CFSCM Year End Report In-Home Support

This Report was Prepared by Ms. Gwen Heinrichs M.S.W.
In-Home Support Program Coordinator

Introduction

The past few years have witnessed an increasing interest in developing child welfare intervention strategies aimed at families with children at risk of out of home placement. A major impetus for the development and implementation of programs in this service area is derived from the long standing concern that too many children are being damaged by being separated from their families. Additional reasons for this growth have been the increasing cost of placing children, limited alternate options, and out of concern that insufficient efforts were being made to prevent out of home placements (Stavert, 1995).

Recent years have evidenced the proliferation of a variety of service models under what has become known as "FAMILY PRESERVATION. Today, numerous service designs or programs exist and are in varying stages of development under this conceptual framework. These programs are characterized by relatively short term, home based services which are designed to keep families together through prevention, co-ordination, and the provision of intensive services. Underlying each of these varied ways to maintain family bonds is an emphasis on the safety, protection and development of children.

Social work is premised on the belief in certain fundamental values about the inherent worth of all human beings. Chief among these values is the belief that people are unique and have the ability and capacity to grow, learn and change (Cole, 1995). Based on this value, In -Home support programs therefore strive to prevent out-of-home placements of children by preserving the family unit through improving the family's coping abilities and parenting skills. Family Preservation programs provide a combination of concrete and clinical services designed to defuse crisis situations, enhance family functioning, and maintain children safely in their homes. These efforts are intended to build a strong support system that allows the family to maintain change and handle future crisis that may arise. Home -based services, because workers are present in the home, tend to produce more accurate and sensitive assessments, allow workers to interact with family members in their natural setting, and facilitate any necessary modifications of the environment and behaviour adjustments in family members (Smith, 1995).

The substantial information found in the literature on In-Home Support Services suggests that In- Home based interventions have made significant contributions to family focused child welfare practices. The central concern of family based services has been the prevention of placement. In a study reported by Smith (1995) 92% of the families were still intact three months after the program was completed. Pecora (1992) had a sample of 446 families and again 92.3% of families remained intact at the completion of the program. Berry s (1992) research found that 88% of 446 families, avoided removal of their children for one year after being involved in the program. Although placement prevention is the crucial criterion in determining treatment effectiveness, it is however not the only measure of success. Pecora (1992) found that Family Preservation Programs were not only correlated with high rates of placement prevention, but also with improvement in family functioning.

The type of service the family receives also makes a difference to the outcome. Berry (1992) found that families were best served and likely to remain intact when services were concrete, such as the teaching of family care, supplemental parenting, medical care, help in securing food, and financial services. It is important to remember, however, that In-Home Support is only one component on a continuum of options. In-Home Support Services cannot meet the needs of all families and therefore is provided as an option to those who would benefit.

Program Design

The In-Home Support Program through Child and Family Services of Central Manitoba began in April 1995 after the agency learned that its proposal had been accepted through the provincial government funding initiative "Family Innovations." In establishing this fund, the government wanted to find ways that would enable child welfare agencies to more closely meet some of the declared fundamental principles of the child welfare act, specifically that "the family is the basic unit of society and its well-being should be supported and preserved.

The In-Home Support Program in CFSCM comprises a coordinator and two workers. The program attained full staff complement in October 1995. The focus of this service has been on strengthening the family through planned intervention strategies, with emphasis placed on ensuring children's safety and augmenting overall family capabilities. The focus of our program is consistent with the goals of family preservation programs outlined by Cole (1995). These goals are a) to keep the child and family safe, b) to avoid unnecessary placement of children in substitute care, by improving family functioning so that the circumstances that led to the crisis are resolved c) to facilitate reunification of child and family by developing positive familial relationships.

In order to achieve the goals outlined above a number of intervention strategies are used. The home is the primary site of service, and the entire family is the client. This emphasizes the importance of treating the family within its own environment and dealing with family interactional difficulty s that precipitate abuse and neglect Treatment strategies include teaching alternative disciplinary techniques and other child-management methods, introducing structure, mutual goal setting, teaching problem solving skills, homemaking skills (such as budgeting, meal planning and preparation and housekeeping) and assisting families in obtaining concrete resources. In assisting the family, one of the goals is to help them develop the skills they need to maintain their integrity independently. Another important component of the program is connecting the family to supports within their community. According to Tracy et al (1994) social and community resources play a key role in intervention success and maintenance of that success.

Characteristics of CFSCM In-Home Support Program

During this reporting period 32 cases were referred to the program. There was a total of 81 children in the 32 families. Fifty-two children were ages 5 and under, twenty-one children were between ages 6 and 12, and eight children were older than 12. A total of 1421.7 hours were spent working with the families. 712.5(50%) hours were spent in the home, 113(8%) hours were spent with external contacts, 341.5(24%) hours were spent on travel status, and 254.7(18%) hours were spent on reports. A minimum of 35 hours in the home were allotted to each family. The time was divided up based on the needs of the family. However, several families required more than 35 hours in home and further time was allocated based on that need. In the study reported by Berry (1992) it was found that the proportion of time spent in the home correlated very positively with success, and families that received larger proportions of in-home service time in the home were even more likely to stay together.

Of the 32 families referred to our program, 91% retained their children at home. In one of the families, 1 of 4 children was removed, but subsequently returned. This occurred while In-Home Support was still involved. Two families left the area before the worker was able to begin working with them.

