Annual Report
to the
North Carolina Department of Health and Human Services
Division of Social Services
on the
Non-Intensive Family Preservation Services Program
for State Fiscal Year 2007
June 2008
Prepared by
Raymond S. Kirk, PhD
and
Diane P. Griffith, MA
Independent Living Resources Inc.
Division of Research and Program Planning
411 Andrews Road, Suite 230
Durham, NC 27705
ray.kirk@ilrinc.comTable of Contents
Executive Summary........................................................................................................................1
Introduction.....................................................................................................................................2
Review of Program Design..................................................................................................2
Review of Program Operation and Service Delivery..........................................................3
Program Summary for SFY 2007....................................................................................................5
Number of Families, Caretakers and Children Served........................................................5
Family Information..............................................................................................................5
Caretaker Demographics......................................................................................................7
Referred Child Demographics.............................................................................................9
Other Child Demographics................................................................................................11
Service Delivery Information............................................................................................12
Closure Information...........................................................................................................14
Five-Year Trend Analysis..............................................................................................................15
Number of Families, Caretakers and Children Served......................................................15
Families Receiving Public Assistance...............................................................................17
Primary Issues Affecting Caretakers.................................................................................17
Race of Referred Children.................................................................................................17
Age and Gender of Referred Children...............................................................................19
Primary Issues Affecting Referred Children.....................................................................19
Referred Children at-Risk for Placement...........................................................................20
Referred Children Living in the Home..............................................................................21
Contact Hours and Services Received...............................................................................22
Family Functioning: North Carolina Family Assessment Scale....................................................25
Ratings at Intake and Closure on NCFAS Domains..........................................................26
Change from Intake to Closure on NCFAS Domains........................................................30
Reliability of the NCFAS..................................................................................................32
Summary of Major Findings..........................................................................................................34
Appendix A. Provider List for SFY 2006-2007............................................................................36
Appendix B. Program Allocations and Expenditures for SFY 2006-2007....................................37
FPS Annual Report, SFY 2007 i
List of Tables
Table 1. Number of Families, Caretakers and Children Served by FPS Programs
During SFY 2007, Listed by Program and County........................................................5
Table 2. Family Information at Case Opening.............................................................................6
Table 3. Demographics of Caretakers..........................................................................................8
Table 4. Demographics of Referred Children............................................................................10
Table 5. Demographics of Other Children.................................................................................11
Table 6. Service Delivery Information......................................................................................13
Table 7. Case Closure Information............................................................................................14
Table 8. Level of Change Experienced by Families on Each Domain of the
NCFAS during FPS......................................................................................................31
Table 9. Reliability Analysis for the NCFAS Version 2.0, SFY 2007......................................33
FPS Annual Report, SFY 2007 ii
FPS Annual Report, SFY 2007 iii
List of Figures
Figure 1. Number of Families, Caretakers and Children Served by FPS Programs...................16
Figure 2. Percent of Families Currently or Ever Receiving Public Assistance...........................16
Figure 3. Primary Issues Affecting Caretakers...........................................................................18
Figure 4. Race of Referred Children...........................................................................................18
Figure 5. Age of Referred Children.............................................................................................19
Figure 6. Primary Issues Affecting Referred Children...............................................................20
Figure 7. Percent of Referred Children at-Risk for Placement at Case Closing.........................21
Figure 8. Percent of Referred Children Living in the Home at Case Opening and Closing.......22
Figure 9. Average Number of Contact Hours per Life of Case..................................................23
Figure 10. Types of Services Families Received..........................................................................23
Figure 11. Environment Ratings at Intake and Closure................................................................26
Figure 12. Parental Capabilities Ratings at Intake and Closure....................................................27
Figure 13. Family Interactions Ratings at Intake and Closure......................................................28
Figure 14. Family Safety Ratings at Intake and Closure...............................................................29
Figure 15. Child Well-Being Ratings at Intake and Closure.........................................................29
Figure 16. Level of Change Experienced by Families on NCFAS Domains................................31
Figure 17. Overall Change on the NCFAS....................................................................................32 Executive Summary
This report presents data and findings on North Carolina’s Non-Intensive Family Preservation Services (FPS) Program from State Fiscal Year 2006 – 2007 (SFY 2007), and on a five-year history of families served SFY 2003 through SFY 2007. This is the fourth annual report on the FPS program and it presents general findings and trends for the last five years of program operation.
During SFY 2007, 7 FPS programs provided services in 6 counties serving 102 families. These families comprise 152 caregivers and 216 children. Treatment outcomes are generally favorable among families served, although apparent shifts in the types of families served (more mental health problems, fewer child abuse/neglect problems) may be affecting placement rates and types and the proportion of families who successfully complete services. A summary of key findings is presented in the last section of this report. Some of the trend data bear scrutiny and more detailed analyses as the total number of families in the data archive increases. Some of the apparent changes in trends observed in this year’s report may be due to a decrease in the number of families served, and a marked decrease in the number of counties served over the past two years. Together these factors may influence trends due to varying referral practices among the counties served, and therefore contributing to the database during SFY 2007.
During SFY 2007, FPS providers implemented the use of the NCFAS Version 2.0 to assess family functioning. Measures of internal consistency (Cronbach’s alphas) are respectable for the 82 families assessed. There appears to be substantial changes made by families on Child Well-Being, Family Interactions, and Parental Capabilities.
FPS Annual Report, SFY 2007 1
Introduction
This is the fourth Annual Report on North Carolina’s Family Preservation Services (FPS) program that presents data and information about families and children that have participated in the program. Information about the FPS program’s activities and performance relating specifically to SFY 2007 is presented. Additionally, trend data are presented for the last five years of program operation, including SFY 2007. Data presented graphically or in tables represent the most interesting findings from the current year, or from past years. There is also a section on Family Functioning, based upon the use of the North Carolina Family Assessment Scale, Version 2.0, implemented during SFY 2007.
