How does Reunification Work: A Study of Reunification Outcomes

1. How does Reunification Work: A Study of Reunification Outcomes ACWA 10 Building a Child Friendly Australia: Responding to Vulnerable Families. Association of Children's Welfare Agencies Conference 2-4 August 2010 Sydney Convention and Exhibition Centre Elizabeth Fernandez Associate Professor, School of Social Sciences and International Studies The University of New South Wales, Australia  AND Rosemary Hamill Senior Manager Barnardos Australia

2. Family reunification – Introduction Reunification is Defined as: • The return of children in foster care placements to the home of their birth family • A process aimed at helping children in out of home care attain the optimum level of reconnection with their birth family. This optimal level of reconnection may fall somewhere on a continuum from physical return through to lesser forms of contact or visitation (Maluccio et al., 1996) • Reunification is a primary goal of foster care systems, the most common permanency planning decision

3. Aims of the Research • Gain an understanding of pre and post intervention characteristics, circumstances and functioning of families whose children enter temporary foster care • Chart the pathways experienced by children in foster care • Identify child and family characteristics of the studied sample that are associated with a) reunification b) other permanent plans for children such as long term care or adoption • Determine the relative influence of child and family characteristics, decision making elements and service variables on reunification outcomes

4. Collaboration and Research Design Research collaboration between University of New South Wales (CI Elizabeth Fernandez) and Barnardos Australia supported with ARC Linkage Grant • Prospective longitudinal design, mixed methods • 168 children from 96 families • Sample drawn from 5 Temporary Family Care programs of Barnardos Australia • Data was collected through face to face interviews with all caseworkers and a subsample of birth parents and foster carers

5. Site of the Research Barnardos Temporary Family Care (TFC) Program • TFC programs provide integrated assessment, family preservation and permanency planning services to families with children aged 0 – 12 years • TFC programs are positioned at the ‘front end’ of the Barnardos permanency planning continuum • ‘Gatekeeper’ to discourage a child’s entry into long term care • Temporary foster care placements are provided with the goal of restoration • Work in partnership with birth families and kinship networks and by building on family strengths as well as identifying and addressing areas of need • Parental visiting and parent/foster carer contact are an important part of case plans • Participation of parents, children and members of the kinship network stressed in case planning • TFC services are provided on a 24 hours x 7 days per week basis for children and families

6. Interviews Explored • Profile of children and families • Assessment of needs and risk factors • Case goals and care plans • Services provided • Care arrangements • Case management • Contact/Visitation • Post restoration issues • Caseworker’s professional support

7. Characteristics of the children Age • 12 months and under - 20% • 1 and 5 years of age - 33% • 5 and 10 years - 30% • over 10 years - 17% Gender • 56% - male • 44% - female

8. Family Profile Age of Birth Mothers • aged 25 and under - 17% • aged between 26 – 35 - 54% • 36 and over - 29% Employment • 87% of families were receiving benefits as their primary source of income • 5% of mothers and 17% of fathers were known to be employed • Housing • 70.5% of families reside in Public Housing • 14.7 of families reside in private rental • 3.7% owned their homes • 4.9% were homeless

9. Family Profile Birth Family Size • 35% had 1 to 2 children • 35% had either 3 or 4 • 24% had between 5 and 7 • 6% of families had 8 or more children Sibling Groups in Care • 65% of families had 1 - 3 children in care • 5% had up to 6 children in care

10. Reasons for Care

11. Case Goals • Most prominent goals included: • Addressing Drug and Alcohol issues • Providing/arranging support for families • Addressing housing concerns • Addressing parenting problems • Ensuring regular contact with birth families • Moving the child to long term care or adoption

12. Assessment and Intervention • Research included the use of a validated standardised assessment tool, the (NCFAS-R) North Carolina Family Assessment Scale-Reunification (Kirk and Reed, 2000) • NCFAS-R is a multidimensional instrument which conceptualises family functioning into seven domains: • Environment • Parental Capabilities • Family Interactions • Child Well-Being • Family Safety • Caregiver/Child Ambivalence • Readiness for Reunification

