Implementing Family Team Conferencing into a System of Care: Lessons Learned from a Federal Grant

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Implementing Family Team Conferencing into a System of Care: Lessons Learned from a Federal Grant Robin Perry, Ph.D. Toni Spoliansky, B.A Florida Child Protection Summit Orlando, Florida Friday,
Implementing Family Team Conferencing into a System of Care: Lessons Learned from a Federal Grant Robin Perry, Ph.D. Toni Spoliansky, B.A Florida Child Protection Summit Orlando, Florida Friday, September 11 This project was funded through the Department of Health and Human Services, Administration for Children and Families, Children's Bureau, Grant # 90CF0021. Introductions and Presentation Objectives Presentation objectives To provide contextual information about Partnership for Strong Families (PSF) and the awarded federally-funded Family Connections Grant [Family Team Conferencing (FTC) study] To provide an overview of the efforts, processes, protocols, and lessons learned that contributed to the development of effective working collaborations as part of this FTC study To share strategies for effective working collaborations within: Model fidelity Family involvement and experience with each FTC model Organization culture and climate Evaluation and outcomes To discuss outcome findings and recommendations for FTC practices in Florida Partnership for Strong Families- Current FTC practice Context: Privatization Milestones 1996: Pilot Legislation 1997: 1st CBC-YMCA Children, Youth & Family Services 1999: Statute Mandates Statewide Implementation Statewide Roll-Out Schedule Service Contracts for Community-Based Care Organizations by year: Contracts Contracts Contracts Contracts Contracts Statewide completion of CBC complete in April 2005 Currently 20 Lead Agencies with Services Contracts Catchment Area Partnerships with Community Organizations Formal relationships consist of: Sub-recipient Contracts, Vendor Contracts, Rate Letters and MOUs Primary FTC Collaborations: Department of Children and Families Case Management Agencies Children s Legal Services Guardian ad Litem Substance Abuse and Mental Health offices Service Providers and Consultants Pre-Grant Context In 2007, Casey Family Programs partners with Florida to explore how to safely reduce the number of children in care by 50% by In 2008, DCF and PSF staff in C3 and C8 (with technical assistance and funding provided by Casey Family Programs) began a major system change initiative called the Foster Care Redesign (Redesign). The Redesign initially focused: 1) on co-locating PSF staff with Child Protective Investigator (CPI) staff to improve communication and coordination; 2) new staff hires to access services for cases diverted from the formal child welfare system, as well as in-home supervision and shelter cases; 3) new staff hires to coordinate multi-disciplinary decision team staffings to ensure that a team of professionals was working together to help ensure that all children who remained in their homes were safe and that those who were removed were placed with relatives, if possible. Pre-Grant Context While professional team decisions were becoming the norm for many cases (especially high-risk), an internal examination of practices suggested: 1) that the family had limited, if any, involvement in decision making, case planning or ongoing service provision; 2) re-referral rates in PSF s service area were higher than the state average; 3) families were being required to complete an array of services that were often overwhelming; and 4) non-compliance with case plans was very high. Subsequently practice model changes Family Team Conferencing, Solution Based Casework and Permanency Roundtables introduced. FTCs as a Pillar of Service Partnership for Strong Families Pillars of Service include: Resource Centers A hallmark of PSF's system of care is our belief that child abuse is preventable. We have found that by providing resources and supports to families in need on the front end, many can avoid reaching the crises that lead to formal child welfare involvement. Not only is this best for the children, it is a more cost-effective use of resources. The Permanency Roundtable This program provides support to the caseworker while taking an in-depth look at helping achieve permanency for every child in out-of-home care, particularly teenagers who have had a difficult time obtaining permanent placement solutions. Family Team Conferencing This and other services help reinforce family values, resolve conflicts, improve communication and provide parents tools to cope with daily challenges. Family Connections Grant Awarded to Partnership for Strong Families on September 28, 2009 Grant awarded by the Administration of Children and Families/Children s Bureau Grant Award = $1.8 million over 3 year period (completed fall 2012) Purpose: Demonstration project designed to evaluate Family Team Conferencing elements leading to a nationwide model Six new full-time positions created to facilitate and coordinate Family Team Conferences