Evaluation of Family Preservation and Reunification Programs:

Chapter 6:
The Families

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Contents

• 6.1 State Policies on Referral
• 6.2 The Kentucky Families
• 6.3 The New Jersey Families
• 6.4 The Tennessee Families
• 6.5 Summary
• Endnotes

6.1 State Policies on Referral

Before describing the family characteristics, services provided, and outcomes of the study, we review the state policies and practices that guided the types of families referred for family preservation services.

In all three study states there were policies specifying the types of families eligible for family preservation services. These criteria emphasized the imminent risk of placing children in foster care if the services were not provided. All three states used the Homebuilders family preservation model and reported they followed the guidelines set forth by the Behavioral Sciences Institute (BSI), where Homebuilders began.⁽¹⁾ According to BSI, the family characteristics that are key to an appropriate referral are:

1. Child is at imminent risk of placement. Placement has already been initiated or will be initiated at once without family preservation services;
2. The family is in severe crisis;
3. One parent is willing to meet with the family preservation worker at least once;
4. There are some family strengths, resources, or social supports available that can be utilized to increase safety;
5. There are no options for long-term placement with relatives;
6. The family has been told that placement is imminent; and
7. Other services have been tried and failed, or other less intense services would not be sufficient to resolve the problems that will cause placement.

Kentucky law defines FPS as “a short-term intensive, crisis-intervention resource intended to prevent the unnecessary placement of children at imminent risk of placement.” Kentucky policy specifies that imminent risk includes children who are at risk of commitment as dependent, abused, or neglected; who are identified through the Regional Interagency Council as severely emotionally disturbed; or whose families are in conflict such that they are unable to exercise reasonable control of the child.

In New Jersey, family preservation is considered to be a “gatekeeper” to prevent out-of-home care for a child. According to state legislation, family preservation services are targeted at families with substantiated abuse or neglect, with the children at risk of harm from maltreatment. The state defines three levels of eligibility for targeting purposes. Only the first level applies to families with children at risk of foster care placement. It includes families with at least one child at imminent risk of placement, unless changes in family coping or behavior patterns are made, placement will occur. Cases in which there is one child in temporary placement less than thirty days are also eligible. The referring worker must base the assessment of imminent risk on a face-to-face interview with the family no more than 5 days prior to the referral.⁽²⁾ Although the term “imminent risk” is used as the litmus test for referring families, definitions of this term are left to the counties and ultimately the individual caseworker and his or her supervisor.

In Tennessee, criteria outlined in policy are also based on the criteria established by the BSI. CPS intake workers complete a risk assessment form to identify high, intermediate, low, or no risk situations. High risk cases are identified as cases where “the child or children in the home are at imminent risk of serious harm if there is no intervention in the situation.” A typical high risk case might involve such factors as: (1) a vulnerable child; (2) a history of previous maltreatment; (3) a perpetrator who has continued access to the child; and (4) no available support or family strengths to offset the risks.

In Kentucky and New Jersey workers were being encouraged to focus family preservation referrals on younger children. Although not a written policy, managers were emphatic that families with younger children should be a priority for family preservation referral. Conversations with workers revealed that this was not necessarily being adhered to. In addition, when workers were queried about the types of families they actually referred to family preservation their responses varied.

Divergence of Practice from Policy. As expected, policy and practice were not always synchronized. In New Jersey, county practices on referral varied. Workers interviewed in the seven study counties presented several alternatives. In most counties the workers indicated they mainly referred ongoing cases, cases in which they had worked with families for an extended period of time. Workers had to demonstrate that they offered many alternative services and workers said that they used family preservation because it was the only service option left to offer a long-term case. Workers also indicated that they considered family preservation services most appropriate for family problem cases, rather than child abuse and neglect cases, especially those with adolescent issues.

In Kentucky, criteria outlined in policy mirror the criteria established by BSI. However, in practice workers said they referred cases that they felt really needed services, and were not necessarily facing imminent placement. Workers who referred cases from ongoing units as opposed to intake and investigation units said that ongoing referrals did not involve a specific incident of maltreatment. Instead, referrals of ongoing cases were more likely to involve chronic problems that were getting worse. When asked specifically about the types of cases referred for family preservation services, some workers identified:

1. Low functioning parents with no parenting skills;
2. Young mothers who are overwhelmed and need help getting supportive services;
3. Dirty house cases, something very concrete that family preservation services could work on and see improvement in;
4. Domestic violence cases; and
5. Psychiatric cases where a parent might be schizophrenic and would not take medication.

When queried, supervisors stressed that referrals are made based on families in crisis who have an immediate need because of risk of placement.

