1. Family Group Decision Making for In-Home Services
Issues in Implementation and Fidelity
19th Annual National Conference on Child Abuse and Neglect
New Orleans, Louisiana
May 2, 2014

2. Icebreaker

3. Agenda No Place Like Home project overview
What is FGDM?
Evaluation and CQI
NPLH Evaluation overview
Texas – implementation issues, successes and lessons learned
South Dakota – implementation issues, successes and lessons learned
Larimer County, Colorado - implementation issues, successes and lessons learned
Conclusions and discussion

4. No Place Like Home Project
Kempe Center for the Prevention and Treatment of Child Abuse & Neglect
Heather Allan, MSW; Project Coordinator
Lisa Merkel-Holguin, MSW; Project Advisor
Casey Family Programs
Erin Maher, PhD; Project Evaluator
Texas Department of Families and Protective Services
Ellen Letts, Site Lead
South Dakota Department of Social Services
Lisa Fleming, Family Service Specialist Supervisor
Larimer County Department of Human Services
Deb DeLuca-Forzley, Supervisor

5. About NPLH
3 child welfare agencies, each with many years implementing FGDM
Examining the effectiveness of FGDM in safely preventing children from entering or re-entering foster care when they are receiving in-home services.
Various family meeting models across sites
Training, technical assistance and coaching
Process and outcome evaluation components

6. NPLH: Project Goals and Objectives
To improve the safety, permanency and well-being of children through implementation, program enhancement, and evaluation of FGDM.
Test the effectiveness of FGDM models in preventing children from entering or re-entering foster care
Determine the costs for FGDM implementation
Analyze implementation of multiple FGDM models to provide knowledge on fit, flow and sustainability
Disseminate implementation, cost and outcome findings and products

7. Evaluation, Performance Management, and CQI
Systematic collection of information with explicit design to answer specific questions
Designed to assess implementation, utility, and outcomes
Performance Management
Develops, collects, and uses performance data to improve programs
Typically, integrated into regular operations
Involves regular reporting
Continuous Quality Improvement
Identification of ways to improve
Uses available data to make decisions
Creates a learning environment
Continuous, ongoing

8. Evaluation Overview 18-month data collection period 5 surveys
Staff Survey
Caregiver (Pretest) Survey
Fidelity Survey (2 versions: Participant (Pretest) and Facilitator or Coordinator)
Case-Specific Questionnaire
Caregiver and Participant Fidelity Posttest Surveys
Administrative data extracts (services, outcomes)
Proposed Site-Specific Evaluation Designs:
Texas – Randomized Control Trial
South Dakota – Intent-to-Treat
Larimer County – Propensity Score Match
Functional cost analysis

9. Family Group Decision Making (FGDM)
What is it?
Family group = natural + formed group
Voluntary group process
Participatory decision making
Process to widen circle of support
What it is NOT?
Group therapy
Mediation between parties
Legal proceedings
Joan

10. Six Core Elements of FGDM
An independent coordinator
Family group as key decision-making partner—resources put towards finding and preparing group members
Private family time
When plan meets agency concerns, preference to family plan
Follow-up processes after the family group decision making meeting occur until the intended outcomes are achieved
Services and resources available to meet agreed upon plans
Case-carrying staff are unlikely to have the time and flexibility to coordinate
When agency staff are given positions as coordinators without cases, other staff may believe this structure increases their own caseloads
When coordinators are contracted and paid per conference: they may not have sufficient internal systems support to do their jobs; referrals may decrease; workers may see it as an add-on.
Question debated in North America: Should the Coordinator be internal or external to the public child welfare agency?
Source: National Center on Family Group Decision Making (2013)

11. No Place Like Home Fidelity Tool
Significant gaps
FGDM/family meeting practices have evolved
Nuances better understood
Increasing similarities among the family meeting models
Release of FGDM guidelines
Two versions
Participant and Facilitator/Coordinator versions
New tool measures
Preparation activities
All stages of the process
Restructured
Negative-to-positive orientation
6-point Likert scale

