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Assessing the Effect of Family-Centered Out-of-Home Care on Reunification Outcomes

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Assessing the Effect of Family-Centered Out-of-Home Care on Reunification Outcomes
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  AssessingtheEffects of Family-CenteredOut-of-Home Care onReunificationOutcomes CatWeen A. Lewandowski,Ph,D,Ph,D"TheUniversity of Kansas,1997AssistantProfessor,SocialWorkProgramCoordinatorWichitaStateUniversityWichita,KansasStatement of theResearchProblemTherehasbeenanincreasedinterestinfamily-centeredapproachestoout-of-homecaredueinparttotheinadequacies of statechildwelfareagenciestomeetchildren'sneedforpermanency,However,littleisknownabouttheeffectivenessoffamily-centeredapproachesinimprovingreunificationoutcomes, The aim of thisresearchistocontributetotheknowledgebaseonfamily-centeredout-of-homecareprogramsbyassessingone model's effectivenessinimprovingreunificationoutcomes,ThismodelistheFamily-CenteredOut-of-HomeCarepilotproject,developedbyMissouri'sDepartment of FamilyServices,Threedominantviews of children'sneedshaveemergedovertime,agenericview,achild-centeredview,andafamily-centeredview,Thegenericview,prevalentfromthenation'sbeginningsuntilthemiddle of the19thcentury,didnotdistinguishbetweentheneeds of childrenandtheneeds of adults,Rather,assistancewasprovided to peopleinneed,withoutregardtoageortothewaystheneeds of childrenmaydifferfromthose of adults,Beginninginthe1850' s, achild-centeredviewemerged,wherechildren'sneedsweredistinguishedfromadults'needs,Thisviewholdsthatnotonlydochildrenhaveuniqueneeds,butthattheseneedscanbeunderstoodoutsidethecontext of children'sbiologicalfamilies,Thelatterhalf of the20thcenturysawtheemergence of thefamily-centeredperspective,Thefamily-centeredperspective,likethechild-centeredperspective,maintainsthatchildrenhaveuniqueneeds,However,unlikeamorechild-centeredperspective,thefamily-centeredperspectiveholdsthatchildren'suniqueneedscanbestbeunderstoodwithinthecontext of theirbiologicalfamilies,Thoughtheterm"family-centeredpractice" is relativelynew,family-centeredpracticeprincipleshavealongstandingtraditionthatdatesbacktoearlysocialcasework,Likeearlysocialcasework,family-centeredpracticeviewsclients'concernswithinthecontext of theirfamilyandtheiruniquesituations,Traditionally,childwelfarehasmaintainedachild-centeredapproachtopractice,Familieshaveoftenbeenseenasthe"cause" of theirchildren'sproblems,andattemptsto 51  involvethemcouldonlyinterferewiththeinterventionplannedtomeetchildren'sneeds.Thus,viewingthefamilyastheproblemratherthanasaresourcehasbeenasignificantbarriertoimplementingafamily-centeredapproachinchildwelfareagenciestoday..Asafamily-centeredapproach,Missouri'sFamily-CenteredOut-of-HomeCare(FCOHC)pilotprogramrepresentsaphilosophicalshiftfromachild-centeredtoafamily-centeredapproachtoservices.FCOHCstressestheimportance of identifYingfamilies'strengthsaswellastheirproblems.Translatedintopractice,thebiologicalfamily,ratherthanthechild, is theidentifiedclientbecausethis is themostdesirablemeans of providingforchildren'sneeds.Onecriticalcomponent of theFCOHCmodel is invitingfamilies,particularlybiologicalparent(s),toparticipatemorefullyintheassessmentandtreatmentplanningprocesswhiletheirchildrenare in out-of-homecare.Providingassessmentandtreatmenttobiologicalfamiliesassoonastheirchildrenenterout-of-homecareallowsworkerstoquicklyassesswhetherfamiliesarecapable of caringfortheirchildren'sneeds.FCOHCservicesaugmentalreadyexistingfostercareservices,whichcontinuetobeprovidedinbothpilotandcomparisoncounties.Thekeyaspects of theFCOHCmodelarehavingoneidentifiedworkerassignedtoafamily,conductingassessmentandinterventionteammeetings,andincreasingthenumber of assessmentstodocumentfamilies'progresswhenitoccurs.Increasedteamandworkerinvolvementassoonaschildrenenterout-of-homecareisstressedthroughoutchildren'sstayinout-of-homecare.ResearchQuestionsThisstudyassessedtheeffects of Family-CenteredOut-of-HomeCare(FCOHC)onreunificationoutcomesandonfostercareservicedelivery.Thestudy'Sconceptualmodeldepictedthehypothesizedrelationshipsbetweenfamilyandchildcharacteristics,groupmembership,standardfostercareservices,andreunificationoutcomes.Theset