Investigative workers in Tennessee reported that Home Ties was used as their first resort for families at imminent risk of removal because program staff could be in the home monitoring and assessing families. Ongoing workers reported that they used Home Ties as a last resort, after they had tried less intensive services because of the intensity of the intervention and the availability of concrete resources (flexible funding, transportation) that could be used. Department of Children’s Services workers also said that the best candidates for Home Ties were families who needed assistance with communication skills and anger management

Both Kentucky and New Jersey policies excluded families in which there was a substance abuse problem and a current plan for treatment was not being pursued. Kentucky excluded families in which there was sexual abuse and the perpetrator was still in the home.

We turn now to a description of the families in the evaluation. Descriptive information about the families was gathered from the initial interviews with caretakers. Those interviews included information on the families involvement with social programs prior to referral to family preservation. Questions on family problems and social program participation were also asked in the post-treatment and follow-up interviews. Data from those interviews are presented in Chapter 8. In addition, administrative data were used to describe prior involvement of families with the child welfare system. Because families were randomly assigned, we would expect the families in the experimental and control groups to be similar at the time of random assignment, and for that reason, the sample is described as a whole. However, by chance it is expected that the groups would differ in statistically significant ways on a few variables. We identify below those characteristics on which the groups differed significantly.

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6.2 The Kentucky Families

Table 6-1 summarizes certain characteristics of 311 Kentucky caretakers and families for which we have initial caretaker interviews (89% of the 349 net study cases). The respondents were primarily women (93%). Most (85%) of the respondents were birth mothers, 7 percent were biological fathers, 6 percent grandmothers, and the rest were other relatives, including one adoptive mother (for 6% the relationship to the child was not ascertained). The racial composition of the respondent group was mostly white (55%) and African American (not Hispanic) (43%), along with 1 percent Hispanic and 1 percent other. The average age of the respondents was 32 (n = 306, s.d. = 9.49). Nine percent of the respondents had less than a high school level education, 44 percent had some high school, 32 percent had graduated from high school or obtained a GED, 14 percent had at least some college education, and 1 percent had special education or vocational schooling. Approximately 24 percent of the respondents indicated they were married, 19 percent divorced, 21 percent separated, 3 percent widowed, and 33 percent never married.⁽³⁾ Thirty-five percent reported that they were living with a spouse or partner. At the time of the first interview, 38 percent of the respondents indicated they were employed, 29 percent were unemployed and looking for work, and 33 percent were unemployed and not looking for work.⁽⁴⁾ Overall, 83 percent of the respondents rented their homes. Respondents in the experimental group were more likely to rent their homes than those in the control group (89% vs. 77%, p = .005). Provided with a list of income categories, respondents were asked to approximate their household incomes. Of the 300 respondents who answered the question, 15 percent reported an income less than $5,000, 23 percent between $5,000 and $10,000, 43 percent between $10,000 and $20,000, 16 percent between $20,000 and $40,000, and 3 percent reported an income of $40,000 or more. There were no significant differences between experimental and control group respondents in reported household income.

On average, these families were comprised of 1.6 adults and 3 children for an overall average family size of 4.6 persons. The average age of the youngest child in the family was 4.6 years (n = 311, s.d. = 4.35), and the average age of the oldest child in the family was 9.9 years (n = 311, s.d. = 5.00). The distribution of the age of the youngest child was 19 percent under 1 year, 42 percent between 1 and 4, 33 percent between 5 and 12, and 6 percent 13 and over. The distribution of the age of the oldest child was 3 percent under 1 year, 16 percent 1 to 4, 42 percent between 5 and 12, and 39 percent 13 and over.

While there were no significant differences between families in the experimental and control groups with regard to total number of persons, number of children in the home, or ages of youngest and oldest child in the home,⁽⁵⁾ there was a statistically significant difference in the number of adults in the home. The control group averaged 1.7 adults per household (n = 155) whereas the experimental group averaged 1.5 adults per household (n = 156; p = .012). Respondents were also asked to provide information regarding the relationship of other adults in the home relative to the youngest child in the home. This information was then used to determine household composition for these families. Forty-three percent of households were headed by a single birth mother, 24 percent had a birth mother residing with one male adult, 9 percent had a birth mother and extended family, 6 percent were headed by a biological father, and 17 percent were headed by another relative caretaker.

