California s Title IV-E Child Welfare Waiver Demonstration Project Annual Process Study Report Intensive Services Components

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California s Title IV-E Child Welfare Waiver Demonstration Project Annual Process Study Report Intensive Services Components October 1, 2002 to March 31, 2003 Table of Contents I. Family Conferencing Sub-study...1
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California s Title IV-E Child Welfare Waiver Demonstration Project Annual Process Study Report Intensive Services Components October 1, 2002 to March 31, 2003 Table of Contents I. Family Conferencing Sub-study...1 A. Introduction and Methodology...1 B. Focus Group Results Fresno Riverside...14 C. Family Conference Observations Fresno Riverside...41 II. Wraparound Sub-study...50 A. Introduction and Methodology...50 B. Alameda Process Study...51 C. Humboldt Process Study...58 D. Los Angeles Process Study...61 E. Sacramento Process Study...67 F. San Luis Obispo Process Study...71 Annual Process Study Report Intensive Services Component, Family Conferencing Substudy (ISFC) Information in this Annual Process Study Report for the Title IV-E Waiver Intensive Services Family Conferencing Sub-study (ISFC) covers the implementation period from April 1, 2002 to March 31, Fresno and Riverside are the two counties participating in this study. Process study data discussed in this report include: (1) focus groups conducted during site visits in Summer 2002 with county program staff; (2) focus groups conducted with county direct service staff in Winter ; (3) direct observations of family conferences conducted in Winter 2001 Winter 2003 and (4) a synthesis of data collected since the study inception regarding the benefits and challenges associated with the experimental intervention, as well as factors that facilitate or constrain implementation. Themes extracted from the data are discussed below. Focus Groups with Staff Themes that emerged during focus groups with varying levels of county staff are presented by county below. This represents a change from the manner in which data have been presented in prior reports. Previously, the data from all counties were grouped together and no county was identified by name. The current format has been adopted in order to increase the readability and utility of the information. Counties were notified of this change by letter on October 17, 2002 and were given assurances that efforts would be made to ensure that the material contributed by a specific individual could not be identified in the report. In addition, county staff were provided the opportunity to review material included in this report prior to its submission. During the past year, evaluation team staff conducted a series of focus groups and interviews with varying levels of Fresno and Riverside county staff to collect data for the Process Study. A focus group with administrative and program staff in Fresno was conducted on July 30, Two telephone interviews were conducted with Riverside administrative and program staff on August 19, 2002 and September 20, 2002, in lieu of a focus group, due to the small numbers of staff involved and staff availability. Focus groups were subsequently conducted with line staff in Fresno and Riverside on December 17, 2002 and January 14, 2003, respectively. Line staff involved in the Waiver program in each county were also asked to complete a short self-administered questionnaire regarding their roles, levels of experience and training (Attachment 1). In total, staff participating in the focus groups and telephone interviews in both counties included agency subdivision managers, ISFC program coordinators, family conference coordinators and facilitators, child welfare staff supervisors, social workers and case aides. Each focus group/interview lasted approximately 2 hours. Data collected during separate focus groups with administrative and line staff have been grouped together below in order to prevent identification of specific individuals. As in prior years, interview questions for the focus groups were developed by CSSR evaluation team staff, following federal guidelines for the IV-E Waiver Process Study. The interview 1 schedules for focus groups with program administrators (Attachment 2) and line staff (Attachment 3) contain items exploring (1) the organizational structure of family conferencing programs, including implementation strategies, program oversight and monitoring, problem resolution, staff acceptance and staffing structure; (2) service factors within each agency, such as characteristics, roles, and training of staff, type and duration of services offered, and timelines and scheduling of program services; and (3) contextual factors, including social and economic factors at the client, county, state and federal levels, community and neighborhood resources, and political factors. Once informed consent was obtained from all focus group/interview participants, the proceedings were recorded on an audio cassette, and notes were taken by all CSSR evaluation team staff in attendance. Evaluation team staff notes were then transcribed and key points/issues were extracted and summarized. The resulting summaries were subsequently sent to the focus group/interview participants for review. When county feedback was provided, it was incorporated into the final draft. Final versions of the focus group/interview summaries for both study counties are included in Attachments 4 and 5. Key themes from the focus groups/interviews with staff in each county are discussed below. In addition, a summary of data collected in both counties via the self-administered questionnaire completed by line staff involved in the Waiver program is presented in Tables 1-4, following discussion of the focus group/interview material. Fresno Focus Group Results Implementation Status: Waiver experimental services in Fresno continued to be implemented within the Voluntary Family Maintenance (VFM) unit. The program continued to focus on preventing out of home placement and court intervention. VFM social workers continued to provide services to both experimental and control group families. The average duration of the experimental intervention was six months. However, some families remained in the intervention for up to twelve months. The agency concurrently implemented a non-waiver conferencing program. Study contamination was avoided by only offering VFM families who did not have a protective hold on their children the opportunity to participate in a non-waiver conference. A protective hold was one of the requirements for Waiver study participation. Families receiving services in Permanency Planning, Adoption, Reunification and Emergency Response were also eligible to be referred to the