of familyandchildcharacteristicvariablesareexogenousvariablesandwereincludedascontrolvariables.Thesevariablesaretotalbarrierstoreunification,reasonforremoval,whetherachild is fromasingleparentfamily,child'sage,andtotalnumber of previousplacements.Groupmembership is alsoanexogenousvariable,indicatingwhetherchildrenwere in theFCOHCpilotorcomparisongroup.Theset of ninefostercareservicevariablesareendogenousvariables,astheirvariance is explainedbytheexogenousvariablesandotherendogenousvariables in themodel.Theseservicevariablesaretotalnumber ofteam meetings,number of attendeesatteammeetings,on-goingassessment,identification of familystrengths,totaltypes of servicesprovidedwhilethechild is inout-of-homecare,andtotalworkercontactswiththechild,parentes),re1ative(s),andwithcollateralagencies.Thesenineservicevariablesmeasuretheaspects of fostercareservicedelivery52  b thatwereexpected to increaseasaresult ofFCOHC. Theoutcome, or dependentvariablesarereunification,placementrecidivism,andtime in out-of-homecare.FCOHC is designedtoimprovecontinuity of care,increaseteamandfamilyinvolvement,andprovidemoretimelyandmeaningfulassessmentsandinterventions.ByaugmentingstandardfostercareserviceswithFCOHC,itwasexpectedthatstandardfostercareserviceswouldbeenhancedandreunificationoutcomeswouldbeimproved.Interms of theconceptualmodel,itwasexpectedthatFCOHCwouldhaveadirecteffectonreunificationoutcomesandonfostercareservicedelivery.Differencesinreunificationoutcomescanbeattributedtodifferencesingroupmembershipandfostercareservices.Thefirstresearchquestionderivedfromthemodel is: what is theeffect ofFCOHC onreunification,placementrecidivism,andtimeinout-of-homecare?Thesecondresearchquestion is: what is theeffect ofFCOHC onfostercareservices?MethodologyThestudydesignmostcloselyresembledanonequivalentcontrolgroupdesign,andcomparedthereunificationoutcomes of childrenwhosefamiliesreceivedFCOHCservices in pilotcountieswiththosewhosefamiliesreceivedstandardfostercareservicesincomparisoncounties.ThestudytookplaceinMissouri,duringtheperiodoffall1994throughspring1996.Thecounties in thisstudywerelargelyrural,thoughafewcountiescontainedmetropolitanareas.Inall,374childrenwereselectedforthesample;220frompilotcountiesand 154 fromcomparisoncounties.Thereweresomedifferencesbetweenthetwogroupsonthedemographicvariablesincluded in theconceptualmodelascontrolvariables.ChildrenintheFCOHCpilotgroupwereolderthancomparisoncountychildrenatplacement,withtheaverageagebeing10.7and7.7, respectively(t= 5.16, df=313.64, p=.000).Pilotcountychildrenhadanaverage of 1.3 previousplacements,whilecomparisoncountychildrenhadanaverage of .81 placements(t=2.773, df= 372.00,P=.007).Thegroupsdidnotdiffersignificantlyontotalnumber of barrierstoreunification,ethnicityorgender of children,reasonforremoval,or in thenumber of childrenfromsingleparentfamilies.Datawerecollectedfromchildren'scaserecordsandfromthestate'scomputerizeddatabase.Toavoidskewingresults,onlyonechildfromafamilywasselectedforthesamplewhenfamilieshadmorethanonechildplaced in out-of-homecareatthesametime.Thedatacollectioninstrumentwasacaserecordreviewformthatwasdevelopedspecificallyforthisstudy.Toassesstheform'sreliability,agreementpercentagesand 53  Cronbach'salphawerecalculatedasameasure of interraterreliability.Thesetests of reliabilityindicatedthattherewasahighdegree of internalconsistencyinthewayreviewersrecordeddatafromcaserecords.Reunificationwasdefinedaswhetherthechildwasreunifiedwithhis/herbiologicalparent(s)withintheinitial12months of thestudyperiod.Placementrecidivismwasdefinedaswhetherachildreturned to out-of-homecareduringthe 18 monthstudyperiod.Onlythe269childrenwhoexitedout-of-homecareduringthestudyperiodwereincludedintheanalysisforplacementrecidivism.Timeinout-of-homecarewasdefinedasthetotalnumber of daysthechildwasinout-of-homecareduringthe 18 monthstudyperiod.Thus,childrenwhoreturned to out-of-homecarehadtwoout-of-homeplacementperiodsthatwereincluded in thismeasurement.Whenmeasuringservicevariables,familystrengthsandserviceswerecontinuousvariables,indicatingthetotalnumber of strengthsandservicesprovided to