Population includes In-home Supervision and Shelter Cases Each of the three research models include special attention and processes for cases involving serious domestic violence, substance abuse and/or mental health issues Research Model Pathways FTC as Usual Case worker plans and facilitates FTC Modeled after pre-grant process FTC- New Grant staff plan and facilitate FTC Case worker participates as cofacilitator Service providers and family supports encouraged to attend FTC- New + Family Alone Time Same process as FTC- new Additional time given where family is able to meet alone, without professionals, to develop their own service and safety plan FTC Models The key components of the proposed experimental FTC models are aligned with the components of FGDM and other types of family meetings that have shown the most promise or some evidence of success in specific jurisdictions. The key components include: A non-case carrying facilitator who will facilitate each FTC The family will be prepared for the FTC The extended family and support system will be involved in the FTC Key service providers who can meet the family's needs will be involved in the FTC and provide expedited services The family will have alone time to develop their own case plan A support person will prepare the victim and attend the FTC when there is domestic violence involved Follow-up FTCs will be conducted at critical junctures throughout the life of each case Overview of Topic Areas Model fidelity Intake/assignment process Adherence to model timelines Comparison group FTCs Training all staff levels Family Involvement Family alone time Empowering families and their supports to drive the conference Parent s legal counsel Org. culture and climate Leadership support Case manager adjustment FTC drives case plans Tracking systems Evaluation and outcome findings Principle questions Select process evaluation findings Select outcome evaluation findings Model Fidelity Barrier Difficulty with staff following intake process appropriately Intake notifications not sent timely Late notification of case initiation Ability to complete initial FTCs within proposed timeframe Overwhelming schedules Initiating contact with families Family schedules Comparison group FTCs Administering informed consent Collecting research material Solution Constant follow-up and reminders to leadership, supervisory and front line staff Implementation of new scheduling process Helped with timeliness Impact: More FTCs without case manager presence Offering of support Shadowing and case consultation Helpful hints tool and example packet Model Fidelity There were no major modifications to the FTC models made during project implementation. However, one major change to the system as a whole that had implications for the project was the start of Solutions Based Casework (SBC). Since that time, Florida has introduced a new practice model-safety Decision Making Methodology which incorporates family centered practice and focuses on standardizing the information collection process and improving quality and consistency for decision making. Family Involvement Barrier Families not taking advantage of Family Alone Time Professionals, rather than family, driving the FTC Families are withdrawn, quiet during FTC Professionals come to FTC with own agenda Difficulty getting informal (family supports) to the FTC Opposition from client legal counsel Concern clients will agree to inappropriate services Solution Addressing/explaining Family Alone Time at onset of FTC Participation of family s support system makes big difference Best practice to have more family supports than professionals around the table FTC Coordinators research case to determine which informal supports would be appropriate to participate Inclusion of defense attorneys Invitations to FTC, where appropriate Processes implemented in response to some attorneys reluctance to allow clients participation in FTCs Organizational Culture and Climate Leadership support Executive leadership buy in Leading by example Case Manager adjustment Professional case manager approach to family centered approach Scheduling/ FTC champions Permanency staffing timelines Frequency and length of FTCs FTC drives Case Plans Family now has a say in services Build on strengths to address needs Tracking systems Implemented and improved tracking systems Process streamlined across service sites P-Kids Evaluation Principal Main Process Evaluation Questions: Was the FTC model implemented with fidelity? To what extent were linkages made between community partners? To what extent were family members involved in the FTC process; did families have a real voice in the process? Evaluation Principal Main Process Evaluation Questions: What was the role of the Family Service Facilitator (FSF), Family Team Conference Coordinator and primary caseworker/family Care Counselor in the FTC? Did the availability (or lack thereof) of community resources impact the FTC process? Evaluation Principal Outcome Evaluation Questions: To what extent did each FTC model impact removal or