The impact of system of care support in adherence to wraparound principles in Child and Family Teams in child welfare in North Carolina

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Abstract

North Carolina is one of a growing number of states to implement family meeting models in child welfare as a way to engage families, while simultaneously addressing complex familial needs and child safety issues. However, much is still unknown regarding how family meetings actually operate in child welfare, underscoring a clear need for further evaluation of this process. Utilizing direct observational data of Child and Family Team (CFT) meetings, collected as part of two separate evaluations of the North Carolina Division of Social Service's Multiple Response System (MRS) and System of Care (SOC) initiatives, the purpose of the current study was to examine whether the support provided by SOC improved fidelity to the CFT model in child welfare. The observations were conducted using the Team Observation Measure consisting of 78 indicators that measure adherence to ten domains associated with high quality family team meetings (e.g., collaborative, individualized, natural supports, outcomes based, strengths-based). Findings indicate that receiving SOC support in child welfare leads to a more collaborative and individualized decision-making process with families. Meeting facilitators in SOC counties were better prepared for CFTs, and had greater ability to lead a more robust and creative brainstorming process to develop a family-driven case plan. The current study also provides a much needed description of the CFT meeting process within child welfare using a direct observational measure.

Highlights

► Utilized direct observations of Child and Family Teams (CFT) in child welfare. ► System of Care (SOC) in child welfare leads to more collaborative family meetings. ► Provides a much needed description of the CFT meeting process within child welfare.

Introduction

Over the past several decades, many child protective services (CPS) agencies have struggled with systemic challenges such as effectively responding to increasing reports of child maltreatment, engaging families in services, and limited resources to meet the complex needs of families (Shusterman et al., 2005, U.S. Department of Health and Human Services, Administration for Children and Families, 2008). North Carolina is one of a growing number of states to develop new strategies designed to utilize a less adversarial approach to working with families to increase family engagement by actively partnering with them in case planning and decision-making (Center for the Study of Social Policy, 2002). To that aim, North Carolina has implemented two important reform efforts within the child welfare system: the Multiple Response System and System of Care Initiatives.

In 2002, the North Carolina Division of Social Services (NCDSS) developed and piloted MRS, a differential response system which utilizes a family assessment track for selected reports of child maltreatment, in addition to the traditional investigative process. MRS allows social workers to conduct a more holistic assessment of familial strengths and needs and put into place supports and resources to improve family functioning and children's safety. This process aims to set a more cooperative tone and is designed to be more open and transparent than the traditional forensic assessment. Similar to prior findings for alternative response systems in other states (Loman and Siegel, 2004a, Loman and Siegel, 2004b), MRS had a positive impact on child safety evidenced by a decline in the rates of substantiations and re-assessments, increased the number of upfront services provided to families during assessment, and improved rapport and family engagement (Lawrence et al., 2011).

In addition to the development of the family assessment track, another core component of MRS is the implementation of Child and Family Team meetings (CFT) with all child maltreatment cases receiving in-home or out-of-home services. As with other family meeting models (e.g. Family Group Decision Making, Team Decision Making), CFT meetings bring together family members and their community supports for the purposes of creating, implementing, and updating a case plan with the full participation of the child, youth and family (North Carolina Department of Health and Human Services, Division of Social Services [NCDSS], 2009). The plan builds on the strengths of the child, youth, and family to address their current needs and hopes for the future. This process is used as the primary vehicle for engaging families and community partners in an effort to build individual family support networks that will exist after CPS is no longer directly involved. North Carolina policy requires that cases found in need of services or substantiated for child maltreatment must have a CFT within 30 days of the case decision. Additionally, CFT meetings must be held every 90 days for the life the case or more often as needed. The requirement to hold a CFT at these intervals is not limited to placement cases, and is a recommended practice at any point during life of the case from initiation to case closure. Additional components of the CFT process are that a neutral facilitator, who is neither the social worker for the family nor the supervisor of that social worker, shall be used in all cases with a current risk rating of high or intensive, and that CFT preparation with families begin as soon as possible in the life of a case (NCDHHS, 2009).

There are also some key differences between CFTs and other family team meeting models in both implementation and purpose. For example, Team Decision Making (TDM) meetings, developed as part of the Family to Family child welfare reform initiative, are used in cases involving current or impending out of home placement (Crea, Crampton, Abramson-Madden, & Usher, 2008). While CFT meetings in North Carolina are used to address placement issues, they are regularly held for all cases receiving case management services regardless of in-home or out-of-home placement status. Additionally, unlike CFTs or TDMs, the Family Group Decision Making (FGDM) meeting process provides opportunities for family groups to meet independently (e.g., without authorities and service providers) to process information collectively and develop plans to present to the larger team (McCrae & Fusco, 2010).

Studies that have examined family meeting models in child welfare in the U.S. have yielded mixed findings. Several studies have found Family Group Decision Group Making (FGDM) meetings to be associated with decreased additional contact with CPS, decreased future maltreatment, better placement stability, and increased placement with relatives (Crampton, 2003, Crampton and Jackson, 2007, Pennel et al., 2010). However, studies utilizing evaluation data from the only randomized trial of FGDM (Berzin, 2006, Berzin et al., 2008) found no significant differences between children whose families had participated in FGDM and those who had not with regard to future maltreatment rates, placement stability, and permanency.

