Strengthening Child Welfare Services
In Baltimore City
University of Baltimore School of Law
Urban Child Symposium
Center for Families, Children & the Courts
The Urban Child in the Child Welfare System:
From Fracture to Fix
Richard P. Barth
School of Social Work
University of Maryland
Baltimore, MD 21201
Disclaimer
• Commissioner, Baltimore City Department
of Social Services Advisory Board, since
2008
Background
• Have been involved with child welfare
services research & analysis since 1978
Four Take Home Points
• Acknowledge the Recent Success of Baltimore City Child Welfare Services
• Improve Parent Training for birth families at removal and point of reunification
• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care
• Help the City End LJ so Baltimore City can become more innovative
Baltimore City DSS Recent Successes
• Two consecutive awards as DHR Local DSS of the Year
(2009, 2010)
• Reductions of children in group care are significant
• Development of Active Youth Advisory Board
• Gaining ground on ultimate conclusion of LJ Consent
Decree
• Nation leading work with local School District to share
emergency contact information
• Growing proportion of MSW-trained child welfare workers
and, now, all supervisors have LCSWs
• < 10% vacancy rate
Parent Education
• 800,000 parents get parent education through CWS each year in the U.S. – If .002% of America‘s children live in Baltimore that‘s
still 1600 families that should get high quality parent training each year
• Evidence based parent education programs have emerged :– Parent Child Interaction Therapy (PCIT)
– The Incredible Years
– Parent education campaigns (Triple P) are growing (perhaps in Baltimore County)
• Common elements approaches to parent education is emerging…
Parent Education II
• Only PCIT actually includes competencies that parents have to demonstrate achieving and that can be provided to the court!
• Yet it is hardly available
• It‘s time for advances in parent education in CWS, generally, and at DSS.
Evidence Based Implementation Requires
Reform of Programs and Processes
• Good new ideas have been developed that could assist CWS
– Parent training is the most developed and needed
• It‘s use will require deep involvement of CWS in implementation:
– We cannot implement them all at once
– We must allocate adequate resources to starting them and to adapting them to CWS populations and practice parameters
– We must also provide extensive supervision during implementation
– Willing partners exist but the support is needed
Child Welfare Services Have Been Dominated
by Attachment Theory
• Attachment theory ostensibly helps to explain
children who are remote, disconnected,
indiscriminant, stuck, and unreciprocating
• The principle of PARSIMONY calls for ―the simplest
and most frugal route of explanation available‖
• Question: Does attachment theory add
something that other newer neuro-psychosocial
interventions do not provide?
8
Past Time to Detach from Attachment
• Our CWS involved
children and families
do not need their own
Freudian-based theory
Arredondo, D., & Edwards, L. P. (2000). Attachment,
bonding, and reciprocal connectedness: Limitations
of attachment theory in juvenile and family court
[Electronic version]. Journal of the Center for
Families, Children, and the Court, 2, 109-127.
Indiscriminate Friendliness From Inhibitory
Control Not Problems with Attachment
Bruce, Tarullo & Gunnar (2009); Pears, Bruce, Fisher, & Kim (2009)
Inhibitory
control, not
attachment
predicts
indiscriminant
friendliness
Risks of Over Use of Attachment Theory
• Barahona case in Florida-- Clear warnings
from CWW and other professionals that the
girl, at least, was not doing well (loosing hair,
depressed, etc).
– Psychological report focused on attachment –
resulting in conclusion that children needed to
stay with Barahona‘s
Risks of Over Use of Attachment Theory
• Recent Audit of cases in Maryland where
children were left with parents with indicated
abuse and neglect… 2 Baltimore City cases in
which court had ordered them to be placed
there despite DSS recommendation
• California study in mid 1990s; families that
indicated that they were ―bonded to young
children‖ and allowed to keep them in care;
20% of children subsequently had 4 or more
moves in the next 3 years
Relationships Matter …
• …but future relationships matter as much
as past relationships
Implement KEEP in Baltimore City
• Parent Management Training-O
• Multi-dimensional Treatment Foster Care-
Adolescents (and MTFC-Pre)
• KEEP (MTFC-lite) and, soon, KEEP-
SAFE, and KEEP-Pre
Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent
training intervention: model description and effectiveness. [Article]. Child & Family
Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x
MTFC-Pre Intervention
Child NeedsCaregiver-Child
RelationshipCase Management
Foster Parent
Consultant
Family Therapist
‗Daily Report‘ Caller
Case Manager
Child Therapist
Behavioral Skills
Trainer
Child Psychiatrist
STAFF
KEEP Intervention
Caregiver-Child
Relationship
Foster Parent Consultant
Foster Parent Behavioral Groups
‗Parent Daily (WEEKLY) Report‘
(PDR) Caller
Which Foster Care Placements Disrupt?