agency s non-waiver conferencing program. During one particular month, there were four non-waiver conferences and two Waiver conferences convened by the agency. The frequency of Waiver versus non-waiver conferences was reported to vary from month to month and there were months when only Waiver conferences had been scheduled. While efforts to target the non-waiver conferencing program to families who were not eligible to participate in the study normally ensured that control group families did not have access to conferences, one VFM social worker indicated having been involved in supporting a control group family s interest in convening a conference. The conference held by this family was reported to differ from conferences provided to the experimental group by its lack of a 2 designated, neutral coordinator and facilitator. The extent to which control group families received or implemented such conferences appeared to be minimal; the frequency of such conferences and their differences and similarities with experimental group conferences will be further clarified during the next report period. The philosophy of the Waiver program and the VFM unit were seen to be the same. The philosophy embraced by Fresno county VFM staff was one where staff worked to maintain children in their own homes whenever possible and to provide the support services that would make this possible. It was felt that this philosophy had not changed over time and that the conferencing process was an extension of this philosophy. Family conferencing was described as a good fit within the agency because the intervention was strengths-based and family-focused, a direction the agency as a whole was reported to be moving towards. Most Waiver staff reported being in agreement with the philosophy and goals of family conferencing. In addition, some social workers were reported to view the research process and the random assignment as an impediment to full realization of the conferencing philosophies with all clients. Screening process and eligibility criteria: Enrollment procedures in this county were reported to have remained the same since the report was submitted in March The enrollment criteria for Fresno Waiver families had not changed since the previous reporting period. Enrollment criteria in this county included: (1) the child must be at moderate or high risk for out-of-home placement as measured by the SDM Family Risk Assessment; (2) parents must have at least three family/friends able to attend a family conference; (3) the child must be a county resident; and (4) there must be a protective hold on the child or sibling(s). In the Fall of 2001, the Fresno program staff considered removing the protective hold requirement for participation in the study. However, after discussion with the researchers at University of California, Berkeley, it was agreed that altering the criteria in this way might compromise the integrity of the evaluation, since children without protective holds were likely at lower risk for out-of-home placements than children who had previously been accepted into the study. The criterion that a child must be under a protective hold had been problematic and had become a point of contention among VFM staff. Some families did not have a protective hold placed on their children, but were viewed by VFM social workers as otherwise good candidates for experimental group services. Staff indicated that only law enforcement could exercise the authority to place a protective hold on a child and that social workers sometimes disagreed with the law enforcement assessment. staff indicated an interest and some effort to work more closely with local law enforcement to increase the consistency between agency and law enforcement officials when reaching decisions about when to place protective holds on children. All VFM social workers were reportedly trained to assess cases for Waiver eligibility by the time the focus groups were conducted. In the past, social workers had assisted the program coordinator and conference coordinator in screening cases, but social workers were now the primary screeners and the program staff assisted them only when needed. VFM social workers attended staffing meetings for all new Emergency Response (ER) referrals and participated in Multi-Disciplinary Response Team meetings (MDRT) in order to screen cases for VFM. Once cases were accepted into VFM, they were then assessed for Waiver study eligibility. In addition to screening cases and conducting in-home assessments for Waiver eligibility, social workers 3 also explained the study to eligible families and obtained informed consent. Staff indicated that they experienced some challenges with completing these duties. The back-to-back scheduling of some staffings, for example, was reported to impede their ability to adequately assess cases for the Waiver. Service provision timelines: Service provision for experimental group families usually began upon acceptance of the case in the VFM unit, before the family conference was convened. Initial case staffings for ER were held within 48 hours of the police hold and the case was usually assigned to VFM within days of the initial ER staffing. Most services for Waiver families began at that point; however, there were some services that typically started earlier. For example, after completing the Addiction Severity Index (ASI) some appointments for substance abuse services were scheduled prior to case assignment in VFM. The conferencing process: Fresno employed a full time conference coordinator who arranged all family conferences in the county. This staff position was being supported through Waiver funding. The coordinator was stationed within the VFM unit and worked in close proximity to the Waiver program coordinator. When the conference coordinator was absent or ill, the program coordinator stepped in to complete the conference coordination duties. The conference coordinator drew from a pool of in-house staff trained in conference facilitation and assigned two facilitators to each conference. While the facilitators were themselves case carrying social workers, they typically worked outside of the VFM unit. The facilitators were always separate from the assigned VFM social workers and were only involved in the facilitation of the conferences for families involved in the Waiver experimental group. During the summer of 2002, there was some difficulty with regular facilitator availability and at times the coordinator paired an experienced facilitator with a non-experienced facilitator in order to address the lack of adequately trained staff. The conference coordinator typically began to coordinate conferences within 24 hours of the referral to VFM and enrollment in the experimental group. The conference was then convened