Monthly Archives: October 2014

Family Preservation Services and Ebola

ebola On Saturday, October 18, 2014, I woke up at 8:30 AM with the thought: “What can IFPS staff do to protect themselves from this deadly disease called Ebola?” While it is pretty strange that this was the first thing that came to my mind, it makes sense to think about it as the majority of our work with the IFPS families is in their natural environment.

What are the Risks for IFPS Staff?

The media attention on Ebola reminds us that it is important to educate ourselves, and in some cases, our IFPS client families about contagious diseases, how they are transmitted, and what steps we can take to protect ourselves. The majority of IFPS workers will never be in a situation that puts them at risk of Ebola but there are many highly contagious diseases that we are more likely to come in contact with: colds, flu, pneumonia, gastrointestinal diseases, pink eye and skin infections, lice, measles, mumps and chicken pox. We’re entering the flu season and the holidays are approaching. People are more likely to get sick at this time of year.

In IFPS we teach our clients strategies for prevention and we intervene as needed. These are the same steps for minimizing the spread of infectious diseases. Prevent whenever possible and seek medical intervention as needed. You can teach and model these strategies for your clients.

General Guidelines for Protection and Prevention

Wash your hands with soap and water. When you can’t wash your hands, use hand sanitizer.
Keep yourself and your family current on flu and other vaccinations.
Take care of yourself: eat well, get enough sleep and take breaks when you aren’t with clients.
Stay home if you get sick, especially if you have a fever or are vomiting.
Pay attention to outbreaks such as norovirus or chicken pox or flu—in your own community as well as your clients’.

Another important prevention strategy is to learn if anyone in your client families has traveled overseas or has been in contact with contagious diseases such as malaria, parasites, tuberculosis, tropical diseases or Ebola.

On the Subject of Ebola…

Few, if any, IFPS workers will ever be a situation that puts them at risk of Ebola. There have been very few cases in the United States. The highest risk is for healthcare workers caring for Ebola patients and family and friends of those patients.

According to the Centers for Disease Control and Prevention (CDC): “All cases of human illness or death from Ebola have occurred in Africa (with the exception of several laboratory contamination cases: one in England and two in Russia). One travel-associated case was diagnosed in the United States on September 30, 2014. On October 12, 2014, a healthcare worker at Texas Presbyterian Hospital who provided care for the index patient has tested positive for Ebola. CDC confirms that the healthcare worker is positive for Ebola.” www.cdc.gov/vhf/ebola/exposure

“Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, chimpanzees). Ebola is caused by infection with a virus of the family Filoviridae genus Ebolavirus… Ebola viruses are found in several African countries. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. The natural reservoir host of Ebola virus remains unknown. However, on the basis of evidence and the nature of similar viruses, researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa.” www.cdc.gov/vhf/ebola/

Symptoms of Ebola according to the CDC website:

Fever
Severe headache
Muscle pain
Weakness
Diarrhea
Vomiting
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)

“Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.” www.cdc.gov/vhf/ebola/symptoms

Prevention

The following are steps prevent the spread of the Ebola virus:

Wash your hands at all times with anti-bacteria soap or use hand sanitizer with alcohol-base
Avoid contact with blood and body fluids of any person, particularly someone who is sick
Do not handle items that may have come in contact with an infected person’s blood or body fluids.
Do not touch the body of someone who has died from Ebola.
Seek immediate medical care if you develop a fever (100.4 F/38.0 C or higher), headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
The CDC website has a checklist for health care workers that provides additional information: http://www.cdc.gov/vhf/ebola/pdf/could-it-be-ebola.pdf

For more information about Ebola, please visit the CDC website: www.cdc.gov/vhf/ebola/

Posted by: Moneefah D. Jackson

moneefah-jackson

Field Placement Experiences in IFPS

Peg Markworth When I was getting my Masters in Social Work, my advisor suggested a field placement at Homebuilders™. At that point I had no idea what Homebuilders™ was, what kinds of interventions they provided, or what skills I might learn. I’d never actually worked with a family in their home. It turned out to be an incredible experience—an introduction to a set of values about families as well as the opportunity to learn skills and interventions that truly helped families. That was the start of my IFPS career. After I finished my MSW I went to work for Homebuilders™. A few years later I joined the Family Preservation Practice Project, a collaboration between the University of Washington School of Social Work and Behavioral Sciences Institute, which developed the Homebuilders™ program. That project gave me the opportunity to have one foot in the clinical side and one foot in the academic side of IFPS.

The Family Preservation Practice Project offered a group of MSW students a concentration of studies in Family Preservation Services. I worked with staff and faculty from the School of Social Work to develop curriculum that taught the philosophy, theory, research, and skills of family preservation. Each student in the project had a field placement at Homebuilders™. Although Homebuilders™ had offered field placements for a number of years, the project offered an opportunity to hone that experience for students by adding Master’s level courses in conjunction with field placements.

