Child-Welfare Agency Gets Props for New Approach to Helping Families Navigate Challenges

Happy stories rarely land the city’s child-welfare system in the headlines, and the last few weeks have been no exception.

The Administration for Children’s Services stepped in just this past weekend to remove a young boy who reportedly told school officials on Staten Island that his mother beat him when he found her illegal handgun. A lawsuit filed a few days earlier by a former youth detainee claimed he was sexual abused by guards at a juvenile detention facility. Earlier in August, the agency was called into the controversial dispute involving school officials and parents who have sued over treatment of their “gender expansive” son. Before that, a psychotherapist in Dongan Hills pled guilty to groping two young girls referred to him by an ACS contractor. The racial disparities in ACS foster-care placement even got prime-time treatment at a mayoral candidates’ debate.

But much of what the agency does occurs out of the media spotlight, and last week research emerged telling a different kind of ACS story.

According to a new report by Casey Family Programs and the National Implementation Research Network, ACS’s “pioneering” decision six years ago to incorporate evidence-based models into its prevention programs has made it a national leader.

“This initiative is the largest and most diverse continuum of evidence-based and evidence-informed preventive programs in any child welfare jurisdiction in the country,” the report read.

What’s more, preliminary evidence suggests the programs are working: “While outcome data are still limited, some preliminary results indicate that preventive EBMs are having a positive impact.”

Help and hard evidence

Basically, evidence-based programs are designed based on a thorough review of existing academic research on what works and then are redesigned as real-world results come in from actual clients using the new system. Evidence-based practices have gained broad usage in human-services and other fields, although Casey says their uptake in the child-welfare arena has been slow.

Through contracted service-providers, ACS operates a menu of preventive services meant to help families navigate the pressures that could put children at risk of neglect or abuse, like substance abuse problems, mental health issues or intense medical needs. While there are other paths into the programs, most families enter through an ACS investigation of a report of abuse or neglect. Whether the allegation is found to have merit or not, ACS might refer a family to preventive services, which are free of charge and voluntary. In fiscal year 2017, some 9,000 families began receiving preventive services through ACS, and a daily average of 23,000 children were in the programs.

In 2011, ACS decided to focus more of its preventive work around evidence-based models. According to Kailey Burger, ACS’s assistant commissioner for community-based strategies in the Division of Prevention Services, the new models were seen not just as potentially more effective, but more efficient, too. “A big part of it was really thinking about how long we wanted to be in a family’s life. If we can shorten the intervention, it’s getting them back to their normal life,” she tells City Limits.

For families, “just the clarity around the goals and the time they can plan to be involved, I think it’s comforting. I think there’s some more clarity and transparency in how you communicate,” Burger says. And for child-welfare workers and clinicians, “there’s more of a sense of ownership.”

Among the 11 programs that are part of that initiative is Brief Strategic Family Therapy, which is aimed at “children and youth with serious behavior problems and/or drug use” and “works well for families with poor behavior management and problematic relationships,” according to Casey. Under the program, in weekly meetings, it “identifies patterns of family interaction and improves them to restore effective parental leadership and involvement with the youth.” Another is called Functional Family Therapy and serves families deemed to be “high risk” and dealing with “violent, criminal, behavioral, school, and conduct problems.” The program is founded on a belief “that the motivation of a family is to a great extent the responsibility of the therapist, not just the family,” according to the report.

A bigger role

Before 2013, about 1 in 25 families in the ACS preventive programs were using evidence-based models. In 2015 the share swelled to about one in four—some 5,000 households. While stressing that “outcome data are still limited,” Casey did find that families tended to spend less time in evidence-based programs that others, and that the new programs were more likely to see cases closed with goals for family progress met.

There was also some evidence that the evidence-based programs reduced the likelihood of ACS substantiating an allegation of child abuse or neglect against families that had participated. Among low-risk families participating in the programs from October through December 2015, a child-abuse allegation was indicated in only 8.8 percent of cases in the evidence-based families, compared with 10.4 percent in the older programs. For high-risk families, the difference was starker: Only 9.5 percent of families in the new programs had an indicated case against them within six months of finishing the services, versus 21.5 percent among those in the general preventive pool.

Both sets of statistics offer just a snapshot, however. While evidence-based models do employ a more rigorous approach to social services, on the ground it’s not pure science. Comparing the families who were referred to ACS’s evidence-based models with those who were sent to different programs is not an apples-to-apples measurement: Difference among families determined who went where. ACS was not conducting a human experiment. “We’re in the service-delivery business,” Burger notes. “It’s really hard to measure outcomes because we don’t put families in a control group. It’s a challenge that we contend with regularly.”

The shrinking of the foster-care system is an under-appreciated success story for city policymakers and families. The system cared for 40,000 children in 1997, but in the fiscal year that ended this past June, it served just 8,966 kids. Even in recent years, the decreases have been striking. Nearly 1,000 fewer children are in foster care now than were a year ago, and the census has dropped by 31 percent just since Mayor Bloomberg’s last full fiscal year, 2013.

More than 10,000 kids entered foster care in fiscal year 2000. Only 4,177 children entered it in fiscal year 2017. That’s despite the fact that the number of mandated investigations of alleged child abuse or neglect has been stable over that period, and the share of reports that ACS has substantiated has trended higher. Of course, some advocates still believe the numbers in foster care are too high.

In a statement, ACS said its increased use of all types of preventive programs “has paralleled a dramatic decline in the number of New York City children in foster care, suggesting that these up-front interventions are succeeding in keeping children safe while reducing the trauma associated with family separations.”

Next steps

The agency, which has a budget of about $3 billion and spends another $1.8 billion on contracts, is spending $26 million in preventive services in the current budget in an expansion of the effort.

Much of the work of implementing the models at ACS was not about designing the programs themselves but integrating them into the existing system, which meant breaking down bureaucratic stovepipes, setting up mechanisms for getting feedback and scheduling a ton of phone calls. Not everything about the implementation of evidence-based programs was smooth, Casey found. While communication between the agency and providers was good and leadership of the initiative was strong, there was a lot of turnover at the providers, and that made training a more costly effort than expected.

Burger says ACS is reviewing its preventive contracting across the board, and is sensitive to the rise in cost of living and other expenses that providers must absorb. The budget is not the only aspect of the programs that could change in future years: The whole point of evidence-based models is that they respond to new evidence and evolve along with the types of families they serve.

“We do want things that are responsive to the kind of families we see if New York City. You do need to adjust over time. Even in New York City over the past 10 years we’ve seen shifts in the family dynamics,” she adds. A case in point: The number of families who contend with homelessness which, among other challenges, can mean that a family that was receiving services in the Bronx now needs them in Staten Island.

Casey notes that New York’s experience could pave the way for other child-welfare authorities to use evidence-based models more. New York’s size and the diversity of its population could make it complicated to take ideas tested here and replicate them in other places. But Burger believes what ACS has learned does apply to social-service work everywhere. The lesson, for instance, that doing evidence-based models right involves getting a lot of different voices around a very large table, “That’s scalable and generalizable to any policy-making practice,” Burger says.