familieswhiletheirchildrenwereinout-of-homecare.Theremainingservicevariables,teammeetings,teamattendance,on-goingassessment,andworkercontactswithchildren,parents,relatives,andcollateralagenciesweremeasuredastheratio of thetotalnumber of thatservice per totaldaysthechildwasinout-of-homecare. To assesstheeffect ofFCOHC onoutcomes,each of theoutcomevariableswereregressedonthegroupmembershipvariablewhilecontrollingforfamilyandchildcharacteristics. Of thethreeoutcomevariables,timeinout-of-homecare is acontinuousvariablewhilereunificationandplacementrecidivismaredichotomousvariables.Consequently,mUltipleregressionwasusedwhentime-in-out-ofhomecarewasthedependentvariable,andlogisticregressionwasusedwhenreunificationandplacementrecidivismwerethedependentvariables.Theanalysis of theeffect ofFCOHC onfostercareservices took placeinthreestages.First,factoranalysiswasused to identifyunderlyingconstructsamongthenineservicevariablesincluded in theconceptualmodel.Second,multivariateanalysis of variance(MANOYA)wasused to comparegroupmeansonthenineindividualservicevariablesand on theservicefactors.Third,multipleregressionwasused to regresstheservicefactorsongroupmembershipwhilecontrollingforfamilyandchildcharacteristics to assesstheeffect ofFCOHC ontheindividualservicefactors.ResultsFindingsfromthelogisticregressionanalysisindicatedthatFCOHCdidnothaveaneffectonreunification,whencontrollingforfamilyandchildcharacteristics.Childrenwho54  wereremovedduetophysicalabusewereleastlikely to bereunifiedduringthestudyperiod.FCOHCdidhaveaneffectonplacementrecidivism,thoughnotinthedesireddirection.Childrenfromthepilotgroupwere2.6timesaslikelytorecidivatethancomparisonchildrenwhenothervariablesremainedunchanged.Whilecomparisoncountiesreunifiedmorechildren,pilotcountychildrenspentsomewhatfewerdaysinout-of-homecare,onaverage,thancomparisoncountychildren.Thesedifferences,however,werenotstatisticallysignificant. Of thefamilyandchildcharacteristics,thetotalbarrierstoreunificationidentified in thecaserecorddecreasedtheoddsforreunification,andwaspredictive of increasedtimeinout-of-homecare.Havingapreviousplacementwiththestate'spublicchildwelfareagencydecreasedtheoddsforreunificationbuthadlittleeffectonrecidivism or time in out-of-homecare.Beingfromasingleparentfamilyincreasedtheoddsforplacementrecidivismbuthadlittleeffectonreunification or timeinout-of-homecare.Childrenwhosereasonforremovalwassexualabuse,homelessness,orphysicalabuse,werelesslikelytobereunifiedthanchildrenplacedforotherreasons.Childrenwhowereremovedattherequest of theirparentsweremostlikelytobereunified.Thesecondresearchquestionasked,whatwastheeffect ofFCOHC onthedelivery offoster careservices.Hotelling'sTfortheset of nineservicevariablesindicatedthatthetwogroupsdiffered in theamount of servicesprovidedduringthestudyperiod(p < .01).BasedontheunivariateFstatisticsfortheindividualservicevariables,FCOHCcountieshad,onaverage,moreteammeetingsandmoreattendeesatthesemeetingsthoughthesedifferenceswerenotstatisticallysignificant.FCOHCpilotcountiesidentifiedsignificantlymorestrengthsandtheirfamiliesreceivedalmosttwiceasmanytypes of services,onaverage,thancomparisoncounties(p < .02).Comparisoncountiesconductedsignificantlymoreassessments,onaverage,thanpilotcounties(p < .05).Comparisoncountieshadsomewhatmoreindividualcontactswithparents,children,relatives,andcollateralagenciesthanpilotcountiesthoughthesedifferenceswerenotsignificant(p > .05).Thefactoranalysis of thenineindividualservicevariablesproducedthreefactors,identifiedasteam,agency,andfamilyinvolvement.Basedonatest of theunivariate F's associatedwiththethreefactorscores,thetwogroupsdifferedsignificantlyonagencyandfamilyfactors.Groupmembershipwasthenregressedonthethreeservicefactorswhilecontrollingforfamilyandchildcharacteristics,toassesstheeffect ofFCOHC onfostercareservices. Of thetlueeservicefactors,groupmembershiphad an effectonbothagencyandfamilyinvolvement.FCOHChadthemostsignificanteffectonthefactorfamilyinvolvement,whichwasone of theobjectives of thefamily-centeredmodel.Thisfindingsuggeststhatworkers in pilotcountiesweresuccessful in increasingfamilyinvolvementandinprovidingmoreservicestofamilieswhiletheirchildrenwere in out-of-homecare.However,FCOHCcountieshadlessagencyinvolvementthan 55
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