ISSUE BRIEFS | APRIL 2021

In-Home Services to Strengthen Children and Families

Most children involved with the child welfare WHAT'S INSIDE system are not separated from their families but instead receive services while living at What are in-home services? home. These child welfare "in-home services" are designed to strengthen and stabilize families that come to the attention of child In-home services delivery protective services (CPS).

This issue brief explores effective in-home In-home services funding services that are being used to promote safety and help keep children and families together, as well as practical considerations for their In-home services practice elements implementation. It then presents promising practices used by States and jurisdictions that Evidence-based programs are working to improve their delivery of in- home services. Promising practices

Conclusion

References

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 1 WHAT ARE IN-HOME SERVICES? routines, and manage stressful everyday situations. The location where services are Child welfare in-home services are a delivered will depend on the protocols of the continuum of prevention-related supports local service providers and the availability of and programs designed to enhance the services. protective capacity of caregivers and improve the conditions that may contribute to safety In defining in-home services, there and risk concerns for children (e.g., mental is a common misconception between health concerns, substance use, parenting those described above and home visiting practices). They can be primary prevention programs, which match at-risk families services geared toward the general population; with professionals or paraprofessionals secondary prevention services for families who provide support, education, training, with one or more risk factors for child and resources during visits to the home. maltreatment; or tertiary prevention services Home visiting programs are often used aimed at preventing out-of-home placement as a preventive approach with high-risk for families in which maltreatment has already populations, such as teen parents and occurred, provided children can remain in families with infants and young children. their homes safely. Tertiary in-home services However, some home visiting programs allow children to stay connected with their address the needs of families receiving in- siblings, extended family, friends, school home services and can be used or adapted connections, and other support systems and for a child welfare population, often through provide resources that can help parents their inclusion as part of an in-home services focus on addressing the issues that led to case or treatment plan (see Child Welfare abuse or neglect or that could lead to Information Gateway's Home Visiting web future maltreatment. section for more information.)

In-home services may be voluntary or HOW ARE IN-HOME SERVICES INITIATED? court ordered and can encompass an array When a report of child maltreatment is filed of supports, interventions, and programs, with CPS, intake workers screen the report to ranging from transportation and housing assess the allegations and determine whether assistance to intensive family preservation there are any immediate or impending safety services. The term "in-home" refers to the concerns. If safety concerns are identified location where the child and family are and thresholds are met, CPS will recommend residing and not necessarily to the place that the family receive either an investigation where services are delivered. The services or a family assessment, the latter of which may be provided in the community or other is typically an option in jurisdictions using places, such as at a counseling center or child differential response systems. In either case, welfare agency. However, services offered child welfare caseworkers will conduct a in the home have several added benefits. safety and risk assessment to determine They give providers opportunities to identify how safe children are in their homes and the family strengths, offer support around family level of risk for future harm. These safety

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 2 and risk assessments, accompanied by a more WHAT TYPES OF SERVICES ARE INCLUDED? comprehensive family assessment, are used to There is no standard set of required in-home inform the feasibility of maintaining the child services; the goal is to find the right combination safely in the home through the use of safety of services and supports tomeet the specific plans. Safety plans are written agreements needs of each family. In-home services are designed to help parents focus on addressing the geared toward meeting the following goals: issues that led to unsafe conditions or threats to child safety, strengthen parental protective ƒ Ensuring children's safety capacity, and enhance community connections ƒ Strengthening parental protective capacity so families can safely and sustainably care for ƒ children without further agency intervention. Improving overall adult, child, and Safety stabilization creates conditions for family functioning working collaboratively with families to cocreate ƒ Building caregiving and coping skills case plans with individualized in-home services. ƒ Supporting healthy and nurturing relationships ƒ Fostering physical, emotional, behavioral, and WHO RECEIVES IN-HOME SERVICES? educational well-being and mental health In-home services are typically provided to ƒ Enhancing the potential for permanency families who have open cases with a child welfare agency and whose children remain at Services to address family challenges could home or have returned home from foster care. In include general prevention-related or some cases, the allegations of child maltreatment knowledge-building information or referrals for have been substantiated, but the child is not in tangible and intangible support, such as—but not immediate or impending danger. In other cases, limited to—the following: allegations have not been substantiated, but a ƒ Age-specific parenting support, including comprehensive assessment of family functioning teen or adult parent training, coaching, or prompts the provision of targeted services to skill building to help with complex parent- help strengthen parental protective capacities child interactions and address any general concerns. In-home ƒ Individual and/or family therapy services can also be provided to families whose children have returned home after a stay in ƒ Referral for substance use treatment and skill foster care; in these cases, the child welfare building to enhance coping and encourage agency strives to ensure that parents have the behaviors that replace substance use necessary strengths, protective capacities, and ƒ Referral for mental or behavioral health community and relational supports to safely care treatment followed by support in applying for their children and prevent their reentry into what was learned in treatment to improve care. During fiscal year 2018, approximately 2 family management and child safety million children nationwide received prevention ƒ Information and referrals for resume-building services and about 1.3 million received services as well as interview and job training to postresponse services from a child welfare help with economic and financial stability and agency (Children's Bureau, 2020b). self-sufficiency

