CHAPTER
16
Family
Support: The Critical Paradigm Shift
Families
have traditionally relied on each other and on friends,
neighbors and community groups for support and material
assistance during difficult times. Today, families are experiencing
unprecedented levels of stress. Many factors have resulted
in parents having less time and resources to devote to their
own children and families. Changes in family structure brought
about by divorce, single parenthood, geographic mobility,
and increasing numbers of mothers in the workforce have
left families more vulnerable and in need of more support
than ever before.[246] These changes have also left many
families isolated, under increasing stress, and less able
to provide support to each other.
For
example, one study conducted by the Children's Defense Fund
involved two-parent, non-minority families with mothers
who had at least a high school education - families not
traditionally considered at risk. Disturbingly, almost half
of the families studied showed family stress and poor coping
skills, poor parent/child communication, and delays in their
children's development.[247]
It is
often unacknowledged that many middle class families routinely
receive "help" in raising their families. Paid babysitters,
visits to private pediatricians, attendance at prenatal
exercise classes at the local gym are all examples of family
supports. Most middle-income families can afford to pay
for these basic services. Few would dispute that these families
benefit from the peer support offered.[248]
Lower
income families have similar needs but may have difficulty
obtaining similar support. Basic services such as healthcare,
housing assistance, and employment may be lacking in their
lives. Pressured with the additional stresses that poverty
brings, these families can benefit greatly from help in
coping with the daily challenges of raising children, and
from services tailored to their individual needs.[249]
Very
young parents face especially difficult child-rearing challenges.
They typically have less money and personal resources than
older parents, and their own needs for self-discovery and
independence may conflict with their parental responsibilities.
Family supports can assist young parents in recognizing
and reconciling these conflicts. Educational opportunities
that address these issues and support responsible parenting
can be a lifeline to both teenage parent and child.
A 1997
survey of 3,238 Massachusetts families conducted by the
Urban Institute's National Survey of America's Families
revealed that parents in Massachusetts experience one of
the highest stress levels in the nation.[250] Two indicators
in the survey are worth noting: parental aggravation and
poor parental mental health.
Parental
aggravation was assessed using a scale that summed a parent's
estimates of how often in the month prior to the survey
interview he or she felt the child was much harder to care
for than most, the child did things that really bothered
the parent a lot, the parent was giving up more of his or
her life to meet the child's needs than expected, and the
parent felt angry with the child. On that indicator:
 |
High
parental aggravation was reported in over 10 percent
of all Massachusetts families. For those families living
below 200% of the poverty level, the figure rose to
nearly 21 percent compared with 13 percent for other
poor U.S. families surveyed. |
On the
mental health indicator, parents were asked five questions
about how often in the past month they had been a very nervous
person, felt calm and peaceful, felt downhearted and blue,
been a happy person, and felt so down in the dumps that
nothing could cheer them up.
|
Nationally,
17 percent of children lived with a parent whose survey
responses suggested poor mental health, while in Massachusetts
the figure was 25 percent. For Massachusetts children
living in families with low incomes, however, nearly
32 percent lived with a parent who had symptoms of poor
mental health. |
Researchers
now understand that one of the best ways to serve children
is to serve parents also. Studies confirm that supportive
networks contribute significantly to all parents' ability
to raise their children.[251] When programs and services
reach a parent early, and when parents are better linked
to positive connections in the community, their children
benefit. When individuals feel responsible for their communities
and the safety and health of their residents, children also
benefit. Corroborated by research, these common sense principles
have led to a growing family support movement at the federal
and state levels.[252]
The
Family Support Philosophy
This
Family Support movement is grounded in the belief that families
function best when they can determine their own needs and
how best to address them. Family support services work to
strengthen families by creating opportunities to acquire
the knowledge and skills they need and want to better manage
the many demands placed on them.
Special
features of family support programs and policies include:[253]
- Family strengths rather than deficits are the focus.
All people have strengths or the capacity for growth.
By enhancing strengths, as well as addressing deficits,
people become more able to deal with difficult life events,
set growth-oriented goals, and achieve personal aspirations.
- Families can access support services and resources
as needed.
Families themselves should determine what resources and
services they need and receive. They should not be made
to accept services that don't fit, just because they are
the only available services. Services must be flexible
and responsive and they must make families feel welcomed
and valued.
- Family diversity is valued and respected.
Because families come from a variety of cultural backgrounds
and life experiences, they respond differently to assistance
and support. Services are offered and made available in
ways that reflect the strengths of diversity.
- Parents and families are given opportunities to
contribute to their own and their community's well-being.
Any meaningful effort to provide resources and services
to families must provide ways for them to be a part of
the planning, implementation and evolution of programs.
Parents and youth must be encouraged and supported in
their efforts to contribute to the community. They should
be given opportunities to experience how their involvement
can bring about change and contribute to their own well-being.
