Department of Health and Human Selv1ces 

OFFICE OF 

INSPECTOR GENERAL 

RESPITE CARE SERVICES FOR FOSTER 

PARENTS - SIX CASE STUDIES 

SER"I('l" 

q""d3a 

JU GIBBS BROWN 

Inspector General 

AUGUST 1994 

OEI-0493-0071 
. 

OFFICE OF INSPECTOR GENERA 

The mission of the Office of Inspector General (DIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services' (HHS) programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by three DIG operating components: the Offce of Audit Service, the 

Offce of Investigations, and the Offce of Evaluation and Inspections. The OIG also informs 

the Secretary of HHS of program and management problems and recommends courses to 

correct them. 

OFFICE OF AUDIT SERVICE 

The OIG's Offce of Audit Servces (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carryng out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and effciency throughout the Department. 

OFFCE OF INTIGATIONS 

The OIG's Offce of Investigations (01) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions 

administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 

control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFCE OF EVALUATION AN INSPECTONS 

The DIG's Offce of Evaluation and Inspectiors (DEI) conducts short-term management and 

program evaluations (called inspections) that focus on issues of concern to the Department 

the Congress, and the public. The findings and recommendations contained in these inspection 

reports generate rapid, accurate, and up-to-dale information on the effciency, vulnerabilty, 

and effectiveness of departmental programs. 

DEI's Atlanta Regional Offce staff prepared this report under the direction of Jesse J. 

Flowers, Regional Inspector General, and Christopher Koehler, D puty Regional Inspector General. Principal DEI staff included: 

Atlanta Region Headquarters 

Paula Bowker, Project Leader Alan Levine, Program Specialist

Ron Kali 

Ruth Reiser 

Maureen WHce

EXECUTIVE SUMMAR Y


PUROSE 

To describe characteristics of effective programs which provide respite care servces to 

foster parents. 

BACKGROUN 

Between 1983 and 1992, the number of foster care children increased about 74 

percent while the number of family foster homes declined about 11 percent. A major 

reason for the decline in foster homes is the stress involved in caring for foster 

children -- particularly children with special needs. 

Foster care experts and advocates generally agree that provision of respite care for 

foster parents helps recruit and retain foster parents. For example, a 1992 study 

sponsored by the Administration for Children and Familes (ACF), Department of 

Health and Human Services (HHS) showed, and several experts have concluded that 

respite care is one of the top needs of foster parents. Retaining foster parents helps 

keep foster care children out of "at risk" environments and institutions, as intended by 

Federal statutes and regulations. 

SCOPE AN METIODOLOGY 

We studied six programs selected from 27 that child welfare experts and public 

officials operating child welfare programs recognized as effective at providing respite 

care. We defined respite care as planned, temporary, periodic relief from foster care 

responsibilties for foster parents. Respite care is intended to relieve foster parent 

stress and prevent disruption of placements of foster children. Our selected six 

programs provided wide geographic dispersion throughout the United States, and they 

represented urban and rural populations, public and private administration, and a 

variety of target populations. We interviewed child welfare program offcials and 

experts at HHS, selected States and counties, and various organizations which have an 

interest in foster care. We also analyzed respite care servces provided by each selected program. 

FIINGS 

Respite care can be provided effectively in varius ways 

No single model program or blueprint is essential for providing respitelcare to foster 

parents. The six programs we inspected differed in a number of ways, including 

program management, program requirements for respite services, criteria for providing respite care, settings for respite care, types of respite care providers, payment methods, and target populations. 
For example, three programs were operated by private organizations while three were 

operated by government child welfare agencies. Two programs provided respite care 

to all foster parents, but four served only foster parents of special needs foster 

children. Five programs used compensated providers and one used volunteers. 

Effectie respite programs share some commn characteritic 

Although there was no blueprint for an effective respite program, the six programs we inspected shared some common characteristics. In each program, respite care was established to meet a specific need. Each program was affilated with an established 

organization that served foster children. An programs promoted teamwork and trust. 

Each program screened, trained, and monitored respite providers. Lastly, each program was flexible to meet changing respite needs. 

Fedral and State suppon have been imponant elents of respite programs 

All six programs received Federal or State financial support when started, or they made program enhancements with government funds. Two of the six programs 

received Federal financial support to get started or they evolved from other Federally 

funded programs. A third program was s.:arted with private funds but later received Federal funds from various sources, such as Title XX of the Social Security Act. A fourth program started with private funds and later obtained Federal funds for 

program enhancements. A fifth program started with State funds but now operates 

with Federal funds. The sixh program started with county funds and later obtained State funds to make program enhancements. The sixth program now operates with 

Federal, State, and county funds, and private donations. 

CONCLUSION 

This report shows that while recognized, successful respite programs differ, certain program elements are common to each. The Administration for Children and 

Familes should provide recognized effective practices for providing respite care to 

States , counties and private sector organizations. Such information will help officials 

involved in developing respite care programs learn what works. For example, public and private sector officials involved in developing State five-year plans to implement Family Preservation and Family Support Servces authorized by the Omnibus Budget 

Reconcilation Act of 1993 should find information on respite care of particular interest. 

Another OIG report that can be useful in planning respite servces is titled "Respite Care Services for Foster Parents " (OEI-04-93-00070). That report provides

information on availabilty of respite care, use of respite care, primary ource of 

respite care providers, and barriers to respite care use. 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. 

TABLE OF CONTENTS€

PAGE€

EXECU SUMY€

INODUCfON . € . . . . . . . . . . . . . 1 

FIINGS. . . . . . . . . . . . . . . . . . . 6€

. Respite Care Can Be Provided In Various Ways. . . . . . . . . . . . . . . . . . . . . . . . 6 

. Effective Respite Programs Share Some Common€

Characteristics. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . € . . . . . . . . . . . . . . 8€

. Federal and State Support Have Been Important Elements 

Of Effective Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

CONCLUSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . €

APPENDIX A: Description of Selected Six 

Respite Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AHIV/AIDS Respite Program . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . A-€

Brooklyn, New York€

Family Support Services of the Bay Area. . . . . . . . . . . . . . . . . . . . . .. AOakland, California 

Harris County Foster Parent Respite Program. . . . . . . . . . . . . . . . . .. A-€

Houston, Texas€

People Places, Incorporated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AStaunton, Virginia 

Vermont Foster Care Program Waterbury, Vermont € . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A

Fragile Infant Special Care Program . . . . . . . . . . . . . . . . . . . . . . . .. A-€

San Francisco, California 
INTRODUCTION€

PUROSE 

To describe characteristics of effective programs which provide respite care servces to€

foster parents. 

Numer Of Foster Chilen Increasg While Number Of Foster Home Decreasg 

The number of children entering foster care increased about 74 percent in the past 

ten years. The National Foster Parent Association (NFPA) and the Administration for€

Children and Familes (ACF), Department of Health and Human Servces (HHS), 

estimated that 259 000 foster care children in 1983 increased to about 450 000 in 1992. 

Foster care children reside in a variety of settings, including family foster homes, group homes, and institutions. 

While the number of foster children continues to increase, the number of foster homes 

and foster parents continues to decline. The NFPA estimates that the number of 

licensed foster homes declined by nearly 11 percent between 1983 and 1992, from 

approximately 140 000 to 125 000. The NFPA estimates that only about 100 000 of the 

125 000 licensed foster homes in 1992 were available to accept a foster child 

placement. 

