strengthening child welfare services in baltimore...
TRANSCRIPT
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Strengthening Child Welfare Services
In Baltimore City
University of Baltimore School of Law
Urban Child Symposium
Center for Families, Children & the Courts
The Urban Child in the Child Welfare System:
From Fracture to Fix
Richard P. Barth
School of Social Work
University of Maryland
Baltimore, MD 21201
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Disclaimer
• Commissioner, Baltimore City Department
of Social Services Advisory Board, since
2008
Background
• Have been involved with child welfare
services research & analysis since 1978
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Four Take Home Points
• Acknowledge the Recent Success of Baltimore City Child Welfare Services
• Improve Parent Training for birth families at removal and point of reunification
• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care
• Help the City End LJ so Baltimore City can become more innovative
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Baltimore City DSS Recent Successes
• Two consecutive awards as DHR Local DSS of the Year
(2009, 2010)
• Reductions of children in group care are significant
• Development of Active Youth Advisory Board
• Gaining ground on ultimate conclusion of LJ Consent
Decree
• Nation leading work with local School District to share
emergency contact information
• Growing proportion of MSW-trained child welfare workers
and, now, all supervisors have LCSWs
• < 10% vacancy rate
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Parent Education
• 800,000 parents get parent education through CWS each year in the U.S. – If .002% of America‘s children live in Baltimore that‘s
still 1600 families that should get high quality parent training each year
• Evidence based parent education programs have emerged :– Parent Child Interaction Therapy (PCIT)
– The Incredible Years
– Parent education campaigns (Triple P) are growing (perhaps in Baltimore County)
• Common elements approaches to parent education is emerging…
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Parent Education II
• Only PCIT actually includes competencies that parents have to demonstrate achieving and that can be provided to the court!
• Yet it is hardly available
• It‘s time for advances in parent education in CWS, generally, and at DSS.
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Evidence Based Implementation Requires
Reform of Programs and Processes
• Good new ideas have been developed that could assist CWS
– Parent training is the most developed and needed
• It‘s use will require deep involvement of CWS in implementation:
– We cannot implement them all at once
– We must allocate adequate resources to starting them and to adapting them to CWS populations and practice parameters
– We must also provide extensive supervision during implementation
– Willing partners exist but the support is needed
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Child Welfare Services Have Been Dominated
by Attachment Theory
• Attachment theory ostensibly helps to explain
children who are remote, disconnected,
indiscriminant, stuck, and unreciprocating
• The principle of PARSIMONY calls for ―the simplest
and most frugal route of explanation available‖
• Question: Does attachment theory add
something that other newer neuro-psychosocial
interventions do not provide?
8
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Past Time to Detach from Attachment
• Our CWS involved
children and families
do not need their own
Freudian-based theory
Arredondo, D., & Edwards, L. P. (2000). Attachment,
bonding, and reciprocal connectedness: Limitations
of attachment theory in juvenile and family court
[Electronic version]. Journal of the Center for
Families, Children, and the Court, 2, 109-127.
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Indiscriminate Friendliness From Inhibitory
Control Not Problems with Attachment
Bruce, Tarullo & Gunnar (2009); Pears, Bruce, Fisher, & Kim (2009)
Inhibitory
control, not
attachment
predicts
indiscriminant
friendliness
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Risks of Over Use of Attachment Theory
• Barahona case in Florida-- Clear warnings
from CWW and other professionals that the
girl, at least, was not doing well (loosing hair,
depressed, etc).
– Psychological report focused on attachment –
resulting in conclusion that children needed to
stay with Barahona‘s
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Risks of Over Use of Attachment Theory
• Recent Audit of cases in Maryland where
children were left with parents with indicated
abuse and neglect… 2 Baltimore City cases in
which court had ordered them to be placed
there despite DSS recommendation
• California study in mid 1990s; families that
indicated that they were ―bonded to young
children‖ and allowed to keep them in care;
20% of children subsequently had 4 or more
moves in the next 3 years
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Relationships Matter …
• …but future relationships matter as much
as past relationships
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Implement KEEP in Baltimore City
• Parent Management Training-O
• Multi-dimensional Treatment Foster Care-
Adolescents (and MTFC-Pre)
• KEEP (MTFC-lite) and, soon, KEEP-
SAFE, and KEEP-Pre
Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent
training intervention: model description and effectiveness. [Article]. Child & Family
Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x
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MTFC-Pre Intervention
Child NeedsCaregiver-Child
RelationshipCase Management
Foster Parent
Consultant
Family Therapist
‗Daily Report‘ Caller
Case Manager
Child Therapist
Behavioral Skills
Trainer
Child Psychiatrist
STAFF
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KEEP Intervention
Caregiver-Child
Relationship
Foster Parent Consultant
Foster Parent Behavioral Groups
‗Parent Daily (WEEKLY) Report‘
(PDR) Caller
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Which Foster Care Placements Disrupt?