Family Problems. We can get some sense of the difficulties families faced from the first interviews with caretakers, in which we asked whether they had experienced certain problems in the last month (see Table 6-2). In Kentucky there were few significant differences on these items between the experimental and control groups at the initial interview. With regard to emotional problems, 55 percent of the respondents reported feeling "blue or depressed,"56 percent reported feeling nervous or tense, 47 percent were overwhelmed by work or family responsibilities, 31 percent said they had just wanted to give up at some point in the last month, and 30 percent felt they had few or no friends. With regard to financial difficulties, 49 percent responded that in the past month they did not feel they had enough money for food, rent, or clothing. In response to more specific questions about difficulties paying bills in the past 3 months, 24 percent reported difficulty paying rent, 32 percent reported difficulty paying electric or heating bills, 23 percent difficulty buying food for the family, and 31 percent difficulty buying clothes for their children.⁽⁶⁾

Three percent of respondents acknowledged having too much to drink several times a week, and 1 percent reported using drugs several times a week. Seven percent of respondents indicated they had gotten in trouble with the law in the past month.⁽⁷⁾

Most (90%) respondents felt they were "doing a pretty good job raising [their] kids"(94% of the experimental group, compared to 86 percent of the control group, a difference significant at p = .02).

Table 6-3 shows problems of children identified by caretakers. Over four-fifths of caretakers said at least one child in the family threw tantrums and about the same proportion said a child "didn't show much interest in what is going on." Over two-thirds said a child "gets upset easily." Items identifying difficulties in school were endorsed by a quarter to a third of respondents (frequent absences, suspension, failed classes). Aggressive behavior was a fairly common problem, a third of the caretakers said a child fights a lot with other kids and 43 percent said a child was very aggressive toward them.

Caretaker Abuse or Neglect as a Child. When asked two separate questions about whether they had been abused or neglected as a child, 31 percent of the 311 initial interview respondents reported having been abused and 20 percent neglected. Sixteen percent responded affirmatively to both questions, and overall, 35 percent of the caretakers reported having either been abused, neglected, or both as a child. Eighteen percent of caretakers had been in a foster home or institution. Experimental and control groups did not differ significantly with respect to these previous experiences.

Previous Allegations and Placement. Historical reports of maltreatment and of placement in substitute care were available from the administrative data files. Two hundred and ninety-five (96%) of the Kentucky families had been investigated for maltreatment prior to random assignment. Two hundred and thirty-six (77%) of the families had experienced at least one substantiated⁽⁸⁾ allegation prior to random assignment. The administrative files reported five types of allegations; dependency, emotional, neglect, physical abuse, and sexual maltreatment. The allegation just prior to random assignment was of primary interest. This particular allegation provides some indication of reason for referral to family preservation. The distribution of last allegation prior to random assignment is: 34 percent dependency, 5 percent emotional, 32 percent neglect, 44 percent physical abuse, and 24 percent sexual maltreatment. The distribution of last substantiated allegation prior to random assignment is as follows: 34 percent dependency, 3 percent emotional, 34 percent neglect, 41 percent physical, and 19 percent sexual maltreatment. As individual families can have multiple allegations on any given day, percentages add to more than 100 percent. In 68 cases (29% of the 236), the only substantiated allegation just prior to random assignment was dependency. Hence, there were a substantial number of cases referred for family preservation services in which it appears that abuse or neglect were not major issues.

The above data describe the allegations that may be considered to be associated with the current involvement of the family with the child welfare system. The administrative data can also be used to explore the extent of prior involvement with the system. Of the 295 Kentucky families with at least one allegation prior to random assignment, 139 (47%) had a substantiated report of maltreatment prior to the allegation just before referral to family preservation.

Regarding substitute care placement, 124 children in 53 (17%) families had experienced placement prior to random assignment.⁽⁹⁾ The administrative files contained placement dates for 123 of these 124 children. On average, 20.2 months elapsed between the last day of care and random assignment. In the placement spell just prior to random assignment the average length of time in substitute care was 5.9 months.⁽¹⁰⁾

Length of Time from Case Opening to Referral to Family Preservation Services. The Kentucky administrative data also contained information about case opening and closing dates. In Kentucky, opening and closing data are recorded at the individual rather than family level, and the dates of opening and closing for various members of a family may differ. Our analyses, however, were conducted at the family level. We considered a case open from the date of the first open record for any person in the family to the time that the last record for any person in the family had been closed out. In other words, the opening and closing data described here refer to periods of time during which DSS was involved with at least one person in the family. It should also be noted that in Kentucky a family does not necessarily need an open record in order to receive services, as services or referrals for services may be provided by the investigating worker prior to opening the case. Presumably, such cases should be opened shortly after referrals for services. With this in mind, cases were examined for the date of case opening or the date of the last maltreatment report, both of which may indicate DSS involvement in that case.

Of the 307 cases for which administrative data were available, 183 (60%) were open at the time of the referral to family preservation services. An additional 89 cases were not open at the time of referral to FPS, but had had a prior maltreatment report (15 of these cases had been open previously). In 59 of the 272 cases open at the time of referral or with prior maltreatment reports, the most recent case opening or maltreatment report occurred over six months prior to referral, in 34 cases, over a year prior. Appendix G provides a more detailed breakdown of case openings and maltreatment reports as well as the timing of these events in relation to the referral to family preservation services.

