July/August 2019Vol. 20, No. 6Print issueSpotlight on Building Evidence and Using Evidence-Based Practices in Child Welfare

Issue Spotlight

• Extraordinary Work Requires Extraordinary Evidence

  Extraordinary Work Requires Extraordinary Evidence

  Written by Lee Porter, chief program officer, Children's Trust of South Carolina

  Using evidence-based programs (EBPs) and building evidence to support family strengthening isn't only for well-known or sophisticated organizations. This is a story of how a small organization utilized existing data resources and intentionally built its internal evaluation capacity so that it could demonstrate program impact and contribute meaningful evidence to the child welfare field.

  In 2008, Children's Trust of South Carolina, which exists to strengthen families and lead communities in preventing child abuse and neglect, was a small office with a big vision: to significantly reduce child maltreatment in the state through evidence-based approaches. This journey into EBPs began with the utilization of federal Community-Based Child Abuse Prevention grant funding to support EBPs in five counties for primary prevention efforts. Due to its success in this modest endeavor and its growing reputation as a trusted intermediary organization, the Children's Trust was designated as the state's federal Maternal Infant Early Childhood Home Visiting (MIECHV) grantee, which allowed it to take a deeper dive into using EBPs and building evidence. During this timeframe, the organization also became the Annie E. Casey Foundation KIDS COUNT designee for the state, opening new doors for building capacity around data and its use. This convergence bolstered Children's Trust's reach, visibility, and credibility.

  The small staff at Children's Trust began MIECHV implementation in 2011 with three evidence-based models and utilized a contracted university research team for the required evaluation elements. Organization leadership opted for a comprehensive, rigorous measurement plan from the beginning. For service delivery, a "hub-and-spoke" geographic approach was utilized to identify strong partners that could also facilitate service in contiguous counties. The South Carolina MIECHV profile has since grown to 17 community partners that are contracted to serve 42 of the state's 46 counties in 2019. From 2012 to 2018, there were 78,861 home visits. The continuous quality improvement model utilized by South Carolina MIECHV is now used as the model for national home visiting innovation and improvement, and Children's Trust provides support for the first Pay for Success initiative for home visiting in the country.

  While acknowledging the growing success of home visiting efforts around place-based EBPs, Children's Trust also recognized the need to build capacity for population-level approaches to programming and for measuring population-level outcomes. Children's Trust then secured a capacity-building grant from a regional foundation, which enabled the hiring of its first research and evaluation staff. Concurrently, implementation of the evidence-based Strengthening Families Program (SFP) was launched at the request of the state's Department of Social Services. This was followed by the creation of the South Carolina ACE (Adverse Childhood Experience) Initiative. The implementation of SFP allowed Children's Trust to test a more intentional coaching model for supporting EBP effectiveness and fidelity, and the ACE work allowed the new research and evaluation staff to begin collecting and mining multiple years of South Carolina ACE data for meaning and application.

  The confluence of the additional research staff capacity with the initiatives around SFP and ACEs allowed Children's Trust to grow its own expertise in EBP implementation and in data collection and evaluation, respectively. Like a domino effect, these new internal capacities then led to additional funding opportunities, which in turn allowed for the addition of more staff to support research and evaluation efforts. This department in Children's Trust now provides white papers, journal articles, briefs, and consultation at the state and national levels.

  Following the growth of SFP into nearly 30 counties with its coaching support model, Children's Trust is now using its capacity in implementation and evaluation to pilot a population-level implementation of the evidence-based Positive Parenting Program. Children's Trust has the internal expertise to design and execute the evaluation and continuous quality improvement process for this project, as well as apply its knowledge of coaching EBPs for program fidelity. Small organizations that are intentional and determined can find ways to use and grow evidence that builds resilient families and healthy communities. You might even say, the evidence is in.

  For more information on the Children's Trust of South Carolina, visit scchildren.org.
  
   

• The Need to Balance the Evidence in Child Welfare

  The Need to Balance the Evidence in Child Welfare

  Written by Jerry Milner and David Kelly

  In recent years, talk of evidence has dominated the field of child welfare. During this time, grants have been awarded, research has been conducted, and evaluation has become a hallmark of most federal, state, and philanthropic efforts to support work in the field. These efforts have made important contributions. We have gained knowledge about the effectiveness of specific interventions with specific populations. 