within 10 to 12 days. The process of setting up the conference was reported to be very time consuming. The number of families who needed conferences at a particular time and the availability of staff to attend and facilitate conferences both impacted conference scheduling. Staff were not always available for conferences at times preferred by family members and it took effort on the coordinator s part to align social worker schedules with those of the families. Staff also expressed that when families showed reluctance to disclose their support network at the time of the initial assessment or the assessment of available support was not conducted thoroughly, the conference coordinator then needed to take additional time to do this. The more flexible a social worker s schedule, the more easily a conference could be scheduled on short notice. A highly flexible social work staff, with open availability and limited commitments outside of work, was described as the most desirable fit for the conferencing model. In the past, VFM and facilitation staff were all located in the same building, which was also more conducive to the scheduling process. VFM and facilitation staff were now located at different sites, which made communication more difficult. Recent staff turnover had also increased the challenges for the conference coordinator. In addition to losing some staff who 4 had been trained as facilitators, the influx of new staff had presented the coordinator with less flexible schedules than the cohort from the previous year. Conference planning and coordination was reported to be very important to the success of the conference. Staff emphasized that time needed to be taken to research the extended family and to search for a wide support system in advance. Staff felt that when only three or fewer attendees were involved, conferences were less effective. For this reason, it was felt that the best approach was to allow adequate time to ensure that the maximum number of attendees could be identified, contacted, their schedules coordinated and arrangements made for them to attend. Staff acknowledged, however, that there were often competing pressures to convene conferences quickly. The family s motivation to participate in the conference, for example, could dissipate over time. This placed pressure on the coordinator to get things done right away. Parents could also be asked to enter a substance abuse treatment facility with little advance notice, before the conference was fully coordinated and scheduled. In one case, the staff felt that an early conference would help with making a decision about child placement before the parent entered a substance abuse treatment facility. In this case, there were pressures to schedule the conference before treatment began. Staff reiterated, however, that the result of convening a conference too quickly might be that not all potential participants would be identified and that there would not be sufficient time to make travel arrangements for all those who might want to attend. Language barriers were also suggested to have an impact on the conference scheduling process. While most families involved with VFM spoke English, a significant number were primarily Spanish-speaking. When a facilitator who was fluent in a language other than English was needed, the scheduling process could be delayed. The VFM program was described as best equipped to deal with English and Spanish language conferences as the conference materials were already available in these languages and some in-house facilitators were bilingual in English and Spanish. However, in one case, Cambodian was the family s native language and conference coordination was impacted by the need to find a Cambodian translator, which proved difficult. In addition, the agency was noted to serve a significant number of Hmong families. None of these families had yet been enrolled in the Waiver, however, it was anticipated that the language and cultural issues that might arise would be particularly challenging in the event such families were referred. Fresno continued to implement a blended model of family conferencing that incorporated elements of Family Group Conferencing and the Family Unity Model. Families were provided private time to develop a plan for the child s safety and care after engaging in a joint discussion regarding the family strengths and concerns with all other attendees. Staff indicated their belief that the family alone time was empowering for families. They reported that as a result of this approach, families were afforded the opportunity and support to develop their own plans for the child s care and protection. Family input and self determination was emphasized. The alone time was reported to encourage family ownership of the plan that was generated and promote the accountability of family members to one another. Staff expressed a concern that many families had little experience with solving their own problems and dealing with their own situations and that such families might find the process challenging. However, staff believed that the model provided these families with the agency s vote of confidence, conveying that they were capable of coming up with a plan that would work. 5 The availability of a full time coordinator was described as key to the successful implementation of the county s chosen model. This person was available to monitor the process and ensure that the focus remained on allowing the family to create their own plan. The coordinator s role was presented as being central to preserving the neutrality of the conference facilitators. The coordinator made efforts not to convey too much information about the family to the facilitators in order to prevent them from becoming biased toward a particular view of the family or a specific set of recommendations prior to the conference. In this way, the coordinator worked to ensure that the conferencing process was not simply used as a means to approve the plan of action preferred by the agency caseworker, but that the family was truly given the opportunity to develop their own plan. The coordinator was seen as useful in redirecting both staff and families toward this goal. Good facilitation was also viewed as critical to successful conferencing. The conferences were described as places where both sides of a family often came together. While bringing together as many support persons as possibly was generally the goal, bringing together the maternal and paternal sides of the family could also mean bringing together two different styles of communication. In some cases, it could also mean dealing with an emerging sense of competition between the families. While these dynamics are not always present, it was felt
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