500 (In Thousands) 

450 

400 

300 259 

200€

140€

125€

100€

1983 1992 

-FOSTER CHILDREN E2FOSTER HOMES 
Specil Need Foster Care Chilen Increase DeTlnd On Availble Foster Parents 

In addition to the increasing number of foster care children, available foster parents are frequently asked to care for foster children with special needs. Special needs 

children are tyically medically fragile , handicapped, or seriously il. They may suffer from fetal alcohol syndrome, or from exposure to HIV and drugs. According to a 

1992 ACF report written by James Bell Associates, children entering foster care today 

have more emotional and behavioral problems than ever before. 

Such children require a greater level of time and attention than many foster parents 

are able, or willng, to give. According to the Bell report, it may become increasingly diffcult to recruit and retain foster parents who are wiling to care for special needs 

children. This is particularly true for single foster parents who comprise between 28 

and 32 percent of all foster parents, according to the Single Foster Parent Network.

The head of the Network said that special needs children place a potentially greater 

demand on single foster parents than on couples who may share foster care duties. 

Respite Care May Help Retain Foster Parents 

Foster care experts and advocates generally agree that respite care for foster parents 

is important for recruiting and retaining foster parents. It also helps prevent out-ofhome placement of children. For example, a 1992 HHS report stated that respite care is important for relieving social, economic, and financial stress among families with 

special needs children, including foster familes. Further the Director, Information and Servces Office, National Foster Parent Association, stated that respite care is the most important factor for retaining foster parents--particularly those caring for special needs children. The James Bell Associates study showed that foster parents may not be 

willng to care for special needs children unless respite care and other support services 

are available. The Bell report showed that current and former foster parents 

identified respite servces as the fourth most important un met servce need for them. 

The first three were counseling, day care, and health care that is not covered by 

Medicaid. 

To the extent that respite care helps retain foster parents, it can help keep foster care children out of "at risk" environments and institutions. Federal statutes and HHS 

regulations require foster children to be placed in the least restrictive and most family- like setting possible. 

However, little information exists on what /espite care programs are available and 

which ones are effective. According to the experts we intervi wed, such information would be useful to communities and organizations which are interested in designing 

respite care programs. They could learn from existing programs and Pfrhaps adopt 

methods that have proven effective. 
Fedral Suppon For Respite Care For Foster Parents 

Typically, Federal funds for respite care have been made available as part of other 

family and children programs. As a result, we could not readily determine the extent 

of Federal funding and support for foster parent respite care servces. 

The HHS has supported respite care through demonstration grant projects authorized 

by the Temporary Child Care for Children with Disabilties and Crisis Nursery Act. 

The Administration for Children and Familes (ACF), HHS, administers the grants. In 

addition, the ACF funds a center charged with providing technical assistance, training,

evaluation, and research to demonstration project grantees. The center, located in 

Chapel Hil, North Carolina, is called the Access to Respite Care and Help (ARCH). 

The ARCH publishes and distributes a quarterly newsletter to approximately 600 

organizations that have some involvement in foster care and respite care programs. 

Beginning in 1994, ARCH plans to serve as a referral system for foster parents

seeking respite care. 

More recently, Federal support for the provision of respite care for foster parents has 

been broadened by funding for Family Preservation and Family Support Services. The 

Omnibus Budget Reconciliation Act of 19S3 authorized funds for States to plan and implement servces intended to keep famEies together and td strengthen them. Each 

State child welfare agency desiring funds must develop and submit a five-year plan to the Department by June of 1995. Respite care for both biological and foster parents 

is one tye of family preservation and one type of family support servce which a State 

may elect to include in their five-year plan. Respite care, however, is not mandated. 

Finally, the HHS funds and administers several other programs that agencies serving 

foster children may use to obtain respite services for foster parents. They include 

Maternal and Child Health Services Block Grants 

Medicaid 

Social Servces Block Grants 

HHS' Abandoned Infants Assistance Program , and 

HHS' Child Welfare Research and Demonstration Program. 

SCOPE 

We included six programs which provide respite care for foster parents in our study. The selected programs are listed below. 

The HIV/AIS Respite Program in Brooklyn, New York 
The Family Support Servces of the Bay Area Program in Oakland, California€

The Harrs County Foster Parent Respite Program in Houston, Texas 

The People Places, Incorporated Foster Care Program in Staunton, Virginia 

State of Vermont Foster Care Program, Department of Social and 

Rehabilitation Servces, Agency of Human Services, Waterbury, Vermont 

The Fragile Infant Special Care Program in San Francisco, Caliornia 

METIODOLOGY 

We conducted case studies of six programs selected from 27 that child welfare experts 

and public officials operating child welfare programs recognized as effective at 

providing respite care. We defined respite care as planned, temporary, periodic relief from foster care responsibilities for foster parents. Respite care is intended to relieve€

stress and prevent disruption of placements of foster children. To identify programs 

that are recognized as providing effective respite care, we intervewed experts in the 

child welfare field. We included the 

Administration for Children and Familes, HHS 

National Foster Parent Association


American Public Welfare Association 

Child Welfare League of America 

Access to Respite Care and Help (ARCH), 

Abandoned Infants Assistance Resource Center, and 

National Foster Care Resource Center. 

The experts we intervewed based their opinion that respite care programs were 

effective on several factors. The criteria most often cited included (1) respite care 

program longevity, (2) widespread reputation in the child welfare field for excellent 

respite and foster care -- i.e., recognition as a model program and selection for€

awards, (3) increases in the number of foster care familes served by respite care 

providers since starting a respite care program, and increases in the number of respite 

care providers, (4) decreases in turnover of foster parents and disruptiqn of 

placements of foster children, and (5) clear policies and procedures for respite care. 

Using information obtained from experts and public officials, we selected six respite€

care programs that provided wide geographic dispersion throughout the United States. 
We also structured our selection of programs to obtain representation of urban and€

rural populations, public and private administration, and a variety of target populations. 

To identify and describe characteristics of effective programs, we conducted on-site 

case studies of each selected program. We intervewed program officials using a standardized discussion guide and reviewed applicable program policies, procedures and performance records. 

We conducted this inspection in accordance with the 
 Quality Standards for Inspections€ issued by the President's Council on Integiity and Efficiency. 

Concurrently with this inspection, we performed an inspection to determine availability 

and use of respite care for foster parents. In performing this companion inspection 

we surveyed 12 State and 66 local foster care agencies and 11 State Foster Parent 

Associations. The results of that inspection are presented in an OIG report titled€

Respite Care for Foster Parents" (OEI-04-93-00070). That report provides


information on the availability of respite care, use of respite care, the primary source€ of respite care providers, and barriers to respite care use. 
FINDINGS€

REPIT CAR CAN BE PROVIED EFFCfL Y IN VARIOUS WAYS 

No single model program or blueprint is essential for providing respite care to .foster 

parents. According to the experts and public officials we interviewed , all six programs 

we examined effectively provide respite care to foster parents. Yet, the programs 

were diverse. The programs differed in a number of important ways, including 

(1) program management, (2) program requirements for respite services, (3) criteria 

for providing respite care, (4) settings for respite care, (5) types. of respite care 

providers, (6) payment methods, and (7) target populations. Appendix A contains a 

description of each effective program. 