Social Program Participation. In the initial interview, respondents were asked whether they or anyone else in the household had participated in various social programs within the past 3 months. The overall rates of participation by Kentucky families are provided in Table 6-4. Over two-thirds indicated that they received food stamps, just under half received AFDC, more than a third received WIC, about a third received social security disability,⁽¹¹⁾ and just under a fifth received a housing voucher. Overall, respondents indicated that they participated in an average of 2.1 of the 5 income support programs listed (s.d. = 1.36) and 82 percent of the sample participated in at least one of the five programs.⁽¹²⁾ Differences in the rates of program participation were found for WIC and community mental health programs, with both programs showing higher rates of participation among the experimental group. Forty-eight percent of the experimental group reported WIC participation within the last 3 months compared to 34 percent of the control group (p = .01) and 16 percent of respondents in the experimental group reported participation in community mental health programs compared to 9 percent of respondents in the control group (p = .04). Reports of participation in alcoholism, drug treatment, marriage counseling, and job training programs were less than 10 percent for each. Slightly less than a third of the sample reported participation in Head Start or another pre-school program.

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6.3 The New Jersey Families

As in Kentucky, we describe the sample of New Jersey families based on information from our first interviews with caretakers (n = 328, 74% of the 442 net study cases). Again, we describe the sample as a whole, identifying the variables on which the experimental and control groups were statistically different.

Table 6-5 summarizes a number of characteristics of New Jersey caretakers and families. Most (88%) of the caretakers were women. The sample was about evenly divided between whites and African Americans. Forty-seven percent were white, 42 percent African American (not Hispanic), 9 percent Hispanic, and 2 percent other. On average there were 4.7 persons in these families, 1.8 adults and 2.9 children. The average age of the respondents was 39 (n = 324, s.d. = 10.8), the youngest child in the family was, on average, 7.1 years old (n = 328, s.d. = 5.4), and the oldest child in the family, 12.5 (n = 328, s.d. = 4.3). The distribution of the age of the youngest child was 15 percent under 1 year, 26 percent between 1 and 4, 37 percent between 5 and 12, and 23 percent 13 and over. The distribution of the age of the oldest child was 2 percent under 1 year, 5 percent 1 to 4, 30 percent between 5 and 12, and 63 percent 13 and over.

About 9 percent of the respondents had no high school education, 40 percent some high school, 26 percent high school graduation or a GED, 20 percent at least some college education, and 4 percent had special education or vocational schooling (0.9% were unknown). Thirty percent of the respondents were married, 34 percent divorced or separated, 6 percent widowed, and 30 percent never married. At the time of the first interview, 41 percent were employed, 18 percent reported that they were unemployed and looking for work, and 41 percent were unemployed and not looking for work. Two hundred ninety-one respondents provided information about their household incomes, with significant differences between the experimental and control groups (p = .03). Fewer control group cases were at the middle of the income spectrum.⁽¹³⁾

Most (71%) of the respondents were birth mothers, 10 percent were biological fathers, 11 percent grandmothers, and the rest were other relatives, including step-relatives. Four of the respondents were adoptive mothers and two were adoptive fathers. As to household composition at the time of the first interview, 34 percent of the families were headed by birth mothers with no other adults in the home, 27 percent had a birth mother and one male adult, 8 percent had the birth mother with other extended family, 9 percent were headed by a single father, and 17 percent had another relative caretaker (4% of the families did not fall into one of these categories). Forty-three percent reported that they were living with a spouse or partner. Seventy percent of the respondents rented their homes. On none of these characteristics did the experimental and control groups differ significantly at the time of the first interview.⁽¹⁴⁾

Family Problems. Problems identified by New Jersey caretakers are summarized in Table 6-6. Emotional and financial problems were most often cited. Fifty-eight percent of the respondents said they had felt "blue or depressed," 52 percent said they felt nervous or tense, 56 percent were overwhelmed by work or family responsibilities, 33 percent said they had just wanted to give up sometime in the last month, and 27 percent said they had few or no friends. Over half (52%) responded affirmatively to the general question as to whether they experienced not having enough money for food or rent, and on more specific questions about difficulties paying bills, 29 percent said they had difficulty paying rent, 37 percent difficulty paying electric or heat bills, 30 percent difficulty buying food (on this item there was a significant difference between the groups, 26% of the experimental group vs. 36% of the control group, p = .04), and 45 percent difficulty buying clothes for their children. Few respondents reported problems in drinking or using drugs (only 0.9% said they "had too much to drink in the last week" and 0.9% said they used drugs several times in a week). Only 3 percent said they had gotten into trouble with the law. Most (93%) thought they were "doing a pretty good job raising [their] kids."

