Collaborations that Work

(Originally published June 2018)

Public child welfare agencies face a variety of difficult predicaments:

 

  • The children and parents they work with are overwhelmingly poor, often destitute, but the income support, food stamps and housing programs they urgently need are controlled by other agencies;

  • A large percentage of parents with children in foster care are afflicted by substance abuse, chronic mental health conditions and/or domestic violence, but the services these parents are mandated to complete to be reunited with their children are administered by other state or community agencies;

  • Developmentally delayed children and parents may also depend on the services of an agency or agencies other than child welfare. 

  • The safety and well being of school-age children in foster care and children in voluntary service plans is crucially affected by the attitudes and actions of school staff and by the availability and quality of children's mental health services;

  • Public child welfare agencies often lack the specialized expertise in substance abuse, mental health, domestic violence, developmental disabilities, education, child development and various cultural beliefs and practices needed to inform decision making regarding safety plans and service plans. Child welfare practitioners are extraordinarily dependent on resources, services and knowledge that the agencies who employ them do not have, or have in short supply,  and often cannot afford to purchase; and

  • Public child welfare systems fund evidenced-based parenting programs to varying degrees, and continue to utilize crisis oriented family preservation services; and, for some families, these programs are sufficient.  However, for families engaged in severe and/or chronic abuse and neglect of children and for most foster children and their  birth parents, these programs usually do not come close to meeting their needs. 

 

What can be done in these circumstances? 

 

Strategies for improving collaboration

 

Public service bureaucracies sometimes depend on written agreements between agencies that set forth referral procedures, time lines for assessment and priority populations when resources are limited, as is often the case. For example, a substance abuse and treatment agency may agree to schedule a parent for a substance abuse assessment within x days of referral, and place the referred parent at the top of the list for residential services. My experience with agreements of this type is that they are effective as long as the managers who developed and signed them remain in their positions. However, these agrements are increasingly ignored following managerial changes.

 

Public child welfare agencies in urban areas sometimes employ liaisons with specialized knowledge of substance abuse, mental health or DV to facilitate access of children and parents with open child welfare cases to   the services of other public and private agencies. In the early 2000's, Washington State's child welfare system employed chemical dependency liaisons in a number of offices: specialists who assisted caseworkers with assessment of parents substance abuse issues and facilitated timely access to assessment and treatment programs. These highly useful staff were eliminated in budget cuts within a few years. Legislators and governors' offices are unlikely to view liaisons as essential when budget cuts are required. In addition, funding liaisons for multiple service systems (e.g., substance abuse, mental health, DV, education, law enforcement, courts, etc.) is expensive. Absent federal grants or foundation funding, public agencies can rarely afford many of these positions, especially when agencies lack sufficient caseworkers, supervisors and support staff to perform basic functions.        

 

In agencies that are co-located with community services offices which administer income support programs, or serve communities where a small group of human services professionals have frequent interactions and sit on the same inter agency committees, collaboration depends on interpersonal relationships to an extreme degree. Practitioners and managers from various agencies can and do exchange favors, agree to share resources, resolve problems quickly over coffee or lunch, or perhaps refuse to have anything to do with someone they regard as a jerk or an enemy. Community professionals may refuse to go out of their way to help persons referred by someone they don't like.  A supervisor I worked for in another state many years ago informed me that in the community where she lived, “you don't belong for 20 years, and then you wish you didn't.”

 

Competent and resourceful child welfare practitioners and managers will find that one of the most effective ways to access the resources of other agencies on behalf of children and parents is to create or participate in partnerships in which multiple agencies and professionals share a common goal. There are many opportunities for such partnerships in child welfare, for example, family treatment drug courts or “baby” courts, in which a judge conducts review hearings with  parent(s) more frequently than is usual, and in which a community team forms around the parent(s) to support reunification or expedited permanency for a young child when timely reunification is not possible. Family treatment drug courts and “baby” courts require sufficient funding to allow a judge to attend to a smaller docket and to afford high quality mental health services. However, participating agencies often contribute a significant amount of their own scarce resources to these teams because of the enthusiasm and commitment of all team members. It's a remarkable experience to be part of a team that can generate extraordinary resources, including both concrete poverty related services and mental health services, to support a struggling parent in recovery after years of watching parents fail at drug treatment and lose their children to adoption. Once professionals feel they are effective in helping parents they may have previously viewed as “untreatable”, they are highly motivated to expand use of these teams. Competent and enlightened child welfare managers will do everything in their power to support these types of initiatives. 

 

The capacity of well-resourced case management teams with a wide range of pertinent expertise to develop effective interventions with difficult to serve youth and families offers the potential for dramatic improvements in child welfare services and outcomes. For example,

public child welfare agencies rarely have any cogent response to families with numerous CPS reports who have co-occurring chronically relapsing conditions, other than to utilize time limited parenting programs or to place children out-of-home, approaches that are frequently ineffective and/or risky (or both).  The most promising model I've seen for helping this group of chronically neglectful or chronically maltreating (neglect combined with physical abuse and/or sexual abuse) families was developed in Oregon during the late 1990's using family preservation funding.  In this model, 4-5 person case management teams, including a chemical dependency specialist, mental health therapist, parent advocate and CPS caseworker, were co-located, and served 20-25 families at any one time through a team approach. Cases were not divided up among team members; each team member worked with all families on open cases. Other possible members of these teams include public health nurses, infant mental health specialists and DV advocates. These teams had experienced knowledgeable personnel and great morale. They brought exceptional expertise and resources to the families they worked with, and their teamwork afforded a degree of immunity to the hopeless/helpless attitudes of parents they interacted with on a daily basis. Sadly,  the Oregon legislature gradually chipped away at the funding for these teams until their functioning became untenable. In recent years, a similar case management model has been utilized within Oregon's substance abuse treatment system.

