Differential and Alternative Response:

Implications for Fairness and Equity

Jill Duerr BerrickSchool of Social Welfare

UC Berkeley

Co-Authors:Amy Price & Amy Conley et al.

Study inspired by CalSWEC Research Agenda

Focus on Safety

Parallel Studies

• Alameda County: Alternative Alameda County: Alternative Response Services since 2002. Response Services since 2002.

• Contra Costa County: Differential Contra Costa County: Differential Response since 2005. Response since 2005.

• Slightly different models; similar Slightly different models; similar study designs and outcomesstudy designs and outcomes

Alternative/Differential Response:

Putting it in context: • 1) Screening by risk levels; 2)

voluntary provision of case management; 3) less punitive approach

• Over 20 states have some form of DR

• Various approaches to delivering services: through public child welfare agencies, through CBOs, or mixed

Study Goals Reflect Program Goals

• Overarching goal: Prevention of child welfare system involvement

• Proximal goals: Increased connections with community

resources Provision of temporary social support Elimination of unmet basic needs Improvement of parent-child

relationship

Methods: Alameda County

Process study Focus groups with line staff (n=12) Interviews with managers (n=16) Interviews with clients (n=30)

Outcome study (Survival Analysis) Treatment group: 161 families who received

intervention Comparison group: 477 families eligible for

intervention

Methods: Contra Costa County

Process & Client Satisfaction Study Interviews with CFS staff (n=13) Interviews with CBO staff (n=16) Interviews with clients (n=51)

Outcome Study Treatment: 164 families offered Path 1

services Comparison: 335 families eligible for but

not offered Path 1 services

Family Engagement

♦ A unique challenge

Unlike other home visitation Unlike other home visitation programs, where the provider’s programs, where the provider’s point of entry is clear and point of entry is clear and services are invited by parents, services are invited by parents, AR/DR services often are AR/DR services often are prompted by family crisisprompted by family crisis.

Rates of Client Engagement in AlamedaARS agencies have experienced varying rates of client engagement

Agency: Referrals Served*▪ FSSBA 2002-2007: 337 35%

▪ La Familia 2002-2007: 611 33%

▪ Prescott Joseph 2005-2007: 84 12%

*As of February, 2007

Rates of Family Engagement in Contra Costa

♦ 49% engagement rate in Path 1♦ Hispanic families significantly

higher engagement rate (66% vs. 33% for other groups)

♦ Initial allegation of substantial risk, or child welfare history less likely to engage.

What Explains Low Rates of Engagement?

♦ Client mistrust

♦ Fear

♦ Uncertainty

♦ Resentment

Why Parents Engage?

• Need help and see DR/ARS as an opportunity

• Feel they have no choice (Hispanic families in particular believe DR services are mandatory, but also welcome services in their language)

• Convinced by actions and/or qualities of case worker

Program components:Providing social support

• Theoretical support: Perceived and enacted social support (House, 1981)

• Types of interventions Listening to clients share their feelings Giving reassurance and compliments Normalizing the experience of asking

for help

Providing Quality Social Support

Begin by identifying and building from families’ strengths and goals

Maintain frequent contact with families in their own homes, as it provides comfort and promotes trust

Encourage parents to make their own decisions and acknowledge that they are experts in their own lives

How Workers Offered Support and Built Positive, Trusting

Relationships♦ “He transmits confidence. And it

doesn’t matter the time; he will find time to listen and help.”

♦ “She really cares. I feel like I have a new friend. I can tell her anything. She can help me.”

♦ “She would listen to my problems, help guide me about how to look at things, set goals – like a coach, you could say.”

♦ “She speaks my language.”