- All sectors of the community are involved in networks
and collaborations whose unifying mission is to support
families.
A helpful community is one that fosters social caring
and "situation-changing" supports, as opposed to rehabilitation
and "people-changing" services. Ensuring that all children
grow up in an environment that supports their healthy
development is in everyone's best interest. Members of
all sectors of the community have a role to play in supporting
families. Each sector must make decisions that will support
the positive efforts of the other sectors and ultimately
enhance rather than impede family functioning. This requires
open communication and a willingness to plan for long-term
benefits, as well as short-term gains.
Traditional
Services and Family Support
The
philosophy of family support and the services grounded in
that philosophy distinguish themselves dramatically from
traditional services.[255] Traditional services offer only
specific services or treatment with the expectation that
the family will adjust to fit the program's requirements.
Parents are rarely included in decision making about what
service would be welcomed or beneficial. Program and funding
sources often dictate types of services and eligibility
requirements. Rigid office hours and waiting lists are typical
the norm. Services emphasize deficits and tend to focus
on the individual as opposed to the family unit. In most
cases, intervention occurs after a crisis, and only when
a family's needs intensify.
In
contrast, family supports meet the needs of the family and
child early on, before a crisis occurs and needs become
greater. Family supports offer flexible help to meet basic
family needs. The focus is on the family rather than strictly
on the individual. Services build on family strengths rather
than on family weaknesses. Outreach to families is paramount.
Services are available on a drop-in basis and can be offered
in a family's home or in home-like centers.
Parental
Involvement in Decision Making
As stated
above, families themselves should assist in the process
of determining what services would be most welcome and beneficial.
Communities in other states have successfully implemented
parent involvement models. These models value child safety
and well-being, engage families respectfully, and build
upon existing family strengths to encourage and support
lasting change. Two of these outstanding approaches are
described below.
Individualized Courses of Action
The
Edna McConnell Clark Foundation has been committed to
the research and study of family support initiatives within
communities through its Community Partnerships for Protecting
Children Initiative. It has funded and supported communities
willing to engage in family support philosophies and services.
Four sites - Cedar Rapids, Iowa; Jacksonville, Florida;
Louisville, Kentucky and St. Louis, Missouri - have developed
partnerships in which civic and volunteer groups have
joined with public agencies to increase community participation
in strengthening families and keeping children safe.
In
the St. Louis site, families are being served using an
innovative parental involvement approach called "Individualized
Courses of Action" (ICA).[256] Here the core focus is
the family's actual strengths and underlying needs, as
opposed to their immediate problem or crisis. The expressed
needs of parents are addressed with services that are
appropriate, not just any services that happen to be available.
A "contract," also called an "ICA" defines how parents,
service providers, and other parties can sign on to assist
in meeting identified goals. Neighbors who agree to provide
weekly respite care, or a local minister who agrees to
counsel the family, would all be responsible parties to
the agreement. A family conference in which the family's
needs are fully identified could include the development
of several ICAs involving a larger pool of natural family
helpers.
Family
Group Decision Making
Family
Group Decision Making (FGDM)[257] is a new approach to
working with families involved in the child protection
system. A hallmark of the approach is the collaboration,
communication and cooperation it fosters between the family
and professional.
Since
1989, two primary models of FGDM have been practiced worldwide
in child welfare: Family Group Conferences and Family
Unity Meetings. The Family Group Conferencing model was
developed and legislated in New Zealand in 1989 and has
since been embraced by communities in Canada, the United
States, Sweden, Australia and England. The Family Unity
Model originated in Oregon in 1990.
The
philosophy of these models is grounded in the belief that
families, communities and government must partner together
to ensure child safety and well-being. These models support
the regular involvement of families in making decisions
about their children's protection and safety. Conferences
are held in which families play a key role. In the Family
Group Conference model, professionals are excluded during
the decision-making portion of the meeting. In the Family
Unity model, professionals are included, however, birth
family members can limit the participation of extended
family members and others based on federal confidentiality
laws designed to protect children from unnecessary disclosures.
New
programs, adopting features of both these programs have
been developed in California, Illinois, Kansas, Michigan,
Vermont, Washington, Canada and the U.K. Each has adapted
the model to reflect the needs and philosophies of local
families and agencies. Interest in these models has been
sparked by the alarming shortage of foster and adoptive
parents, especially for children of color. Involving extended
family in these meetings can increase appropriate placements
of children within kin homes.
Critics
of these family-centered practices are concerned that
children's safety may be compromised if the decision-making
role is turned over to the family. Others fear that families
simply do not have the ability to make difficult decisions
regarding the best interests of their children. Anecdotal
reports, however, support the view that families are thoughtful
and creative in identifying plans and solutions to meet
their needs.
