Differential and Alternative Response: Implications for Fairness and Equity

1. Differential and Alternative Response:Implications for Fairness and Equity Jill Duerr Berrick School of Social Welfare UC Berkeley Co-Authors: Amy Price & Amy Conley et al.

2. Study inspired by CalSWEC Research AgendaFocus on Safety

3. Parallel Studies Alameda County: Alternative Response Services since 2002. Contra Costa County: Differential Response since 2005. Slightly different models; similar study designs and outcomes

4. Alternative/Differential Response: Putting it in context: • 1) Screening by risk levels; 2) voluntary provision of case management; 3) less punitive approach • Over 20 states have some form of DR • Various approaches to delivering services: through public child welfare agencies, through CBOs, or mixed

5. Study Goals Reflect Program Goals • Overarching goal: Prevention of child welfare system involvement • Proximal goals: • Increased connections with community resources • Provision of temporary social support • Elimination of unmet basic needs • Improvement of parent-child relationship

6. Methods: Alameda County Process study • Focus groups with line staff (n=12) • Interviews with managers (n=16) • Interviews with clients (n=30) Outcome study (Survival Analysis) • Treatment group: 161 families who received intervention • Comparison group: 477 families eligible for intervention

7. Methods: Contra Costa County Process & Client Satisfaction Study • Interviews with CFS staff (n=13) • Interviews with CBO staff (n=16) • Interviews with clients (n=51) Outcome Study • Treatment: 164 families offered Path 1 services • Comparison: 335 families eligible for but not offered Path 1 services

8. Family Engagement ♦ A unique challenge Unlike other home visitation programs, where the provider’s point of entry is clear and services are invited by parents, AR/DR services often are prompted by family crisis.

9. Rates of Client Engagement in Alameda ARS agencies have experienced varying rates of client engagement Agency: Referrals Served* ▪ FSSBA 2002-2007: 337 35% ▪ La Familia 2002-2007: 611 33% ▪ Prescott Joseph 2005-2007: 84 12% *As of February, 2007

10. Rates of Family Engagement in Contra Costa ♦ 49% engagement rate in Path 1 ♦ Hispanic families significantly higher engagement rate (66% vs. 33% for other groups) ♦ Initial allegation of substantial risk, or child welfare history less likely to engage.

11. What Explains Low Rates of Engagement? ♦ Client mistrust ♦ Fear ♦ Uncertainty ♦ Resentment

12. Why Parents Engage? • Need help and see DR/ARS as an opportunity • Feel they have no choice (Hispanic families in particular believe DR services are mandatory, but also welcome services in their language) • Convinced by actions and/or qualities of case worker

13. Program components:Providing social support • Theoretical support: Perceived and enacted social support (House, 1981) • Types of interventions • Listening to clients share their feelings • Giving reassurance and compliments • Normalizing the experience of asking for help

14. Providing Quality Social Support • Begin by identifying and building from families’ strengths and goals • Maintain frequent contact with families in their own homes, as it provides comfort and promotes trust • Encourage parents to make their own decisions and acknowledge that they are experts in their own lives

15. How Workers Offered Support and Built Positive, Trusting Relationships ♦ “He transmits confidence. And it doesn’t matter the time; he will find time to listen and help.” ♦ “She really cares. I feel like I have a new friend. I can tell her anything. She can help me.” ♦ “She would listen to my problems, help guide me about how to look at things, set goals – like a coach, you could say.” ♦ “She speaks my language.”

16. Offering Referrals to Community Resources • Find resources close to families’ homes • Make initial calls prior to giving resources to the family; let the family know what to expect • Encourage families to access services independently, but also balance their needs for immediate services and assist or accompany them when necessary

17. Referrals and Supports that are Helpful ♦ Low-income legal services ♦ Family and individual counseling and parenting classes ♦ Help baby-proofing the house ♦ Links to asthma, nutrition, and other health programs ♦ Assistance with resume and job search ♦ Assistance with housing search ♦ Advocacy for children at their schools and for parents at CalWorks

18. Program components:Targeting basic needs • Theoretical support: Hierarchy of needs (Maslow, 1943) • Types of interventions: • Use of basic needs fund to address one-time, acute needs • Referral to community resources that address basic needs, such as food banks • Assistance with transportation

19. Providing for Basic Needs can Alleviate Stress ► Funding to support basic needs may help families overcome crises ► For financially stressed families, small contributions of diapers, clothes, and food can help to alleviate stress and have positive impact on parenting ►Assess whether the need is one-time or regular; help families budget