Table 6-7 shows problems of children identified by caretakers. About four-fifths of caretakers said at least one child in the family threw tantrums and about three-fourths said a child "gets upset easily." School problems were common; over 40 percent had been absent a lot or failed classes and nearly a third had been suspended. Aggressive behavior was common, 40 percent of caretakers said a child fights a lot with other kids and 56 percent said a child was very aggressive toward them.

Caretaker Abuse or Neglect as a Child. Twenty-eight percent of New Jersey caretakers reported having been abused as a child and 25 percent reported having been neglected. Twenty-one percent answered "yes" to both questions, and overall, 32 percent of the caretakers reported having been abused, neglected, or both as a child. Fourteen percent of the respondents had been in a foster home or institution. There was little difference between the experimental and control groups in these previous experiences.

Previous Allegations and Placement. Of the 434 New Jersey families for which we had administrative data, 89 percent had an allegation of maltreatment prior to the date of referral to family preservation services. Sixty-four percent had a substantiated report of maltreatment prior the referral date.⁽¹⁵⁾

We have data for 369 cases on the type of allegation just before the last case opening before referral. Forty-two percent of the cases had allegations of physical abuse, 11 percent of lack of supervision, 20 percent of other neglect, 5 percent of sexual abuse, and 5 percent of emotional abuse (cases could fall in more than one of these categories). In 22 percent of the cases, there was no abuse or neglect found before the case opening.

Similar to the analysis of Kentucky data, we examined reports of maltreatment before the allegation prior to the referral to family preservation services, as an indication of prior involvement with the child welfare system. Of the 386 families with allegations prior to referral, 205 (53%) had a substantiated report of maltreatment before that, indicating that about half of the families had previous involvement with the system.

As to substitute care placement, 191 children in 94 families had previously experienced placement. Eighteen of these children were in 5 adoptive homes and the referral to family preservation services was for the purpose of preserving the adoptive home. For the remaining 173 children, the average length of time between the end of the previous placement and random assignment was 53.5 months. The average length of time in that placement spell was 12.9 months.⁽¹⁶⁾ Seventy percent of the first placements in the previous placement spell were foster family care, the remainder were residential treatment, shelter care, group homes, and institutions. There was a difference between the experimental groups in the previous placement experience of children, with control group children averaging 85 days and the experimental group children averaging 104 days (a nonsignificant difference).

Length of Time from Case Opening to Referral to Family Preservation. On 434 New Jersey cases for which we have administrative data, 13 cases were not open at the time of the referral to family preservation services. Two of these 13 cases were opened within 30 days after the referral, and two were opened within 2 to 6 months after the referral. The remaining 9 cases had not been opened as of the last date of observation for these analyses (August 31, 1998). In 34 percent of the 421 cases open at the time of random assignment, the referral to family preservation services occurred within a month after case opening while in another 33 percent it came between two and six months after case opening. In 21 percent of the cases the referral occurred more than a year after case opening. The administrative data also recorded reports of maltreatment prior to random assignment for 386 families. In 37 percent of these cases, the report occurred in the month prior to referral, in another 28 percent it came between two and six months prior. In 25 percent the report occurred more than a year before referral.

Social Program Participation. Table 6-8 shows the rates of participation by New Jersey families in social programs. About half of the respondents reported having received food stamps; two-fifths, AFDC; a third, social security disability; and a fifth, WIC. About a third had been in a community mental health program and two-fifths had had children in Head Start or another pre-school program. Very few had been in alcohol or drug treatment or marriage counseling. The experimental and control groups differed significantly only with regard to job training, 2 percent of the control group and 8 percent of the experimental group had been in such a program (p = .01).

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6.4 The Tennessee Families

As with Kentucky and New Jersey, a description of the Tennessee families was compiled using information from the initial interviews with caretakers (n = 117, 80% of the 142 net study cases). In addition to the description of the sample as a whole, specific characteristics on which the experimental and control groups differ significantly are identified below.

Table 6-9 shows some of the characteristics of the caretakers and families in the Tennessee sample. Slightly more than 93 percent of the respondents were women. Eighty-three percent of the sample was African American (not Hispanic), 15 percent Caucasian, and 1 percent Hispanic. Nine percent of the sample had less than a high school education, 46 percent some high school, 18 percent high school graduation or GED, 22 percent at least some college education, and 4 percent had special education or vocational schooling. Over half the sample (54%) had never been married, 3 percent widowed, 14 percent separated, 13 percent divorced, and 17 percent were married. At the time of the initial interview, approximately 40 percent of the respondents were employed, 24 percent reported they were unemployed and looking for work, and 36 percent reported they were unemployed and not looking for work. Information about household income was provided by 115 of the respondents. Thirty-eight percent reported an income less than $5,000, 24 percent reported between $5,000 and $10,000, 23 percent reported between $10,000 and $20,000, 11 percent reported between $20,000 and $40,000, and 3 percent reported an income of $40,000 or more.