Review of Program Design
The program design of the Non-Intensive Family Preservation Program (FPS) shares many elements of the Intensive Family Preservation Services Program (IFPS). Services are time-limited, home based, focus on building strong and stable families, strive to be culturally relevant and appropriate, are available when the family needs them (i.e., during “non-traditional” work hours) and are delivered by workers with small caseloads. However, the levels of service intensity and availability as well as the worker caseloads are commensurate with the lower risk levels of the families receiving non-intensive family preservation services, when compared to those receiving services under the intensive model.
For example, whereas families eligible for the IFPS model have one or more children at imminent risk of removal and out-of-home placement due to child abuse or neglect, families eligible for the FPS model have a child or children at risk of current or future role dysfunction in the home or community. Although services in the FPS model are, indeed, time limited, they can be provided for up to 6 months, as opposed to the 4-6 weeks permitted under the IFPS model.
FPS Annual Report, SFY 2007 2
Whereas IFPS workers are expected to be available “24/7” as a matter of routine, the FPS services are characterized as available 24/7 in the event of a “crisis or emergency.” Whereas, IFPS workers carry a caseload of 2 to 4 families, FPS workers can carry more cases, up to as many as 8 cases at a time, depending upon the intensity of service need, as determined by the caseworker and the supervisor.
Providers who deliver non-intensive services under the FPS model may also deliver similar services as an adjunct to reunification efforts when a child has previously been removed for reasons of abuse, neglect, delinquency, or dependency due to emotion-, mental-, or physical health treatment.
Review of Program Operation and Service Delivery
Like the IFPS model, FPS providers are expected to provide:
•
Family Assessment
•
Family and individual counseling
•
Client advocacy
•
Case management/referral to other services as appropriate
•
Development and enhancement of parenting skills.
FPS providers are also required to deliver other clinical services, and have the option of delivering “concrete” services that may include small amounts of monetary assistance to assist in the provision of basic necessities or to facilitate goal-oriented outcomes like transportation connected with labor force attachment.
All families served by FPS providers experience a comprehensive family assessment, and workers conducting those assessments are assisted by the use of the North Carolina Family Assessment Scale (NCFAS). The NCFAS facilitates the identification of family strengths and
FPS Annual Report, SFY 2007 3
resources as well as needs and weaknesses. The purpose of assessment is to help the worker and the family set measurable, realistic and achievable goals and to develop strategies for achieving those goals. The NCFAS promotes a family assessment model, focusing on the family as a system, operating in the social environment. Specialized assessments also may be conducted and are considered on a case-by-case basis (e.g., neurological assessment, psychological assessment, alcohol/drug dependency assessment, toxic metal screening, etc.)
Family and individual counseling comprise a therapeutic interaction between the family preservation services worker and the family members, either individually or as a family unit, to solve problems and build or enhance skills. Workers strive to establish a trusting relationship with the family, to define and clarify family issues and perceptions, assess the areas needing to change, to evaluate change as it occurs, and to terminate the relationship when appropriate.
Case management involves the coordination of the efforts of all service providers involved with the family. The goals of case management include the development of joint service plans, to ensure that intervention efforts are working towards common goals, to ensure that methods used by different serving agencies do not conflict with one another or send conflicting or confusing messages to families, and to ensure that there is sufficient “follow through” and “follow-up.”
Development or enhancement of parenting skills focuses on the areas of nurturing, knowledge of child development and age-appropriate expectations of children, supervision, discipline, behavior management, communication, anger management or control, and other general parenting skills.
Concrete services are optional for programs and may include tangible services such as modest financial assistance, household chores and repairs, transportation, and the like.
FPS Annual Report, SFY 2007 4
Program Summary for SFY 2007
Number of Families, Caretakers and Children Served
During SFY 2007, 7 FPS programs provided services to families in 6 counties throughout North Carolina. Table 1 presents a detailed list of the programs and counties served, as well as the number of families, caretakers, children served. A total of 102 families received services that ended before July 1, 2007. There were 102 referred children identified in these families, among 216 children in the families; 152 caretakers were served directly by the programs.
Table 1: Number of Families, Caretakers and Children Served by FPS Programs
During SFY 2007, Listed by Program and County
FAMILY PRESERVATION PROGRAM
COUNTY SERVED
FAMILIES SERVED
CARETAKERS SERVED
CHILDREN SERVED
Family Services of the Piedmont
Guilford
24
32
50
Youth Homes
Mecklenburg
19
27
45
Mountain Youth Resources—Clay
Clay
7
12
13
Youth Focus
Guilford
31
45
65
Mountain Youth Resources—Macon
Macon
9
17
20
Mountain Youth Resources—Graham
Graham
3
5
5
Chatham County DSS
Chatham
9
14
18
Totals
102
152
216
Family Information
Table 2 presents information collected about families at case opening. In SFY 2007, one family had previously received FPS and four had previously received Intensive Family Preservation Services (IFPS). Fifty percent or more of families served presented with the
FPS Annual Report, SFY 2007 5
FPS Annual Report, SFY 2007 6
Table 2: Family Information at Case Opening
Family Information
Number
Percent
Families that Previously Received FPS
1
1.0%
Families that Previously Received IFPS
4
3.9%
Strengths Identified in Families at Opening
Eager to keep family together
89
87.3%
Verbal
87
85.3%
Pleasant
81
79.4%
Order/neat in person
79
77.5%
Order/neat in home
74
72.5%
Responsive
73
71.6%
Caring
72
70.6%
Receptive
68
66.7%
Respectful of others
61
59.8%
Employed
61
59.8%
Involved in children’s school life
58
56.9%
Punctual
58
56.9%
Honest
57
55.9%
Interested in learning
53
52.0%
Protective
50
49.0%
Resourceful
47
46.1%
Supportive/strong network of family/friends near
46
45.1%
Health
46
45.1%
Involved in children’s recreational activities
41
40.2%
Fun loving/cheerful
38
37.3%
Wants more education
38
37.3%
Cooperative with agency in the past
30
29.4%
Youth oriented
22
21.6%
Average Number of Strengths Identified per Family
13.04 (SD=5.42)
Families Currently or Ever Receiving Public Assistance
67
65.7%
Medicaid
61
59.8%
Food stamps
41
40.2%
Housing
19
18.6%
WIC
13
12.7%
SSI
10
9.8%
Work First
10
9.8%
General assistance
3
2.9%
Other
3
2.9%
following strengths identified at the time of case opening: eager to keep family together, verbal, pleasant, order/neat in person, order/neat in home, responsive, caring, receptive, respectful of others, employed, involved in children’s school life, punctual, honest, and interested in learning. Similar strengths were identified in families in prior years of service. The average number of strengths identified per family was 13.