Many in human service research have advocated that studies of implementation fidelity precede full outcome evaluations of a program (Crea et al., 2009, Gilliam et al., 2000, Wind and Brooks, 2002). Crea et al. (2008) and Crea et al. (2009) examined implementation fidelity of Team Decision Making Meetings (TDM) in three sites across the U.S. The focus of these process evaluations utilized both qualitative data from interviews with social workers and quantitative data regarding participant attendance at TDM meetings and foster care placement trends. Berzin, Thomas, and Cohen (2007) also examined FGDM implementation utilizing a mixed methods approach, which included direct observations of FGDM meetings. Although the sample of observed meetings was small (n = 10), it is the only study we are aware of that utilized direct observations of family meetings in child welfare to evaluate implementation fidelity. Findings from their meeting observations indicated that staff members made a concerted effort to include family in the decision-making process and allow them to lead the discussion which primarily focused on developing a service plan.

Building on the MRS initiative, in 2003 North Carolina was awarded one of nine national grants from the Children's Bureau to expand System of Care (SOC) to the child welfare system. Before this time, SOC grants had only been funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) for children with serious emotional disturbances (SED). System of Care and wraparound programs were developed more than two decades ago to help develop more individualized and collaborative services and supports for children with serious emotional disturbances and their families (Stroul & Friedman, 1986). System of Care is a nationally recognized framework for: 1) developing partnerships between individuals and families who need services or resources from multiple human service agencies; 2) building on individual, family, and community strengths; and 3) improving the skills, knowledge, and attitudes of all service providers regarding more family-centered practices.

Unlike SAMHSA SOC grants which provide funds for direct service provision, the child welfare SOC grants were designed to provide support for infrastructure development to implement systemic changes in the way CPS works with families and other agencies. North Carolina piloted SOC in counties that were also implementing MRS and represented a mid-size county, a small rural county, and a large urban county. Grant resources allowed each of the three counties to hire full time SOC coordinators and family partners. SOC coordinators were charged with building relationships and fostering interagency collaboration among child-serving agencies as well as facilitating cross-agency trainings and CFT meetings. Family partners served as advocates, assisting families in navigating the system.

In the SOC wraparound process used for children with SED, families are also involved in a meeting process with formal and informal supports to develop an individualized plan of care that emphasizes child and family strengths (Epstein et al., 2003). Several studies have utilized direct observational methods to measure and evaluate implementation fidelity of wraparound meetings in SAMHSA-funded SOC sites (Epstein et al., 1998, Epstein et al., 2003, Singh et al., 1997, Singh et al., 2000). Epstein et al. (2003) conducted a study that utilized the Wraparound Observation Form (WOF) to observe 112 team meetings involving families receiving mental health services through a SOC initiative. The instrument measured key characteristics of wraparound as implemented within family team meetings including: community-based, individualized, family-driven process, interagency collaboration, unconditional care, measurable outcomes, meeting management, and care coordination. Their findings showed strong adherence to the wraparound principles at family meetings, with observers indicating that there was frequent discussion of child and family strengths, families were treated as active partners, and in all of the meetings families were given opportunities to provide meaningful input when developing the plan of care. In addition, service providers from other agencies attended 81% of the observed meetings, while 33% of meetings had informal supports present, and extended family were present at only 9%.

Although these studies have provided important insight regarding implementation fidelity of family meetings, much is still unknown concerning the dynamics of how family meetings actually operate in child welfare and whether practice-level implementation of the meeting is consistent with their conceptual framework and practice guidelines. This is important given that North Carolina dedicates substantial resources to training all social workers on the use of this model, as well as hiring facilitators to conduct these meetings in many counties across the state. Previous research has indicated that having a child welfare SOC grant increased family meeting adoption and implementation (Rauktis, McCarthy, Krackhardt, & Cahalane, 2010). Thus, the goal of the current study was to build upon those findings by utilizing observational data from two separate evaluations (MRS and SOC) in order to evaluate whether the support provided by System of Care improved fidelity to the CFT models and child welfare practice. Both evaluations employed direct observations of CFTs, which allowed for the examination of possible differences between North Carolina's SOC counties and non SOC (e.g., MRS only) counties.

Section snippets

Sample and participant selection

Six North Carolina counties were included in the two evaluations. Four MRS counties (non-SOC counties) were chosen using a stratified sampling strategy that provided variation in county size and geographic region within the state (selected counties included one large urban county, one mid-size county, and two small rural counties). Two MRS-plus-SOC counties participated; including one large urban county and one small rural county (see Table 1).

A total of 70 child and Family Team (CFT) meetings

Results

All meetings included in the analyses had at least one parent present (see Table 1). However, the percentage of CFT meetings that had both parents in attendance did differ by SOC status, χ2(1, N = 52) = 4.39, p < .04. Thirteen SOC observations (45%) had both the mother and father present compared to only four in non-SOC counties (17%). In addition, CFT meetings observed in SOC counties were more likely to have community supports present, χ2(1, N = 52) = 21.11, p < .001. These supports tend to represent

Discussion

The purposes of the current study were to evaluate implementation of Child and Family Team (CFT) meetings with families involved in the child welfare system in North Carolina utilizing an observational measure and to test differences in the quality of CFT meetings between counties implementing the System of Care (SOC) principles and those not implementing them. Although previous studies have examined implementation fidelity of various family meetings in child welfare and mental health (CFTs,

Acknowledgments

This work was supported by evaluation grants to the Center for Child and Family Policy at Duke University from the North Carolina Department of Health and Human Services. The “Improving Child Welfare Outcomes through Systems of Care” demonstration initiative was funded by the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services. Points of view or opinions in this paper are those of the authors and do not necessarily represent the official position or

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