Every
program implemented to date allows social work professionals
or the court to veto family decisions if they place children
in jeopardy. It is important to note that these family
support models are not intended for situations in which
a child's safety is in immediate jeopardy or where allegations
of sexual or physical abuse have been made.
A
benefit of these family support approaches is that they
lead to an increase in voluntary self-referrals for treatment
and support and, due to their preventive nature, a reduction
of more serious cases over time. An appropriate balance
can be struck between respecting the family's request
for self-determination in pursuing services without additional
help, and the need to monitor the family's progress and
address any issues subsequently identified. Advocacy should
be available, if requested and needed, to better ensure
that the family obtains the services it needs.
The
Effectiveness of Family Support
In 1994,
the Minnesota-based McKnight Foundation funded the Ramsey
County Community Human Services agency to conduct a project
designed to reduce abuse and neglect and strengthen family
functioning among high-risk families.[258] Families in the
study had high risk factors associated with child abuse
and neglect, but were not involved with the state child
protection agency. Half of the families were assigned to
the treatment group and were offered the opportunity to
work with one of 39 local agencies participating in the
project. Families worked with this agency to develop a service
plan to help address some of their identified needs.
Families
could use project funds to purchase a wide array of services,
as long as they related to the family plan. Funds were used
to purchase transportation, child or adult education services,
respite care, health related services, individual counseling,
parenting education, legal advocacy, and/or recreational
opportunities. Families in the control group were not eligible
to receive free consultation or services.
Comparisons
between the treatment and the control group were striking:
|
During
the 30-month project period, out-of-home placement costs
for the treatment group were 7.3 times less than for
the control group - $24,638 compared to $180,133. |
|
Child
Protective Services case openings during this period
were substantially lower for the treatment group - 1.6
vs. 5.7 for the control group. |
|
Families
in the treatment group were more likely to have been
employed six months or longer - 60.4 % vs. 44.9%. |
|
During
the 12 months following the program, the treatment group
was less likely to report abusive behavior by a partner
- 12.3% vs. 22.19%. |
Based
on the project's outcomes, the State of Minnesota in 1996
provided additional funds to enroll 100 new families. This
phase of the project did not include a control group, but
the state-funded Family Support Project provided essentially
the same services to the high-risk families. Eight months
following the project, differences emerged between those
who received family support services and those who proceeded
on a "business as usual" course.
|
Parents
were significantly less likely to report violent behavior
among adult household members (8.4% vs. 24.1%), threats
of violence (15.7% vs. 32.5 %), or frequent arguments
between adults (21.7% vs. 37.3%). |
|
Parents
were more likely to be employed (26.5% vs. 9.6%) and
reported higher earnings. |
The
results of these demonstration projects are promising and
document that family support services offered to high-risk
families not involved with child protective services
can reduce child abuse, domestic violence, and out-of-home
placements, as well as improve employment status.
DSS
Family Support Programs
Although
the Department of Social Services' primary focus is to protect
abused and neglected children, its mission also includes
providing a range of services to support and strengthen
families with children at risk of abuse or neglect. However,
because of the stigma or fear of agency involvement in their
lives, many families who would welcome support services
are unlikely to seek them directly from DSS.
In contrast,
studies show that high quality support services offered
in and by the community can result in an increase in voluntary
self-referrals from this group of underserved families and,
therefore, a reduction of more serious child abuse and neglect
cases over time.[259]
State
funding does not currently support wide-scale family support
efforts within DSS, however, the Department does play a
role in working to reduce child abuse and strengthen families
by funding local community initiatives. Three types of DSS
programs or pilots that embrace the principles of family
support are described:
Community Connections
Community Connection was established by DSS in response
to the federal Family Preservation and Support Act of
1993. Working at the state and community levels, it was
established to build a continuum of family support services
in neighborhoods across Massachusetts, particularly to
serve the needs of families not involved with child
protective services.
It
was largely modeled after Dorchester CARES, a 5-year federally
funded demonstration project initiated in 1989 by MCC,
working in collaboration with its local Boston partner,
Federated Dorchester Neighborhood Houses. CARES was built
with a commitment to Collaboration, Advocacy,
Resource development (people and money),
Education, and Services. During its ten-year
history, CARES has developed independently into a continuum
of supports that include: three neighborhood cooperatives
offering parenting and social supports, educational opportunities,
food and clothing pantries, childcare, and newborn home
visiting. Within CARES, families can look to their own
neighborhood and community for supports that are truly
useful and respectful of family strengths and diversity.
Since
federal funding provided to DSS, the state's child welfare
agency, was inadequate to build a statewide family support
network, it applied the research of James Garbarino and
Massachusetts census data to target areas where risk factors
for child abuse and neglect were highest.[260] A wide
variety of family supports are now offered through 22
local Community Connection sites that function as local
family support collaboratives.