FPS Annual Report, SFY 2007 7
Two-thirds (66%) of families were identified as currently or formerly receiving public assistance in SFY 2007. This represents a decline in the proportion of families receiving public assistance as compared to the previous three years. Refer to the “Five Year Trend Analysis” section for more information on the trend of receipt of public assistance.
Caretaker Demographics
In SFY 2007, 152 caretakers were living in the homes of the 102 families served by the FPS programs. Table 3 presents demographic information for these caretakers. The average age of caretakers served by the program was 39 years. One quarter (26%) of the caretakers were 30 years old or less, two-fifths (40%) were over the age of 40, and the remaining 34% were between 31 and 40 years old. Two-thirds (69%) of caretakers were female. Half (51%) of caretakers served were white. This continued the significant trend begun in SFY 2005 where about half of the population served were African American or other minority. In SFY 2007, 41% of caretakers were African American, and 8% comprised other minority races. Half (53%) of caretakers were employed in full-time work and 16% of caretakers were unemployed and in need of work.
One quarter (25%) of all caretakers had less than a high school diploma. Thus, as with other human service populations where children may be at risk, factors of single parenting, insufficient income or poverty, labor force detachment or intermittent attachment, and low educational attainment are prevalent. Three-fifths (60%) of caretakers were the mothers of the referred child. Caretakers served during the prior ten-year history of the program were similar with respect to age, gender, employment status, educational status, and relationship to the referred child. On average, nearly two major issues were identified per caretaker that affect family functioning and place the children at-risk. The most frequently occurring issues identified
FPS Annual Report, SFY 2007 8
FPS Annual Report, SFY 2007 9
Table 3: Demographics of Caretakers
Demographics of Caretakers
Number
Percent
Age
Average Age
39.16 (SD=11.39)
17 – 24
12
8.4%
25 – 30
25
17.5%
31 – 40
49
34.3%
41 – 50
33
23.1%
51 – 60
18
12.6%
Over 60
6
4.2%
Gender
Female
104
69.3%
Male
46
30.7%
Race
White
76
51.0%
African American
61
40.9%
Other
12
8.1%
Working Full-Time
80
52.6%
Working Part-Time
14
9.2%
Unemployed
24
15.8%
Unemployed—Homemaker
9
5.9%
Unemployed—Disabled
12
7.9%
Educational Status
Less than 10th grade
9
6.9%
10th – 12th grade
24
18.3%
High school/GED
54
41.2%
Some college or more
44
33.6%
Relationship to Referred Child
Mother
91
59.9%
Father
38
25.0%
Grandparent
14
9.2%
Aunt/uncle
1
0.7%
Other
8
5.3%
Special Areas of Concern
Absence of parent/caretaker
40
26.3%
Domestic violence
29
19.1%
Unemployment
23
15.1%
Grief/loss
20
13.2%
Teenage parent (<20 years old)
15
9.9%
Mental illness
14
9.2%
History of teenage child bearing
13
8.6%
Other drug abuse
13
8.6%
Child abuse/neglect
11
7.2%
Physical chronic illness
10
6.6%
History of sexual abuse as a child
9
5.9%
History of other abuse as a child
8
5.3%
Alcohol abuse
7
4.6%
FPS Annual Report, SFY 2007 10
Demographics of Caretakers
Number
Percent
Special Areas of Concern (Continued)
Physical disability
6
3.9%
Incarceration in jail or prison
3
2.0%
Developmental disability
3
2.0%
Average Number of Issues Identified per Caretaker
1.64 (SD=1.45)
in SFY 2007 included: absence of a parent or caretaker, domestic violence, unemployment, and grief or loss. Similar issues were identified in caretakers during prior years of program operation.
Referred Child Demographics
In SFY 2007, 102 families were referred for services because a child was at-risk for current or future role dysfunction in the home or community, and possible future out-of-home placement. Table 4 presents demographic information on the referred children in these families. The average age of the referred child was about 11 years old. Forty-five percent of the referred children were female and 55% were male. Similar proportions were found in the referred
children served in the prior ten years of program operation. Two-fifths (40%) of the children were White and 45% were African American. Other minority children represented 15% of the referred children served. This sustained the significant and increased service to minority populations that began in SFY 2005. Refer to the “Five Year Trend Analysis” section for more information on this increasing trend of service to minority populations. At case opening, 93% of referred children served were living in the home and 3% were living with relatives.
The most frequently cited issues placing referred children at risk for role dysfunction include: being undisciplined, family disruption, being out of parental control, family violence, delinquency, grief or loss, school failure, and BEH. Referred children averaged a total of 4 identified issues. Similar issues were found to be affecting referred children in prior years.