One of the goals of the project was to develop students who could step easily into family preservation programs. At the same time we recognized that some students in the Family Preservation Practice Project would not continue in this field, but would go on to other jobs in other clinical situations. We quickly realized they would do so with an understanding of the value of IFPS and a set of skills that would serve them well in their chosen practice.

The structure of IFPS, its focus on evidence-based practice and the intensity of the intervention created a unique experience for these students. The Family Preservation Practice Project, through its curriculum and classroom experience, prepared students for their field placement experience. The field placement broadened, accelerated and integrated the classroom learning.

Certainly, the focus of the field placement was to provide an opportunity for students to put what they were learning in the classroom into practice, but it wasn’t a direct translation. The students learned what it means to walk into a family’s home with the ability to respond to what was going on that day—to understand that you may have a plan but the situation might need another direction. Students learned to have the flexibility to step back and say, for example, “Here, give me the broom. I’ll sweep the floor while you change the baby’s diapers. Don’t worry about it. Yes, we have an appointment, but we can do this while we talk.” For many students, that ability was a major step to take—to understand what it means to be present with a family, while observing, teaching and helping them go through their day-to-day life.

We had the advantage in The Family Preservation Practice Project of having Homebuilders™ therapists—very experienced Homebuilders™ therapists—teaching and guiding students through their field placements.

One of the things we heard from those students was that an amazing part of the experience was having a relationship with practicum instructors who were: 1) skilled practitioners on the front line, 2) who fully understood the integration of theory and practice, and 3) were skills-based and evidence-based in how they thought, approached students, and worked with families.

Students in the Family Preservation Practice Project came in with a real interest in family preservation but no real understanding of the evidence-based Homebuilders™ model. They graduated from the program after going through both the classroom process and the field placement with an understanding of:

The rationale for family preservation services
Current policy context and policy initiatives for family preservation
The value base of family preservation
Theory bases underlying family preservation
Theoretical and practical knowledge of the Homebuilders model™
Culturally responsive family preservation practice
Basic skills needed by family preservation practitioners

Posted by Peg Marckworth

A Bibliography of Intensive Family Preservation Services

The 40th Anniversary of IFPS provided an opportunity to compile a bibliography that best represents the history, impact, and effectiveness of intensive family preservation services. We want everyone involved in IFPS to be aware of the most important documents in this field. You can view the IPFS biography here.

bibliography-lineup

History of IFPS
Let’s begin with the history of IFPS. Portions of the earliest history of IFPS have now been preserved through reflections of the key players, and are available on the IFPS Website here.

And then there is IFPS—the movie! PBS did a special documentary on IFPS in 1992.

In the early days IFPS had its own publication, the Family Preservation Journal. All of the journal articles have been digitized and can be accessed for free. It’s a quick and easy way to review much of the history of IFPS. Here is the link to the first issue: (PDF, 10.6 MB)

Impact of IFPS
How did we know if IFPS was having an impact in “pre-viral” times? Take a look in the bibliography at the prestigious groups that wrote about IFPS:

Child Welfare League of America
Children’s Defense Fund
National Conference of State Legislatures
Center for the Study of Social Policy
Universities
Media

The articles by Frank Farrow and Jim Whittaker provide good summaries of the impact of IFPS.

Effectiveness of IFPS
And, let’s not overlook the importance of the research that has established the effectiveness of IFPS. A lot of the early research is captured in the Family Preservation Journal. The gold standard for research—random control trials—was first conducted by Betty Blythe in Michigan, and you won’t want to miss reading the summary of the outstanding results.

Ray Kirk has conducted frequent studies of IFPS over the past two decades. Read Dr. Kirk’s seminal findings on IFPS here.

Last Word on Bibliographies
A bibliography is like a treasure that you unearth in your back yard: a pleasant surprise you weren’t looking for that becomes a valued keepsake you look at frequently!
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Posted by Priscilla Martens, Director, National Family Preservation Network

Patrick McCarthy, Remarks at the IFPS 40th Anniversary, July 18, 2014

patrick-mccarthy I have to start with a disclaimer. Not only am I not the most qualified person in this room, by a long shot, to do a summary of everything that’s happening over the child welfare horizon, I’m not even the best person in the room from the Annie E. Casey Foundation to do this. Tracey Feild directs our Child Welfare Strategy Group and she knows an awful lot about this. I tried to give her wrong directions about how to get here so she wouldn’t have to sit through this, but she’s doing it anyway. So here I am and, in the next few minutes, I’m hoping to touch on some of the important developments I see going forward. I’ll stay at the tops-of-the-trees level and I’ll start with front-line practice.

As we’ve been discussing, there seems to be a reignited interest in intensive family-based services. Along with this I see a veritable explosion of interest in evidence-based interventions and in the related issues of fidelity and implementation science. I think this trend is worth encouraging if we get it right.