There was an average of 4.9 persons in the families, 1.6 adults and 3.3 children. The average age of the respondents was 33 (n = 116, s.d. = 8.5). The age of the youngest child in the family ranged from 0 to 17 with an average of 4.0 years (n = 117, s.d. = 4.2); 33 percent were under the age of one, 25 percent were between 1 and 4, 38 percent between 5 and 12, and 3.6 percent 13 and over. The age of the oldest child in the family ranged from 0 to 17 with an average of 10.8 (n = 117, s.d. = 4.8); 4.3 percent were under the age of one, 6.1 percent were between 1 and 4, 46 percent between 5 and 12, and 44 percent 13 and over.

When asked about their relationship to the youngest child in the home, 84 percent of the respondents reported they were birth mothers, 6 percent were biological fathers, 4.3 percent were grandmothers, one respondent was an adoptive mother, and the rest were other relatives (including aunts, uncles, a sister, and a great grandmother). With respect to the household composition at the time of the first interview, exactly half of the sample was comprised of families headed by birth mothers with no other adult in the home, 21 percent had a birth mother and one male adult, 14 percent had a birth mother and extended family, 6 percent were headed by a biological father, and 9 percent had an other relative caretaker (1% of the families did not fall into one of these categories). Thirty-one percent responded that they were living with a spouse or partner. Seventy-six percent reported that they rented their homes while 24 percent reported owning their home. While there were no statistically significant differences between the experimental and control groups, there was a marginally significant difference with respect to the proportion of respondents living with a spouse or partner. A larger proportion of the experimental group reported living with a spouse or partner (36% vs. 19%, p = .06).

Family Problems. Table 6-10 summarizes the problems and strengths identified by caretakers. When asked about emotional and financial problems within the last month, 61 percent of respondents said they felt "blue or depressed," 53 percent said they felt nervous or tense, 46 percent were overwhelmed with work or family responsibilities, 28 percent said they had just wanted to give up, and 24 percent said they felt they had few or no friends. Over half (56%) responded affirmatively to the general question of whether or not they experienced not having enough money for food or rent. On more specific questions about financial difficulties, 35 percent indicated having difficulty buying clothes, 26 percent buying enough food, 42 percent paying electric or heat bills, and 37 percent paying rent (on this last item, a significantly greater proportion of control group respondents answered affirmatively, 54% vs. 29%, p = .01). Less than 10 percent of the sample reported problems in drinking or using drugs (2.5% said they had too much to drink several times a week, and 7.7% reported using drugs several times a week). Only 4.3 percent had gotten in trouble with the law in the past month. Almost all respondents (97%) thought they were "doing a pretty good job raising their kids."

Table 6-11 shows problems of children identified by caretakers. About two-thirds of caretakers said at least one child in the family threw tantrums and 60 percent said a child "gets upset easily." As in Kentucky and New Jersey, school problems were common; over a quarter had been absent a lot, nearly 40 percent had failed classes, and over 40 percent had been suspended. Somewhat fewer children in Tennessee displayed aggressive behavior, 18 percent of the caretakers responded yes to the items "fights a lot with other kids" and "is very aggressive to you."

Caretaker Abuse or Neglect as a Child. Approximately 33 percent of Tennessee caretakers reported having been abused as a child and 25 percent reported having been neglected. Twenty-one percent responded "yes" to both questions, and overall, 38 percent reported having been abused, neglected, or both as a child. Twelve percent of the respondents reported having been in a foster home or institution as a child. There were no significant differences between experimental and control groups with respect to these previous experiences.

Previous Allegations and Placement. Of the 144 Tennessee families for which we had administrative data, 117 (81%) had an allegation of maltreatment prior to the date of referral to family preservation services. Sixty-seven percent had a substantiated report of maltreatment prior to the referral date.

We have data for 106 cases on the type of allegation just before the last case opening before referral. Seventy-six percent of the cases had allegations of physical abuse, 15 percent lack of supervision, 8 percent neglect, and 2 percent injury. The distribution of last substantiated allegation is 79 percent physical abuse, 12 percent lack of supervision, 8 percent neglect, and 1 percent injury.

Similar to the other states, we examined reports of maltreatment before the allegation prior to the referral to family preservation services, as an indication of prior involvement with the child welfare system. Of the 117 families with allegations prior to referral, 48 (41%) had a substantiated report of maltreatment before that, indicating that about two-fifths of the families had previous involvement with the system.

As to substitute care placement, according to the CORS administrative data, 9 children in 4 families had previously experienced placement. The average length of time between the end of the previous placement and random assignment was 6.27 months. The average length of time in that placement spell was 16.47 months. Data on previous unpaid relative placements were not available.