Number of behavior
problems per day on PDR
After 6, every additional
behavior problem increases
probability of disruption by 25%
within next 6 months
7
8
9
10
11
1 2 3 4 5 6KEEP is very good
at keeping behavior
problems in the 3, 4,
and 5 range
Effect Of Prior Out-of-home Placements On
Placement Moves: MTFC-P Vs. Regular FC
(Fisher, Burraston, & Pears, 2005)
RFC
MTFC-P
Predicted Probability Of Negative Exit By
Prior Placements and Intervention Group
KEEP
0
5
10
15
20
Negative Exit Positive Exit
Per
cen
tag
e
Percentages of Exit Type by Group
KEEP
KEEP Implications
• Investing in therapeutic interventions that
change physiology and behavior may make
it more likely that the improved behavior will
be sustained
• KEEP could become a prototype for
adoptive parent support—it is much more
likely to matter than PRIDE or MAPP which
have no parenting support component
End LJ (Now that Results are In)
• Baltimore DSS has worked heroically to end
the LJ consent decree
– Many performance indicators are now achieved
– More need to be accomplished
• The State of Maryland should not continue to
pursue and end to the lawsuit in court—the end
should come under mutual agreement with the
plaintiff
• Ending LJ will give Baltimore City even more
chance to innovate
Four Take Home Points
• Acknowledge the Recent Success of Baltimore City Child Welfare Services
• Improve Parent Training for birth families at removal and point of reunification
• Implement KEEP to support foster and adoptive parents, reduce placement instability, and increase positive exits from care
• Help the City End LJ so Baltimore City can become more innovative
Partial References Ahn, H. N., & Wampold, B. E. (2001). Where oh where are the specific ingredients? A meta-
analysis of component studies in counseling and psychotherapy. Journal of Counseling Psychology, 48, 251-257.
Barth, R. P., & Miller, J. (2001). Building effective post-adoption services: What are the empirical foundations? Family Relations, 49, 447-455.
Barth, R. P., Crea, T. M., John, K., Thoburn, J., & Quinton, D. (2005). Beyond attachment
theory and therapy: Towards sensitive and evidence-based interventions with foster and
adoptive families in distress. Child and Family Social Work, 10, 257-268.
Berry, M., Propp, J., & Martens, P. (2007). The use of intensive family preservation services with adoptive families. Child & Family Social Work, 12(1), 43-53.
Brooks, D. & Barth, R.P. (1999). Adjustment outcomes of adult transracial and inracial adoptees: Effects of race, gender, adoptive family structure, and placement history. American Journal of Orthopsychiatry, 69, 87-102.
Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 66, 624-633.
Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? [Article]. Child Abuse & Neglect, 30(4), 409-424. doi: 10.1016/j.chiabu.2005.11.004
Chorpita, B. F., & Viesselman, J. O. (2005). Staying in the clinical ballpark while running the evidence bases. Journal of the American Academy of Child and Adolescent Psychiatry, 44(11), 1193-1197.
Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46(5), 647-652.
Partial References Cohen, J. A., Mannarino, A. P., Zhitova, A. C., & Capone, M. E. (2003). Treating child
abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27(12), 1345-1365.
Fisher, P. A., Gunnar, M. R., Dozier, M., Bruce, J., & Pears, K. C. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. In Resilience in Children (Vol. 1094, pp. 215-225).
Foulkes Coakley, J. (2005). Finalized adoption disruption: A family perspective. Unpublished manuscript, University of California at Berkeley.
Gibbs, D., Barth, R. P., & Houts, R. (2005). Family characteristics and dynamics among families receiving post-adoption services. Families in Society, 86, 520-532.
Goerge, R.M., Howard, E.C., Yu, D., Radmosky, S. (1995). Adoption, disruption, and displccement in the child welfare system (1976-1995). Chicago: Chapin Hall Center for Children at the University of Chicago.
Price, J., & Chamberlain, P. (2005). A parent-mediated intervention for elementary-aged children in foster care: Child problem behavior changes and placement outcomes: Manuscript in preparation.
Price, J. M., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster-parent training intervention: model description and effectiveness. [Article]. Child & Family Social Work, 14(2), 233-242. doi: 10.1111/j.1365-2206.2009.00627.x
Smith, S. L., Howard, J. A., Garnier, P. C., & Ryan, S. D. (2006). Where Are We Now?: A Post-ASFA Examination of Adoption Disruption. Adoption Quarterly, 9, 19-44.
Wind, L. H., Brooks, D., & Barth, R. P. (2007). Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions*
doi:10.1111/j.1741-3729.2007.00467.x. Family Relations, 56(4), 378-389.