13. NCFAS-R The NCFAS-R assessment for families was completed by caseworkers at intake (Time 1) and at the subsequent interview (Time 2) six months later, or at restoration or case closure. The data from Time 1 provided a baseline on outcomes against which to compare ratings at Time 2 and assess family change. Within each domain are multiple single item subscales which are scored ranging from ‘+2=clear strength’ to ‘−3=serious problem’. Each domain also includes a single global item that asks the caseworker to provide an overall rating of functioning in relation to that domain, only after completing the specific ratings on the subscales

14. The North Carolina Family Assessment Scale-Reunification (NCFAS-R) for Intensive Family Preservation ServicesPrograms Serving Reunification Cases (Version R2.0)

15. Child Wellbeing Domain Subscales

16. Table 5- Subscales for Family Safety Domain Family Safety Domain Subscales

17. Comparison of NCFAS scoresat Time 1 and Time 2

18. Environment Domain Subscales

19. NCFAS – R • The “overall” parental capabilities in general illustrate significant improvement. At Time 1, 70% of cases fell within the ‘moderate and serious problem’ index. This number showed a considerable decrease of 31%.However 39% of families were still experiencing problems of a moderate or serious nature at Time 2. • At Time 1, 60% of families were considered to be experiencing problems in regards to the child’s wellbeing, by Time 2 however, this number had decreased significantly to 20% with only 7% labelled as a ‘moderate or serious problem’.

20. Case Status • 52% of children were Restored

21. Analysis 1 • Study window: 18 months since entry • Event: Reunification with parents or kin • Time to the event: weeks since the entry to restoration • Censoring: • Exited with other outcomes (e.g., moved to other agencies) • Not restored until the end of study period (ongoing) • Uses primary reasons in care as predictor of reunification

22. Analysis 2 Focus on restoration outcomes • Return to parent/return to kin • Predicting time to restoration • Uses typology of risk and protective factors based on NCFAS-R as predictor of reunification Latent profile analyses • Used typology as a predictor in Cox regression

23. Sample • 168 original sample from 96 families • Reduced to 155 for this Analysis (due to missing data on specific items)

24. Variables analysed in the model Age, sex, referral source, primary reason in care and typology of risk based on NCFAS Descriptive statistics of study sample (n=155)

25. Kaplan-Meier survival estimates by restoration outcome

26. Note: ** p<0.01, * p<0.05, SE stands for standard error. Note: ** p<0.01, * p<0.05, SE stands for standard error. A cause-specific proportional hazard model with competing risks: Using the primary reason in care (n=155) Note: ** p<0.01, * p<0.05, SE stands for standard error.

27. Patterns of Restoration and Predictors • Children were restored to parents rapidly until three months, declining rate of restoration thereafter • Restoration to kin was slower • Rate of restoration was higher for older children Age: Compared to rate for infants the rate for 5 year olds is 2.38 times greater Reasons: Compared to children in care for reasons of parental ill health • parental substance abuse as reason – 86% lower rate of return • Abuse and neglect as reason – 83% lower rate of return • Domestic violence/ other – 73% lower rate of return

28. Results: Using typology of NCFAS-R Typology of NCFAS-R (Latent Profile Analysis)

29. Note: ** p<0.01, * p<0.05, SE stands for standard error. Note: ** p<0.01, * p<0.05, SE stands for standard error. Note: ** p<0.01, * p<0.05, SE stands for standard error. A cause-specific proportional hazard model with competing risks: Using the risk typology based on NCFAS-R (n=155) Note: ** p<0.01, * p<0.05, SE stands for standard error.

30. Latent Profile Analysis: NCFAS-R Risk Typology Three risk groups identified • Low Risk 14% • Medium Risk 48% • High Risk 37.5% • High risk group e.g. Parents had moderate to serious problems in parental capabilities, family safety and family interactions • Children in high risk group had 73% lower speed of reunification - Age: older children reunified at a faster rate - Compared to infants the rate for 5 year olds is 1.8 times greater

31. Services and Agencies Accessed by Families

32. Contact/Visitation • 97% of workers considered contact with birth family to be of utmost importance to the reunification process. • 67% of children had more than weekly contact with siblings • 28% of children had no contact with birth fathers • 60% of Restored cases had supervised contact • 90% of Not-Restored cases have supervised contact