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 3 ƒ Assistance with child care and IN-HOME SERVICES DELIVERY transportation Child welfare agencies must deliver effective ƒ Concrete assistance, such as food, in-home services that can stabilize and clothing, furniture, or housing to strengthen families and prevent the need for contribute to positive health and out-of-home care whenever possible. In some well-being outcomes instances, caseworkers can provide in-home services directly to families, and in other VOLUNTARY VS. COURT-ORDERED IN- HOME SERVICES instances they may facilitate contact between families and community-based service In-home services can be delivered either providers, such as family resource centers on a voluntary basis (meaning that family (FRCs). Having the capacity to provide an members have agreed to participate of their array of evidence-based or evidence-informed own accord) or as the result of a court order family support, family preservation, and (meaning a judge has mandated a family's postreunification services enables agencies participation). Policies regarding whether to provide individualized treatment so that these services can be delivered on a voluntary children can remain safely in their homes. or court-ordered basis vary by State. A diverse service array includes programs Caseworkers may encounter difficulties when that can address the physical, emotional, attempting to engage families in voluntary social, mental, developmental, and services because some potential participants educational needs of children and families, may view the services as either intrusive or while also considering key systemic unlikely to provide useful benefits. (Daro factors, such as individual, family, and et al., 2005). In addition, parents may fear community circumstances that may impact that more frequent contact with the child service delivery. welfare system and its service providers could put them at risk for having their children SERVICE ARRAY removed from the home, a circumstance that A child welfare agency's service array includes underscores the importance of caseworkers services funded by the agency and those building rapport with the families on their provided by other agencies and community caseloads to foster trust and engagement organizations. Families need accessible, in services. When treatment services are quality services to strengthen parental mandated by a court order and conditions protective capacity and support child safety at in the home environment that threaten the all points along the child welfare continuum. safety of a child cannot be controlled despite However, Child and Family Services Reviews the agency's reasonable efforts, a child could Aggregate Report: Round 3: Fiscal Years 2015– be removed from the home and subsequently 20181 showed that State child welfare agencies placed into out-of-home care. did a better job of assessing the needs of

1 The Child and Family Services Reviews (CFSRs) are periodic Federal reviews of State child welfare systems to (1) ensure conformity with Federal child welfare requirements, (2) determine what is actually happening to children and families engaged in child welfare services, and (3) assist States in helping children and families achieve positive outcomes.

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 4 children and families than providing services answering the following questions about an to meet the identified needs, suggesting that area's service needs (Capacity Building Center States should examine the systemic issues for States, 2019a): that create difficulties in meeting family ƒ What are the current needs of the children needs identified in assessments. In fact, only and families being served? the District of Columbia earned a strength rating in this area (Systemic Factor #29: Array ƒ What services are currently available and of Services). Systemic factor concerns that being provided to children and families? were cited in the CFSRs include the following ƒ What child and family needs are currently (Children's Bureau, 2020a): not being met by the existing service array?

ƒ Gaps in the availability of services or long Building a service array that meets waiting lists for services community needs allows child welfare ƒ Difficulty accessing services due to agencies to facilitate collaboration with payment-related or transportation-related service providers for presently underserved issues or more vulnerable subpopulations of children and families. In cases where agencies ƒ Delays in referrals and arranging services need to increase the types of services due to caseworker workloads available to families, they can approach ƒ Lack of quality providers community- and faith-based organizations ƒ Lack of services—especially specialty and discuss the potential expansion of their services—in rural areas services to meet client needs. For more information on partnering with community- The report also noted the types of services and faith-based groups to increase service that were most often needed but were provision, visit Information Gateway's insufficiently available, including substance Engaging Communities to Support Families use treatment, behavioral and mental health web section. For more information on using treatment, domestic violence services, data to inform service array development, trauma-informed services, housing, child see A Data-Driven Approach to Service care, employee assistance, transportation, Array Guide by the Capacity Building Center visitation, and services to support youth for States. transitioning into adulthood.