FPS Annual Report, SFY 2007 11
FPS Annual Report, SFY 2007 12
Table 4: Demographics of Referred Children
Demographics of Referred Children
Number
Percent
Age
Average Age
10.95 (SD=4.63)
0 – 5
15
15.2%
6 – 12
35
35.4%
13 – 15
37
37.4%
16 – 17
12
12.1%
Gender
Female
46
45.1%
Male
56
54.9%
Race
White
41
40.2%
African American
46
45.1%
Other
15
14.7%
Living Situation at Case Opening
Home
94
93.1%
Relative
3
3.0%
Foster care
2
2.0%
Detention center
1
1.0%
Emergency shelter
1
1.0%
Special Areas of Concern
Undisciplined
55
53.9%
Family disruption
52
51.0%
Out of parental control
49
48.0%
Family violence
34
33.3%
Delinquency
30
29.4%
Grief/loss
23
22.5%
School failure
23
22.5%
BEH
22
21.6%
Child is taking medication
16
15.7%
Truancy
14
13.7%
Neglect
12
11.8%
Runaway
11
10.8%
Emotional disability
8
7.8%
Drug abuse
8
7.8%
Learning disability
7
6.9%
Suicidal behavior
7
6.9%
Developmental disability
6
5.9%
Sexual abuse
6
5.9%
Inappropriate sexual behavior
6
5.9%
Emotional abuse
4
3.9%
Physical abuse
4
3.9%
Behavioral disability
4
3.9%
Serious health problems
3
2.9%
Extreme poverty
2
2.0%
Teen pregnancy
2
2.0%
Physical disability
1
1.0%
Alcohol abuse
1
1.0%
Child exploitation
1
1.0%
Average Number of Issues Identified per Child
4.25 (SD=2.47)
FPS Annual Report, SFY 2007 13
Refer to the “Five Year Trend Analysis” section for more information about the living situation and special areas of concern of the referred child population.
Other Child Demographics
In SFY 2007, 114 other children were living in the homes of the 102 families served by the FPS program. Table 5 presents demographic information on these children. The average age of the other children was 9 years old. Forty-seven percent of the other children were female and 53% were male. Two-fifths (41%) of the children were White and 45% were African American. Other minority children represented 14% of the other children served. At case opening, nearly all (95%) of other children served were living in the home, and 4% of other children were living with relatives. The top issues affecting other children placing them at-risk for role dysfunction include: family disruption, being undisciplined, family violence, being out of parental control, grief or loss, and neglect.
Table 5: Demographics of Other Children
Demographics of Other Children
Number
Percent
Age
Average Age
9.44 (SD=5.55)
0 – 5
30
28.0%
6 – 12
40
37.4%
13 – 15
17
15.9%
16 – 17
17
15.9%
18 or older
3
2.8%
Gender
Female
54
47.4%
Male
60
52.6%
Race
White
47
41.2%
African American
51
44.7%
Other
16
14.0%
Living Situation at Case Opening
Home
106
94.6%
Relative
4
3.6%
Wilderness camp
1
0.9%
Emergency shelter
1
0.9%
FPS Annual Report, SFY 2007 14
Demographics of Other Children (Continued)
Number
Percent
Special Areas of Concern
Family disruption
37
32.5%
Undisciplined
29
25.4%
Family violence
20
17.5%
Out of parental control
18
15.8%
Grief/loss
17
14.9%
Neglect
12
10.5%
Child is taking medication
10
8.8%
Emotional abuse
9
7.9%
Learning disability
7
6.1%
School failure
6
5.3%
BEH
5
4.4%
Truancy
4
3.5%
Delinquency
4
3.5%
Behavioral disability
4
3.5%
Drug abuse
3
2.6%
Extreme poverty
2
1.8%
Serious health problems
2
1.8%
Inappropriate sexual behavior
2
1.8%
Sexual abuse
2
1.8%
Emotional disability
1
0.9%
Developmental disability
1
0.9%
Physical disability
1
0.9%
Alcohol abuse
1
0.9%
Physical abuse
0
0.0%
Runaway
0
0.0%
Suicidal behavior
0
0.0%
Child exploitation
0
0.0%
Teen pregnancy
0
0.0%
Average Number of Issues Identified per Child
1.83 (SD=1.78)
Service Delivery Information
Table 6 presents regularly collected service delivery information from the 102 families served in SFY 2007. Workers averaged 62 hours of service to each of the families during the typical service period. Most of the hours, on average, were spent in face-to-face, telephone, collateral and travel contact (46 hours). About 10 hours were devoted to administrative tasks and record keeping, and about 5 hours were spent providing supervision. All families received family assessment and family or individual counseling. The majority of families also received case management and referral services and client advocacy as part of their services.
FPS Annual Report, SFY 2007 15
The total number of hours of contact and the number and types of services provided to families during SFY 2007 were similar to figures from prior years of program operation. However, there does appear to be a slightly increasing trend in the average hours of face-to-face, telephone, collateral and travel contact hours over the last five years. Refer to the “Five Year Trend Analysis” section for more information about trends in contact hours provided to families.
FPS programs provided monetary assistance totaling $454 to 4% of all families served to alleviate emergency crises and stabilize the living situation. This amount averaged $113.50 per family receiving monetary assistance. Compared to families in crisis served by the IFPS program, this amount of assistance, less than one forth the number of families received assistance, and the assistance provided was just over half the amount provided to IFPS families.
Table 6: Service Delivery Information
Service Delivery Information
Number
Percent
Average Number of Contact Hours
Face to Face, Telephone, Collateral and Travel
45.57 (SD=25.26)
Supervision
5.38 (SD=4.01)
Administrative/Record Keeping
9.82 (SD=6.93)
Miscellaneous
0.91 (SD=2.73)
Average Number of Hours of All Case Related Activities
61.69 (SD=33.38)
Services Families Received
Family Assessment
102
100%
Family/Individual Counseling
102
100%
Client Advocacy
71
69.6%
Case Management/Referral
88
86.3%
Optional Services
4
3.9%
Other
12
11.8%
Families in Need of Monetary Assistance
4
3.9%
Families Provided Monetary Assistance (of those needed)
4
3.9%
Total Dollars Families Needed
$454.00
Total Dollars Families Provided
$454.00
Average Dollars Provided per Family in Need
$113.50
FPS Annual Report, SFY 2007 16
Closure Information
Table 7 presents information collected about families served at the time of case closure. The average FPS case in SFY 2007 lasted 14.29 weeks (about 3.5 months), and received an average of just over 4 hours of service per week. The majority (71%) of cases closed with services completed successfully. One-fifth (20%) of cases were closed because the family withdrew from services or was uncooperative. At case closure, 96% of referred children were living in a home setting (either at home, with relative or family friend). One referred child was placed with social services and one in an other placement; two children were placed with juvenile justice at the time of case closure. Twenty-two percent of referred children were considered to be at-risk for placement at the time of closure. The majority (69%) of families were referred for other services after case closure.