12. Fidelity vs. Outcomes Outcomes Effectiveness No Problem
Poor
Good
Effectiveness
No Problem
High
Better
Outcomes
Increased
Fidelity
Type of Problem
Fidelity
Implementation
Measurement
Measure Fidelity AND Measure Outcomes
BECAUSE you need to know:
Are we having an implementation problem?
Low fidelity + Poor outcome =
Implementation problem OR
Are we having an effectiveness problem?
High fidelity + Poor outcome =
Effectiveness problem
Low
Adapted from National Implementation Research Network and Casey Family Programs

13. Construction of Effectiveness Variable
Implementation Science as a framework
Child welfare staff buy-in to organizational change
Staff perceptions of FGDM

14. Staff Perceptions of FGC Effectiveness (N=300)

15. Overview of Child Welfare in Texas
26.1 million total TX population
7,159,172 total child population
State administered child welfare system
254 counties and 11 regions
4,563 caseworkers, 734 supervisors
Four levels of regional management
160,240 completed investigations
29,332 Family Based Safety Services cases
17,022 removals
27,924 children in substitute care
FY 2013 DFPS Annual Report & Data ault.asp

16. Texas Family Meetings FY 2013
FTM (primarily INV)
FGC (primarily CVS & FBSS)
COS

17. Texas Case Flow

18. NPLH and Texas Child Welfare
FGDM evaluation in FBSS
Evaluate disproportionality in FGDM
TA and shared learning
Enhance FGDM practice statewide
What does NPLH mean to TX child welfare?
NPLH gives TX an opportunity to evaluate FGDM in FBSS - In TX, we’ve completed 2 evaluations on FGDM – 2006 (FGC post-removal) & 2010 (primarily on FTMs) - but never evaluated FGDM in FBSS. This evaluation, which potentially can be one of the strongest evaluations on FGDM to date, supports the work we are already doing & can help support additional expansion of FGDM (=more staff to conduct FGDM).
NPLH gives TX an opportunity to examine if dispro exists in FGDM, and if it does, why? Are there disparities in how we offer FGC’s to AA and Latino families? If so why?
NPLH gives TX the opportunity to gain technical assistance from experts in FGDM, as well as shared learning opportunities with other jurisdictions with mature FGDM processes.
Through TA & evaluation, NPLH gives TX the ability to further evaluate FGDM practice & apply lessons learned statewide.

19. Site Challenges: Texas
FGC referral issues:
Ethical dilemma
FBSS worker/leadership buy-in
FGC referral challenge is two-fold:
Tarrant – ethical dilemma related to the random control assignment design of the evaluation;
Dallas – FBSS worker and leadership buy-in

20. Site Challenges: Texas
Communication & Collaboration:
FGDM FBSS
FGDM leadership
Communication and collaboration:
Disconnected relationship between FGDM and FBSS (coordinators to workers/supervisors and FGDM leads to supervisors/PD’s) contributes to the FGC referral issues, worker buy-in; and their discomfort with offering FGDM to families.
FGDM coordinators are not seen as experts in FGDM and are not given the enough hands on guidance to empower themselves as experts in FGDM
Disconnect between FGDM program & FGDM as regular part of practice = Mimics the silo-ing affect of many child welfare processes

21. Site Successes: Texas Intensive technical assistance:
Training for FBSS & FGDM staff
Consultation for FGDM staff
Leadership Meeting
Intensive TA:
FGDM training for FBSS and FGDM staff (basic to advance) has led to better understanding of FGC, including:
CPS staff person’s role vs. Coordinator’s role in FGC process (before, during, and after the meeting),
Purpose of FGC – is the meeting a staffing or an FGC?
What constitutes a family group
Consultation for FGDM staff has led to enhanced & more efficient FGC practice, including:
More thorough preparation/coordination of FGC’s…which has led to:
reduced length in actual meeting time, which has led to increased worker buy-in
Widening the circle (= involving more family than what the case started with)
Ensuring the “family group” is identified by the family, not just the parents
Enhanced FGDM supervisor’s leadership…more hands on guidance & tools to develop FGDM staff