Agencies may need to adjust their service THE ROLE OF COMMUNITY COLLABORATION arrays to provide the necessary mix of supports and programs that foster the Enhanced collaboration with community safety, permanency, and well-being of providers can help build a service array families in the communities they serve. that is sensitive to local needs, increase the Decisions made around service array availability of evidence-based and evidence- adjustments and expansions should be informed services, and strengthen community informed by data collection geared toward collaboration with family support and

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 5 preservation programs and other State and in their communities—not just vulnerable local entities. When agencies support multiple families or those referred from the child community providers working together to welfare system—which minimizes stigma that deliver needed in-home services through may be associated with service reception. For systems of care, families benefit. These more information on FRCs, see the National providers may include the following (Capacity Family Support Network's Family Resource Building Center for States, 2017): Centers web section.

ƒ Providers contracted for other State IN-HOME SERVICES FUNDING interagency programs (e.g., mental health, The primary source of funding for child public health, workforce development) welfare in-home services is provided through ƒ Specialized program providers (e.g., provisions of title IV-B of the Federal Social substance use treatment, therapeutic Security Act. Historically, that funding has services, at-risk youth interventions, life been invested in out-of-home care services skills services, sports and recreational (e.g., foster care). However, the 2018 Title IV-E activities) Prevention Services Program has prompted a ƒ Advocacy centers and volunteer resources new emphasis on prevention services, ƒ Local churches or charitable organizations and States are increasingly investing in evidence-based in-home services that meet Child welfare agencies may also refer children the program's requirements. Funding for and families to collaborative community in-home services also comes from a variety support groups, such as FRCs, for services. of other sources, including Federal funds FRCS are community- or school-based hubs and grants made available through legislative that provide and connect families with a programs. Most States use more than one variety of in-home services for every stage of the following sources to fund their of the prevention continuum (i.e., primary, in-home services. secondary, tertiary). They offer both formal and informal supports and services—as well Title IV-E Prevention Services Program. as referrals for supports and services—that In 2018, the Family First Prevention Services are targeted to a community's specific needs Act amended the Social Security Act to allow and interests (Russo, 2019). FRCs provide States and Tribes to use Federal title IV-E access to a range of programs and supports funds that were previously set aside for in a single location, thereby making in-home foster care expenses for services designed services more accessible for families. FRCs to prevent children from entering foster take a strengths-based, culturally informed, care. The amendment of the Act established and family-centered approach to service the Title IV-E Prevention Services Program, provision, allowing families to determine their which provides optional funding for certain own goals and level of involvement. They time-limited prevention services, including build communities that foster peer support in-home parent skill-based programs (i.e., for families and reduce feelings of stress and parenting skills training, parent education, isolation. Importantly, they serve all families and individual and family counseling).