There were many reasons why families were referred to the In-Home Support Program. Families deemed appropriate were those families who showed regular and consistent problems with parenting and whose behaviour placed the child at risk. The following is a list of the primary reasons why families were referred to the program:

Inadequate Parenting 61%

Abuse 18%

Alcohol/drug abuse 6%

Domestic Violence 6%

Parent-Child Conflict 3%

Inadequate Homemaking skills 3%

Teenage Pregnancy 3%

There were also several contributing factors for referral. They were neglect, psychiatric difficulty of parent, anger management of both child and parent, and transition back into the home. It was also clear that lack of parenting abilities led to neglect and safety concerns which placed the children at high risk.

In all of the cases referred to the program, the families agreed to being involved and made the commitment to try an alternative method in attempting to solve some of their difficulties. In selecting families most suited for this program, one of the important criterion for selection was the family' s likelihood of success. It was decided that a family with a greater likelihood of success would be a family who see themselves as needing help, present as more willing to engage with the agency, more trustful of the agency, and was appreciating of the new help provided. This family would also have more of a vested interest in working on the problems which caused concern. The family was also involved in identifying the areas of concern and setting the goals.

Although there were some families who showed a certain amount of mistrust in working with the In-Home Support worker, the majority of families were very receptive and worked toward achieving their goals. The In-Home Support workers had tremendous success in formulating positive working relationships with the families.

Over the past year, In-Home Support staff found themselves engaged in a number of important activities with families. They helped the families to learn parenting and home-management skills, interpersonal communication skills and use of community resources. This was accomplished through:

a) educating parents on matters of developmental needs of children, parenting, budgeting, good nutrition, discipline and house cleaning.

b) modelling appropriate responses to physical care requirements, supervision requirements, emotional care requirements and modelling appropriate interaction with children.

c) advocating for the family re: housing, financial support.

d) fostering better relations between the family and the larger community network, and increasing outside support systems to the family.

A great deal of contact, both written and oral, was maintained with the referring social worker. The social worker provided direction regarding their referred family to the In-Home Support Worker. The social worker also maintained responsibility for the family and continued with their day-to-day activities. In order to explore the effectiveness and satisfaction with the In-Home Support Program, evaluation questionnaires were designed and sent to the referring social workers and the families (appendix 1). The responses from the social workers were very positive. Many felt that the children in the family they referred would have been taken into care had this service not been available. To date, only two families have responded to our questionnaire and these responses were very positive.

It is interesting to note that between October 1 1994 and July 31, 1995 eighty-nine children were brought into the care of the agency. In the time period of this report (Oct. 1995 - July 1996) only fifty-one children were brought into the care of the agency, a clear reduction of 38 children, while the program was operational. Based on our average of 50 days care per child, this amounts to a total of 1900 days care saved in our first one year period. We believe that in addition to our early intervention efforts with abdicating parents, the focused attention and care provided by our In-Home Support Program has provided significant help to those families where there was risk of children being placed out of the home.

Conclusion

The In-Home Support Program has proved to be a very successful intervention strategy in working with families at Child and Family Services of Central Manitoba. While in the home, workers have been able to establish working relationships with family members; observe family functioning; participate with the family; and interact, direct and teach the parents in their relationships with their children, the community and one another. This program provides a hands on approach, including concrete services to families with the goal of empowering parents with the skills and resources necessary to create a safer, more enriching environment for their children.

In-Home Support services, however, is not a miracle cure and should be viewed as one part of a continuum of child welfare and family services. Cole (1995) emphasizes this point most emphatically when he states that Family Preservation programs need to be regarded as an integral part of the overall service provision to child welfare families. Further, that family preservation services cannot carry the burden of other services if they are lacking and should not be perceived as failing because they cannot meet the expectations of those who think the program should be all things to all families.

The In-Home Support Program through Child and Family Services of Central Manitoba has had strong support within the agency and the community. A significant amount of positive changes have taken place in the families where this service was provided. Our experience with the program has shown us that it has been an important factor in avoiding unnecessary placements of children and preserving the integrity and independence of the family.

References

Berry, M. An Evaluation of Family Preservation Services: Fitting Agency Services to Family Needs. Social Work, 1992, 37.

Cole, E. Becoming Family Centred: Child Welfare s Challenge. Families in Society: the Journal of Contemporary Human Services, 1995, March.

Dare, M.M. Family Preservation and Poor Families. Families in Society: The Journal of Contemporary Human Services, 1993, 74.

Pecora, P.J., et al.Intensive Home-Based Family Preservation Services: An Update from the FIT Project. Child Welfare, 1992, 74(2).

Ronnau, J.P., and Marlow, C.R. Family Preservation, Poverty And the Value of Diversity. Families in Society: The Journal of Contemporary Human Services, 1993, 74.

Smith, M.K. Utilization-Focused Evaluation of a Family Preservation Program. Families in Society: The Journal of Contemporary Human Service, 1995, January.

Stavert, D. In-Home Support Program Overview. Unpublished document prepared for Alberta Family and Social Services, 1995, January.

Tracy, E., et al. Support Networks of Primary Caregivers Receiving Family Preservation Services: An Exploratory Study. Families in Society: The Journal of Contemporary Human Services, 1994, October.

Warsh, R., et al. The Meaning of Family Preservation: Shared Mission, Diverse Methods. Families in Society: The Journal of Human Services, 1995, December.