re-entry into foster care for In-Home Supervision cases? To what extent did each FTC model meet the needs of children and parents/caregivers? Did the FTC model affect the rates of reunification, guardianship and permanent placement with relatives? Evaluation Principal Outcome Evaluation Questions: Does immediate engagement with families and engagement throughout the life of the case lead to desired outcomes for children and families? Does utilizing a separate entity to exclusively provide FTCs impact child and family outcomes? Does a skilled approach (using specially trained staff) to connecting families to services impact child and family outcomes? Evaluation Study Participants and Primary Data Sources/Tools Families/children (in conjunction with each FTC): Goal Attainment Scale (GAS) Protective Factors Survey (PFS) Strengths and Difficulties Questionnaire (SDQ) Questionnaire for Family Members and Professionals (QFMP) Focus groups and interviews Independent observation of randomly selected FTCs Evaluation Study Participants and Primary Data Sources/Tools Family supports*: Questionnaire for Family Members and Professionals (QFMP) *Family supports are other family members, friends or family advocates who are invited by the family to participate in the FTC. Professionals: Questionnaire for Family Members and Professionals (QFMP) Key informant interviews of randomly selected Family Care Counselors and FTC Facilitators Independent observations of FTCs in all pathways Focus groups with community partners/professionals Survey of community partners/professionals Evaluation Secondary Data Sources Florida Department of Children and Families Florida Safe Families Network (FSFN), the SACWSIS system for Florida Partnership for Strong Families P-Kids Data System (service utilization and case monitoring database) Population and Sample Info. A total of 1,894 FTCs (across all Pathways) were conducted with 1,156 unique cases/families. Of these cases/families, 623 agreed to participate in the formal evaluation. With the 623 family participants, 1,252 FTCs were conducted % 7.80% 10.80% 47.20% 21.60% Initial Month 4 Month 7 Month 10 Other Number of participants Participation Rate Population and Sample Info % 90.00% 80.00% % 66.00% 70.00% 60.00% % % 40.00% 30.00% % 10.00% 0 Pathway 1 Pathway 2 Pathway % Demographics The demographic characteristics of the families served were as expected. Overall, there were no statistically significant differences in these characteristics across the Pathways. Examples: Gender of Parent Participants Pathway 1 Pathway 2 Pathway 3 F: 80% M: 20% F: 68.9% M: 31.1% F: 72.2% M: 31.1% Ethnicity of Parent Participants Pathway 1 Pathway 2 Pathway % 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% Other Hispanic/Latino African American White Demographics Examples: Age of Parent Participants Pathway 1 (n=75), Mean Age = (SD=8.13) Pathway 2 (n=228), Mean Age = (SD=8.15) Pathway 3 (n=241), Mean Age = (SD=7.85) Relationship Status of Parent Participants Pathway 1 Pathway 2 Pathway % 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00% Unable to Determine/Other Separated Unmarried Couple Single Male Married Couple Single Female Substance Abuse and D.V. History Referral history involving Domestic Violence Pathway 1: 32.0% (n=24) Pathway 2: 37.7% (n=86) Pathway 3: 36.9% (n=89) Referral history involving Substance Abuse Pathway 1: 53.3% (n=40) Pathway 2: 51.8% (n=118) Pathway 3: 42.7% (n=103) Process Evaluation: Service Referrals A total 3,410 service referrals were provided to those participating in FTCs (across Pathways) over the course of the study. Service Service Service Referrals Service Referrals Biological Parents (Totals) n=1107 Biological Children (Totals) n=733 Mental Health 822 Mental Health 549 Domestic Violence 337 Domestic Violence 0 Substance Abuse 185 Substance Abuse 5 Parenting Classes 829 Parenting (includes children) Classes 605 Other 43 Other 35 Totals Service Referrals 2,216 Totals Service Referrals 1,194 There were no statistically significant differences in the average number of services and service units authorized and delivered for each service classification across the three Pathways. Process Evaluation: Service Costs In total, $1,437, was spent on referred services for study participants across all three Pathways. There are no statistically significant differences in the average expenditures across service categories for services delivered to cases across FTC Pathways. The greatest expenditures (and number of cases receiving services) are for mental health services followed by parenting classes and supports and substance abuse services. The project cost data suggests that the costs of service are equal across all Pathways in terms of average service costs (to the system) that result from case plans and service recommendations. The amount, type and cost of service referrals did not change as a result of a family s participation in any FTC Pathway. Process Evaluation: Service Costs Average Costs for Services for Applicable Cases/Families Across FTC Pathways Process Evaluation: QFMP A total of 1,202 QFMP surveys were completed by study participants (associated with 422 study cases) following the completion of each FTC % mothers 40.20% 44.40% all other family members/supports professionals Study participants agreed that FTCs across all three Pathways were implemented with fidelity, participants were adequately prepared and the family was clear on their role, the family members were active participants and empowered, participants (including family members) were satisfied with the process and the outcomes (especially related to case plans) were appropriate, clear and in keeping with the goals and objectives of Family Team Conferencing. Process Evaluation: Independent Observations Occurred in the early implementation phase of the project The FTC Facilitators demonstrate high fidelity to the FTC models with respect to facilitating the FTCs and engaging families in the decision-making process. Some families were not aware of the purpose and goals of the FTC. Also, few families invited their supports to attend the FTC. There seemed to be inconsistent and at times insufficient communication about the FTC purpose and goals. As a result of this finding, the procedures for contacting families and providing more information to better prepare families for the FTC was revamped. Some FCCs were uncertain about their role in the FTC. They were unaware of the partnership between themselves and the FTC Facilitator in facilitating the FTC. As a result of this finding, this partnership was emphasized in trainings with FCCs on the FTC models and grant implementation. Process Evaluation: Focus Groups The parents in the focus group responded positively to FTCs, as did the service providers from both Circuits, but identified glitches in how, when and by whom FTCs are implemented suggest that a number of improvements could be made (for example, processes that reinforce the invitation of family supports). A larger-scale and longer-term area of improvement is the idea of culture change that was raised in the focus groups. Despite promising features of the FTC models that have been identified from various sources, there is the bigger challenge of culture change (among FCCs and others to put into practice the philosophy and approach of FTCs) that is necessary for FTCs to be successful and sustainable. All in all, the information collected to provide insights into this challenge suggested that culture change is attainable and that current practices through FTCs and other means are evidence of culture change. Process Evaluation: Community Partners Survey The Community Partners Survey results showed that service providers support the FTC philosophy and approach; praise the FTC Facilitators for their skilled facilitation; believe families are respected during the FTCs and support greater flexibility in the timeframes for FTCs. These positively perceived features, however, were counter-balanced with perceived challenges to implementation, impact and sustainability of Family Team Conferencing from the perspective of survey respondents. The ambivalence of survey respondents about the impact of FTCs on their own work and whether a cultural change has occurred to fully promote FTCs across the entire system presented the need to modify the FTC program to assure sustainability. Outcome Evaluation: Protective Factors Protective Factors Survey were used to measure and monitor: Family Functioning/ Resiliency, Social Emotional Support, Concrete Support, Child Development/Knowledge of Parenting, Nurturing and Attachment. A total of 653 Protective Factors Surveys were completed over the course of the study with 124 (19.0%), 246 (37.7%) and 283 (43.3%) of the sample associated with Pathway 1, Pathway 2 and Pathway 3 (respectively). The vast majority (79.5% or n=519) of these were completed at the baseline (i.e. Initial FTC) with no follow-up measure. The willingness of study participants to complete this instrument at follow-up periods was low. Outcome Evaluation: Protective Factors The panel of cases (for which there was a baseline and follow-up measure[s]) included a total of only 10 Pathway 1 cases, 65 Pathway 2 cases and 59 Pathway 3 cases for which change in Protective Factors could be measured over time. The very low follow-up response rate (especially for Pathway 1) does not allow valid comparisons across Pathways (especially between Pathway 1 with Pathway 2 or Pathway 3). For Pathway 2, the protective factor of family functioning increased over time; for all other scales of the PFS, there were no statistically significant changes over time. For Pathway 3, there were no significant changes over time to any protective factor. Outcome Evaluation: Reunification Rates Reunification within 12 months of entry into care was also analyzed using SACWIS Data. The reunification rate for Pathway 1 (58.8%) was significantly higher than the rate observed for Pathway 3 (36.6%) but not Pathway 2 cases (50.3%). The reunification rate for Pathway 2 cases did not differ signif
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