Respite Prgrams Were Managed By Pu/it; and Prvate Agencie 

Public agencies managed and operated three of the six respite programs we examined 

and private agencies managed the remaining three. The three pubJic programs were 

in Vermont, Harris County, Texas, and San Francisco, California. The private respite 

programs were in Brooklyn, New York, Oakland, California, and Staunton, Virginia. 

Respite Programs Had Diferent Requirements For Using Respite Care 

The six recognized respite programs we studied had various requirements for foster€

parent use of respite care. To ilustrate, the Fragile Infant Special Care Program in€

San Francisco required foster parents to use 50 hours of respite care each month.€

Conversely, the Family Support Services Program in Oakland and the HIV/AIDS 

Respite Program in Brooklyn allowed respite care within specified limits, but did not 

require a specific number of hours. The Oakland program allotted families a yearly 

number of hours and allowed them to use those hours on an as-needed basis each€

month. The Brooklyn program allowed 15 hours of respite care per week, with 

additional respite during emergencies.€

Finally, three of the six programs allowed respite care on a case-by-case basis. They 

were the People Places, Inc., in Staunton, Virginia; the Harris County program in 

Texas; and the State program in Vermont. These programs set no limits or 

parameters on the amount of respite care foster parents should or could use. 

However, respite care in the Harris Coun1y program was available only on weekends.€

Respite Care Was Provided In Diferent Sel'ings€

The six programs we studied provided respite. care in various settings. For example 

the Harris County, Texas program provided respite care only in out-of-home settings. 

In such instances, a respite care provider might keep a foster child in their home 

during a weekend to provide a respite break for the child's foster parent. Conversely, 
the HIV/AIDS Respite Program in Brooklyn, New York generally provided respite to 

foster parents only through in-home settings. In such instances, a respite care provider 

would come to a foster parent's home to care for the foster children. The Family 

Support Servces of the Bay Area offered both in-home and out-of-home respite. 

Some programs considered the performance of certain daily activities and tasks as a€

form of respite. For example, the Family Support Servces of the Bay Area in€

Oakland, California, provided in-home respite services and also considered a 

recreational outing for a foster child to be a form of respite for foster parents. Also 

the HIV/AIDS Respite Program in Brooklyn considered the provision of a respite 

provider to take a foster child to a medical appointment as respite for a foster parent. 

Likewise, the Brooklyn program provided respite for foster parents by providing a 

respite provider to give bedside attention for a hospitalized foster child. 

Respite Prms Used Diferent Type Providers


The six respite programs we examined used various types of respite care providers. 

To ilustrate, the HIV/AIDS Respite Program in Brooklyn and the Family Support 

Services of the Bay Area in Oakland used paid full or part-time employees to provide€

respite. People Places, Inc., in Staunton, Virginia allowed respite care to be provided 

only by another foster family enrolled in their program. 

Conversely, The Harris County Foster Parent Respite Program in Texas uses all€

volunteers for providing respite care. This is somewhat unique for a public program.€

Finally, foster parents in the Vermont and San Francisco programs and the Family€

Support Servces of the Bay Area were allowed to find their own respite care€

providers. The respite providers they found, however, had to be approved by 

appropriate foster care agency officials. 

Diferent Metho Used To Pay For Respite Care€

The six respite programs we studied used various methods to pay for respite care. 


ilustrate, the Harris County Foster Parent Respite Program in Texas did not pay 

volunteers who provided respite care. The county foster care agency, however required foster parents who used respite care to contribute $5 per day per foster child 

to a volunteer, as a token of appreciation. Two other programs, Brooklyn and 

Oakland, paid full and part-time employees who . provided respite care. In Brooklyn, the payments ranged from $6 per hour for up to two children to $9 per hour for three 

or more children. In Oakland, the payments ranged between $6 to $8 per hour€

depending on the number of children, and full time providers also received some 

agency fringe benefits. 

Two other programs used creative methods to pay for respite care. 
 example€

People Places, Inc. in Virginia debited a custodial foster parent for the hours of 

respite care received and transferred that a::nount to a foster parent who provided 

respite care. Likewise, foster parents in V rmont who received respite care initially 
paid a respite care provider themselves and then subsequently obtained 

reimbursement as a monthly expense. 

Diferences In Target Popultions 

The six programs we studied were successful at finding respite care providers who 

could care for children with a wide variety of needs. Four of the respite programs 

examined served foster parents of special needs children. For example, the Brooklyn program served children with HIV/AIDS. The Staunton, Virginia program served severely emotionally disturbed foster children. Both the Oakland and San Francisco California programs served foster parents of medically fragile, vulnerable, and extremely il foster children. 

The program in Harris County, Texas served any foster parent in the county. 

However, not all volunteer respite providers had the. skils to care for foster children 

with severe physical, emotional, or behavioral problems. Likewise, the remaining . program, Vermont, offered respite care to any foster parent in the State, when appropriate and necessary.€

EFFCf REPIT PROGRAS SHA SOME COMMON CHCTRISTICS 

Respite Care Was Establishe To Meet A Specifc Need 

Each of the six programs we inspected developed respite care as an integral part of 

their overall mission. For example, in 1980 a foster parent group in Vermont surveyed foster parents statewide to identify their support service needs. The survey 

showed that the foster parents said respite care was the most needed service. The 

foster parent group subsequently obtainecl funding from the State legislature for 

respite care.€

Family Support Servces of the Bay Area in Oakland, California was developed to continue and expand the respite program which had been under the auspices of the 

Children s Home Society. The Bay Area regional centers and Alameda County Social Services Department strongly supported this new agency so that servces to their 

clientele would not be eliminated. 

Affiatin Wih Establihe Organiztions Tht Served Foster Chilen 

All six programs we inspected evolved from other larger programs that served foster 

children. All six continue to be affiliated with other larger programs. One program is 

a component of a larger foster care program which serves severely emqtionally disturbed children. Three of our selected six programs are part of foster care systems administered by local or State government. The remaining two are part of . 

multipurpose, private, nonprofit organizations which provide a variety of services to 

children, including children with special needs. 
Larger organizations provided essential elements for starting a respite program, such€ as financial support, administrative support, and credibility with foster parents. For 

example, the HIV/AIDS Respite Program in Brooklyn, New York is administered by 

Brookwood Child Care. Brookwood Child Care is a private agency financed through a 

State contract to provide a full range of foster care, adoptive, and preventive servces. 

Likewise, People Places, Inc. , in Staunton, Virginia makes respite care available as 

part of a treatment foster care program servng severely emotionally disturbed 

children. Program managers recognized the importance of respite care and made it€

available to foster parents from the very beginning of the program. 

Promote Teamwork And Trt€

Officials at the six programs we reviewed said that teamwork and trust have a 

significant effect on the use of respite care by foster parents. For example, program officials at two of the six programs said that foster parents initially did not request and€

use respite care services to the extent anticipated. They said foster parents did not€

trust respite care providers. Foster parents feared respite providers were spying on€ them to determine their performance as foster parents. They also feared that respite€

care providers did not possess adequate skils and depth of concern needed to care for€

their foster children. Some foster parents also feared that using respite care would€

suggest a weakness such as insufficient commitment and inability to cope with the€

stress and demands of fostering. 

One respite program manager found that using a team approach for all facets of€

foster care, including respite care, helped alleviate fears about using respite' care. He 

negotiates a "Family Foster Care Teamwork Agreement" with foster parents when a foster child is placed with them. The agreement is signed by agency staff and foster parents. It serves as a contract in which everyone is equal partners. It stipulates that respite care is an acceptable support servce which the agency sanctions and 

encourages. This approach allows foster parents to have input into decisions regarding their foster child rather than the foster care agency dictating all decisions.