These evidence-based interventions are taking advantage of what we’re learning about brain development, about trauma, and about toxic stress and applying these science-based insights to child welfare practice. That is awfully important. I also think we’re starting to see more recognition of the importance of training and other supports to ensure fidelity in implementation of skills that all or most evidence-based practices are calling upon.

What I mean here is that, if you look across the many specific, brand-name models and their dedicated manuals tied to discrete interventions, you see common themes. For me the best example is family engagement because it is core to just about everything else and so many evidence-based interventions, appropriately, put a lot of emphasis on getting that right. So what people are starting to figure out is how to train staff in those skills so that when a child or a family walks in with a particular problem that may not be exactly what one or another specific evidence-based intervention deals with, staff have the skills to help that are based on well-tested and well-developed approaches.

Team decision-making, which in its early days I think we would have talked about more as an administrative approach than a front-line practice, is now becoming much more focused on the practice skills to do it well. So it’s no longer just a check-the-box, we had a team decision-making meeting kind of thing, but it is coming increasingly under the heading of an important part of front-line practice and more attention is being paid to the actual quality of the practice.

We’ve been talking today about the increased focus on child well-being and along with that I’m seeing a reignited interest in measuring child well-being. If done properly, and we’re experimenting with this at Annie E. Casey, we can do a better job of matching both services and service provider to particular kinds of presenting issues and tracking who does what well. It would take a whole other conference to go deep enough on this, but I think we’re getting much closer than we were before to looking at which children ought to be in which kind of service for what kind of purpose.

An often neglected yet critically important element in good practice—and we haven’t talked much about it here—is ensuring that families have quality legal representation. Legal representation is an intervention that, all by itself, can change the game in terms of family and family voice.

The field has focused increasingly on kinship care, but in recent years I think we’re recognizing the need to go much deeper on what it takes to do it right. Instead of just placing a child in a kinship setting and then saying “OK, let us know if there’s a problem,” I see more thinking about what it takes to really support kin so they can be successful.

I see a whole range of practices emerging around older youth. As you know well, the experience of older youth in the system is very, very different than the experience of young children. Most of the data that we look at show that the older youth are coming in with a different set of problems, and I think we’re starting to understand what it takes to work with these older youth and their families.

Related to that, and this is a big, big, big issue for Annie E. Casey, is reducing reliance on congregate care. Use of it varies from under 5% of all the children in care in some states to over 30%, and I just can’t believe that the children in State X are that much different from the children in State Y. So that’s another big initiative for us.

Somewhat related to this, there is a whole range of financing issues that we are working on and advocating for. We think there are federal financing strategies that, if adopted, could actually drive down congregate care and deal with some of the length-of-stay issues.

One of the things that family preservation helped us do was to pay attention to the concrete and material needs of families. I think that is part of the reason that today we are seeing new models in supportive housing. Since housing and poverty drive so much of placement, if you can have a more effective supportive housing system in place, you can prevent lots of placements and get better outcomes for children.

This next one is a bit weird in some ways but hear me out. We’ve developed a family-based information system and I know we don’t often think of that as part of the equation. But a bad system trumps a good program any day of the week and if you don’t have good data and the data is not family-based, you won’t be thinking about families in the same way. So we’ve developed a Facebook-type information system that Indiana—and they are here—is the first state to use statewide in its child welfare system

I’m going to end by raising an issue that goes well beyond child welfare. One of the things that I think Peter [Forsythe] and others really did in launching the family preservation movement was to change the narrative, to change how we think about families who are at very high risk of coming to the attention of Child Welfare. I think the next frontier is actually an even more ambitious change in the narrative.

Back then, there was this tendency – and I think it still lingers – to see families as being in trouble because of what the rest of us saw as bad choices or bad character or bad parents, etc. What has happened in the intervening 25 years is that the economy has been really, really tough on working families. It has been so tough on working families that the group of families that are at risk of coming to the attention of child welfare has expanded exponentially. Now, as many as 45% of the children in our country are at risk because their families are facing circumstances that undermine even the best efforts to meet their children’s needs.

I grew up in a neighborhood where everyone was working class and no one had gone to college but pretty much everybody did okay. The reality would be far different in that same neighborhood today. Because of the erosion in earning power and undermining of financial security for lower income families, both of my parents and all my friends’ parents would be working multiple jobs. We would see an increase in family stress and a decrease in the bandwidth parents have for their children. We would see erosion in neighborhood ties. I would be growing up much poorer, more isolated, less likely to benefit from social supports beyond my family. This is the reality for as many as 45% of our nation’s children. I think we have to challenge ourselves to recognize how many families who come to the attention of the child welfare or other public systems find themselves in trouble not because of bad choices or flawed characters, but because we have failed to provide the supports many families now need to make it.

That’s my quick summary tour.