22. Site Successes: Texas Enhanced communication & collaboration:
Monthly newsletter
Leadership agreements
FGDM Webinar Series
Communication and collaboration:
FGDM webinar series – using the TA to teach & guide FGDM staff statewide
Monthly newsletter provides on-going communication & provides an opportunity for feedback
Leadership agreements established in each county related to increasing relationship & communication between FGDM and FBSS staff, including:
FGDM staff sitting in on FBSS staffings
More specific & intentional planning & preparation done with FBSS staff prior to FGC
Revising referral criteria (getting rid of form)

23. Discussion Group
Question: What challenges have you experienced related to implementing family meetings and how have you handled them?

24. Break
Please be back by 10:15am

25. And you said…

26. South Dakota Demographics
814,180 people
52% live in urban areas
48% live in rural areas
16th in size of the 50 states
380 miles from east to west
210 miles north to south
8.8% of South Dakota’s population is Native American
3rd highest proportion of Native Americans of any state
4 of the top 10 poorest counties in the nation are located in South Dakota’s Indian reservations
9 Tribes/Reservations within the state
Discussion of South Dakota Demographics

27. South Dakota
View of the map and reservations – locations – difference between east/west

28. South Dakota FGDM
Rapid City was the only region to have Family Group Conferencing other than two tribal agencies in SD.
Implemented in 2005
Family Group Decision Making (FGDM)
Family Group Conferencing (FGC)
Team Decision Making (TDM)
Concurrent Planning Meetings (CPM)
Placement Team Meetings (PTM)
In 2005, Rapid City began FGC. We were offered technical assistance through Casey Family Services and two of their tribal agencies who had implemented FGDM on Rosebud Indian Reservation and the Pine Ridge Indian Reservation. Rapid City began services with one coordinator and only held FGC’s. After a few years other meeting types were developed. Brief description of the different meetings – when they are used.

29. South Dakota Family Meetings 10/12-1/14
Family Group Conference: 22
Concurrent Planning Meeting: 30
Placement Team Meetings: 86
Team Decision Making: 48

30. South Dakota Case Flow

31. NPLH Outcomes
The effectiveness of FGDM on children and families receiving in-home services.
How FGDM can meet the needs of children and families receiving in-home services.
The effectiveness of FGDM in supporting culturally diverse populations.
When the grant period began, we projected we would have an increase in our in-home service cases. We believed Family Services Specialists would see a benefit in FGC and allowing the family to partner with the agency to manage the safety of the children in the home, rather than in out of home care. We believed we would be able to prevent children from entering the court system while being more culturally responsive to the needs of families in our community.

32. NPLH Study Group Initial Family Assessment completed
Impending danger identified
In-home safety plan needed
No court involvement
The next slide has what we projected.

33. NPLH Projections vs. Actuals
Projected there would be 104 families in the evaluation within a 9 month window
2 full time coordinators
3-4 FGC’s per month would be held
Actually had 11 families enter the evaluation in a 15 month window
1. 5 coordinators
9 FGC’s were held in a 15 month period
2 TDM’s held in the 15 month period
This is what was projected prior the beginning of the study. When the evaluation period began, the referrals were slow to start. We were using the randomizer and it two cases were selected for TDM’s. As time progressed and we did not have referrals for in-home services we needed to take a look at what was causing this. Even when changes were made in the evaluation process and the selection of families, our referral’s have been low. We are holding other FGC’s but these are specific to ongoing cases where it is likely reunification will not occur within the first six months.