Table 7: Case Closure Information
Case Closure Information
Number
Percent
Average Number of Days from Opening to Closing
100.05 (SD=47.52)
Reason Case was Closed
Risk to children too high/child placed
5
4.9%
Family/child moved
2
2.0%
Family withdrew or was uncooperative
20
19.6%
Services completed successfully
72
70.6%
Other
3
2.9%
Referred Child Living Situation at Closure
Home
88
86.3%
Relative
10
9.8%
Social Services
1
1.0%
Juvenile Justice
2
2.0%
Other Placement
1
1.0%
Referred Child at-Risk for Placement at Closure
21
21.6%
Families Referred for Other Services at Closure
63
68.5%
FPS Annual Report, SFY 2007 17
Five-Year Trend Analysis
Since SFY 1997, North Carolina’s FPS providers have served 1,606 families. The automated FPS case record and management information system contains detailed information on these families served. This large database provides highly reliable estimates of program trends since the system has been operating at “full capacity” for 11 years. Findings in this section relate to the total population of families served in the last five years, SFY 2003 through SFY 2007. Five-year trend analyses of a number of variables indicate a high degree of stability, and therefore predictability, in a number of areas of interest to FPS programs, policy executives and the legislature.
Number of Families, Caretakers and Children Served
The number of programs offering FPS services remained fairly constant from SFY 2002 through SFY 2004, ranging from 12 to 16 programs serving 11 to 12 counties plus the Eastern Band of Cherokee Indians. In SFY 2005, all Community Based Programs providing in-home services were part of a re-bid process which allowed new programs to compete for these grants, as well as shifting the allocation between program types in order to comply with federal requirements. As a result, there was a significant reduction in the number of programs to 9, providing services to families in 8 counties and the Eastern Band of Cherokee Indians. In SFY 2007, only 7 programs offered FPS services in 6 counties. Figure 1 presents the number of families, caretakers, and children served annually by FPS programs. Over the last five years, the program has served an average of 142 families per year. The number of caretakers served in these families for the last five years averages 216, and the number of children served in these families for the last five years averages 317 per year.
FPS Annual Report, SFY 2007 18
Figure 1. Number of Families, Caretakers and Children Served by FPS Programs109102289122196179283152295186163216441376261050100150200250300350400450500SFY '03SFY '04SFY '05SFY '06SFY '07Number of FamiliesNumber of CaretakersNumber of ChildrenFigure 2. Percent of Families Currently or Ever Receiving Public Assistance736673627056586062646668707274SFY '03SFY '04SFY '05SFY '06SFY '07Percent of Families
FPS Annual Report, SFY 2007 19
Families Receiving Public Assistance
Figure 2 presents the percentage of families that are currently receiving, or have ever received, public assistance. Public assistance includes Medicaid, food stamps, housing assistance, Work First, SSI, WIC, and general assistance. There was a significant increase in the percentage of families receiving public assistance, beginning in SFY 2004, until this year. In SFY 2007, the proportion of families receiving public assistance dropped to 66%.
Primary Issues Affecting Caretakers
Figure 3 presents data on the types of problems affecting caretakers. (Note that each section of a bar represents the percent of families experiencing a particular problem, and that families may experience multiple problems. Therefore, the bars do not add to 100%, but represent the cumulative percentages of families experiencing that problem in a given year). The types of problems affecting families have fluctuated slightly over the last five years, with significant reductions in SFY 2007 in caretakers presenting with problems of unemployment, grief or loss, and alcohol abuse.
Race of Referred Children
Figure 4 displays the racial distribution for the referred children living in the families served by the program over the last five years. There has been a statistically significant increase in the proportion of African American referred children served to an all time high of 45% in SFY 2007. The proportion of other minority children served was at an all time high of 23% in SFY 2005. At the same time, there has been a steadily decreasing proportion of White referred children served. In SFY 2007, only 40% of the referred children were White and 60% were African American or of other minority race.
FPS Annual Report, SFY 2007 20
Figure 3. Primary Issues Affecting Caretakers29282525152225232219293534292622262120131612914713159858141099111415109151211129SFY '03SFY '04SFY '05SFY '06SFY '07UnemploymentDomestic violenceAbsence of parent/caretakerGrief/lossChild abuse/neglectAlcohol abuseOther drug abuseHist. teenage child bearingMental illnessFigure 4. Race of Referred Children5859414440293639451712231615250102030405060708090100SFY '03SFY '04SFY '05SFY '06SFY '07Percent of Referred ChildrenWhiteAfrican AmericanOther
FPS Annual Report, SFY 2007 21
Age and Gender of Referred Children
Figure 5 presents the information on ages of children served over the preceding 5 years. Although not statistically significant, the age distribution of referred children has varied somewhat over the last five years. The average age of referred children reached its lowest in SFY 2004 at 10 years old. The gender of referred children over the last five years has ranged between 41% to 48% female, and 52% to 59% male. Figure 5. Age of Referred Children171818161545342835363037463777111012390102030405060708090100SFY '03SFY '04SFY '05SFY '06SFY '07Percent of Referred Children0-56-1213-1516-17
Primary Issues Affecting Referred Children
The types of problems affecting referred children have fluctuated slightly over the last five years. These data are presented in Figure 6. There has been a significant and decreasing proportion of referred children presenting with problems of truancy and taking medication. One-fifth to one-third of referred children present with problems of family violence, delinquency and
FPS Annual Report, SFY 2007 22
school failure. Two-fifths to half of referred children present with problems of being out of parental control, being undisciplined and experiencing family disruption. Figure 6. Primary Issues Affecting Referred Children525360665149474353544546424548313228282331193030293231373433273118272321151430142830172116SFY '03SFY '04SFY '05SFY '06SFY '07Family disruptionUndisciplinedOut of parental controlSchool failureDelinquencyFamily violenceGrief/lossTruancyChild taking medication
Referred Children at-Risk for Placement
Figure 7 displays the proportions of referred children that were at-risk of placement at the time of case closure. There has been a significant reduction in the proportion of referred children that are considered to be at-risk for placement after services have ended, from a high of 48% in SFY 2003 to a low of 22% in SFY 2007. For the last five years, the average number of referred children considered to be at-risk of placement at the time of case closure is 34%.