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 6 States and Tribes with an approved title Promoting Safe and Stable Families (PSSF) IV-E prevention plan may claim title IV-E title IV-B program. PSSF is a Federal program reimbursement for a portion of trauma-informed under title IV-B of the Social Security Act mental health services, substance use treatment, that provides funding to States and Tribes to and in-home parent skill-based programs for implement a coordinated program of community up to 1 year. To qualify for reimbursement, services that includes family support, family programs must be rated promising, supported, preservation, time-limited reunification, and or well-supported by the Title IV-E Prevention adoption support (Capacity Building Center Services Clearinghouse or have an approved for States, 2016). For more information on designation through an independent systematic the program, including its funding mechanisms review process. At least 50 percent of the and requirements, see Promoting Safe and amount paid to the State in any fiscal year Stable Families by the Capacity Building Center must be for prevention services that meet the for States. "well-supported" practice criteria. For more Temporary Assistance for Needy Families information, see "A Complete Guide to the Family (TANF). The Office of Family Assistance First Prevention Services Act" in The Imprint. administers TANF block grants to States. These Medicaid. Medicaid, as authorized by title XIX grants have a high degree of flexibility when it of the Social Security Act, is a program funded comes to the use of these funds. When families jointly by Federal and State governments to receiving TANF assistance through public welfare provide health-care coverage to low-income programs are also involved in child welfare, the people who meet certain additional criteria. two systems can coordinate on case planning. Most children and youth involved with the child Specifically, they can allow activities in a child welfare system are eligible for Medicaid, and welfare case plan—including in-home services— States can facilitate collaboration across child to count toward TANF work requirements. protection, Medicaid, and behavioral health For more information, see the Center for systems to fund a broad range of in-home the Study of Social Policy's 20 Years of TANF: services that fulfill these children's needs (Center Opportunities to Better Support Families Facing for Health Care Strategies, 2019). States can Multiple Barriers. provide in-home services through a combination Child Abuse Prevention and Treatment Act of Medicaid benefits, home- and community- (CAPTA) Community-Based Child Abuse based waivers, and general State funds. In Prevention (CBCAP) grant program. CBCAP addition, select evidence-based practices grants are provided through CAPTA to fund included in the Title IV-E Prevention Services child abuse prevention programs at the Clearinghouse can be funded through Medicaid. community level. To learn more, visit the For more information, see How Can Medicaid- FRIENDS National Center for Community-Based Funded Services Support Children, Youth, and Child Abuse Prevention website, which provides Families Involved With Child Protection? by the resources and capacity-building services to Casey Family Programs' Center for Health Care CBCAP grantees. Strategies and Information Gateway's Health

Insurance: Medicaid, CHIP, and the Affordable

Care Act web section.

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 7 It is also important to note that some in-home One strategy that caseworkers can employ to services may be reimbursable under a family's encourage family engagement with in-home personal health insurance plan. This generally services is family group decision-making (FGDM). applies to services related to reunification and FGDM uses a trained facilitator to guide parents, crisis stabilization (before or after residential children, and other family members through a placement) but may also be used for intensive structured case-planning process. This approach in-home therapeutic services aimed at gives each member of the family a voice and a preventing out-of-home placements. greater sense of ownership over the decision- making process, which can result in more IN-HOME SERVICES PRACTICE engagement with their service plan and ultimately ELEMENTS better outcomes. While FGDM is typically used There is no one-size-fits-all approach for in- as an engagement strategy following a child's home services delivery; however, researchers in placement in out-of-home care, some agencies the field have identified a set of core elements employ the practice earlier on in CPS cases for effective practice (D'Aunno et al., 2014). The (NRCinhome, n.d.). Specifically, caseworkers National Resource Center for In-Home Services can involve families in developing safety plans, (NRCinhome), which was funded by the Children's identifying family strengths and anticipating Bureau from 2009 to 2014, conducted a nationwide needs, preventing imminent placements, and assessment of in-home service delivery practices making placement decisions. To learn more, see in 2014. The analysis found that the following the NRCinhome research brief Family Group in-home services elements are among those that Decision Making and In-Home Services and visit are supported by research and consistent with the Family Group Decision-Making section of the evidence-based practices and programs. Information Gateway website.

Family-centered practice and family Safety assessment and management. Child engagement. Family-centered practice focuses welfare agencies have the responsibility to on children's safety and needs within the context ensure the safety of children who remain in of their families and communities and builds on their homes. Careful decision-making and safety family strengths to achieve optimal outcomes. planning at the front end of a case can prevent Rather than treating individuals within a family, future abuse and the unnecessary placement of family-centered practice uses the power of family children in out-of-home care. However, results relationships, interactions, and supports to help from round 3 of the CFSRs indicated that most the entire family system. An important element States struggled when it came to providing of family-centered practice—and in-home services to families to prevent children's entry or services delivery—is engaging families in the reentry into foster care. Caseworkers typically casework process. Effective family engagement use safety assessment models and tools (e.g., occurs when caseworkers recognize families as the Safety Assessment Family Evaluation model, the experts in their respective situations and the structured decision-making model, the empower them throughout the casework process. Signs of Safety approach, the Safety Organized (To learn more, see Information Gateway's Practice approach) to help them assess and Family Engagement: Partnering With Families to determine a child's level of safety in the home. Improve Child Welfare Outcomes.) Risk assessments are used to assess a family's

