R esearch
As stated in the conclusion of the five-year evaluation of
family preservation programs in several California counties, "A
reliable and valid method for determining when placement is
appropriate needs to be developed" (Yuan et al., p. 5.8, 1997). In
determining when out-of-hom e placement is appropriate, several
variables should be researched in addition to family risk factors.
One is the availability of placement options. Kinship care
has significantly increased in California over the past ten years.
If appropriate grandparents, aunts and/or uncles are available,
208
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the placement decisions are clearly influenced. As guardianship
and adoptions are promoted, the number of foster homes may
decrease. Research into how to better empower kin providers
could clearly benefit children by reducing the trauma of going to
a stranger's home in the heat of crisis.2
Fiscally-driven influences also enter into placement
decisions. For children that may benefit from highly-structured
group homes that provide mental health services, there are now
two options: group home placement and wrap-around services.
Wrap-around services bring the mental health and other services
that a child receives in a group home directly into the home of
origin. This home can be a birth family, a kinship family, or a
foster family. A goal of wrap-around services is to provide
services to children in the least restrictive environment.
As counties further develop opportunities for wrap-around
services, the variables that determine the appropriateness of
placement will change. As wrap-around programs continue to be
developed and enhanced, services can be provided in the family's
209
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home providing that the child's safety can be ensured. The
development of family preservation programs is currently
fiscally constrained. At this point, there is no clear cap as to
the number of families that can benefit from wrap-around
services. However, services are limited to children who are at
imminent risk of being placed in expensive group homes. Federal
funds for out-of-hom e placement for children from families that
receive federal Temporary Assistance for Needy Families are
entitlem ent funds; that is, as long as a need is determined to
exist, federal funds are not limited. Research into the benefits
of family-based services could assist in developing legislation
to include family-based services in federal waivers in order to
include family-based services in the entitlem ent funding.
In addition to identifying risk factors in families, child
protective service workers that make recommendations for
placement are also being trained to look for family strengths. By
utilizing concepts from the family unity, fam ily-to-fam ily, or
community-based ecological models, caseworkers can focus on
210
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the strengths that exist in families and determine which
services are available to build on those strengths. The family-
based services movement could benefit from research testing
relationships between family characteristics and family-based
service models. For example, is it appropriate to provide the
same services to a family with substance abuse issues as a
family with children in need of mental health services?
In some California counties, for example, San Mateo,
Solano, and Placer, funds have been utilized to provide
assessment centers and non-secure settings for children that
may need more permanent out-of-home care. The determination
of the appropriateness of placing children into temporary county
programs such as these is influenced by the availability of these
programs. Thus, given identical families in two different
counties which have different county-based service availability,
there may be two different views of the appropriateness of
placement. Research could possibly identify which programs are
beneficial and which are not.
211
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Research addressing the effectiveness of family-based
services for families that require out-of-hom e placement is
limited and quite expensive; it is imperative that as much
information as possible be gleaned from existing studies.
i In the late 1990's, the welfare state was defined broadly to
include all kinds of people-helping policies serving every
member of the population at a variety of points in their lives.
Categories of the welfare state currently include regulations at
all levels th at restrain corporations, landlords, and businesses
from public exposure to hazards, maintenance of a minimum
acceptable level of wages, and definitions of working hours that
require overtime. Needs-meeting policies provide basic health
and economic benefits to citizens at risk of poverty, poor health,
and excessive hunger. Opportunity-enhancing policies including
education, training, and affirm ative action, help citizens develop
their potential to enter the economic mainstream and increase
the tax base. A vast variety of social services assists the public
in addressing individual and familial pathologies, and referrals
and linkage programs help people get social services. Equality-
enhancing policies such as Medicaid, AFDC/TANF, Food Stamps,
and progressive taxation targ et specific precarious populations.
Rights-conferring policies seek to protect citizens from
discrimination. Public im provem ent policies benefit all citizens.
Economic-development policies promote economic growth.
Finally, asset-accum ulation policies benefit primarily affluent
citizens such as income tax deductions for mortgage payments
(Jansson, p. 375, 1997.)
212
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2 California's SB 2 3 0 7 , which was signed into law in the fall of
2 0 0 0 , requires community colleges that provide foster care
education classes to provide orientation courses to prospective
kinship care providers.
213
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Asset Metadata

Creator Stovall, Robert Mayo (author)

Core Title Development of a family risk-factor measure that predicts imminent risk of placement and appropriateness for family-based, wrap -around services

School School of Policy, Planning and Development

Degree Doctor of Public Administration

Degree Program Public Administration

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Social Work,sociology, individual and family studies,sociology, public and social welfare

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Clayton, Ross (committee chair), Caulk, Robert (committee member), Newland, Chester (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-111189

Unique identifier UC11326913

Identifier 3027783.pdf (filename),usctheses-c16-111189 (legacy record id)

Legacy Identifier 3027783.pdf

Dmrecord 111189

Document Type Dissertation

Rights Stovall, Robert Mayo

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA