Strengthening Child Welfare Services

In Baltimore City

University of Baltimore School of Law

Urban Child Symposium

Center for Families, Children & the Courts

The Urban Child in the Child Welfare System:

From Fracture to Fix

Richard P. Barth

School of Social Work

University of Maryland

Baltimore, MD 21201

rbarth@ssw.umaryland.edu

Disclaimer

• Commissioner, Baltimore City Department

of Social Services Advisory Board, since

2008

Background

• Have been involved with child welfare

services research & analysis since 1978

Four Take Home Points

• Acknowledge the Recent Success of Baltimore City Child Welfare Services

• Improve Parent Training for birth families at removal and point of reunification

• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care

• Help the City End LJ so Baltimore City can become more innovative

Baltimore City DSS Recent Successes

• Two consecutive awards as DHR Local DSS of the Year

(2009, 2010)

• Reductions of children in group care are significant

• Development of Active Youth Advisory Board

• Gaining ground on ultimate conclusion of LJ Consent

Decree

• Nation leading work with local School District to share

emergency contact information

• Growing proportion of MSW-trained child welfare workers

and, now, all supervisors have LCSWs

• < 10% vacancy rate

Parent Education

• 800,000 parents get parent education through CWS each year in the U.S. – If .002% of America‘s children live in Baltimore that‘s

still 1600 families that should get high quality parent training each year

• Evidence based parent education programs have emerged :– Parent Child Interaction Therapy (PCIT)

– The Incredible Years

– Parent education campaigns (Triple P) are growing (perhaps in Baltimore County)

• Common elements approaches to parent education is emerging…

Parent Education II

• Only PCIT actually includes competencies that parents have to demonstrate achieving and that can be provided to the court!

• Yet it is hardly available

• It‘s time for advances in parent education in CWS, generally, and at DSS.

Evidence Based Implementation Requires

Reform of Programs and Processes

• Good new ideas have been developed that could assist CWS

– Parent training is the most developed and needed

• It‘s use will require deep involvement of CWS in implementation:

– We cannot implement them all at once

– We must allocate adequate resources to starting them and to adapting them to CWS populations and practice parameters

– We must also provide extensive supervision during implementation

– Willing partners exist but the support is needed

Child Welfare Services Have Been Dominated

by Attachment Theory

• Attachment theory ostensibly helps to explain

children who are remote, disconnected,

indiscriminant, stuck, and unreciprocating

• The principle of PARSIMONY calls for ―the simplest

and most frugal route of explanation available‖

• Question: Does attachment theory add

something that other newer neuro-psychosocial

interventions do not provide?

8

Past Time to Detach from Attachment

• Our CWS involved

children and families

do not need their own

Freudian-based theory

Arredondo, D., & Edwards, L. P. (2000). Attachment,

bonding, and reciprocal connectedness: Limitations

of attachment theory in juvenile and family court

[Electronic version]. Journal of the Center for

Families, Children, and the Court, 2, 109-127.

Indiscriminate Friendliness From Inhibitory

Control Not Problems with Attachment

Bruce, Tarullo & Gunnar (2009); Pears, Bruce, Fisher, & Kim (2009)

Inhibitory

control, not

attachment

predicts

indiscriminant

friendliness

Risks of Over Use of Attachment Theory

• Barahona case in Florida-- Clear warnings

from CWW and other professionals that the

girl, at least, was not doing well (loosing hair,

depressed, etc).

– Psychological report focused on attachment –

resulting in conclusion that children needed to

stay with Barahona‘s

Risks of Over Use of Attachment Theory

• Recent Audit of cases in Maryland where

children were left with parents with indicated

abuse and neglect… 2 Baltimore City cases in

which court had ordered them to be placed

there despite DSS recommendation

• California study in mid 1990s; families that

indicated that they were ―bonded to young

children‖ and allowed to keep them in care;

20% of children subsequently had 4 or more

moves in the next 3 years

Relationships Matter …

• …but future relationships matter as much

as past relationships

Implement KEEP in Baltimore City

• Parent Management Training-O

• Multi-dimensional Treatment Foster Care-

Adolescents (and MTFC-Pre)

• KEEP (MTFC-lite) and, soon, KEEP-

SAFE, and KEEP-Pre

Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent

training intervention: model description and effectiveness. [Article]. Child & Family

Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x

MTFC-Pre Intervention

Child NeedsCaregiver-Child

RelationshipCase Management

Foster Parent

Consultant

Family Therapist

‗Daily Report‘ Caller

Case Manager

Child Therapist

Behavioral Skills

Trainer

Child Psychiatrist

STAFF

KEEP Intervention

Caregiver-Child

Relationship

Foster Parent Consultant

Foster Parent Behavioral Groups

‗Parent Daily (WEEKLY) Report‘

(PDR) Caller

Which Foster Care Placements Disrupt?

Number of behavior

problems per day on PDR

After 6, every additional

behavior problem increases

probability of disruption by 25%

within next 6 months

7

8

9

10

11

1 2 3 4 5 6KEEP is very good

at keeping behavior

problems in the 3, 4,

and 5 range

Effect Of Prior Out-of-home Placements On

Placement Moves: MTFC-P Vs. Regular FC

(Fisher, Burraston, & Pears, 2005)

RFC

MTFC-P

Predicted Probability Of Negative Exit By

Prior Placements and Intervention Group

KEEP

0

5

10

15

20

Negative Exit Positive Exit

Per

cen

tag

e

Percentages of Exit Type by Group

KEEP

KEEP Implications

• Investing in therapeutic interventions that

change physiology and behavior may make

it more likely that the improved behavior will

be sustained

• KEEP could become a prototype for

adoptive parent support—it is much more

likely to matter than PRIDE or MAPP which

have no parenting support component

End LJ (Now that Results are In)

• Baltimore DSS has worked heroically to end

the LJ consent decree

– Many performance indicators are now achieved

– More need to be accomplished

• The State of Maryland should not continue to

pursue and end to the lawsuit in court—the end

should come under mutual agreement with the

plaintiff

• Ending LJ will give Baltimore City even more

chance to innovate

Four Take Home Points

• Acknowledge the Recent Success of Baltimore City Child Welfare Services

• Improve Parent Training for birth families at removal and point of reunification

• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care

• Help the City End LJ so Baltimore City can become more innovative

Partial References Ahn, H. N., & Wampold, B. E. (2001). Where oh where are the specific ingredients? A meta-

analysis of component studies in counseling and psychotherapy. Journal of Counseling Psychology, 48, 251-257.

Barth, R. P., & Miller, J. (2001). Building effective post-adoption services: What are the empirical foundations? Family Relations, 49, 447-455.

Barth, R. P., Crea, T. M., John, K., Thoburn, J., & Quinton, D. (2005). Beyond attachment

theory and therapy: Towards sensitive and evidence-based interventions with foster and

adoptive families in distress. Child and Family Social Work, 10, 257-268.

Berry, M., Propp, J., & Martens, P. (2007). The use of intensive family preservation services with adoptive families. Child & Family Social Work, 12(1), 43-53.

Brooks, D. & Barth, R.P. (1999). Adjustment outcomes of adult transracial and inracial adoptees: Effects of race, gender, adoptive family structure, and placement history. American Journal of Orthopsychiatry, 69, 87-102.

Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 66, 624-633.

Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? [Article]. Child Abuse & Neglect, 30(4), 409-424. doi: 10.1016/j.chiabu.2005.11.004

Chorpita, B. F., & Viesselman, J. O. (2005). Staying in the clinical ballpark while running the evidence bases. Journal of the American Academy of Child and Adolescent Psychiatry, 44(11), 1193-1197.

Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46(5), 647-652.

Partial References Cohen, J. A., Mannarino, A. P., Zhitova, A. C., & Capone, M. E. (2003). Treating child

abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27(12), 1345-1365.

Fisher, P. A., Gunnar, M. R., Dozier, M., Bruce, J., & Pears, K. C. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. In Resilience in Children (Vol. 1094, pp. 215-225).

Foulkes Coakley, J. (2005). Finalized adoption disruption: A family perspective. Unpublished manuscript, University of California at Berkeley.

Gibbs, D., Barth, R. P., & Houts, R. (2005). Family characteristics and dynamics among families receiving post-adoption services. Families in Society, 86, 520-532.

Goerge, R.M., Howard, E.C., Yu, D., Radmosky, S. (1995). Adoption, disruption, and displccement in the child welfare system (1976-1995). Chicago: Chapin Hall Center for Children at the University of Chicago.

Price, J., & Chamberlain, P. (2005). A parent-mediated intervention for elementary-aged children in foster care: Child problem behavior changes and placement outcomes: Manuscript in preparation.

Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent training intervention: model description and effectiveness. [Article]. Child & Family Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x

Smith, S. L., Howard, J. A., Garnier, P. C., & Ryan, S. D. (2006). Where Are We Now?: A Post-ASFA Examination of Adoption Disruption. Adoption Quarterly, 9, 19-44.

Wind, L. H., Brooks, D., & Barth, R. P. (2007). Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions*

doi:10.1111/j.1741-3729.2007.00467.x. Family Relations, 56(4), 378-389.