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 8 risk and protective factors and to assign a value ƒ Problem-specific interventions. regarding the degree to which these factors Interventions should be individualized indicate a likelihood for future maltreatment. to meet the unique needs of families. While it is critical that caseworkers receive Caseworkers should understand that for proper training on using safety assessment certain services to be effective, they must tools, the tools are most effective when align with the needs of the families they they are directly connected to assessment are working with. For example, family practices, engagement with families, safety preservation services may not be appropriate and service planning, service identification, for families struggling with unmanaged and monitoring the ongoing progress of the mental health or substance use disorders. family. Furthermore, caseworkers must develop Providing services for the purpose of fulfilling the ability to understand and assess family practice requirements or expectations is dynamics, caregiver protective capacities, not an effective approach to stabilizing and family strengths and needs so they can and strengthening families. Common critically analyze the information in its totality specialized interventions include substance and accurately apply the tools used to guide use treatment, mental health services, decision-making. For more information, see age-specific parenting skills training, and the Safety and Risk Assessment and the Safety interventions for certain child behaviors. Planning in Child Protection sections of the ƒ Culturally specific services. When referring a Information Gateway website. family for services, child welfare caseworkers Individualized services. Caseworkers should should seek out programs that are specifically connect their clients with available and designed for people with that family's racial, accessible services that target the family's ethnic, and cultural backgrounds. Having needs. Having an array of services that are access to in-home services that employ accessible and available allows an agency to cultural awareness and sensitivity is critical respond in a timely manner to family needs for serving the diversity of families involved in order to keep children at home safely. with the child welfare system. For more Caseworkers should assess needs around the information on providing culturally specific following factors when matching families with services to families, see the Information appropriate in-home services: Gateway's Child Welfare Practice to Address Racial Disproportionality and Disparity. ƒ Concrete supports. Families in crisis often have concrete needs that are not being Strengthening protective factors. Although met. Caseworkers should determine if there protective factors were not evaluated as are family needs around income, housing, part of the NRCinhome assessment, they transportation, utilities, health care, child are increasingly being emphasized by child care, and other basic or essentials needs. welfare in-home services providers (e.g., FRCs), programs (e.g., home visiting programs),

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 9 and agencies (Child Welfare Information ƒ Incredible Years Gateway, 2020). A protective factors approach ƒ Interpersonal Psychotherapy to child maltreatment prevention focuses ƒ Motivational Interviewing on positive ways to engage families, such as by emphasizing their strengths and ƒ Multidimensional Family Therapy identifying areas where they have room to ƒ Multisystemic Therapy grow with support. Examples of protective ƒ Nurse-Family Partnership factors include parental resilience, social ƒ Parents as Teachers connectedness, and social-emotional ƒ competence in children. To learn more, Parent-Child Interaction Therapy see Information Gateway's Protective Factors ƒ SafeCare Approaches in Child Welfare. ƒ Trauma-Focused Cognitive-Behavioral Therapy EVIDENCE-BASED PROGRAMS ƒ Triple P (Positive Parenting Practice) Evidence-based programs are those that have been evaluated for effectiveness and Other programs that have not yet met the shown to produce positive outcomes. Since clearinghouse criteria but are highly regarded the enactment of the Title IV-E Prevention in the field include the following: Services Program, there has been an ƒ Family Connections increased emphasis on scaling up programs ƒ that are rated as promising, supported, or Project Connect well-supported by the Title IV-E Prevention ƒ Signs of Safety Services Clearinghouse. As of March 2021, ƒ Solution Based Casework the in-home services programs listed below Additional evidence-based programs can have met the rigorous evaluation standards be found on the California Evidence-Based prescribed in the ratings criteria and are Clearinghouse for Child Welfare website. It is therefore eligible for reimbursement under important to note that Tribal IV-E agencies the Title IV-E Prevention Services Program. are not required to implement programs Please note that the clearinghouse is regularly that meet the Title IV-E Prevention Services updated. You can find the most up-to-date list Program's rating requirements and may of eligible programs in the Find a Program or instead determine their own practice criteria Service section of the clearinghouse website. for services that are adapted to the culture ƒ Brief Strategic Family Therapy and context of the Tribal communities ƒ Child-Parent Psychotherapy that they serve. For additional Federal guidance, see the Program Instruction ƒ Families Facing the Future ACYF-CB-PI-18-10, Tribal Title IV-E Agency ƒ Functional Family Therapy Requirements for Electing Title IV-E ƒ Healthy Families America Prevention and Family Services and Programs. ƒ Homebuilders