Offering Referrals to Community Resources

• Find resources close to families’ homes

• Make initial calls prior to giving resources to the family; let the family know what to expect

• Encourage families to access services independently, but also balance their needs for immediate services and assist or accompany them when necessary

Referrals and Supports that are Helpful

♦ Low-income legal services♦ Family and individual counseling and

parenting classes♦ Help baby-proofing the house♦ Links to asthma, nutrition, and other

health programs♦ Assistance with resume and job search♦ Assistance with housing search♦ Advocacy for children at their schools

and for parents at CalWorks

Program components:Targeting basic needs

• Theoretical support: Hierarchy of needs (Maslow, 1943)

• Types of interventions: Use of basic needs fund to address

one-time, acute needs Referral to community resources

that address basic needs, such as food banks

Assistance with transportation

Providing for Basic Needs can Alleviate Stress

► Funding to support basic needs may help families overcome crises

► For financially stressed families, small contributions of diapers, clothes, and food can help to alleviate stress and have positive impact on parenting

►Assess whether the need is one-time or regular; help families budget

Families Received These Basic Services

♦ Donations of food and diapers♦ Assistance with PG&E and EBMUD

bills as well as referrals for their low-income programs

♦ Transportation to children’s school and appointments

♦ Gift cards for groceries and clothing

♦ Help with an initial rent payment/ deposit

Program components:Strengthening parent-child

relationships

• Theoretical support: Attachment theory (Bowlby, 1969)

• Types of interventions: Providing opportunities for parents

to enjoy time with their children Modeling appropriate behavior with

children Offering information on child

development

Naturally Occurring Semi-Structured Activities that

Support Families► Organized activities can teach parents

that playing with their children is important for family development.

► Relationships created among parents in semi-structured activities can create new, important sources of peer support.

♦ ““I really enjoyed the science I really enjoyed the science classes….It was a nice experience classes….It was a nice experience and it and it taught me that the kids come first…that day was taught me that the kids come first…that day was cool, because I got to be with them.cool, because I got to be with them.”

Analysis of client outcomes

Alameda client outcomes: Report of Maltreatment

• No difference in rates of re-report for treatment & comparison groups.

• Slim possibility of modest differences for children w/prior report.

0.00

0.25

0.50

0.75

1.00

0 500 1000 1500 2000Days

tx = 0 tx = 1

Kaplan-Meier survival estimates for re-report by treatment,clients with prior reports only

CCC Path 1 Client Outcomes: Re-Referral

• Engagement had no impact on re-referral: 28% engaged; 30% not engaged

• Rates by race: 42% Black, 37% Hispanic, and 9% White

• Odds of non-white child being re-referred is 5.9 times the odds of a white child

• Odds of referral for child from family with prior referral history 3 times higher

CCC Path 1 Client Outcomes : Removal

Removal within 1 year

No Yes Total

Services Engaged 78 2 (3%) 80

Services Not Engaged

74 10 (12%)

84

No Capacity 285 12 (4%) 297

Unable to Contact 36 2 (5%) 38

Total 473 26 (5%) 499

Other CCC OutcomesPaths 1 & 2

• 94% of clients noted life changes as 94% of clients noted life changes as result of programresult of program

• Most reported a little (20%) or a lot Most reported a little (20%) or a lot (73%) of improvement in quality of (73%) of improvement in quality of family lifefamily life

• 75% felt more connected to 75% felt more connected to community after involvement in DRcommunity after involvement in DR

Implications

• Findings in-line with meta-analyses of child maltreatment prevention programs that show small treatment effects

• Findings also fit with other DR studies that have found no difference in re-reporting for DR and non-DR families

• Maltreatment prevention and placement prevention may be too narrow or inappropriate targets for intervention.

Implications• Child maltreatment may not be

affected, but ARS/DR may have other benefits: Access to resources Connections to community Basic parenting practices may improve. Serving families in need who wouldn’t

otherwise be served Improved trust and collaboration with

CBOs Changing perception of CPS in the

community.

Positive Family Changes Identified by Parents

♦ “I am more focused, self confident. I'm more comfortable in my own skin. I'm willing to do all the things I need to do to get things done.”

♦ “She allowed me to realize all the things I've overcome, and that made me feel proud.”

♦ “I’m less suffocated. I can talk more, and sometimes about problems that I have had.”

♦ “They helped me to believe and gave me strength.”

Curriculum Title:

Differential Response and Alternative Response in Diverse

Communities

Available from:CalSWEC library website

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