Number of behavior
problems per day on PDR
After 6, every additional
behavior problem increases
probability of disruption by 25%
within next 6 months
7
8
9
10
11
1 2 3 4 5 6KEEP is very good
at keeping behavior
problems in the 3, 4,
and 5 range
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Effect Of Prior Out-of-home Placements On
Placement Moves: MTFC-P Vs. Regular FC
(Fisher, Burraston, & Pears, 2005)
RFC
MTFC-P
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Predicted Probability Of Negative Exit By
Prior Placements and Intervention Group
KEEP
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0
5
10
15
20
Negative Exit Positive Exit
Per
cen
tag
e
Percentages of Exit Type by Group
KEEP
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KEEP Implications
• Investing in therapeutic interventions that
change physiology and behavior may make
it more likely that the improved behavior will
be sustained
• KEEP could become a prototype for
adoptive parent support—it is much more
likely to matter than PRIDE or MAPP which
have no parenting support component
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End LJ (Now that Results are In)
• Baltimore DSS has worked heroically to end
the LJ consent decree
– Many performance indicators are now achieved
– More need to be accomplished
• The State of Maryland should not continue to
pursue and end to the lawsuit in court—the end
should come under mutual agreement with the
plaintiff
• Ending LJ will give Baltimore City even more
chance to innovate
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Four Take Home Points
• Acknowledge the Recent Success of Baltimore City Child Welfare Services
• Improve Parent Training for birth families at removal and point of reunification
• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care
• Help the City End LJ so Baltimore City can become more innovative
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Partial References Ahn, H. N., & Wampold, B. E. (2001). Where oh where are the specific ingredients? A meta-
analysis of component studies in counseling and psychotherapy. Journal of Counseling Psychology, 48, 251-257.
Barth, R. P., & Miller, J. (2001). Building effective post-adoption services: What are the empirical foundations? Family Relations, 49, 447-455.
Barth, R. P., Crea, T. M., John, K., Thoburn, J., & Quinton, D. (2005). Beyond attachment
theory and therapy: Towards sensitive and evidence-based interventions with foster and
adoptive families in distress. Child and Family Social Work, 10, 257-268.
Berry, M., Propp, J., & Martens, P. (2007). The use of intensive family preservation services with adoptive families. Child & Family Social Work, 12(1), 43-53.
Brooks, D. & Barth, R.P. (1999). Adjustment outcomes of adult transracial and inracial adoptees: Effects of race, gender, adoptive family structure, and placement history. American Journal of Orthopsychiatry, 69, 87-102.
Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 66, 624-633.
Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? [Article]. Child Abuse & Neglect, 30(4), 409-424. doi: 10.1016/j.chiabu.2005.11.004
Chorpita, B. F., & Viesselman, J. O. (2005). Staying in the clinical ballpark while running the evidence bases. Journal of the American Academy of Child and Adolescent Psychiatry, 44(11), 1193-1197.
Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46(5), 647-652.
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Partial References Cohen, J. A., Mannarino, A. P., Zhitova, A. C., & Capone, M. E. (2003). Treating child
abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27(12), 1345-1365.
Fisher, P. A., Gunnar, M. R., Dozier, M., Bruce, J., & Pears, K. C. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. In Resilience in Children (Vol. 1094, pp. 215-225).
Foulkes Coakley, J. (2005). Finalized adoption disruption: A family perspective. Unpublished manuscript, University of California at Berkeley.
Gibbs, D., Barth, R. P., & Houts, R. (2005). Family characteristics and dynamics among families receiving post-adoption services. Families in Society, 86, 520-532.
Goerge, R.M., Howard, E.C., Yu, D., Radmosky, S. (1995). Adoption, disruption, and displccement in the child welfare system (1976-1995). Chicago: Chapin Hall Center for Children at the University of Chicago.
Price, J., & Chamberlain, P. (2005). A parent-mediated intervention for elementary-aged children in foster care: Child problem behavior changes and placement outcomes: Manuscript in preparation.
Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent training intervention: model description and effectiveness. [Article]. Child & Family Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x
Smith, S. L., Howard, J. A., Garnier, P. C., & Ryan, S. D. (2006). Where Are We Now?: A Post-ASFA Examination of Adoption Disruption. Adoption Quarterly, 9, 19-44.
Wind, L. H., Brooks, D., & Barth, R. P. (2007). Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions*
doi:10.1111/j.1741-3729.2007.00467.x. Family Relations, 56(4), 378-389.