Journal Issue: Protecting Children from Abuse and Neglect Volume 8 Number 1 Spring 1998
Challenges of Service Planning and Delivery
Efforts to increase the focus on family-centered community-based services as a means of protecting children confront a number of substantial and far-reaching challenges. Key operational issues arise for family-centered services in the areas of planning, financing, and targeting services, as well as enhancing relationships between families and workers.Planning for Family-Centered Services
Increasingly, the staff of public child welfare agencies have been drawn into collaborative efforts to reform the ways that services are delivered to children and families. Currently, numerous service systems assist the same families and children, and no one system has overall responsibility for the child or for helping the child's family. For instance, a child's aggressive behavior may be the responsibility of the mental health system, his failing grades the responsibility of the school, his asthma the responsibility of the health care system, and his abuse the responsibility of the protective service system. Examples of system reform initiatives include efforts to use the schools as delivery sites for health, family support, and social services; and "wraparound" community-based supportive services that assist children and their families as they exit from mental health, child welfare, or correctional systems.54
Often, these initiatives draw together community groups and human service agencies that seek to develop family-centered, community-based, preventive, culturally competent, results-oriented services that are flexible and accessible to families and children. Stronger relationships with these providers help the child welfare system gain access to needed services for families; and better linkages with parents, community members, and community-based organizations help assure that services are appropriate and will enhance the well-being of children and families. Perhaps most important, efforts that integrate social supports and services with economic and community development strategies help to build community.
The comprehensive, broad-based planning process required by the Family Preservation and Support Services Program (Public Law 103-66) contributes to collaborative service delivery. This legislation authorized states to develop coordinated planning approaches that included a number of voices not usually involved in planning for child welfare services, including parents, consumers, businesses, civic groups, and professionals from other disciplines and agencies (for example, child care, mental health, juvenile justice, schools). Recognizing the importance of community context, federal and state governments called for broad community participation at the local level, and the law allowed diversity in program design to meet the different needs expressed by community participants. In many jurisdictions, this process has yielded new state and local partnerships and a service infrastructure to support continuing development of family-centered services.13 Despite this progress, however, many challenges to operating and maintaining family-centered services still lie ahead. Indeed, the most critical challenge may be that of financing these services over the long term.Financing Family-Centered Services
In a system built on separate categorical funding streams that address different aspects of family life, financing family-centered services (which span a number of different disciplines) is a dilemma. Social services of different types are financed through a patchwork of federal, state, local, charitable, and fee-for-service dollars that differ from one locality to another. For example, child welfare is largely financed by federal foster care dollars, while mental health services are largely funded by state and local tax dollars. (See the discussion of federal programs funding child welfare in the article by Courtney in this journal issue.) The states have considerable discretion to decide how to use federal funds, and how generously to augment those funds with state and local tax dollars.
Local nonprofit agencies that provide social services for families and children are funded by a combination of government contracts and grants, foundation grants, fees for service, and charitable donations. For example, in Los Angeles County, there are more than 1,100 separate nonprofit agencies providing social services to families and children, with total average annual expenditures of more than $1 billion. Their efforts supplement those of the more than 90 county-run programs for families and children, which spend about $4 billion annually.55
Family-centered programs, in particular, have generally been funded through federal funds (especially Title XX, the Social Services Block Grant, and Title IV-B, the Child Welfare Services Program), state discretionary funding, foundation grants, and charitable donations. A recent report by the U.S. General Accounting Office (GAO)10 points out that while there is great diversity among the states in the funding streams they tap to support family-centered services, available funds are generally inadequate to meet increasing demands. The passage of Public Law 103-66 was a major achievement because it designated a specific federal funding stream to support family-centered services. While the reauthorization of these services in 1997 through Public Law 105-89 indicates continuing federal interest in family-centered approaches, many local child protection agencies still do not have stable, long-term funding mechanisms in place for these services.Targeting Services for Families
Another major challenge faced by child welfare professionals is the fact that the prevention and early intervention services that might help families resolve their problems before maltreatment occurs are, in many communities, the very services that have been lost during the past two decades of service cutbacks. In an era of increasing need and decreasing resources for social services, agencies in most communities have had to focus services on families with the most serious problems at the expense of "discretionary" services, which include prevention. Many service agencies have tightened eligibility criteria, or have such long waiting lists that families despair of ever getting help. In contrast, child protective services are open to all and remain one of the few social services to which families with children are "entitled." Thus, the protective services system is often the only door through which families who may need help can access services.
As a result, families served by the protective services system include those with deep intransigent parenting and other problems (including developmental disabilities, serious emotional problems, health crises, poor education, and little earning potential), as well as those who need only temporary assistance or help with parenting skills to provide more appropriate care for their children. Child welfare agencies are struggling to develop more effective assessment strategies to better target their services to needy families. (See the article by English in this journal issue.) Unfortunately, most lack an information base that can link family conditions and characteristics with service planning to ensure more effective outcomes. Without such information systems, the field is left with what one author called "a decision-making process that relies on what interventions are available, since it is not always clear what is needed. . . ."56
Without timely and accurate assessment of family strengths and needs, it is difficult for workers to take advantage of the continuum of services that are available and to plan services for individual families.57 Better data collection systems could connect assessment information, intervention, and service experiences with family and child outcomes, to learn which families do best with which services over time. For such longitudinal data gathering efforts to be successful, however, agreement is needed on indicators that should be used to judge the success of child and family services.58 (See Box 1 for a discussion of the difficulty of identifying appropriate outcomes for family support and preservation services.)Relationships Between Families and Workers
Another key challenge facing child welfare services is that of building more effective relationships between families and workers. As the child welfare system is currently designed, public agency social workers often play both policing and helping roles with the same family. One critic has argued that these are such disparate functions that the public child welfare system cannot do both: "A system that investigates parents for wrongdoing cannot be supportive of families, and a system that separates children from families cannot promote family preservation."59 (See the commentary by Pelton in this journal issue.)
Others believe that it is possible to build relationships that allow problem solving with parents while still protecting the safety and interests of children.60 In some cases, the public agency worker plays an authoritarian role with the family, while workers in community-based agencies play the role of advocate for the family. (See the discussion of community-based partnerships in the article by Waldfogel and in the commentary by Weber in this journal issue.) Other programs rely on service contracts developed jointly by worker and client. Their experiences show that even parents who are "involuntary" service recipients can often decide which services are in their child's and their own best interest.47 Such joint decision making usually occurs because worker and parent have developed a relationship that allows for genuine communication.
As noted earlier, family-centered practice is based on respect for the integrity and strengths of families and their members, and on the belief that individuals can find solutions to their own problems through relationships with engaged and committed service providers. A recent evaluation of family-centered family preservation services in Los Angeles completed by the authors,47 and an earlier study in New York,61 both suggest that the relationship between the worker and the family is more critical to service success than service length, intensity, or worker caseload.
Of course, if it is to be feasible for workers to develop close relationships with families, they need to have manageable caseloads, adequate training and supervision, and sufficient time to focus on the families they are trying to help. In addition, a commitment to the philosophy and values of family-centered services appears to play a key role in fostering the formation of such relationships.