FPS Annual Report, SFY 2007 23
Figure 7. Percent of Referred Children at-Risk for Placement at Case Closing3234362248010203040506070SFY '03SFY '04SFY '05SFY '06SFY '07Percent of Referred Children
Referred Children Living in the Home
Figure 8 illustrates the proportion of referred children living in the home at case opening as compared to case closing. Living in the home is defined as being in the home, with a relative, or with a family friend. Over the last five years, the proportion of referred children who are living in the home at the time of case opening and case closing has remained fairly stable. However, there has been a slight trend for more children to be in the home at opening and at closing. The proportion living in the home at case opening has averaged 96%, and the proportion living in the home at case closing has averaged 93%. It can also be seen from this figure that the trend over the previous four years for fewer children to be living in the home at the time of case closing than were living in the home at case opening did not continue into SFY 2007.
FPS Annual Report, SFY 2007 24
Figure 8. Percent of Referred Children Living in the Home at Case Opening and Closing929791919796989492960102030405060708090100SFY '03SFY '04SFY '05SFY '06SFY '07Percent of Referred ChildrenCase OpeningCase Closing
Contact Hours and Services Received
Figures 9 and 10 show data relating to required family services and contact hours spent with families. Figure 9 displays the average number of contact hours spent in each type of activity over the last five years. Workers have averaged 59 total contact hours with families. The majority of these hours has been spent in face-to-face, telephone, collateral and travel contact. There appears to be a trend towards an increase in average total service hours provided (from 58 in SFY 2003 to 62 in SFY 2007), and an increasing trend in the average service hours spent in face-to-face, telephone, collateral and travel contact.
FPS Annual Report, SFY 2007 25
Figure 9. Average Number of Contact Hours Per Life of Case4141404277101011100.40.11.51.00.95858616246577105801020304050607080SFY '03SFY '04SFY '05SFY '06SFY '07Average HoursFace-Face/Telephone/Collateral/TravelSupervisionAdmin/Record KeepingMiscellaneousTotal HoursFigure 10. Types of Services Families Received9999837089128321791210010099100100100979976778386958892415170102030405060708090100SFY '03SFY '04SFY '05SFY '06SFY '07Percent of FamiliesFamily AssessmentFamily/Individual CounselingClient AdvocacyCase Management/ReferralOptional ServicesOther Services
FPS Annual Report, SFY 2007 26
Figure 10 displays the percent of families that received each of the required services during the life of their case. Nearly all families received family assessment and family or individual counseling throughout the last five years. The data indicate a decreasing trend in the proportion of families receiving optional services during the FPS intervention. The provision of client advocacy, case management and referral, and other services have been fairly stable.
FPS Annual Report, SFY 2007 27
Family Functioning: North Carolina Family Assessment Scale
During SFY 2007, the North Carolina Family Assessment Scale (NCFAS) Version 2.0 was implemented as a formal part of the FPS case process and record keeping system. This replaced the previous use of the NCFAS Version 1.4. The NCFAS provides information on family functioning in a variety of areas relevant to the typical FPS family, and provides pre-service and post-service information in order to measure change that occurs during the FPS service period. Changes in family functioning that occur during this period are related to stressors affecting families, which in turn, affect their ability to remain united at the end of the service period.
The NCFAS Version 2.0 examines five broad areas of interest and a number of more specific sub-areas. The broad areas, referred to as domains, include: Environment, Parental Capabilities, Family Interactions, Family Safety, and Child Well-Being. Each of these domains comprises a series of sub-scales. For example, the domain of Environment includes sub-scales on housing stability, safety in the community, habitability of housing, income/employment, financial management capability, adequacy of food and nutrition, personal hygiene, availability of transportation, and the “learning” environment.
Assessments are made by FPS workers at the beginning of the service period and again at the conclusion of service. The data of interest includes both the absolute ratings at intake and closure and the change scores derived between the two assessment periods. For example, if a family received a rating of “-2” on the Environment domain at the beginning of service and received a “+1” at the end of service, the change score is +3, indicating movement of three scale increments in the positive direction. The change score is derived independently from the actual position of the scores on the scale; that is, a change from “0” to “+2” is considered to be of the
FPS Annual Report, SFY 2007 28
same magnitude as a change from “-3” to “-1”, or +2 in both cases. This strategy is deliberate in that the change scores may indicate a meaningful change in the status of the family, or of the trajectory of the family (i.e., deterioration to improvement), while at the same time acknowledging that not all problems can be resolved completely during a brief intervention.
Ratings at Intake and Closure on NCFAS Domains
Findings in this section relate to the 82 families served during SFY 2007 and were assessed using Version 2.0 of the NCFAS. Figures 11 through 15 present the aggregate intake and closure ratings for the 5 domains on the NCFAS. The findings from the NCFAS are quite consistent with expectations, based on the results of the reliability and validity study. Figure 11. Environment Ratings at Intake and Closure22111214923133924060102030405060Clear S.Mild S.Baseline A.Mild P.Moderate P.Serious P.Percent of FamiliesIntakeClosure
Data in Figure 11 suggest that the majority of families do not enter services with problem ratings in the area of Environment. Sixty-six percent of families are rated as being at
FPS Annual Report, SFY 2007 29
“Baseline/Adequate or above” at intake. At closure, nearly all families (93%) are “Baseline/Adequate or above.” Families not rated as having environmental issues to resolve at intake also are not likely to have case plans focusing on those issues. However, there was substantial movement of the aggregate data towards the positive end of the scale: the proportion of families rated as having environmental problems declined from 34% at intake to only 7% at closure.