The manager of People Places, Inc., in Staunton, Virginia uses a team approach to 

foster care. The team approach allows foster parents to become involved in all phases 

of care for their foster children, including respite care. The team approach allows 

foster parents access to the program manager and involvement in decision making. In 

this way, foster parents help control care for their foster children. The program€

manager believes that when foster parents feel in control, stress is alleviated or€

minimized. As a result, a need for respite servces is minimized. However, respite care is always available and is provided when a foster family and program staff identify 

a need for it. 

Screen, Train And Monitor Respite Providers€

Managers and staff of the six programs we studied have developed procedures for€

screening, training, and monitoring respite care providers to assure quality care. To€
ilustrate, the procedures used byfour of the six selected programs are highlighted 

below. 

Screenig Applicants: To screen respite providers, the Harris County Foster Parent€

Respite Program staff subject each applicant to the same background investigation as€

they perform on potential foster parents. They check, for example, such records as€

arrest, conviction, traffc violations, and child abuse. If a respite provider applicant 

has not been a State resident for at least three years, they check FBI criminal records. 

Additionally, they intervew relatives and acquaintances to screen respite provider€

applicants.€

Respite provider applicants at the HIV/AIDS Respite Program in Brooklyn, New 

York are screened through a State central registry. Applicants also provide references€

which are checked. Further, respite proviaer applicants must pass a medical 

examination. 

The State of Vermont Department of Sodal and Rehabiltation Servces program staff 

also screen respite provider applicants through a State central registry. Further, they must pass a Federal criminal background check. 

Likewise, staff of the Fragile Infant Special Care Program in San Francisco, Caliornia€

screen respite provider applicants through a State criminal records system to ascertain


their suitability for caring for foster children. Family Support Servces of the Bay Area€

in Oakland, California thoroughly interviews each applicant, requires at least three€

reference checks, tuberculosis clearance, Department of Motor Vehicles clearance€

and also accesses the State s criminal records via fingerprint checks.


Traig Respite Providers: The staff of the HIV/AIDS Respite Program in Brooklyn€ require each respite provider to attend two full days of training. One day is a general€

course on foster care and respite care, and the second day is on HIV. The HIV€

course is administered by a local university. Further, each respite provider must€

attend two hours of in-service training every six weeks. 

Program officials in the Vermont Department of Social and Rehabilitation Services€

encourage, but do not require, respite providers to attend the same 8-week training 

course that new foster parents must attend. 

Monitorig Respite Provider Performance: The staff of the Harris County Foster 

Parent Respite Program in Houston, Texas monitor respite provider performance 

through use of a questionnaire. The questionnaire is sent to both foster parents and 

respite providers after each respite experience. It is specifically focussed on getting 

feedback on the performance of respite providers and experiences duriflg respite. 

The staff of the HIV/AIDS Respite Program in Brooklyn monitor respite provider€

performance by intervewing foster famiJes who use respite providers. The intervews€

are conducted weekly either by phone or face-to-face. Among other purposes, the€
intervews focus on determining the satisfaction of foster parents with performance of€

respite providers.€

Flle Opeatins To Meet Changig Need€

None of the six recognized programs we inspected were static. Program staff all€

attributed their success partly to a wilingness to adjust program policies and€

operations as needed. For example, the HIV/AIDS Respite Program in Brooklyn,€

New York initially used other foster parents as their primary source of respite€

providers. However, other foster parents proved not to be the best source of respite€

providers. They were good and competent as respite providers, but once they€

accepted a foster child of their own they did not always continue servng as a respite€

provider. The program director made a needed adjustment and -began advertising for€

people who could serve as respite providers full-time. The director found that this€

was the best way to assure having quality respite providers when needed.€

The program staff of the Harris County Foster Parent Respite Program in Texas had€

to adjust their program to increase use of respite care by foster parents. They initially€

assumed that foster parents would all want and use respite care if it was made €

available. This proved to be an incorrect cssumption. They then initiated program€

activities specifically focussed on educatinf, foster parents about the benefits of respite€

care. Their program is now growing in the number of foster parents who use respite€

care and in the number of volunteers who provide respite care.€

FEDERA AN STATE SUPPORT HAVE BEEN IMORTAN ELEMENT€ EFFCT PROGRAS€

All six programs received Federal or State financial support when started, or they€ made program enhancements with government funds. Two of the six programs€

received Federal financial support to get started or they evolved from other Federally€

funded programs. To ilustrate, the Harris County Texas Children s Protective€

Services obtained an HHS discretionary grant to determine community approaches to€

foster parent recruitment and retention. The grant project identified respite care as€

an important support service to help retain foster parents. This led to the creation of€

the Harris County Foster Parent Respite Program. In Brooklyn, New York; the€

HIV/AIDS Respite Program started with a grant from HHS and some matching local€

funds. Due to delays in obtaining a continuation on their Federal grant, the parent€ organization for the Brooklyn program recently assumed full financial responsibilty for€

the respite program.€

A third program, People Places, Inc. in Virginia, was started with private funds but€

later received Federal funds from various sources, including Title XX or the Social€

Security Act, as payment for program services.€

A fourth program started with county funds and later obtained State grant funds for€

program enhancements. This program, the Fragile Infant Special Care Program in€
San Francisco, received State demonstration funds two years after the program began. 

Those funds were used for program enhancements such as hiring a consultant 

psychologist and paying for program staff and foster parents to attend conferences. It 

is now funded by a combination of Federal, State, and county funds and some private 

donations. 

A fifth program started with State funds, but now operates with Federal funds. The 

State of Vermont began its respite care program with $50 000 of State funds after 

foster parents approached the State legislature. However, in Vermont most respite 

care for foster parents is now paid for with Federal funds channeled through the State. 

The sixh program, the Family Support Servces of the Bay Area program in Oakland 

California, was able to expand respite care servces for foster parents to four 

surrounding counties with HHS funds channeled through the State of California. 

Those funds were made available through the Temporary Child Care for Children with 

Disabilties and Crisis Nursery Act. The program manager said if Federal funding is 

not continued, the four counties will either have to absorb the full costs of respite 

services or discontinue them. 

CONCLUSION 

This report shows that while recognized, successful respite programs differ, certain 

program elements are common to each. The Administration for Children and 

Families should provide information on recognized effective respite care practices to 

States, counties and private sector organizations. Such information wil help officials 

involved in developing respite care programs learn what works. For example, public 

and private sector officials involved in devdoping State five-year plans to implement 

Family Preservation and Family Support Services authorized by the Omnibus Budget 

Reconciliation Act of 1993 should find information on respite care particularly helpful. 