34. South Dakota Lessons Learned
Structured Team Response (STR)
Staff bias
Problems in our Child Welfare Practice and Safety Analysis through Initial Family Assessment and the Protective Capacity Assessment
One coordinator went on extended FMLA
Our evaluation period began in October of In December of 2012, the Rapid City DSS implemented Structured Team Response (STR.) This is a process we were introduced to through peer networking with Larimer County (Co.) We used STR for two different processes. 1) the review of referrals of abuse and neglect and screening decisions; and, 2) the review of Initial Family Assessments and Safety Analysis for Safety Planning. As a result of the group supervision process, consulting with Kempe, and some focus groups with staff, it was determined we needed to look at our child welfare practice specific to the safety analysis and safety planning.
Through focus groups, we found there were some staff who felt strongly believed child safety was tied to out of home placement. The felt responsible if they recommended an in-home safety plan and this did not work.
Other challenges we faced was a coordinator going on extended medical leave, returning and then transferring into another position which was a better fit for her.

35. South Dakota Lessons Learned
Critical look at SD’s Child Welfare Practice Model – Comprehensive Safety Integration
Safety analysis and planning
Safety Plan Determination
Conditions for Return
We found there were problems in how staff were assessing the appropriateness of safety planning when impending danger was identified at the closing of the IFA. Families were not being identified for in-home services and safety planning. This prompted us to take a look at our Comprehensive Safety Integration which is our child welfare practice.
Through consultation with Kempe and the NRC for Child Protection Services (ACTION) we looked at the safety analysis and planning process and determined staff and supervisors were not completing analysis correctly. We took a hard look at our process and what we could do to make it easier for staff to understand when it was appropriate for in-home safety planning. From this the Safety Plan Determination worksheet which incorporated Condition for Return was developed. We separated this process form the Initial Family Assessment in order for it to be a separate process in order to allow staff to take a more rigorous approach in their analysis.
There were key differences in this approach which we believed would assist staff and supervisor’s in correctly identifying the appropriate safety plan to meet the needs of the family, and therefore, increase the number of in-home safety plans and decrease the number of children in care.
Conditions for Return had been part of our process, however, prior to these changes, it was really a forgotten step and staff were actually determining the appropriateness of reunification based on caregivers making behavior changes specific to their diminished protective capacities, rather than when the use of an in-home safety plan could control impending danger.
The Safety Plan Determination incorporates CFR in the process and makes it more concrete for staff as well as family members. This process began in June of 2013 and we are still piloting it. The SPD is being piloted across the state with a site in the eastern part of the state as well as another western site.

36. NPLH modifications New study group – Concurrent Planning
Children in out of home care
Reunification should occur within 6 months
Basic concurrent planning determination
Discontinued the use of the randomizer
As we were consulting with Kempe and the NRC for Child Protection Services, it was determined our study group would change to include families where an out of home placement had occurred but through our concurrent planning process it was determined reunification would likely occur within six months of placement. The state of South Dakota recently incorporated a concurrent planning process and through this there was a determination made regarding basic or intensive concurrent planning. In basic concurrent planning cases, reunification is expected to occur within six months of initial placement.
Once we started looking at these type of cases be believed our numbers into the study would increase. The plan was to offer families who met the basic concurrent planning criteria a FGC within 2-4 months of placement in order to allow the family members to come up with in-home safety planning and/or to hear the CFR in the hopes the family could come up with a reunification plan that met the restraints of the CPS child welfare practice.

37. Concurrent Planning
Basic Concurrent Planning vs. Intensive Concurrent Planning
Study group consisted of the basic concurrent planning cases
Intensive Concurrent Planning cases were not studied, but families were still offered FGC

38. Discussion Group
Question: What barriers have you experienced related to referrals in a system change that you have implemented and how did you handle them?