Length of Time from Case Opening to Referral to Family Preservation. On 147 Tennessee cases for which we had administrative data on case openings, 36 cases were not open at the time of the referral to family preservation services. In 57 percent of the 111 cases open at the time of random assignment, the referral to family preservation services occurred within a month after case opening while in another 20 percent it came between two and six months after case opening. In 14 percent of the cases the referral occurred more than a year after case opening.

Social Program Participation. Table 6-12 shows the rates of participation by Tennessee families in social programs prior to the initial interview. Almost three-fourths of the respondents reported having received food stamps; 61 percent AFDC; 30 percent social security disability, and 43 percent WIC. Fifteen percent reported participation in a community mental health program, 10 percent in a drug treatment program, 7 percent in an alcoholism program, and 38 percent had children in Head Start or another pre-school program. None of the respondents reported participating in marriage counseling. Five percent of respondents said they had participated in job training, with marginally significant differences (p = .06) between the experimental group (3%) and the control group (11%).

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6.5 Summary

In all three states, most of the respondents to the first interview were women and birth mothers of the youngest child in the home. In Kentucky and New Jersey, a little over two-fifths of the respondents were African American, while in Tennessee, 83 percent were African American. In Kentucky, slightly more than half were Caucasian, compared to a little under half in New Jersey and only 15 percent in Tennessee. About half of the respondents in all three states had not graduated from high school. Half of the households in Tennessee were headed by a single birth mother, compared to 43 percent in Kentucky, and 34 percent in New Jersey. The average age of the respondents in Kentucky and Tennessee was about 32, while New Jersey respondents were older, an average of 39. Similar differences held for age of youngest child: an average of 4.0 in Tennessee, 4.6 in Kentucky, and 7.1 in New Jersey. The average number of children in the home was around 3 for all three states.

Approximately half of the respondents in Kentucky and New Jersey answered affirmatively to each of three questions about emotional difficulties: "feeling blue or depressed," "feeling nervous or tense," and "feeling overwhelmed with work or family responsibilities." In Tennessee, rates, of reporting these difficulties were a little higher. Half or more of the respondents in all three states indicated that they did not have enough money for food, rent or clothing. Few respondents reported problems with drugs or alcohol. A third or two-fifths reported that they had been abused or neglected or both as a child.

About two-thirds of the respondents in New Jersey and Tennessee reported they participated in at least one of 5 income support programs: AFDC, food stamps, WIC, social security disability, and housing vouchers. In Kentucky, over 80 percent participated in one of these programs. In all three states, the rate of participation was less than 10 percent for each of the following programs: alcoholism treatment, drug treatment, marriage counseling, and job training. A third or two-fifths of the respondents indicated participation in Head Start or another pre-school program.

In Kentucky and New Jersey, about a fifth of the families had children who had previously been in a foster care placement. In Tennessee, only four families had children who had previously been placed.

The Target Group for Family Preservation Services. The families referred to family preservation services in Kentucky, New Jersey, and Tennessee had a variety of problems with a range of severity. Beyond that, they were a diverse group, varying in such things as family composition, ages of children, previous involvement in the child welfare system, and where they were in the system at the time of referral to family preservation services. Question can be raised as to whether a single model can be expected to be appropriate across such a diverse caseload. Can one expect one approach to work as well with older as well as young children? With cases of abuse as well as chronic neglect and dependency? With cases new to the system as well as those with extensive prior involvement?

We may also inquire as to the extent to which the families served in these states are the families for which family preservation services are intended as outlined in the introduction to the chapter. There are two central elements usually found in specifications of the target group for family preservation: imminent risk of placement and the presence of crisis. The paradigmatic case is one in which an allegation of abuse or neglect has recently been made and the case is referred in the course of investigation of that harm. It is evident that many cases are not in this category, particularly in Kentucky and New Jersey. Some are dependency or parent-adolescent conflict cases. Many do not come from the investigative phase of a case but rather from "on-going" workers. Many do not appear to be in immediate crisis, as suggested by the fact that many cases were referred long after the latest reports of maltreatment and after the most recent case opening. Cases in Tennessee more often conformed to this model, although there were a number that did not.

It is true that family preservation services are often advocated in cases other than abuse and neglect (in fact, Homebuilders began in the context of adolescent mental health problems). Furthermore, the specifications of eligible cases, reviewed at the beginning of this chapter, suggest a fairly wide net, including cases referred from on-going workers. Behavioral Sciences Institute's own criteria for referral contain one item that seems to contradict the criterion of crisis: the requirement that other services have been tried and failed. Adhering to this requirement would tend to put off referral to family preservation beyond the time of immediate crisis.