Another OIG report that can be useful in planning respite services is titled "Respite Care Servces for Foster Parents" (OEI-04-93-00070). That report provides 

information on the availability of respite care, use of respite care, the primary source 

of respite care providers, and barriers to respite care use. 
APPENDIX A€

DESCRIPON OF SELECTD PROGRAS THT PROVIE REPIT CAR 

HIV/AIDS Respite Program€

Family Support Servces 

of the Bay Area 

Harris County Foster Parent€

Respite Program 

People Places, Incorporated 

Vermont Foster Care Program 

Fragile Infant Special Care Program 

Brooklyn, New York€

Oakland, California 

Houston, Texas 

Staunton, Virginia 

Waterbury, Vermont 

San Francisco, California 
HI/AIS REPIT PROGRA 

BROOKLYN, NEW YORK 

Prgram Development


The respite program is administered by Brookwood Child Care, a private agency 

under contract with the State of New York to provide a full range of foster care 

adoptive, and preventive servces in Brooklyn. In 1989, Brookwood found that it was 

servng an increasing number of HIV -infected children as drug addicted parents 

abandoned their babies in hospitals or became unable to care for them. Brookwood 

established the HIV/AIDS Respite Program (HARP) to provide intermittent 

temporary relief to foster parents of foster children with HIV and AIDS. The 

objective is to enhance family life, and the life of an HIV-positive child, and to prevent disruption of stable foster care placements. 

Program Operatin


The respite program is run by a full-time director and administrative assistant. A 

foster family which is referred for respite care is matched with a respite provider 

according to geographic proximity and care needs. HARP staff make a home visit to 

a family foster home to determine service needs, understand the foster family routine 

and set up a respite care schedule.


Respite care is generally provided in a family foster home. However, it can also 

include escorting children for clinic visits and providing respite to a foster parent at a 

hospital when an HIV-infected child is hospitalized. Up to 15 hours of respite per 

week, plus emergency respite, is allowed. The agency placed a limit on the amount of 

respite care because they found too much respite care can compromise the 

relationship between a foster parent and a foster child. Further, a respite provider 

can get too involved with a foster family and suffer "burn out. 

Respite care providers must complete an employment application, pass a medical 

exam, provide references, and receive clearance from the State Central Registry. 

Respite providers are required to complete training performed by the Brookwood 

staff, including modules on precautions for families and caregivers; behavior 

management; stress management and grief education; a one-day course on HIV given 

by a local university; and a two-hour in-servce training meeting every six weeks. 

Foster parents do not pay for respite care and do not forfeit their regular foster care 

board payments for respite periods. Providers receive $6 per hour for caring for 1-

children, and $9 per hour for 3 or more children. Respite providers are also paid for 

attending all training sessions. 

The Brooklyn program developed written policies and procedures for providing respite 

care, including rules on administering medications, confidentiality statements, and how 

to handle and report emergencies. They have also developed a training manual. 

A - 2 
Progam Use€

The results of a 1992 survey of foster parents and respite providers showed that 83 

percent of foster parents used respite care at least once a week. Further, 66 percent of the surveyed foster parents said they could use additional hours of respite care. 

HAP is currently providing some respite to all foster families served by the 

Brookwood agency who have HIV-positive children. However, they are serving only 

three foster familes from all other foster care agencies in Brooklyn. According to the 

director of the respite care program, other agencies in their servce area are unable or€ unwiling to finance respite servces. 

Initial barriers to using respite care included a Jack of awareness that the servces 

existed, fear that wanting respite sends a message that foster parents are not doing a 

good job, and concern that respite care providers are sent to spy on foster parents. 

The director used a variety of techniques to overcome such barriers. She conducted 

all HIV training at the agency and sat in on case consultations to develop greater 

collegiality with caseworkers. She also reached out to foster parents directly, offering 

information and a sympathetic ear. Gradually foster parents began to look upon€

respite care as part of a continuum of foster care. 

State and COlUly Agenc Role 

The program initially received an 18-month Federal grant from the Administration for€

Children, Youth and Familes, which was channeled through the State of New York. 

The grant provided $65 000 in Federal funds plus a one-quarter local match for a total of $86 500. Due to delays in obtaining continuation grant funds, Brookwood recently assumed financial support for the respite program. In addition, Brookwood 

supplements respite program funding with private funds from its foundation grants. 

Characteritics of Effectivenes 

The HARP is a small program under the auspices of a large, well-established private 

foster care agency. The larger agency provided financial support and its professional 

stature to the respite program. HARP officials attribute the program s success to a 

combination of structure and support of the larger Brookwood agency, and the 

leadership and dedication of the HARP program director.€

Brookwood has quality assurance standards which HAP is required to meet. In 

addition, the respite director monitors her program by maintaining weekly, informal 

contact with respite care providers and periodic visits to family foster homes. She has 

found that casual encouragement and reinforcement are effective ways to assure 

retention of respite providers. As part of Federal grant requirements, fhe program conducted a final evaluation. The evaluation showed that respite care is a needed 

servce for all family members of an HIV-positive child, respite providers can be more 

effectively recruited from the general public than from other foster parents, and most 

foster care agencies in their service area cannot afford respite care.€

A - 3€
Uniq Prm Featues€

The most unique feature of this project is that it serves an entire foster family, not just 

an HIV-positive foster child in a foster family. Because the HARP serves an HIV 

population, the respite director reported that she initially had a difficult time locating 

sources of information about designing and administering a respite care program for 

populations with special needs. Ultimately she used the Access to Respite Care and€

Help (ARCH), a center in Chapel Hil, North Carolina funded by HHS. The ARCH€ serves as a national clearinghouse for respite care and crisis nursery programs. She€

said ARCH continues to be a valuable source of information for her and a link to€

other programs.


Can the prom be repliated 

The director feels the program can be replicated at other sites that serve HIV-infected foster children. She believes that to do so successfully, an agency should establish a 

funding base, associate itself with an established child care agency in the community, 

and develop personal linkages with other professionals and potential users in the 

community. 

Other organizations have recognized the Brooklyn program as an effective model. 

The Child Welfare League of America invited the project coordinator to present a 

workshop on respite care for HIV-affected familes. The director also made a 

presentation about HAP at the National Conference of Respite Care Programs an!: Crisis Nurseries in Washington, D.C. In addition, the ARCH selected HAP to 

part of an evaluation process of innovative programs.


Contact for informtion€

Marilyn Barney, Director of Respite Care (718-596-5555, extension 530) 

A - 4€
FAMY SUPPORT SERVICE OF TH BAY OAK, CALORN 

Program Development 

Family Support Servces of the Bay Area (FSS) is a private, non-profit organization. It provides respite care and other support servces to parents, relative caregivers, and foster parents of vulnerable children. The FSS contracts with four Bay Area counties 

foster care agencies, which selectively refer familes for services. The four counties 

served are San Francisco, Contra Costa, Alameda, and San Mateo. 

The FSS has its roots in the Children s Home Society (Society), a non-profit multipurpose children s servces agency servng the State of California. The Society 

provided respite care to familes of developmentally disabled children from 1979 to 

1989. In 1988, respite care was expanded to include both in-home and ollt-of-home respite to foster parents who provide emergency foster care in Alameda County. In 

1989, the Society planned to eliminate respite care. Program directors, however decided respite care should be expanded, not terminated. They opened the Family Support Servces of the Bay Area on January 1990, with no interruption in servces and have continued to expand the respite program to different populations ' in four Bay Area counties. 

In the fall of 1990, the State of California Department of Social Servces, Office of Child Abuse Prevention received a grant from the Children s Bureau of HHS. With 

this grant, respite care was expanded through FSS to even more foster parents in the 

four counties. Each county selected its own target population for the expanded

services. San Francisco County offered respite services to relative foster parents. San 

Mateo and Contra Costa Counties offered respite to foster parents of medically fragile 

children, and Alameda County s expanded services included non-emergency, out-ofhome respite care for foster parents of medically fragile children. Contra Costa 

County, however, did not renew their contract with the FSS because of severe county 

budget cuts. 

