By: Deborah Daro, Senior Research Fellow
Chapin Hall at the University of Chicago
The Family First Prevention and Services Act (FFPSA) (Family First) represents an opportunity to bridge the historic gap between interventions to resolve unhealthy parenting practices and behaviors and programs designed to prevent these behaviors from developing. Creating a shared understanding that treatment and prevention are mutually reinforcing would move us closer to an equitable and just balance among the goals of child safety, child development, and parental autonomy. The trick in accomplishing this integrated effort, however, is determining how best to shift Title IV-E funds from foster care reimbursements to supporting direct services to improve parent and child outcomes.
Two factors are central to making this strategy work – selecting the right target populations and investing in those prevention options most likely to successfully reach and serve these target populations. In discerning which families are the most appropriate recipients for Family First investments, there is an unsolved tension in the legislation between targeting these investments to children who are identified by the child welfare system as “candidates for foster care” versus broadening the access portal to include parents at who have not formally entered the system but are at high risk of mistreating their children. Other populations likely to qualify for these service investments include children in unstable adoption situations and pregnant or parenting foster youth.
The potential role early home visiting services might play within this new Family First system will depend upon how states resolve the target population issue. Not all home visiting programs working with young children are equally beneficial for all families. The current three evidence-based home visiting models being considered by the Family First Clearinghouse (Healthy Families America, Parents as Teachers and Nurse Family Partnership) are great fits for working with adoptive families in crisis (assuming the child is an infant or toddler) and for pregnant and parenting foster youth. All three of these models are widely available in many states and have established strong track records with young families. They strengthen parental capacity and enhance child outcomes. Although many of the families served by these models face significant personal and situational challenges, it is less clear these models have as strong a track record engaging and successfully supporting families currently involved in the child welfare system.
There are other evidence-based home visiting models, however, that have deeper experience with child welfare populations including those who have been identified as likely foster care candidates. Three programs – Attachment and Biobehavioral Catch-Up (ABC), Child First, and SafeCare — all have robust evidence of effectiveness in engaging these populations and achieving outcomes. And all are “evidence based” as defined by the federal Maternal Infant and Child Early Home Visiting (MIECHV) initiative, suggesting a high likelihood of approval under the Family First Clearinghouse selection criteria. Specific features of these models include:
- ABC: a 10-session home visiting model designed to enhance parental sensitivity and enhance child attachment security and regulatory capabilities. It has been successfully offered to foster parents and birth parents for children 0-5. ( www.abcintervention.org)
- Child First: a 6-12 month intervention, targeting prenatal women and those with children under the age of five that blends parent guidance and dyadic, psychotherapeutic treatment. The program targets children with emotional/behavioral or developmental/learning problems and families with multiple challenges. (www.childfirst.org)
- SafeCare: a parent-skills training program that addresses three key risk factors associated with child maltreatment – parent-child relationships, home safety, and insuring a child’s health. Each topic is addressed in a 6 session module, with all three modules being delivered in 4 to 6 months. The program has been developed for and successfully served families with substantiated cases of maltreatment and other issues placing them at high risk of out-of-home placement. (www.safecare.org)
All three models meet the qualification criteria established by the Children’s Bureau for using Title IV-E dollars: they have been the subject of randomized controlled trials, with the findings well documented in multiple peer review journals; they have demonstrated a history of working with child welfare agencies and child welfare-involved populations; they can be successfully delivered within the recommended 12 month widow; and they offer a strong replication package including manualized operational guidelines, training protocols and supervisory systems.
Many families reported to the child welfare agencies are rearing their children in conditions fraught with parenting challenges and safety concerns far beyond what any specific parenting program can hope to resolve, regardless of rigor and quality. Removing children from these environments will remain an unavoidable choice in certain instances. That said, the frequency of this outcome can be reduce by the thoughtful adoption of home visiting programs that fit the challenges these families face. The three models described in this post, coupled with the three models currently under review by the clearinghouse, offer child welfare agencies a strong set of options to advance the Family First mission.
For additional information on ABC, Child First and SafeCare see:
Chaffin, M., Hecht, D., Bard, D., Silovsky, J.F., & Beasley, W.H. (2012). A statewide trial of SafeCare home-based services model with parents in child protective services. Pediatrics, 129(3), 509-515.
Crusto, C.A. Lowell, D.I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S. R., & Kaufman, J. S. (2008). Evaluation of a Wraparound process for children exposed to family violence. Best Practices in Mental Health: An International Journal, 4(1), 1-18.
Dozier, M., & Bernard, K. (2017). Attachment and Biobehavioral Catch-up: Addressing the needs of infants and toddlers exposed to inadequate or problematic caregiving. Current Opinion in Psychology, 15, 111-117.
Gershater-Molko, R.M., Lutzker, J.R., & Wesch, D. (2002). Using recidivism data to evaluate Project SafeCare: Teaching bonding, safety and healthcare skills to parents. Child Maltreatment, 7(3), 277-285.
Lind, T., Raby, L., & Dozier, M. (2017). Attachment and Biobehavioral Catch-up effects on foster toddler executive functioning: Results of a randomized clinical trial. Development and Psychopathology, 29, 575-586.
Lowell, D.I., Carter, A.S., Godoy, L., Paulicin, B., & Briggs-Gowan, M.J. (2011). A randomized controlled trial of Child First: A comprehensive, home-based intervention translating research into early childhood practice. Child Development, 82(1), 193-208.
Attachment and Biobehavioral Catch-up (ABC) uses carefully tested and delineated active ingredients to enhance sensitive parenting among parents of young children who have experienced adversity. Manualized session content introduces ABC-targeted behaviors to help parents: nurture the distressed infant, follow the infant’s lead, and avoiding intrusive and frightening behaviors. Throughout all sessions ABC providers deliver real-time feedback (i.e., in-the-moment commenting) to reinforce parent use of the targeted behaviors. Providers receive weekly supervision for one year after the initial 2-day training, and their in-the-moment commenting provides a strong assessment of fidelity to ABC.
Several randomized clinical trials have indicated that, after completing the 10-session ABC sessions, improvements are seen in both children’s and parents’ behavioral and biological functioning, with results sustained 8-10 years after the intervention. ABC has been disseminated in 18 states and 8 countries. Through these dissemination efforts, ABC staff at the University of Delaware have forged strong collaborations with several organizations, including nonprofit agencies serving families referred from Child Protective Services, local child welfare offices, Early Head Start, residential treatment centers, and early intervention programs. Program evaluation data have demonstrated that changes in parental sensitivity are as large in dissemination sites as seen in the randomized clinical trials.