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 10 PROMISING PRACTICES CFSA staff are seen as true members of their collaboratives, which is critical for families' Several States and jurisdictions are making engagement, since they tend to feel more efforts to improve their practice and delivery comfortable working with caseworkers in of in-home services to better serve children these community-based organizations than and families. The following are examples from at the agency's downtown government the field. office building (Capacity Building Center for States, 2020). DISTRICT OF COLUMBIA

In round 3 of the CFSRs, the District of Following the enactment of the Title IV-E Columbia was the only jurisdiction to receive Prevention Services Program, CFSA tapped a strength rating on Systemic Factor #29: into HFTCC's knowledge to assess the Array of Services (Children's Bureau, 2020a). benefits and challenges of the evidence- The robustness of their service array is due in based practices that were already being large part to the nearly 30-year partnership offered through the system. The District of between the Child and Family Services Agency Columbia was the first jurisdiction to have (CFSA) and its Healthy Families/Thriving an approved plan for the Title IV-E Family Communities Collaboratives (HFTCC)—a First Prevention Plan, and CFSA continues network of five neighborhood collaboratives, to partner with HFTCC on implementation each offering services targeted to the specific (Casey Family Programs, 2020). In 2020, CFSA needs of its immediate community (Capacity also launched Families First DC, an initiative Building Center for States, 2019b; Casey to establish 10 neighborhood-based family Family Programs, 2020). Over a 20-year period success centers in wards 7 and 8, which are that spans the CFSA-HFTCC partnership home to approximately 75 percent of the (1998 to 2018), the number of children in children and families served by the agency (N. out-of-home care in the District of Columbia Craver, personal communication, February 4, decreased from 3,188 to just 707 children (78 2021). The family success centers will expand percent) (Children's Bureau, 1998; Children's on the District of Columbia's long-standing Bureau, 2018). prevention and early intervention work by providing neighborhood-driven services While there are innumerable community- and supports to strengthen families in based agencies working in neighborhoods their communities. across the country, HFTCC in the District of Columbia is exemplary for the nature For more information on how the District of and closeness of its partnerships with Columbia partners with HFTCC, listen to the the local child protection agency (Casey How We Partner With the Community to Family Programs, 2020). HFTCC provides Improve Service Options Podcast Series by the community-based case management support, Capacity Building Center for States and read and CFSA colocates its in-home services Transforming Child Welfare Systems: How Do staff in each collaborative within HFTCC, Washington, D.C.’s Community Collaboratives enabling caseworkers to be based in the Provide Neighborhood-Based Supports to communities they are serving. As a result, Families? by Casey Family Programs.

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 11 ALASKA speak to providers and is offering technical assistance for capacity building. OCS is Alaska's Office of Child Services (OCS) partnered specifically focused on developing programs with the State's Division of Behavioral Health that can be easily adapted for rural communities in 2019, and together they worked with the and have a strong cultural component that Capacity Building Center for States to conduct can meet the needs of Tribes throughout the a statewide service provider gap analysis. State. The agency is concurrently working on This comprehensive needs assessment aimed to changing its culture to ensure that staff and identify where evidence-based practices were partners focus on prevention over removal and operating across the State and where critical develop trusting relationships with families. service gaps existed so that the State could effectively implement its 1115 Behavioral Health MONTANA Medicaid Waiver program in coordination with the Title IV-E Prevention Services Program Montana worked with the Capacity Building requirements. The effort included in-person Center for States in 2018 to improve its in-home visits to 73 Medicaid providers across Alaska, services delivery. At that time, the State was including 20 Tribal organizations providing also revisiting how it structured its child welfare behavioral health services. The cross- contracts, which tended to be concentrated organizational team also administered surveys within a few providers (A. Beattie, personal to Medicaid providers and OCS frontline staff communication, November 24, 2020). For working across 13 field offices. example, the 18 counties in region I were all served by a single provider, making adequate Results from the assessment are helping to service provision a challenge. The State took inform how OCS will invest and partner with a two-pronged approach to addressing the Tribes and community-based organizations to service delivery issue: expanding access to develop its serve array and build capacity for services and creating family support teams. Medicaid-reimbursable and evidenced-based services. The analysis revealed key takeaways Expanding access to services. As part of its regarding service gaps in rural areas as well service delivery evaluation efforts, Montana as with the alignment of current services with found there were many small agencies across community needs. OCS is in the process of the State that were trained in evidence-based building a strategy to increase its provision practice models but would not apply for State- of in-home prevention services, with a focus issued contracts, as the contracts typically on programs approved by the Title IV-E allocated between $100,000 and $200,000 Prevention Services Program that can be funded and these small agencies could not provide through Medicaid (S. Abramczyk, personal services at that level. To expand services and communication, December 17, 2020). take advantage of these providers, Montana worked with its procurement office to move In order to encourage existing providers to from using bigger, single-provider contracts to develop prevention services, OCS has brought using smaller contracts with fees for service. in representatives from national programs to The State developed a rate matrix as part of