Program Operation 

The foster care agencies in the four counties determine which foster parents are 

eligible for servces from FSS. After a cOllnty agency has referred a foster parent to 

FSS, program staff contact the parent by t-:lephone or conduct a home visit. Services 

and responsibilties are explained and foster parents are given instructions on how to 

arrange respite care. When respite care is requested, an FSS employee matches a foster parent's needs with one or more appropriate respite providers. Foster parents 

do not pay for respite, nor are their maintenance payments affected bYlthe use of 

respite care. 

Foster parents are given a yearly allotment of respite hours which they can use 

according to their needs. Some schedule monthly respites while others save their 

A - 5 
hours for a long trip or potential crisis. In most situations, a respite care provider may 

come into a home or take a foster child on an outing, such as a trip to a park or 

playground. Out-of-home care is also available on a limited basis. 

Respite care workers are recruited continuously. Recruitment is targeted based on an 

assessment of foster family needs by FSS intake staff. Respite providers are screened 

and receive a minim)Jm of 26 hours of training initially, with optional in-service 

training offered quarterly. Providers are paid between $6 - $8 per hour, depending on the number of children for whom care is provided. Five respite care providers are 

full-time employees, who receive additional benefits, and are able to work virtually any 

hours. 

Program Use


Respite care is so well used that FSS is not able to meet all requests. About 98 

percent of all requests for respite care are met. Currently approximately 200 respite care workers serve 400 familes, of which about half are foster families. 

State and County Agency Role€

FSS and the county agencies seem to do a good job of generating foster parent 

interest in respite care. Each of the four county foster care agencies decides who may€

receive respite servces and how many hours they are allotted. FSS supplies the 

counties with biling sheets showing how many hours of care were provided to which foster parents. 

Characteritics of Effectivenes€

The mission statement of FSS guides their practices. FSS has written policies€

procedures and forms to ensure that servces are tracked appropriately and uniformly.€

This helps assure continuity of servces despite changes in staff. The FSS is strongly€

committed to training and servce, and the four county agencies are committed to 

using respite care whenever possible.€

The program has been featured in a newsletter published by the Access to Respite€

Care and Help (ARCH), a national clearinghouse for respite and crisis nursery 

programs funded by HHS. In addition to this favorable publicity, other evidence of 

program effectiveness include expansion of services and growth through additional 

county and State contracts.€

FSS is currently awaiting results of a survey by the Family Welfare Research Group of€

the University of California, Berkeley, to d termine parent satisfaction ,and the effects€

of respite care on the foster parents and relative caregivers participating in the€

Federal grant. Initial responses to the survey indicate that 94 percent of foster parents 

felt a need for respite care. They identified benefits of respite care, including stress 

reduction, opportunities to spend more time with spouses and other children, and 

A - 6 
needed emotional support. Informal study shows that foster children also benefit from 

having less stressed foster parents. Further, they enjoy the variety and undivided 

attention that respite caregivers provide. 

Uniq Prm Featues€

By hiring full-time providers the program has been able to meet nearly all demands 

for servces, including demands from foster parents who need daytime respite. 

In addition, the agency regards respite workers as quasi-caseworkers. Respite care 

workers are in foster homes more frequently than county agency caseworkers. 

Therefore, they assist both by monitoring foster homes and by "modeling" appropriate behavior for foster care parents, such as appropriate disciplining. 

Can this respite care program be replicated€

This program can be replicated. Program officials have, in fact, been asked to create 

a respite care model program for the ARCH. 

Contact for informtin€

Judy Levin (510-261-2282)€

A - 7€
HAIS COUN FOSTER PARNT REPIT PROGRA 

HOUSTON, TEXA 

Prgram Development€

In 1987, the Harris County Children s Protective Servces, within the Texas 

Department of Protective and Regulatory Servces, received an HHS discretionary 

grant to demonstrate community approaches to foster parent recruitment and 

retention. That demonstration grant showed that respite care was needed to help 

recruit and retain foster parents. The respite care program become operational in 1990. 

Program Operatin€

The Harris County respite care program uses volunteer respite care providers. All 

respite care is out-of-home, and is only available on weekends from 5:00 p.m. Friday 

to 5:00 p.m. Sunday. Volunteers are required to commit to at least four weekends a 

year. The program encompasses Harris County, which includes Houston, Texas. All foster parents in Harris County are eligible for respite servces. 

The County has no specific funding for respite care services. Volunteers provide the 

servce at no cost to the agency. There are, however, two full-time staff employed by the Harris County Children s Protective Servces who direct, plan and coordinate the program. While foster parents are not required to pay a fee for respite care, they are encouraged to contribute $5.00 per day/per child to a respite volunteer.€

The same background check is performed for respite care providers as is performed 

for foster parents. It includes checking Department of Public Safety, Child Protective 

Servces, local police department records, and interviewing relatives and acquaintances. 

An FBI fingerprint and criminal records check are also performed for individuals who 

have not been residents of Texas for at least three years. The agency would like 

eventually expand the screening process to include psychological assessments of 

potential providers.€

Progam Use€

The respite care program is steadily growing. In 1990, 33 requests for respite were 

received. By 1992, the number of requests had risen to 158. The number of providers

also increased, from 15 individuals in 1990 to 88 individuals in 1992. In 1990, when the program began, 28 foster children were served. By 1992, that number had 

increased to 382 foster children. The demand for respite, however, has reached a point that the program can no longer fil all requests due to a limited Ijumber of providers. 

A - 8

Barriers to foster parents using respite servces include transportation problems and 

distances to providers. To help resolve these problems, the respite care staff try to 

match foster parents and respite providers. 

State and County Agency Role 

The Harris County Children s Protective Servces devotes a lot of attention to 

encouraging foster parents to use respite care servces, and to the recruitment and 

retention of volunteer respite care providers. They promote respite care through 

public service announcements, distribution of printed materials such as brochures, and 

attendance at . meetings. A flyer on respite care is included in each foster parent 

application packet. In addition, the foster care respite coordinator helps with foster 

care parent pre-servce training. 

Agency staff attempt to match foster families and children with respite providers. 

They do so by evaluating geographic location, age, skills , family composition and needs of foster and biological children. The agency coordinates and finds respite providers 

for weekend care. The agency then puts a respite volunteer !n touch with the foster 

parent who finalizes the arrangements. Transportation to and from the volunteer 

respite provider s residence is the responsibilty of a foster parent. However, some respite providers will assist with transportation for a foster child. 

Both respite providers and foster parents using respite care services are required to€

have a signed agreement with the Harris County Children s Protective Services. After€

each respite. weekend is completed, the respite coordinator sends a questionnaire to€

both foster parents and respite providers to evaluate the impact of respite care on a€

child. Both positive experiences and significant problems are discussed and 

documented. Additionally, the coordinator maintains data which tracks who is using respite, where, and how often. 

Characteritics of Effectivenes 

Three factors contribute significantly to the effectiveness of the Harris County 

program. They are 1) Federal assistance in the form of a 1987 HHS discretionary 

grant to help plan and develop the respite program; 2) using volunteers to provide 

respite care; and 3) a total commitment from the Harris County Children s Protective 

Servces and everyone in the program to providing respite care. 

Program officials . attribute more successful recruitment and better retention of foster 

parents in part to the respite care program. Prior to implementation of the respite 

care program, the turnover rate among foster parents was 25 percent. It is' now 15 

percent. For a number of years Harris County had 260 family foster hpmes. At the time of our review that number had increased to 467. 

Another indicator of program effectiveness is the high level of satisfaction with the€

respite care program. 

A - 9€
Uniq Prm Featues€

Using volunteers to provide respite care in a public program is the most unique€

feature of this program. The program does not have to depend on funding from any


source.€

Can this respite care proam be replicated€

Agency staff said the program can be replicated at other locales. The program is 

flexible and can be designed around needs of foster parents. The Harris County€

Children s Protective Servces has received and continues to receive numerous requests€

from other agencies around the nation for information about its volunteer respite€

program.€

Contact for informtin€

Pat Shaw, Respite Coordinator, Texas Department of Protective and Regulatory 

Services, Harris County Children s Protective Services, Houston, Texas (713-599-5833) 

A - 10€
PEOPLE PlACES, INCORPORATED 

STAUNON, VIGIN 

Prgram Development


People Places, Inc. (PPI) is a treatment foster care program which includes respite 

care as one support. service. PPI was established in 1973 by staff of a State residential 

treatment center in Virginia. The staff believed that local foster parents might care 

for center youth who needed weekend and aftercare placements. The staff initially 

expected that trained, supervsed, and supported foster parents would be able to 

maintain severely troubled youth for short periods without weakening the effects of 

their center treatment. Over time, however, the effect of care given by the program

treatment foster parents seemed more successful than care provided by the center. 

Not only did PPI successfully serve seriously disturbed youth, but it did so at roughly one third the cost of institutional care. 

Program Opeatin 

Respite care was one of the available support services from the very beginning of PPI. 

PPI defines respite care as "overnight respite in another treatment family foster home 

for the primary purpose of providing a planned break." Since respite providers must 

be other treatment family foster homes in the program, they have received the same 

training as a child's placement family foster parent. They also receive the same support from PPI. 


Other forms of respite, which are not recorded in PPI's database as respite care 

include outings by children with a caseworker, a summer recreation program, and 

occasional babysitting by trusted relatives, neighbors, or friends. The primary purpose 

of such activities is child development. Therefore, respite fonhe foster parents is a 

secondary effect. 

Another PPI program element which provides respite for foster parents as a secondary 

effect is a group program of evening classes for foster children. The classes usually meet once a week for eight to thirteen weeks, and are designed to develop a child' 

skils necessary for continued success in society. Class subjects include finding a job 

keeping a job, social skils, and human sexuality. 

Another aspect of PPI's program provides a two-way respite for both birth and foster 

familes. The program allows foster children to move back and forth between birth 

and foster families, when issues of child safety have been resolved. 

Respite may be requested by a foster parent or may be initiated by PPf. Either way, PPI selects respite care providers for foster parents and makes all arrangements. In 

some instances, PPI may transport a child to a respite provider s residence. 

A.. 11

Program Use 

According to data maintained by PPI, 60 percent of foster parents in the program 

between 1989 and 1992 used respite. Foster parents used respite care on average 

87.25 times per year, or 1.7 times per family per year. Program officials estimated 

that 50 percent of the respite events invo!,ved 1 night, 35 percent involved 2 nights 

and 15 percent involved more than 2 nights, but rarely more than 5 nights. 

State and County Agency Role 

Public agencies have no role in the services provided by PPI other than to refer foster 

childten to the program. 

Characteritics of Effectivene€

PPI enjoys a high retention rate of foster familes, close to five years on average. The 

national average retention rate among treatment foster families, according to a survey of members. of the Foster Family Based Treatment Association, is four years. The director of PPI attributes their high retention rate and low use of respite to the variety 

of support servces provided by program and agency staff. He believes that just 

knowing respite care is available gives program foster parents a sense of control. 

asserts that if foster parents are adequately supported and feel in control then the 

need for respite is mitigated. 

A critical program characteristic which makes the respite component of the treatment€

foster care program successful is a meticulous process for matching a foster child with€

a respite family. To get the best possible match, PPI developed decision guides 

containing twelve variables, such as each family member s age, geographic location of

the home, and nurturance. The decision guides are the same ones that PPI uses to 

match a child with a foster family for placl:ment. 

Uniq Program Featues 

Program officials describe a variety of unique characteristics which make their€

treatment foster care program different from programs servng similar populations. A€

flat organization structure empowers all staff members to be accountable for quality 

servce. It nurtures a strong sense of teamwork among staff, foster parents, and foster 

children. PPI offers rewards for good behavior rather than punishing bad behavior. 

Their emphasis is on supporting foster families and their foster children. 

Much of PPI's success was attributed to its small size. Being small helps avoid 

becoming bureaucratic and hierarchical. The organization is not const ained by 

regulations which much larger public agencies might require. Its size a110ws 

individualized problem solving and flexibility in how they spend their budget. 

Caseloads are small and caseworkers visit each foster family twice a month at a€

minimum. Further, because they support a small number of foster familes at any€

A - 12€
given time, they are able to offer 24-hour on-call support. The on-call duty is rotated 

so that stress among staff is diluted. 

Can this respite care program be repliated€

Program offcials stated that the treatment foster care program, including respite care€ can be replicated elsewhere. It has been adopted by every agency to which PPI staff€

have provided technical assistance, including over 100 other sites throughout the U.S. 

In addition, the Ilinois Department of Children and Family Servces mandated use of 

the PPI model for its treatment foster care programs launched in 1990. Likewise the 

Missouri Department of Social Servces used the PPI model for more than a half 

dozen of its "Behavioral Foster Care" sites. 

Contact for Infonnlin€

Brad Bryant, Director of Research and Training (703-885-8841)€

A - 13€
VERMONT FOSTER CAR PROGRA€

WATERBURY, VERMONT€

Program Development€

The Vermont Department of Social and Rehabiltation Servces (SRS) began its 

respite care program in 1987. The program was developed in response to a State 

Foster Parent Association survey of 400 licensed foster parents in 1986. The survey 

objective was to determine what support servces foster parents in the State most 

needed. The survey showed that€

foster parents believed that respite care was their greatest need, and€

foster parents had extreme difficulty attending training due to a lack of€

caretakers for their foster children. 

Furthermore, over 50 percent of the surveyed foster parents said they would be willng€

to serve as respite providers. About 90 percent said they would use a respite program 

if one was available.€

The survey concluded that a paid respite program would help recruit and retain good€

foster parents in the State of Vermont. 

Program Operatin€

Respite care for foster parents in Vermont is provided by the Vermont Department. of 

Social and Rehabiltation Servces. The program was developed specifically to help 

ensure stable foster placements. To be eligible for the program, a foster home must 

be licensed by the State and must have had at least one foster child placement for at€

least six months. 

A foster child's "special needs" have nothing to do with eligibilty for respite care. 

However, foster children with more severe problems may be placed in a therapeutic 

foster care program, which is run by four private agencies under contract with the 

State mental health agency. All four private agencies provide respite care as part of their support servces. 

Foster parents may obtain both informal and formal respite care servces. Informal 

respite care is tyically provided by relatives or trusted, well-known neighbors. Formal 

respite care services are provided by State-approved providers. The SRS can provide 

recommendations or a list of approved providers to foster parents. Howevt(r, each 

foster parent is free to choose any provider as long as they have been q:hecked through 

the State Central Registry for criminal activity and the Federal criminal information 

system.€

A - 14€
Foster parents tyically pay respite care providers, then obtain reimbursement from 

SRS monthly. The current rate for respite care is $3 per hour for up to 8 hours. 

After 8 hours the fee is $25 per day. How much respite care any individual foster 

family may use in a month is decided on a case-by-case basis. That decision is made 

jointly by a district offce resource coordinator and foster parents. 

Program Use 

Respite care is heavily used by foster parents in Vermont, according to the State 

foster care program manager. The primary barrer to foster parents using respite care 

is a belief that using respite care is a sign of weakness. The State agency is tryng to 

overcome this barrier, primarily by empowering foster parents and strengthening the 

team concept. Another barrier is a shortage of respite care providers. Approximately 

100 State-approved providers are presently available. Further, all licensed foster care 

families are legally eligible to provide respite care. Vermont presently has 

approximately 750 licensed foster care familes and 1200 children in foster care. 

State and County Agenc Role 

State-provided respite care is funded completely with Title IV-E funds and is 

administered by twelve district offices of SRS. Each district office receives a portion 

of the respite care budget each fiscal year. A district office share is based on 

(1) a baseline percentage of the total budget and (2) a percentage based on the 

number of children in foster care. The State respite care budget for FY 93 was 

$51 216. 

Both the State office and district offices actively encourage foster parents to use 

respite care. Respite care is part of the curriculum in an 8-week, preservce training 

program for new foster parents. The district office also assists by providing 

transportation to a respite provider whenever a foster child is Medicaid eligible. 

In an effort to strengthen the bond between SRS and foster parents, SRS recently 

solicited technical assistance from the Child Welfare League of America (CWLA).

CWL heJped SRS develop a best practice program for delivery of family foster care 

servces. The program is based on delivering servces through teamwork founded on 

mutual trust and respect. The program identifies critical actions which should be 

taken in caring for a foster child. The program formally recognizes respite care as a 

key support servce in providing foster care. 

Characteritics of Effectiveness 

SRS has not performed any empirical analyses of the respite care pro am. However 

according to agency staff, the program is working well. They said it has had an impact 

on the stabilty of placements and retention of fpster parents. Data regarding the 

annual turnover rate of foster parents are not available. However, the rate at which€

A - 15

foster family homes close in the State has declined from 22 percent in 1985 to 19 

percent in 1992. 

Perhaps the most significant reason for the effectiveness and success of the foster care 

system overall and the respite care program specifically is that State agency staff 

district offices staff and foster parents work as a team. A team concept is strongly 

supported by all levels of the State foster care agency and the Vermont Foster Parent 

Association. 

Uniq Pram Featues 

The most unique feature of this program is the decentralized and highly flexible 

decision-making process for using respite care. Each district office is empowered to 

pay for respite care for their foster parents in any manner they deem appropriate and 

necessary. They have no rules limiting respite care to a set number of respite care 

hours per family per month or year. The program also enjoys a strong partnership 

between agency staff and foster parents. 

Can this respite care program be replicated 

The foster care program manager in the State headquarters of SRS believes other 

States can provide similar services to their foster parents. 

Contact for informtin 

Steve Dale (802-241-2131) 

A - 16

FRGIL INAN SPECIA CAR PROGRA 

SAN FRCISCO, CALIFORN 

Pram Development 

The Fragile Infant Special Care Program, also known as "Baby Moms " began in 1987. 

It began in response to increased demand to provide family foster homes for newborn 

babies requiring special care because of extreme ilness. The newborns in the 

program often suffer from ilnesses caused by their biological mothers' alcohol and 

other drug addictions. Approximately one third of the babies. eI1tering the program are HIV-positive. The county.-run program is now funded primarily by Federal, State 

and county funds and private donations. 

Progrm Opetin 

The respite care program operates out of San Francisco County. It serves family 

foster homes in some surrounding counties in which San Francisco County foster 

children have been placed. The program has 15 foster homes, most of which have 2 

foster children. Program policy allows up to three foster chiJdren to be placed in the 

same family foster home, but only in rare circumstances. 

To be licensed as a "Baby Mom" foster parent, an applicant must pass a State criminal 

background check, and his or her home must pass a home inspection by county agency 

staff. A foster parent in this program may not hold any other job. They must receive 

30 hours of training. Further, they must meet other specific criteria such as 

demonstrating a willingness to accept a child with AIDS. They must also have a 

medical or childcare background, and no children in the home under age 4 years, and 

no more than 1 child between ages 4 and 6 years in their home. Most foster parents 

currently in the program are nurses or have a long history of servng medically fragile 

children. Training for both foster parents and respite providers is performed by an 

on-staff consultant nurse. Training is focussed on dealing with the specific medical 

needs of a foster child. 


Each foster parent is required to take 50 paid hours of respite care a month. Foster 

parents are allowed to find their own respite provider, contingent upon the provider 

passing a State criminal background check. Caseworkers, the on-staff nurse, and other 

foster parents informally help any foster parent having difficulty finding a respite 

provider. Recruiting respite providers has not been a problem for the program. Their 

experience has been that people like helping infants who are ill. 

All respite care must take place in a licensed family foster home. Most respite care 

therefore, takes place in the home in which the foster child has been p aced. 

However, foster parents may arrange for a respite care provider to provide care to a 

foster child in their own home. 

A - 17

Respite care providers are paid $4 per hour for one child and $7 for two. A foster 

parent pays a respite provider directly and is reimbursed by the county after€

submitting a monthly expense report. Although the average monthly cost for respite 

servces per foster home is around $350 per month, it is inexpensive when compared to the cost of placing and maintaining foster children in institutional settings. The 

program also pays for babysitting. The usual respite care providers may also serve as 

a babysitter.


Prgram Use


AllIS foster familes in the program used the required 50 hours of respite care each month. 

State and County Agency Role€

The county requires respite care. It is considered essential to the support of foster parents. Foster parents are required to report respite hours on their monthly time 

cards. County caseworkers review time cards to .ensure aU foster parents are getting 

required respite. Any reluctant parents are reassured by caseworkers that, as professionals, respite care is part of their job, and that they must, therefore, take it. 

Characteriti of Effectivenes 

A statistical indicator of the success of the program is the rate that foster children are 

adopted and returned to their homes. Forty-three percent of foster children in the€

program are adopted. A few of the foster children were adopted by their foster€

parents. When a foster parent adopts, however, they are no longer eligible to serve as foster parents in the program. Another 36 percent of children in the program are 

returned to their familes.€

The Child Welfare League of America (CWLA) recently recognized the effectiveness 

of this program. Baby Moms program officials have been invited to present information about their program at Pediatric AIDS conferences sponsored by CWLA. 

The keys to this program s success are a philosophy that respite services are a 

necessary support for foster parents, and a policy that respite wil be treated as part of

a comprehensive set of support services for foster parents. County agency staff 

believe that foster parents should be treated with the respect deserved by 

professionals. Policies and procedures support the importance of foster parents and 

respite care for them. Foster parents also attribute program success to the face-toface communication aUowed by small caseloads. 

A - 18€
Uniq Prm Featues€

The program has maintained a firm policy that all foster children in the program wil€

be placed only once. This policy enhances the potential for placing and keeping 

children in family foster homes rather than in institutional settings.€

Can this respit care program be replicated€

Program staff said the respite care program can be replicated. It has served as a 

model for programs in several other counties in California and a metropolitan area in 

another State. The program continues to receive visitors who want to study and 

emulate it. 

Contact for informtion€

Marion Collns, Supervisor (415-558-2371) 

A - 19€