Beyond ambiguities in target group suggested by state policy and by BSI, there are the observations of referring workers that they sometimes, even often, made referrals that did not meet the imminent risk criterion. Although a family might not have a child at risk of placement, they believed the family would benefit from the service, so found a way to refer it. The data presented in this chapter suggest that the imminent risk and crisis criteria were often not met. It appears that the target group for family preservation has been expanded beyond that originally intended, perhaps first by state policy and certainly by practice in the field. Such expansion of the target group is no doubt quite common for social programs. It is natural to attempt to provide a valued service, viewed as beneficial, to more and more cases.

But there is a reason for relatively narrow, carefully defined, target groups. Specification of the target group is closely intertwined with specification of the goals of a program (in family preservation programs, cases of imminent risk of placement are the target group for a service intended to prevent placement). Clarity of target group allows clarity of goals. Once the target group becomes broadened, there is the risk that goals will become muddied. Two problems may ensue: the service being provided may lose structure, definition, and focus; and it becomes more difficult to achieve demonstrable effects of the service.

So the group of families served by family preservation services in these states reveal a central tension: the urge to serve a wide range of families as against the desirability of maintaining program focus on well defined groups. We have no ready solution to this conundrum, which may be inherent in large scale program implementation. We hasten to note that although we focus here on these three states, it is possible that most, if not all, states implementing family preservation programs face very similar issues.

We will return to the targeting problem in family preservation programs after examining the outcomes of the programs in Kentucky, New Jersey, and Tennessee.

[ Go To Contents ]

Endnotes

(1) Behavioral Sciences Institute, "Key elements of an appropriate referral," Behavioral Sciences Institute, Federal Way, Washington, 1992. [Back to Text]

(2) As discussed in Chapter 4 the remaining two levels of eligibility focus on reunifying children with their families after they have already been in placement less than 90 days or are about to return home within the next two weeks. [Back to Text]

(3) When married, divorced, and separated categories are collapsed and compared to never married, a larger percentage of respondents in the experimental group were never married, 40% vs. 28%, p = .04 (8 widowed respondents and 1 not ascertained respondent are not included in these collapsed analyses). [Back to Text]

(4) When the 2 unemployed categories are collapsed and compared to the employed category, a larger percentage of respondents in the control group were employed at the time of the first interview, 43% vs. 33%, p = .12. [Back to Text]

(5) Though not a statistically significant difference, the average age of the oldest child was greater for control group families than for experimental group families, 10.31 years vs. 9.42 years, p = .13. [Back to Text]

(6) More of the experimental group respondents indicated difficulty buying clothes for their children, 35% vs. 27%, p = .16. [Back to Text]

(7) Experimental group caretakers were more likely to answer that a child or children they care for went through alcohol or drug withdrawal when born. [Back to Text]

(8) The state of Kentucky reports five possible outcomes for reports of maltreatment; (1) substantiated, (2) found/substantiated, (3) some indication, (4) unsubstantiated and (5) unable to locate. Substantiated and found/substantiated were collapsed to form a "substantiated" category. [Back to Text]

(9) Our analyses did not include children inplacement at the time of random assignment. [Back to Text]

(10) Placement spells are defined as any consecutive period of time in substitute care and may consist of several distinct placements (i.e., several different foster homes). [Back to Text]

(11) The question on the interview was worded in terms of "social security disability." We intended this to refer to Supplemental Security Income. [Back to Text]

(12) The average number of income support programs used was slightly higher for the experimental group than for the control group, 2.21 vs. 1.98, p = .13. [Back to Text]

(13) Fifteen percent of control group respondents and 17% of experimental group respondents reported an income less than $5,000; 32% control and 22% experimental reported between $5,000 and $10,000; 15% control and 31% experimental reported between $10,000 and $20,000; 24% control and 18% experimental reported between $20,000 and $40,000, and 14% control and 12% experimental reported an income of $40,000 or more. [Back to Text]

(14) Control group respondents more often lived with a spouse or partner, 43% vs. 35%, p = .13. [Back to Text]

(15) In the New Jersey administrative data, there are 7 possible outcomes of investigations of maltreatment: abuse/neglect/injury confirmed perpetrator, abuse/neglect/injury unconfirmed perpetrator, abuse/neglect/injury perpetrator unknown, unsubstantiated incident, unsubstantiated incident with concern, incident never occurred, and no outcome. The data above concern only persons who were children at the time of random assignment. The administrative data also record information on previous allegations involving persons who are now adults. Seventy-four adults (persons 18 or over at the time of random assignment) from 51 families had been the subjects of previous substantiated reports of maltreatment. [Back to Text]

(16) By a "spell" we mean a period of time in placement which may consist of one or more distinct placements in different foster homes or in other settings. [Back to Text]

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