33. Caseworkers’ Reflections on Contact Seen as important in maintaining parent child engagement and attachment • For young children – maintaining attachment so that restoration is not disruptive or distressing • For older children – reassurance that parents care for them • For parents – enhancing the relationship without the pressure of parental responsibility • Contact an important context for assessing feasibility of restoration decision making

34. Parents’ Perspectives • Contact alleviated distress of separation • Exposure to carers’ parenting approach • Identified barriers (cost, travel, location) • Above all, level of supervision and the intrusiveness “we would have some person following us with a goddamn clipboard writing everything down. It was embarrassing for my children. They really resented that.” (Burns Family, Parent)

35. Assessing for Restoration • Assessments of parenting capacity • Level of parental empathy and awareness of children’s needs • Ability to focus on the child’s perspective • Willingness to undertake requirements of statutory Department /Courts/ Barnardos • Evidence of carrying out case plans (engagement with services, change in behaviour) • Parents ability to cooperate • Parents ability to ask for help • Attendance at courses/programs

36. Post Restoration Parents identified several challenges: • Fear of being unsuccessful and kids being removed again • Children’s challenging behaviours • Concerns about children fitting in at school/preschool, and getting over the trauma • Confidence in new found skills • Concern about ongoing support • Fear and trepidation about the future “For me the biggest challenge is putting things back together. When things come along that destroy your life and put it in a big enough mess, then you have to try and put it back together again. Getting it back is a little bit harder than what it is to take it away from someone.” (White Family, Parent)

37. Implications Of Findings For Policy, Practice And Future Research • Findings illuminate a pattern which suggests majority of children who reunify do so in the early months after entry. This has implications for administrators and practitioners in terms of ensuring resources and caseloads are prioritised to maximize the potential for reunification and support for children and families. • As children experienced extended tenure in care reunification occurred at a slower rate. More active social work practice and intensive supportive services are needed to effect reunification once children have been in care for some time. • Families’ unable to address deficits in the environmental domain (housing, finances, and nutrition) experienced delayed return. Responding to the structural dimensions of neglectful parenting and addressing the wider context of welfare arrangements of income support, housing, child care and health care are crucial to reducing the structural risk factors impacting on families and children.

38. Implications Of Findings For Policy, Practice And Future Research • The vulnerability of younger children to entering care and remaining in care for extended periods has implications for preventive services for parents with infants and young children for systematic care planning. • There is a need to model reunification outcomes by stratifying samples into different age groups to better understand factors related to reunification based on age. • The quantitative analysis is to be complemented by more in-depth qualitative analysis of the histories and experience of children and families. • Despite the insights yielded from this study there is a clear need for further empirically oriented research with larger samples. • Reunification can trigger challenges and stresses for families when children reintegrate. Little is known about post reunification outcomes and this is a fertile area for future research.

39. Implications for Practice/Research • Careful assessment prior to reunification to ensure children are not returned to neglectful or unsafe environments. • Adequate support to parents and children after return. • Broader conceptualisation of reunification to allow for range of options • Increased research on reunification outcomes: Children’s Perceptions Parents perceptions Optimal circumstances for reunification

40. References • Hosmer, D., Lemeshow, S., & May, S. (2008). Applied survival analysis: Regression modeling oftime-to-event data (2nd ed.). Hoboken, NJ: John Wiley & Sons. • Maluccio, A. N., Ainsworth, F., & Thoburn, J. (2000). Child welfare outcome research in the UnitedStates, the United Kingdom and Australia. Washington, DC: CWLA Press • Reed-Ashcraft, K., Raymond, K., & Fraser, M. (2001). The reliability and validity of the NorthCarolina Family Assessment Scale. Research on Social Work Practice, 11, 503-520. • Bowen, N., Lee, J., & Weller, B. (2007). School environmental risk and protection: A typology with implications for practice in elementary schools. Children and Schools, 29, 229-242. • Fernandez, E. (1999). Representation and Analysis of Placement Careers of Children in Care Using Event History Models. Children and Youth Services Review, 21(3), 177-216. Acknowledgement Thanks are due to caseworkers, carers and parents of the Barnardos Temporary Family Care Program for their participation in the research. Social work interns and research assistants Jessica Rojas, Amy Godleman, Rosemary Richards, John Healy, Cassey Spratt and Sarah Meoli are acknowledged. The statistical consultation of Dr Jung-Sook Lee is acknowledged.