November 2020Vol. 21, No. 8Happiest at Home: Indiana Launches Program to Preserve Families

Written by the Indiana Department of Child Services

Transitioning to adulthood is hard—for anyone. Doing so while aging out of foster care without the support of a permanent family is even more difficult. The challenges facing this population are many. The Northwest Foster Care Alumni Study found that the following were occurring nationally for youth formerly in foster care:

• More than half have diagnosable mental health disorders.
• Rates of posttraumatic stress disorder are twice that of U.S. war veterans.
• A third live at or below the poverty level.
• Nearly a quarter experience homelessness after age 18.

In 2019, Indiana expanded older youth services supported by the John H. Chafee Foster Care Program for Successful Transition to Adulthood to age 23 for those who were in foster care after they turned 16. That same year, we extended the eligibility for Collaborative Care, Indiana's extended foster care program, from age 20 to age 21 to allow youth to voluntarily stay in foster care with flexible placement types.

Despite these efforts, our older youth made one thing clear in their feedback: Even this additional support is not enough. To truly help the children we serve, we must dedicate more resources to preventing their removal in the first place.

The foundation of all our older youth services is youth voice, and as we have made changes, we have consistently sought their input. Our youth have many avenues to express themselves directly to Indiana Department of Child Services (DCS) leadership so we can learn from their experiences. We have our Youth Advisory Board comprising youth currently and formerly in foster care from across the state, and in the summer of 2020, we launched Older Youth Town Halls to create spaces for them to engage with us. Lastly, our new monthly Lunch With the Leader series invites youth currently and formerly in care to spend 90 minutes talking about whatever is on their minds with these same DCS leaders, with lunch provided to all.

A key theme has emerged from these conversations: Older youth recognize the extra supports we have put in place, but their continued struggles make it clear that "aging out" must be a last resort. What young people need more than Chafee services and Collaborative Care placements is a permanent family. And for the best outcomes, that family needs to be their own.

Adoption and reunification are a core part of what child services agencies do, but even these are second-best options for children in care. The best outcome is to prevent the loss, disrupted bonding, and traumatic separation that happens to every child removed from their home and family.

In December 2017, Indiana had 16,830 children in out-of-home care. This reflects a 75-percent increase in children in out-of-home placements since the same time just 4 years prior. We knew we could do better, and—for the futures of all of our children and families—we had to.

We started by engaging our providers and many other stakeholders in the conversation about what we could do to keep more families safely together. Collectively, we came to some key conclusions:

• Our way of contracting and reimbursing for services, a fee-for-service approach, just wasn't working for many of our families. The likelihood of reimbursement, not family need, was dictating service intensity.
• A per diem reimbursement, with one rate for all families across our state, would allow providers to focus on outcomes, not billable hours.
• We needed evidence-based models to be the foundation of all our work with families.

Family Preservation Services (Family Pres), a program aimed at keeping families together, was born of these conversations. In the midst of the COVID pandemic, Indiana launched Family Pres in June 2020. This initiative focuses on outcomes that are easily measured, with providers understanding that they must excel at matching each family's specific needs with the right service models and the right intensity. Providers' success at achieving good outcomes protects their ability to continue working with the department.

Family Pres includes the following:

• Providers are allowed to use any model that is designated as at least a promising practice by the California Evidence-Based Clearinghouse for Child Welfare. The family's needs and the provider's clinical expertise will determine what models are used, not whichever model is most financially advantageous to the provider or state.
• Each family is assigned one provider under the per diem reimbursement model, which allows us to better track outcomes.
• Providers must provide concrete supports if they are needed to prevent the removal of a child.
• Family Pres offers our families the help they need and supports caregivers as they work to provide a safe and healthy environment for the children in their care.

Family Pres empowers providers to teach our families how to identify and lean on their own resources. The providers who are best at helping families obtain and maintain employment, budget their resources, complete public assistance applications, and learn how to use emergency resources (such as the trustee's office or even the faith community) will be the ones that write fewer checks to landlords and utility companies. Most importantly, their families will be much better prepared to meet their own needs.

Indiana DCS is committed to continuous improvement, and launching Family Pres is a step we expect will pay big dividends for those we serve. Its holistic approach to wrapping around our families gives them the best chance to succeed, not only as we walk alongside them but after we have left them—hopefully stronger, safer, and better-prepared to face whatever comes next.