Among
the supports provided are: clothing exchanges and food
pantries, parent education and support groups, drop-in
centers, respite care, family nurturing programs, parent
mentoring programs, and violence prevention activities.
Services are grounded in family support principles and
involve residents actively in planning for and carrying
out programs and activities.
Community
Connection sites have taken on the role of coordinating
services in 22 of the 27 DSS area offices. These local
collaboration involving multiple agencies, play a crucial
role in coalition building, outreach to the community,
coordination of services, and referral of children and
families to appropriate local resources. Community Connections
also works in partnership with other state agencies, such
as the Departments of Public Health and Education and
the Children's Trust Fund, to coordinate prevention efforts
among state agencies and integrate family support concepts
into child welfare practice.[261]
The
Department of Social Services should be applauded for
its leadership in implementing the family support collaborative
model and its related programs. Funding and expansion
of this network is now essential so that access to critical
family supports can be made available to children and
families statewide.
Family
Based Services
As
discussed in Chapter 8, the DSS has also initiated the
Family-Based Services program, which combines family strengthening
principles within a managed care model. In this model,
established child welfare agencies compete to serve as
the Family Based Service Lead Agency in their particular
area of the state. These Lead Agencies arrange for services
to DSS clients from a wide array of local resources. Increased
family input in planning and designing these services,
and increased use of community, grassroots, and other
supports for families are key to this program. Local,
culturally competent experts in child development, substance
abuse and other clinical areas can be made available to
the network.
Currently,
every DSS Area Office utilizes Family Based Services.
Open DSS cases are served, as well as cases involving
Children In Need of Services (CHINS) referred by the courts.
The services may be used to stabilize children in foster
care settings, and in kinship, guardianship or pre-adoptive
placements. Family Based Services can also be used for
reunification and transitioning children and youth from
group care settings.
Patch
Programs
Another
family support effort is the "Patch" Program, a shared
decision-making, community-based pilot that works to build
partnerships between the community, the Department of
Social Services, and the Department of Youth Services.
(The program originated in England where "patch" is a
term for neighborhood.) The Patch concept calls on community
residents and organizations to help support families and
youth who are involved with these agencies.
A
typical Patch team might involve a DSS caseworker, Patch
coordinator, various service providers and a family clergyman.
Together they craft a package of support strategies and
services that might aid the child and family. Dorchester
CARES in the city of Boston, and North Quabbin Community
Center in the rural town of Athol are the only Patch pilot
sites in Massachusetts at this time. Evaluation results
are pending.
Specific
examples of other state and private family support in
Massachusetts that play a unique role in preventing child
abuse and neglect are discussed in the next chapter.
RECOMMENDATIONS
- Expand "Community Connections" sites statewide,
and build their capacity to serve a broad range of families,
including voluntary referrals, cases screened out before
or after DSS investigations, and low-risk cases active
with DSS.
A budding infrastructure of family supports is developing
in Massachusetts but its scaffolding is fragile. Currently,
there are no plans to guarantee its stability or future
development, or to contribute state dollars to support
and expand the network of Community Connections sites.
Federal dollars have been the only source of support for
these programs since the federal Family Preservation and
Family Support Act was passed in 1993, and these are only
secure until 2002. Massachusetts must work now to ensure
a smooth transition to state funding and the expansion
of this vital family support structure across the state.
- Establish a statewide system of local Family Support
Teams to be coordinated by "Community Connections" sites.
As described earlier in the report, all families that
request them should have access to support and consultation
from Family Support Teams operating at the local community
level. These Teams of local professionals and family advocates
would coordinate "family conferencing" as a tool to assist
families in assessing their own needs and addressing them
through a range of local services and supports. In addition
to direct voluntary referrals from families in the community,
these Teams could also be made available to: families
within DSS that are identified as low risk; families reported
to DSS but screened out without any investigation; and
those families investigated by DSS where abuse or neglect
is not substantiated.
- Ensure collaboration and coordination among state
and private family support and service providers through
a specific state mandate backed with sufficient resources
and quality assurance.
This goal could be achieved through the establishment
of a Governor's Cabinet on Children and Families. The
Cabinet would transcend state department and secretariat
boundaries, and nurture a flexible system for effective
administration of programs for children and families.
The Cabinet could be convened by the Governor or his designee
and include representatives from the Executive Office
of Health and Human Services, and from all other State
Offices or Departments whose mandates include serving
children and their families.
The Cabinet would actively promote the principles of family
support, and coordinate training in family support practices
for state and private service providers. The Cabinet would
be assisted in fulfilling its mission through an Advisory
Council composed of legislators, parents, child welfare/family
support advocates and providers, and officials from local
cities and towns.
Return
to Top
Section
V: Preventing the Hurt:
|