 

Case management teams that bring professionals together from multiple agencies to work with a relatively small group of troubled families are expensive, but so is foster care that continues for lengthy periods of time and adoption support that begins in early childhood and continues to age 18. There is also considerable expense to investigating families multiple times and offering ineffective services that case managers understand to be a waste of time and resources. The claim of some proponents of evidenced based practice that effective interventions for chronic neglect are already available, for example Project Safe Care, is false. Project Safe Care helps some neglecting families, but hardly scratches the surface of chronic neglect and chronic maltreatment.

 

A puzzling feature of US. child welfare systems has been the willingness to spend large amounts of limited resources on lengthy stays in foster care and adoption support payments (to age 18), and on adoption incentives to states with the goal of increasing adoptions and the unwillingness to expend similar resources on in-home services and safe reunification initiatives. It is likely these funding priorities reflect underlying social beliefs and values that view reunification of maltreated children with their parents as a questionable outcome and adoption of maltreated children as an unalloyed good. However, the  political support for adoption should be tempered by the understanding that it is possible to increase safe and stable reunification by as much as 50% with increased use of court teams, housing services and parent or paraprofessional mentors.  

 

Perhaps a change in funding priorities will occur due to recently passed child welfare finance reform that allows IV-E federal funds to be spent on some in-home services. If so, public child welfare agencies should begin to experiment with collaborative case management teams used for a variety of currently intractable therapeutic challenges, including chronic neglect and chronic maltreatment, and to support reunification initiatives. It is also possible to use collaborative teams to find workable alternatives for mentally ill and/or delinquent youth for whom child welfare systems frequently appear to have few, if any, answers.

 

A tough challenge for collaboration

 

In past decades, it was common for many developmentally disabled children and youth to spend years in institutional settings through voluntary agreements with their parents or through dependency actions in which severe disability (not abuse or neglect) was grounds for out-of-home placement in Washington State. During the same time period, DD children were often placed in foster homes or specialized residential facilities. However, policymakers and top DSHS managers were determined to greatly reduce and eventually eliminate institutional care of DD children, while child welfare managers engaged in persistent efforts to reduce residential care placements and to narrow the mission of child welfare to child protection only, an effort that has significantly reduced placement of children or youth for behavior problems and/or disabilities.  Parents who felt unable to adequately care for their severely disabled children were caught between two DSHS agencies, child welfare and DD,  neither of which accepted responsibility for placement of DD children, and both of which insisted that the other agency was responsible for services to children who, prior to the mid-1990's, would probably have been placed in a state institution. This situation sometimes led to angry conflicts at the top of DSHS when political pressure was brought to bear to place a specific child, regardless of cost, on both agencies. After a period of unproductive arguments and finger pointing, Headquarters managers in both agencies intervened to resolve these conflicts on a case by case basis, usually by agreeing to share costs, or by giving in to a parent's demand for institutional care.  However, neither agency budged in its understanding of its mission, and policymakers did not reverse course in regard to the goal of reducing institutional care and residential care. Increasingly, some parents and their severely disabled children were left in desperate straits.

 

Similarly, the Children's Administration has engaged in persistent efforts to reduce Behavior Rehabilitation Services (BRS) for behaviorally troubled youth, especially the use of brick and mortar facilities, due both to cost and to high profile cases of abuse of children in a few residential care facilities such as OK Boys Ranch, abuse that led to many millions of dollars in tort settlements. The legislature then accelerated these developments during the Great Recession of 2008-09 with a $50 million dollar cut to BRS, a reduction in funding that has never been fully restored.  The end result of misguided policy, lack of clear and rational thinking among policymakers and advocates, and draconian budget cuts has been the increased use and gradual acceptance (within CA and by child advocates) of hotel placements, 24 hour placements, and approximately 50 hugely expensive out-of-state residential placements. The state's BRS system is, in turn, greatly affected by the availability of “slots” for mentally ill youth who need institutional care. As in the CA/DD conflict described in the previous paragraph, child welfare staff have sometimes collaborated with RSN's which manage the state's  public mental health resources to create ad hoc placement arrangements through joint funding, rather than arguing over who's responsible for mentally ill youth for whom there is no available institutional placement, BRS program or other existing resource.

 

Competent managers in multiple state agencies (i.e., child welfare, DD, mental health and juvenile justice) have periodically collaborated in useful ways and at other times fought political battles over responsibility for disabled, mentally ill and/or delinquent youth being discharged from juvenile institutions. Managers in state agencies that serve mentally ill and severely disabled children can work together (and have sometimes done so) to make best use of scarce resources instead of protecting agency boundaries and budgets.  However, mid-level and top managers of state agencies cannot indefinitely cope with a mess created by  decades of inadequate funding of children's mental health services and the willingness of policymakers to financially undercut BRS providers without investing in other alternatives, such as a cadre of professional foster parents and Wrap Around services.  

 

To their credit, DSHS, the new child welfare department (DCYF) and the state's Health Care Authority (HCA) have an interagency planning process, the Children's Multi-System Acute Resources Solutions (MARS) team, for identifying urgently needed resources for severely disabled, mentally ill and/or delinquent youth and making recommendations to top managers and policymakers of possible solutions to the state's placement crisis.  Concerned citizens and child advocates should insist that the MARS team issue an annual report (including a needs assessment) regarding the status of the state's institutional and residential care resources for severely disabled, mentally ill and delinquent children and youth, with recommendations for system improvements. Bad policy pursued over decades has driven the state's foster care system into a ditch. It's time to repair the wreck rather than do further damage. 

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