Figure 12 presents data from the Parental Capabilities scale. At intake, half (54%) of families are rated as being at “Baseline/Adequate or above”. At closure, the majority (87%) of families are rated being at “Baseline/Adequate or above”. Like Environment, there was substantial movement of the aggregate data towards the positive end of the scale: the proportion of families rated in the “problem” range decreased from 47% at intake to only 13% at closure. Figure 12. Parental Capabilities Ratings at Intake and Closure92331014204411246100102030405060Clear S.Mild S.Baseline A.Mild P.Moderate P.Serious P.Percent of FamiliesIntakeClosure
FPS Annual Report, SFY 2007 30
The next domain of assessment on the NCFAS is Family Interactions. These data are presented in Figure 13. The data gathered on the families served relating to this domain show significant shifts in family interaction patterns as a result of the services provided. Fully 68% of families are rated in the “problem” range at intake, but only 17% are still rated in the “problem” range at closure. Figure 13. Family Interactions Ratings at Intake and Closure52239152271531160380102030405060Clear S.Mild S.Baseline A.Mild P.Moderate P.Serious P.Percent of FamiliesIntakeClosure
The data gathered on the Family Safety domain for the families served show shifts in safety similar to shifts observed in Environment. Two thirds of families (68%) are rated as being at “Baseline/Adequate or above” at intake. At closure, nearly all families (89%) are “Baseline/Adequate or above” and no families are rated as having “Serious Problems”. These data are presented in Figure 14.
FPS Annual Report, SFY 2007 31
Figure 14. Family Safety Ratings at Intake and Closure2125350162816190110290102030405060Clear S.Mild S.Baseline A.Mild P.Moderate P.Serious P.Percent of FamiliesIntakeClosureFigure 15. Child Well-Being Ratings at Intake and Closure31521715351117481270102030405060Clear S.Mild S.Baseline A.Mild P.Moderate P.Serious P.Percent of FamiliesIntakeClosure
FPS Annual Report, SFY 2007 32
The final domain of assessment on the NCFAS is Child Well-Being. These data are presented in Figure 15. The assessed changes in Child Well-Being are also large, with the large majority (80%) of families rated as having problems in this area at the beginning of service. This is not altogether surprising since Child Well-Being issues, along with Family Interaction issues and Parental Capability issues, are likely to be the issues that initially bring the family to the attention of the referring agency. However, at the close of services, the large majority (79%) of families are at “Baseline/Adequate or above,” and one-third (32%) are rated in the “strengths” range.
Taken as a whole, the ratings on the NCFAS domains reflect the capacity of the FPS programs to influence parental skills, safety, interaction patterns and behavior, and child well-being to a substantial degree. Changes on environmental and family safety, while evident, are less dramatic. This is due, at least in part, to the lower level of need recorded on these domains.
Change from Intake to Closure on NCFAS Domains
The aggregate data presented in the preceding figures indicate the “population” shifts following receipt of FPS services, but do not indicate the amount of change in individual families. Examination of individual family change requires the computation and analysis of the change scores derived on each domain for each family in the cohort. The specific changes that occurred on each of the domains for the 82 families served in SFY 2007 are presented in Table 8. These same data are presented graphically in Figure 16. These data show that just under half (46%) of families do not change on the domain of Environment and just over half (61%) of families do not change on the domain of Family Safety. However, 79% of families on Child Well-Being, 76% of families on Family Interactions, and 72% of families on Parental Capabilities experience change (sometimes large change) from intake to closure. One-third to
FPS Annual Report, SFY 2007 33
Table 8. Level of Change Experienced by Families on Each Domain of the NCFAS
during FPS
Level of Change Per Family (Percent of Families)
N=82
Domain
-1
or more
0
(no change)
+1
+2
+3
or more
Environment
1%
46%
29%
18%
5%
Parental Capabilities
1%
28%
44%
13%
13%
Family Interactions
1%
24%
37%
17%
21%
Family Safety
1%
61%
21%
13%
4%
Child Well-Being
1%
21%
34%
26%
18%
two-fifths of families on these domains experienced a one unit incremental change. But a rather large proportion of families experienced two or more units of change. Because the NCFAS employs a 6-point scale, ranging from “serious problem” to “clear strength”, a 3-point shift during a brief intervention is very large. Figure 16. Level of Change Experienced by Families on NCFAS Domains1185144131242116121134121182946281317372634010203040506070-1 or more0123 or morePercent of FamiliesEnvironmentParental CapabilitiesFamily InteractionsFamily SafetyChild Well-Being
FPS Annual Report, SFY 2007 34
Figure 17 shows the percent of families rated at “Baseline/Adequate or above” at intake and closure. Each “intake/closure” comparison indicates substantial positive change in the population of families served, particularly on the domains of Child Well-Being and Family Interactions. However, approximately one-tenth to one-fifth of families remain below baseline (i.e., in the problem range of ratings) on one or more domain at the time of case closure. Figure 17. Overall Change on the NCFAS838979335466206893870102030405060708090100EnvironmentParentalCapabilitiesFamilyInteractionsFamily SafetyChild Well-BeingPercent of FamiliesBaseline or Above @ IntakeBaseline or Above @ Closure
Reliability of the NCFAS
After using the non-validated NCFAS Version 1.4 since program implementation, FPS programs began using the NCFAS Version 2.0 during SFY 2007. The complete reliability and validity study for the NCFAS was published in the professional literature (Research on Social Work Practice, Volume 11, Number 4, July 2001, pages 503-520). This section presents the
FPS Annual Report, SFY 2007 35
results of the reliability analysis conducted on the use of the NCFAS Version 2.0 for this service population for the 82 families assessed during SFY 2007. The results of the reliability analysis are presented in Table 9.
Table 9. Reliability Analysis for the NCFAS Version 2.0, SFY 2007
Domain
Valid N
Number of Items
Alpha
Environment at Intake
82
10
.886
Environment at Closure
79
10
.923
Parental Capabilities at Intake
76
7
.752
Parental Capabilities at Closure
76
7
.893
Family Interactions at Intake
81
5
.727
Family Interactions at Closure
81
5
.747
Family Safety at Intake
78
6
.788
Family Safety at Closure
77
6
.748
Child Well-Being at Intake
81
8
.690
Child Well-Being at Closure
80
8
.782
Cronbach’s Alpha statistics reflect the internal consistency of the scale items, and Alphas ranged from .69 to .92. By convention among scale development theorists, Alphas above .7 are considered respectable, Alphas above .8 are considered strong, and Alphas above .9 are considered very strong. Thus, the majority of Alphas are in the .7-.8 range, and the scale appears to be reliable when used in the present service environment with the present service population.