39. Larimer County
Population of 310,487 and ranks as the 6th largest county in Colorado
Home to approximately 67,075 children, according to 2010 US Census data, 19,881 of these children were under the age of 5.
Covers 2,596 square miles and includes the cities and communities of Fort Collins, Loveland, Wellington, Berthoud, Estes Park, and Red Feather.
Demographics: Predominately White, approximately 13% of the community self identifies as Hispanic or Latino, as the second largest and fastest growing ethnic group in Larimer County.
Average rent cost for a three-bedroom unit is $1,227 per month.
14,100 students in Larimer County’s Public school system who received free or reduced lunches during the (12/13) school year.
Home to Colorado State University, HP, Woodward Governor,
Budweiser and several local breweries

40. Larimer County has an estimated population of 310,487 and ranks as the 6th largest county in Colorado, 15% growth over the last 10 years. Larimer County is home to approximately 67,075 children, according to 2010 US Census data, 19,881 of these children were under the age of 5.
Larimer County covers 2,596 square miles and includes the cities and communities of Fort Collins, Loveland, Wellington, Berthoud, Estes Park, and Red Feather. While Larimer county is predominately White, approximately 13% of the community self identifies as Hispanic or Latino, as the second largest and fastest growing ethnic group in Larimer County.
Larimer County
Average rent cost for a three-bedroom unit is $1,227 per month.
Median Family Income is $75,800
30,000 individuals on Medicaid
20,500 residents who live on less than 50% of the Federal Poverty level
14,100 students in Larimer County’s Public school system who received free or reduced lunches during the (12/13) school year.
Home to Colorado State University, HP, Woodward Governor, Budweiser and several local breweries

41. Larimer County Fiscal Year 2013

42. Larimer County Family Meetings FY 2013
207 Children participated in a FGC
905 Children participated in a FSRT
888 Children participated in a FUM
52 Children participated in Mediation
Total: 2052 children participated in a family meeting during 2013 in Larimer County.
Note: A child may be represented across multiple meeting types;
this is not an unduplicated number.

43. Larimer County Case Flow

44. Larimer County Practice Model
Expanded Services
1998
Implemented Family Group Conferencing
Applied to Child Welfare
2002
Restorative Justice Practices and Principles
Family Engagement
2004
Family Options
Community Inclusion
Facilitated family meetings - Impartial
Paired Teams

45. Larimer County Practice Model
Olmsted Model
2008
Group Decision Making
RED teams
Consultation team
Group Supervision
Signs of Safety
2009
Safety Organized Practice
Family Assessment and Planning Team
Differential Response
2011
Investigation
Family Assessment
Applied all practice principles

46. Larimer County Implementation Challenges
As a result of our multiple meeting model there were a number of challenges:
Design – Too complex
Language- finding a common language/definitions
Extracting data – using an existing system- Trails - not compatible with evaluation needs, completing manual logs still required many staff hours
Extracting data-based on knowledge of practice – more collaboration between practice and data staff
Differential response – case flow of these cases vs. traditional cases
Surveys – too many different surveys to administer and frequency of surveys
Technology issues – not testing before going live
Project leadership – data staff vs. practice staff

47. Larimer County Family Meeting Implementation Successes
State of Colorado implemented rule and practice guidelines regarding family engagement modeled after Larimer County practice model
Larimer County staff and stakeholders bought into the practice of engaging families on a deeper level
Increase number of families receiving Family Group Decision Making
No family went without a family meeting – as a result of being involved in the project
Larimer County and staff value engaging families through the use of facilitated family meetings
Uphold the value and importance of independent coordinators/facilitators

48. Larimer County – Lessons Learned
Number of families receiving only one family meeting
Importance of training for staff regarding Family Group Decision Making
Importance of collaboration between those doing the practice and evaluation team to gain better understanding
Value of strong leadership within the agency

49. Summary of Lessons Learned to Support FGDM Implementation
Cultural disconnect between FGDM and new practice models compared to existing
Coaching for Supervisors and Facilitators/Coordinators
Culture change oriented toward families
How integrate policies, procedures and guidelines to support this culture change
How combat the tendency in agencies to silo programmatic functions
Using evaluation methods including data tracking to diagnose system issues

50. Q and A What questions do you have for us?
What insights do you have to share?

51. Thank you for your time
Heather Allan:
Lisa Merkel-Holguin:
Erin Maher:
Ellen Letts:
Lisa Fleming:
Deb Deluca-Forzley: