Does family-centered out-of-home care work? Comparison of a family-centered approach and traditional care

This research assessed the effectiveness of a family-centered approach to out-of-home care in reunifying children with their families by comparing differential exit rates of children whose families received family-centered services with children whose families received routine child welfare services. The sample included 472 children who were in foster care from 1994 to 1996 in Missouri. Survival analysis was used to calculate the probability that a child would be reunified with his or her family at a particular time and to compare the differential exit rates for the children who experienced subsequent placement during the study period. The authors used Cox regression analysis to compare the likelihood of reunification between the two groups. Findings indicate that during the latter part of the study, family-centered out-of-home care counties reunified children at a faster rate than comparison counties. Key words: child welfare; family-centered services; out-of-home care; reunification; survival analysis ********** The implementation of the Adoption and Safe Families Act of 1997 (ASFA) (P.L. 105-89) makes it important for us to understand how best to support families whose children have been removed from them for maltreatment. Family-driven practice, in which families are treated as experts and collaborators in goal setting and mobilization of solutions, has produced successful outcomes (Briar-Lawson, 1998). Fraser and colleagues (1997) provided support for this approach in their review of family preservation services (FPS). They found that empowerment of parents, the use of collateral services, and an in vivo focus in which services are provided in a home or a community setting were common elements in successful family preservation programs. They also suggested that successful services are culturally sensitive, action oriented, and carried out in collaboration with family members. Although family preservation services have not been as effective as hoped for in the prevention of placement (Cole, 1995; Fraser et al., 1997; Wells & Tracy, 1996), there is evidence that intensive family preservation services are useful in improving family functioning and can be used as an initial response to families where maltreatment is a problem. Wells and Tracy suggested using FPS to assess a family's strengths and weaknesses, to meet critical concrete needs, and to plan intervention. Walton (1998) described a program using FPS that successfully reunited children with their families. Although the results at a six-year follow-up were somewhat mixed, the families receiving FPS were significantly more likely to be stabilized than a control group of children who received routine foster care services. Timeliness is one of the guiding features of ASFA, which was implemented to move children quickly into permanent placements. For workers to achieve case goals within the ASFA time frames, they must ensure that families have individualized service plans and high-quality comprehensive services, while ensuring that children are safe. All staff need to collaborate with other service providers, quickly engage families in treatment, and determine the parents' capacity for change (U.S. Department of Health and Human Services, 2000). These conditions can be met if intensive assessment and planning with families occurs when a child first enters care. In other words, a family-centered approach to foster care that integrates effective components of FPS and is implemented as soon as the child enters care should ensure the safety of the child and decrease the time the child spends in foster care. However, for FPS to be successful, assessment and planning should recognize and distinguish between problems that are easily resolved and problems that contribute to longer stays in care. For example, a number of studies have found that neglect is more difficult to treat than other types of abuse (Berry, 1992; Nelson & Landsman, 1992; Terling, 1999). …