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 12 this process—not only to increase service SOUTH CAROLINA delivery but also to increase access to The South Carolina Department of Social evidence-based services with the Title IV-E Services (SCDSS) is currently working on Prevention Services Program in mind. The multiple system reform efforts—including rate matrix was set up so that evidence- a new funding model for evidence-based based service providers would earn a services and a new casework practice higher rate for services. The State also model—that are designed, in part, to impact began offering increased rates for providers the State's provision of in-home services willing to travel more than 50 miles or those (S. Ferrufino, personal communication, providing services in the evenings or on January 5, 2021). These initiatives are part the weekends. of a statewide culture shift aimed at moving Family support teams. Montana identified away from punitive child welfare practices a need to be more efficient in offering and toward a focus on family safety, well- services to families at the outset of a case. being, and prevention. Historically, South Montana providers often felt they lacked Carolina's child welfare system has primarily the information necessary for quickly utilized private providers that serve children connecting a family to services, and there in out-of-home care (e.g., group homes). was a general concern that available In addition, although the State had an services were going untapped despite existing network of primary prevention community need. In response to these providers, there were gaps in its secondary concerns, region 2 implemented family and tertiary provider networks. With grant support teams—a successful effort that is funding from the Family First Preventions expanding to other regions. Family support Services Act Transition Grants and program teams are assembled as part of a family's support from the Thriving Families, Safer protection plan (ideally within 72 hours of Children: A National Commitment to Well- the plan's establishment), with the primary Being initiative, South Carolina is expanding goal of maintaining children in their homes its array of prevention programs, with the when possible or quickly reunifying families ultimate goal of shifting service delivery to in cases of removal. In region 2, there the front end of their system. were roughly 18 community providers that To kick off the process, SCDSS convened a committed to being available on an as- prevention services workgroup comprising needed basis to support families in crisis. a diverse range of State agencies and Preliminary data from the first year of stakeholders to assess the statewide this initiative show a 48-percent decrease evidence-based practice landscape and in out-of-home placements and a identify existing programs now eligible 76-percent increase in family receipt of for title IV-E funding through the in-home services.

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 13 Title IV-E Prevention Services Program. CONCLUSION They also created guidelines for providers The delivery of high-quality in-home that were willing to shift their program services that help keep children safely at offerings to provide more evidence- home with their families and prevent entry based practices. South Carolina ultimately into foster care is becoming increasingly invested its Federal grant funds directly into critical as States begin to shift their focus to select provider pilot sites to help enhance prevention in alignment with the Title IV-E their capacity to deliver evidence-based in- Prevention Services Program. It is often in home services. As of January 2021, the State a child's best interests to remain at home was in the process of training the pilot sites, when safety can be controlled and services with the goal of launching service provision are provided, and it is important to avoid during the spring of 2021. unnecessarily placing children in out-of- In the years prior to these initiatives home care. Therefore, agencies must have around in-home services, SCDSS designed a robust array of services and supports a practice model that emphasized a and collaborative systems of care to target prevention-focused approach to service the various family-specific challenges provision, with core principles that were that are present in the communities they subsequently reinforced by the enactment serve. In developing their optional title of the Title IV-E Prevention Services IV-E prevention plans, States must select Program. The model was built and implement evidence-based prevention upon a set of core values—specifically that programs that, based on data for their practice should be trauma informed, family agency's population and characteristics, centered, individualized, and strengths are feasible for their systems and work with based. Agencies across the State are the families living in their jurisdictions. increasingly making a concerted effort to Historically, there has been limited data listen to the perspectives of their families on in-home services implementation and by engaging them in case planning and by related continuous quality improvement; tapping into the experiences of families however, there are established measures currently and formerly involved in their that States can take to evaluate the extent system. They are also working to remove to which their current service provision is the stigma that parents experience when meeting the needs of their families. seeking assistance by shifting agency mindset to one that normalizes help- seeking behaviors.

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Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov 16