20. Families Received These Basic Services ♦ Donations of food and diapers ♦ Assistance with PG&E and EBMUD bills as well as referrals for their low-income programs ♦ Transportation to children’s school and appointments ♦ Gift cards for groceries and clothing ♦ Help with an initial rent payment/ deposit

21. Program components:Strengthening parent-child relationships • Theoretical support: Attachment theory (Bowlby, 1969) • Types of interventions: • Providing opportunities for parents to enjoy time with their children • Modeling appropriate behavior with children • Offering information on child development

22. Naturally Occurring Semi-Structured Activities that Support Families ► Organized activities can teach parents that playing with their children is important for family development. ► Relationships created among parents in semi-structured activities can create new, important sources of peer support. ♦ “I really enjoyed the science classes….It was a nice experience and it taught me that the kids come first…that day was cool, because I got to be with them.”

23. Analysis of client outcomes

24. Alameda client outcomes: Report of Maltreatment • No difference in rates of re-report for treatment & comparison groups. • Slim possibility of modest differences for children w/prior report.

25. CCC Path 1 Client Outcomes: Re-Referral • Engagement had no impact on re-referral: 28% engaged; 30% not engaged • Rates by race: 42% Black, 37% Hispanic, and 9% White • Odds of non-white child being re-referred is 5.9 times the odds of a white child • Odds of referral for child from family with prior referral history 3 times higher

26. CCC Path 1 Client Outcomes : Removal

27. Other CCC OutcomesPaths 1 & 2 94% of clients noted life changes as result of program Most reported a little (20%) or a lot (73%) of improvement in quality of family life 75% felt more connected to community after involvement in DR

28. Implications • Findings in-line with meta-analyses of child maltreatment prevention programs that show small treatment effects • Findings also fit with other DR studies that have found no difference in re-reporting for DR and non-DR families • Maltreatment prevention and placement prevention may be too narrow or inappropriate targets for intervention.

29. Implications Child maltreatment may not be affected, but ARS/DR may have other benefits: Access to resources Connections to community Basic parenting practices may improve. Serving families in need who wouldn’t otherwise be served Improved trust and collaboration with CBOs Changing perception of CPS in the community.

30. Positive Family Changes Identified by Parents ♦ “I am more focused, self confident. I'm more comfortable in my own skin. I'm willing to do all the things I need to do to get things done.” ♦ “She allowed me to realize all the things I've overcome, and that made me feel proud.” ♦ “I’m less suffocated. I can talk more, and sometimes about problems that I have had.” ♦ “They helped me to believe and gave me strength.”

31. Curriculum Title: Differential Response and Alternative Response in Diverse Communities Available from: CalSWEC library website

32. References Bowlby, J. (1969) Attachment and Loss: Attachment (Vol. 1). New York: Basic Books  Center for Child and Family Policy (2004). Multiple Response System (MRS) evaluation report to the North Carolina Division of Social Services (NCDSS). Retrieved online March 15, 2005 from the Center for Child and Family Policy web site: http://www.pubpol.duke.edu/centers/child English, D. J., Marshall, D. B., Brummel, S., & Orme, M. (1999). Characteristics of repeated referrals to child protective services in Washington state. Child Maltreatment, 4(4), 297-307. Geeraert, L., Van den Noortgate, W., Grietens, H., & Onghena, P. (2004). The effects of early prevention programs for families with young childen at risk for physical child abuse and neglect: A meta-analysis. Child Maltreatment, 9(3), 277-291. House, J. S. (1981). Work Stress and Social Support. Reading MA: Addison-Wesley. Jencks, C. & Mayer, S.E. (1990). The social consequences of growing up in a poor neighborhood. In Lynn, L.E. & M.G.H. McGeary, Eds. Inner-city poverty in the United States. (pp 111-186). MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse and Neglect, 24(9), 1127-1149. Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50, 370-396. US Department of Health and Human Services, Administration for Children and Families/Children's Bureau and Office of the Assistant Secretary for Planning and Evaluation. (2005). Alternative responses to child maltreatment: Findings from NCANDS. Washington, DC: U.S. Government Printing Office. Van den Noortgate, W., Geeraert, L., Grietens, H., Onghena, P. (2006). The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: A reply on the comments of Miller. Child Maltreatment, 11(1), 98-101.