  The quest to understand what works, for whom, and under what conditions is critical and will help us better serve children, youth, and families. It is a quest that is closely associated with ensuring the judicious use of resources. It can also be a mechanism for limiting investment in families before the need for expensive, intensive remedial services are needed, which, as such, can lead to greater expenditures of limited funds.

  The language of evidence is central in the most recent child welfare legislation enacted by the congress, which limits federal financial participation in prevention services only to those that meet certain levels of evidence, as defined in the statute (promising, supported, and well-supported) for three types of services families may need (substance use treatment, mental health, and in-home parent skill building).  This approach to using evidence promotes technical considerations of issues such as dosages and time limits in an effort to ensure just the right levels and lengths of service are offered, and nothing more. It opens the door to overvaluing cost control and budget efficiencies over prevention and familial needs.  

  Despite their value in certain situations, and they will likely always be needed at some level, clinical interventions supported by evidence do not represent the whole picture of what children and families need. Child welfare data are clear that the majority of families that make contact with the child welfare system do so on allegations of neglect, not abuse. There is also evidence that poverty is often a major contributor to neglect. 

  This is a different kind of evidence. It is evidence of the need to take on the root causes of what leaves families vulnerable to more serious difficulties requiring more serious and expensive interventions. It is compelling evidence that not every family who comes to child welfare, or is at high risk of coming to child welfare, needs a clinical intervention. It is strong evidence that many families need help making ends meet, that they need basic supports, such as housing, food, and legal assistance. It is plainly apparent that many vulnerable families need people and places to turn to in times of need to boost their resilience and help them enhance their protective capacities.

  This type of evidence must not be ignored or forgotten in our quest to focus on what works.

  I fear we have entered a time where this human evidence has become undervalued. I fear we have become fixated on treating symptoms of the trauma we allow to develop, instead of intentionally and aggressively acting to prevent it. I believe our reluctance to do so reflects a deeply concerning challenge of conscience as opposed to a challenge of science.

  Neglect is something that is within reach to prevent. The problem is, under the current evidence regime, most of the supports that vulnerable families struggling with poverty need do not and may never have a randomized control trial study to justify their provision. Our current child welfare funding structure perpetuates this gap.

  Yet, as a field we continue to deeply  entrench ourselves in ways of thinking and funding that are wed to reacting to trauma and damage alone, instead of working to prevent as much of it as we possibly can. In the process, we risk pathologizing families' vulnerability and reinforcing stereotypes about families who are served by the child welfare system. 

  There is evidence that can, should, and does help us understand what families need to maintain their protective capacities and to care for their children in safe and healthy ways. Yet, our values and judgments regarding parents who need help may make it more palatable to fund rescue missions and clinical services designed to fix the damage rather than acting on the evidence of what families need to avoid the damage.

  We need to balance the evidence in child welfare. 
  
   

• Exploring How We Build, Understand, and Apply Evidence in Child Welfare: The 2019 National Child Wel

  Exploring How We Build, Understand, and Apply Evidence in Child Welfare: The 2019 National Child Wel

  Written by the Capacity Building Center for States

  How do we determine which practices and programs are most likely to produce the best outcomes for the children, youth, and families we serve? And once a program or practice is in place, how do we know that it's working? The child welfare field continues to make important strides using data, research, and evaluation to inform practice and decision-making. We've made great progress and look forward to more opportunities to learn, expand, and improve in this area.

  In 2009, the Children's Bureau (CB) convened the first National Child Welfare Evaluation Summit (Evaluation Summit). Child welfare policy makers, administrators, and evaluators from around the country gathered to learn about ways to build and disseminate evidence about effective child welfare services, programs, and policies; strengthen evaluation practice; and promote the use of findings for sound decision-making in child welfare programs and systems. A second Evaluation Summit was held in 2011.

  Building on the momentum of the second Evaluation Summit, CB launched three research and evaluation workgroups to tackle challenges that emerged during the conference. Each workgroup brought together national experts to develop practical resources, including the following:

  • A framework to guide the process of building evidence and implementing evidence-supported interventions in child welfare
  • A vision and guide describing how to collaboratively perform culturally and scientifically rigorous evaluation with tribal communities
  • A guide for integrating cost-analysis with program evaluation to promote a better understanding of key program components, implementation, and unit costs

  The workgroups developed a collection of useful publications and videos to assist child welfare agency leaders and evaluators.

  CB also released the Child Welfare Evaluation Virtual Summit Series in 2013. The series includes 17 brief and engaging videos featuring perspectives and tips from national experts on a wide range of evaluation-related topics. CB will host its third Evaluation Summit on August 20-21, 2019, at the Marriott Wardman Park in Washington, DC. The 2019 National Child Welfare Evaluation Summit, with the theme of "Leveraging Data and Evaluation to Strengthen Families and Promote Well-Being," will provide an opportunity for 800 child welfare leaders, members of the research and evaluation community, and their partners and stakeholders to explore how we build knowledge and evidence responsibly and use results to ensure children and youth thrive in strong, healthy families. Participants will learn about emerging research and evaluation findings and have the opportunity to discuss dilemmas, challenges, and opportunities related to research, evaluation, and continuous quality improvement. (Click here to register for the Evaluation Summit.)

  The Child Welfare Capacity Building Collaborative will host its annual 1-day online event, the Child Welfare Virtual Expo (Virtual Expo), on September 19, 2019. This year's event will complement the Evaluation Summit. The theme, "Effectiveness in Child Welfare: Our Role in Improving the Lives of Children and Families," will offer participants the chance to build knowledge and skills to boost their ability to participate meaningfully in building evidence of "what works" in their own practice and within their agencies and communities. The Virtual Expo will feature concurrent presentations, exhibits, and networking opportunities for up to 1,500 state and local child welfare leaders, including sessions for agency and legal professionals working directly with children, youth, and families. (Click here to register for the Virtual Expo.)
   
   

• New Study Shows Providing Parents With Multidisciplinary Legal Representation in Child Welfare Cases

  New Study Shows Providing Parents With Multidisciplinary Legal Representation in Child Welfare Cases

  Written by Martin Guggenheim, Fiorello LaGuardia Professor of Clinical Law and co-director, Family Defense Clinic, New York University School of Law

  The child welfare canon holds that children should only be placed in foster care when necessary. This reflects the universally recognized understanding that the needless separation of children from their families can profoundly harm them. Among the more contentious aspects of the child welfare system in the United States is whether, as some claim, too many children are needlessly placed in foster care or remain there longer than needed to protect them from harm.

  A major study (Gerber, Pang, Ross, Guggenheim, Pecora, & Miller, 2019) makes a compelling contribution to this inquiry. Although it did not address whether children are needlessly removed from their homes, it showed that children can be safely returned to their families significantly sooner than commonly happens by the simple device of employing the right kind of legal representation for their parents.

  Efforts to prevent the unnecessary separation of families are notoriously difficult to study because so many factors complicate the risk analysis. Researchers from New York University, Action Research, and Casey Family Programs took advantage of a unique opportunity to compare the outcomes of cases involving more than 18,000 children in which child abuse or neglect was alleged. The study examined what happened when, in 2007, New York City began contracting with holistic family defense offices to provide parents with representation in child welfare cases.

  Until that time, New York City, like most jurisdictions in the United States, exclusively appointed solo-practicing lawyers to represent parents from a rotating panel of lawyers. Panel lawyers in New York are highly experienced practitioners who must apply to be accepted to the panel and are reviewed annually to ensure they take their job seriously and perform it well. Since 2004, these lawyers receive $75 per hour for both in- and out-of-court work. In most cases, there is no cap on the total amount of compensation they can receive once the court is satisfied that the hours they billed were necessary to represent the parent effectively.

  The study focused on the outcomes of cases based on which kind of lawyer parents received by comparing the most popular form of representation used in the United States—solo-practicing panel lawyers—with a reimagined legal representation team that includes lawyers, social workers, and parent advocates. The idea behind multidisciplinary parent representation is that the solo practitioner model is poorly suited to the unique tasks of representing parents in child welfare cases. Because child welfare cases proceed simultaneously along two tracks—the courthouse and the agency—truly excellent parent representation requires that parent lawyers or other members of the parent representation team actively participate with their clients in all aspects of the case. When parents attend team meetings and conference with caseworkers and other agency personnel, parents deserve to be represented on those occasions.

  That, in any event, was the basis upon which New York City gave contracts beginning in 2007 to three parent representation offices. These offices—Brooklyn Defenders, Bronx Defenders, and the Center for Family Representation—began by representing about half of all cases filed in the New York City Family Courts. Today, a fourth office, the Neighborhood Defender Service of Harlem, also has a contract to represent parents. Together, these four offices currently represent the vast majority of all parents in child welfare cases in New York City.

  What all New York City family defense offices have in common, besides employing staff attorneys whose salaries are not based on the number of cases they carry, is that the offices employ social workers and parent advocates who partner on teams with the lawyers to offer their clients a broad range of support well beyond the courthouse. The lawyer member of the team provides legal representation in court. The social worker helps the client access stabilizing services, such as housing, employment training, drug treatment, and domestic violence counseling. Parent advocates—trained professionals who have personally experienced the child welfare system and can empathize with vulnerable families—provide emotional support and help parents engage in services.

  The study's principal purpose was to determine whether the kind of representation provided to a parent makes a difference in terms of keeping families safely together and reducing the time children spend in foster care. The researchers took 3 years and developed a rigorous statistical design that effectively compared outcomes and screened out potential distortions. This meant carefully matching cases based on more than 20 variables, including age, race, number of children involved, county, judge, severity of allegations, and prior involvement with the child welfare system. It also meant that the researchers were able to say that differences in outcomes between the two kinds of representation were attributable to the representation the parents received.

  The results are staggering. The family defense offices were able to secure the safe return of children to their families approximately 43-percent more often in the first year and 25-percent more often in the second year than the solo lawyers. The effects were felt from the very beginning of a child's placement. The researchers found that 17-percent more children would be reunified within a month and 27-percent more children would be reunified with their families within 6 months if their parents had multidisciplinary representation rather than assigned panel attorneys. 

  Providing parents with family defense teams allowed children to be permanently released to relatives more than twice as often in the first year of a case and 67-percent more often in the second year. Of those children who could not be returned to their families, 40-percent more children ended up with permanent dispositions of guardianship when their parents had multidisciplinary representation compared with children whose parents were represented by panel lawyers.

  This study makes clear that many children are kept in foster care simply because their parents were not provided with the right kind of representation and key support services. The study's ultimate finding is that even while the family defense offices helped parents regain the custody of their children months or years sooner, children were at no greater risk of any type of abuse or neglect than their counterparts whose parents were represented by solo attorneys. This means that providing the parents an interdisciplinary legal team dramatically reduces the trauma of family separation without any increased risk to child safety.

  New York City is a national leader in employing interdisciplinary family defense as the preferred method of providing legal representation for parents. It has helped reduce trauma experienced by families and children. It has also saved an enormous amount of money that would otherwise have been spent on children remaining in foster care. The study found that full implementation of a multidisciplinary representation model would reduce the foster care population by 12 percent and annually reduce foster care costs by $40 million as compared with exclusive reliance on solo practitioners.

  The finding that family defense offices achieved a significant reduction in foster care is all the more striking because New York City places children in foster care at one of the lowest rates in the country. In much of the rest of the country, foster care is significantly overused.

  The study was announced at a particularly auspicious time because the federal government recently issued new guidance that will allow reimbursement to states and localities for half the cost of lawyers for children and parents in eligible cases. We now have clear evidence of how to prevent unnecessary family separation in child welfare. Based upon the 12-percent reduction in out-of-home care shown in the study, providing parents with this new kind of legal representation throughout the country suggests we can safely reduce the national foster care population of 440,000 by more than 50,000 children.

  Reference

  "Effects of an Interdisciplinary Approach to Parental Representation in Child Welfare," by Lucas A. Gerber, Yuk C.Pang, Timothy Ross, Martin Guggenheim, Peter J. Pecora, and Joel Miller (Children and Youth Services Review, 102), is available at https://www.sciencedirect.com/science/article/pii/S019074091930088X.
   