FPS Annual Report, SFY 2007 36
Summary of Major Findings from the Outcome-Focused Evaluation of North Carolina’s Family Preservation Services Program
Data from the last 5-year period that the FPS program has been in operation, along with more detailed analysis of SFY 2007 data, reveal the following general findings. More detail on each of these findings is available in the body of the full report.
•
Workers are following the service model. The data relating to case activities reflect policy compliance and adherence to standards.
•
The typical family served by the FPS program is a single female-headed household, struggling financially. This year there was 66% chance of receiving some form of public assistance (Medicaid, Food Stamps, SSI, WIC), but there was a low probability of being enrolled in Work First, with intermittent labor force attachment and periods of unemployment, and low educational attainment. Minimal monetary assistance is offered to these families through the FPS program.
•
The proportion of families served that represents racial minorities is somewhat higher than the proportion of minorities in the general population of the areas served by the program. This suggests that the FPS program may be addressing the problem of overrepresentation of minority children in foster care and other types of out-of-home placement.
•
Although families may receive services for up to 6 months, the average case closes in less than that time (14.29 weeks, slightly less than 4 months).
•
About the same numbers of children are living at home at Intake as are living at home at Closure. This could mean that 1) FPS is successfully preventing the removal of children who were at risk of removal, or 2) that some children are placed out of home at the conclusion of services while others are returned home following services. Future analyses will delve more deeply into the relationships among these variables.
•
Out-of-home placement of referred children is a fairly uncommon outcome.
•
Five-year trend analyses indicate:
o
FPS program size was stable with respect to number of families served thru SFY 2004. There was a significant decrease in the number of families served beginning in SFY 2005 due to all in-home services being re-bid and allocation shifting to comply with federal requirements.
o
There is a decreasing trend in children’s problems at intake for truancy, taking medication, and family disruption.
FPS Annual Report, SFY 2007 37
o
There is a decreasing trend in the proportion of referred children considered to be at risk for an out-of-home placement at case closure, with SFY 2007 representing an all-time low of 22%.
o
There is an increasing trend to serve minority families. During SFY 2007, there was a significant increase in the proportion of minority children served to an all time high of 60%.
o
The number of hours devoted to various case-related activities (face-to-face contact, transportation, supervision, record keeping, etc.) has remained fairly stable over the past 5 years. There appears to be an emerging trend to an overall increase in the total service hours provided to families.
•
The FPS program adopted the NCFAS-V2.0 as the standard assessment instrument for families receiving FPS. Reliability statistics suggest good reliability o the Scale with this service population (with Cronbach’s Alphas ranging from .69 to .89 at Intake, and from .75 to .92 at Closure).
•
NCFAS data suggest that the families served by the FPS program in SFY 2007 were particularly affected by issues relating to Parental Capabilities, Family Interactions, and Child Well-Being.
•
Measures of family functioning (using the North Carolina Family Assessment Scale Version 2.0) reflect population shifts (sometimes substantial) in the “right” direction, away from problems and towards strengths.
•
Taken as a whole, the general improvements in family functioning demonstrate the ability of the FPS program to influence positively all of the assessed domains.
•
Follow-up tracking should be conducted on the 22% of children who were assessed as still being at risk of placement at the time of FPS case closure (as well as those from previous years), in order to determine their longer-term outcomes.
FPS Annual Report, SFY 2007 38
APPENDIX A
Provider List for SFY 2006-2007
Less Intensive Family Preservation Services
Provider
Contact Person
County Served
Mountain Youth Resources
PO Box 99
Webster, NC 28779
Devona Finley
(828) 586-8958
Fax: (828) 586-0649
Clay
Mountain Youth Resources
PO Box 99
Webster, NC 28779
Devona Finley
(828) 586-8958
Fax: (828) 586-0649
Macon
Mountain Youth Resources1
PO Box 99
Webster, NC 28779
Devona Finley
(828) 586-8958
Fax: (828) 586-0649
Graham
Family Services of the Piedmont
315 East Washington St.
Greensboro, NC 27401
Andrea Huckabee
(336) 387-6161
Fax: (336) 387-9167
Guilford
Youth Focus
301 East Washington St.
Greensboro, NC 27401
Valerie Jones
(336) 333-6853
Fax: (336) 333-6815
Guilford
Chatham County DSS
PO Box 489
Pittsboro, NC 27312
Sharon Milham
(919) 542-2759
Fax: (919) 542-6355
Chatham
Youth Homes
601 East 5th St.
Charlotte, NC 28202
Lelia Smallwood
(704) 334-9955
Fax: (704) 375-7497
Mecklenburg
1The actual contract for this area was with Graham County Schools. Mountain Youth Resources is a subcontractor.
FPS Annual Report, SFY 2007 39
FPS Annual Report, SFY 2007 40
APPENDIX B
Program Allocations and Expenditures for SFY 2006-2007
Less Intensive Family Preservation Programs
County
Provider
Allocation
Actual Expenditure
Clay
Mountain Youth Resources
$75,000
$74,819
Macon
Mountain Youth Resources
$75,000
$74,315
Graham
Mountain Youth Resources1
$40,000
$23,222
Guilford
Family Services of the Piedmont
$37,500
$37,500
Guilford
Youth Focus (subcontract)2
$37,500
$37,500
Chatham
Chatham Co DSS
$75,000
$45,892
Mecklenburg
Youth Homes
$75,000
$55,142
TOTALS
$415,000
$348,390
1This program is part of a contract with Graham County Schools. The total contracted amount is $100,000, the remainder of which is designated for a Family Resource Center.
2Youth Focus is a subcontract of Family Services of the Piedmont. The contract with the Division is for $75,000, which represents the sum of the allocation to the primary contractor, who then allocates $25,000 to the subcontract.