• June 2014
  • Vol. 15, No. 6

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Site Visit: Comprehensive Family Assessment in North Carolina

In 2004, North Carolina's Child and Family Services Reviews (CFSR) demonstrated a clear need for more accurate and comprehensive assessments of the strengths and needs of children and families served by child welfare. Specifically, ongoing risk and safety assessments were not conducted, and families were often not involved in case planning. In addition, CFSR findings in 2007 indicated that families receiving in-home services were struggling to connect with or receive appropriate services. Using a 5-year Children's Bureau discretionary grant that began in 2007, the Alamance County Department of Social Services (ACDSS) is implementing a Comprehensive Family Assessment (CFA) project to improve safety, permanency, and well-being for the children and families it serves.

Data from 2005–2006 showed that 48 percent of the children with maltreatment reports had a prior report with ACDSS. Roughly one-fifth of children with initial reports had a second report within 1 year. Findings from the 2007 CFSR showed a disparity in services provided to in-home cases, compared to foster care cases, and children receiving in-home services had higher rates of repeat maltreatment. ACDSS identified the lack of ongoing and comprehensive assessment and planning as directly related to the frequency and purpose of caseworker visits. Its policies did not specifically address the frequency, purpose, or approach for visits, and ACDSS cited this lack of clarity as a barrier to caseworker ability to comprehensively assess family functioning.

The target population for this project was children and families receiving in-home family support or family preservation services. Prior to the onset of the CFA grant, Alamance County was one of three pilot sites in North Carolina for a System of Care (SOC) infrastructure grant awarded by the Children's Bureau in 2003. The SOC grant provided an opportunity to move the agency and the community toward a family-centered approach, and the CFA grant helped achieve that goal by enhancing assessment practices for children and families receiving in-home services.

As part of the CFA project, ACDSS developed assessment tools and family engagement and caseworker visit policies that were implemented with a pilot team in 2008. A randomly selected intervention team was implemented in 2009. Pilot and intervention staff members were trained and coached to utilize motivational interviewing (MI) to develop partnerships and engage families in assessment and case planning. Efforts to improve father engagement also were part of the project.

A number of new and modified assessment tools were developed and utilized to more comprehensively gauge families' needs. A comprehensive risk and safety guide was completed at initial visits and followed by the North Carolina DSS Risk Assessment within 48 hours, in addition to the mandated completion at case closure. At subsequent visits, social workers assessed multiple domains individually using SEEMAPS (social, economic, environmental, mental health, activities of daily living, physical health, and strengths) and screened for possible issues with substance abuse, domestic violence, and depression to obtain a holistic picture of family strengths and needs. Lastly, ACDSS implemented new policies for home visits to provide a consistent purpose, process, and approach (low risk – monthly visits; moderate risk – biweekly; high risk– weekly; this visit schedule is identical to the mandated policy for home visits for cases receiving in-home services).

Alamance County leveraged existing research findings to implement a long-term multilevel approach, utilizing MI and ongoing coaching to increase family engagement in order to obtain a truly comprehensive assessment.

Findings indicate that, overall, the CFA process has been implemented with an acceptable degree of fidelity. For the vast majority of cases:

  • The comprehensive risk and safety guide was completed at case initiation.
  • Assessment of at least one life domain area was completed at subsequent visits.
  • Caseworkers appeared to be maintaining high levels of contact with primary caregivers during the assessment process, especially with low- and moderate-risk cases.

Administrative data were analyzed to examine possible differences in child welfare outcomes between the CFA intervention and control teams:

  • Compared to the control team, the CFA intervention team spent more time on assessment of cases.
  • Compared to the control team, the CFA intervention team had a higher proportion of substantiated cases. They also had a higher proportion of cases with findings of services provided that were no longer needed or recommended.
  • CFA implementation did have an effect on the long-term safety of children. After 18 months from the initial case decision, intervention team cases were significantly less likely to return for another maltreatment assessment. However, significant differences between intervention and control teams were not found at 6 or 12 months on these measures.
  • Significant differences were not found between the two teams for foster care entry or length of time in foster care.

For more information about this project, contact Adrian Daye, Child Welfare Program Manager, Adrian.Daye@alamance-nc.com. The full site visit report is available on the Child Welfare Information Gateway website:
This project is funded by the Children's Bureau (Award 90CA1754). This article is part of a series highlighting successful Children's Bureau grant-funded projects around the country, emerging from Children's Bureau site visits.

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