   

• Evaluating the Allegheny County Family Support Center Network

  Evaluating the Allegheny County Family Support Center Network

  Written by Marc Cherna, director, Allegheny County Department of Human Services

  Allegheny County, PA, is home to a network of 28 family support centers (FSCs) serving approximately 3,600 families each year. FSCs, located in economically disadvantaged communities, are community-based, participant-driven hubs of programs, services, and supports designed to improve outcomes for children (birth through age 5) and their families by increasing the strength and stability of families as well as parents' confidence in their parenting abilities.

  Since opening the first FSC in the early 1990s, significant federal, state, and foundation funds have been committed to the operation of the FSCs. In 2016, the Allegheny County Department of Human Services (DHS) conducted a multicomponent evaluation designed to answer a number of questions concerning their operation and impact. As one component of the evaluation, the Center for State Child Welfare Data at Chapin Hall analyzed case management and administrative data to determine the impact of FSCs on the neighborhoods in which they are located and whether a neighborhood FSC is associated with lower rates of child welfare maltreatment investigations.

  Key Findings

  • Preventing child abuse and neglect: The FSC neighborhoods showed lower-than-expected rates of child abuse and neglect investigations than the matched neighborhoods without an FSC.
  • Fostering supportive relationships: Family members active in FSCs were found to be establishing informal support relationships and networks through their participation in the FSC.
  • Engaging high-risk families: Two-thirds of families participating in the Parents as Teachers program met the definition of high risk.

  About Family Support Centers

  By design, every FSC is unique, reflecting the needs and interests of the individual community. However, all are based on the philosophy that parents are a child's first and most important teachers. At a minimum, every FSC works with parents and children to provide prenatal care, early childhood development, school readiness, parental skill building, and parent support in a safe and welcoming environment.

  FSCs provide drop-in and scheduled programming and socialization opportunities as well as evidence-based home visiting. Centers may also offer or partner with agencies that provide one or more of the following activities: afterschool and summer programs for youth, career readiness training, concrete goods, counseling, child care, Head Start or Early Head Start, English as a second language and literacy programs, food bank access, transportation, and father support groups.

  The Evaluation

  The evaluation utilized both quantitative and qualitative data-collection methods and included five domains: family engagement, connections to social services, early childhood development and school readiness, maternal and infant health, and child abuse and neglect.

  A full report on the evaluation (An Evaluation of the Family Support Center Network), including a summary of the findings from the Center for State Child Welfare Data's analysis, was published by DHS in 2016. It includes an extensive discussion of the FSC network as well as the purpose, function, and structure of family support. Evaluation findings are provided in each domain, with positive findings found in three key areas: preventing child abuse and neglect, fostering support relationships, and engaging high-risk families.

  More recently, a detailed report about the impact on child maltreatment was published by the Center for State Child Welfare Data (Do Family Support Centers Reduce Maltreatment Investigations? Evidence From Allegheny County). The investigators examined administrative data at the neighborhood level to determine whether the presence of an FSC was associated with lower rates of child welfare maltreatment investigations. Looking at first investigations from 2009 through 2013, they asked three questions:

  1. How is the investigation rate related to the level of social disadvantage?
  2. How is the investigation rate related to the presence of an FSC?
  3. How are the investigation rate, the level of social disadvantage, and the presence of an FSC interrelated?

  Because the connection between child welfare investigation rates and social disadvantage is well established in the literature, we would expect the investigation rate to be higher in areas with higher levels of social disadvantage. In the simplest terms, we expect lower rates of investigation in areas with an FSC because the FSC alters the balance of risk and protective factors at the community level such that communities with an FSC are less dependent on the front door of the child protection system as a mechanism of child protection. The evaluation supported these assumptions; areas within Allegheny County served by FSCs had fewer maltreatment investigations once the level of social disadvantage and population size were considered.

  Conclusion

  The evaluation provides evidence that FSCs are associated with lower rates of child welfare investigations. It also demonstrates that FSCs are effective in reaching the highest-risk families in specific evidence-based programming and in helping families develop natural support networks that enhance their stability. These findings alone provide a rationale for continued investment in the FSC network. Nevertheless, additional research is needed to determine the exact mechanisms at work and to assess whether FSCs have a further role to play in reducing the length of child welfare involvement or decreasing the number of subsequent reports of maltreatment.