Child Neglect Demonstration Projects: Synthesis of Lessons Learned

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You are in section: Table of Contents 1 - Overview of Services and … 2 - Common Challenges/Succesful … 3 - Lessons Learned 4 - Conclusion 5 - Appendix A 6 - Appendix B

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2. Common Challenges/Successful Strategies

Despite the many differences in program design, services, and target population, grantees experienced a number of common challenges associated with addressing families' needs, engaging families, employing qualified staff, and sustaining the programs themselves. Details of these challenges and the strategies programs used or recommended to overcome them follow.

2.1 Addressing Families' Needs

The causes of child neglect are multiple and complex.⁷ Families at risk for neglect face serious challenges. Most live in poverty with few resources available to them. Many neglectful families experience frequent crises, such as eviction, job loss, domestic and neighborhood violence, physical and mental illness, substance abuse, and involvement with the child welfare and legal systems. Children who are neglected often experience negative long-term consequences, including developmental and neurological deficits; poor health; and social, emotional, and academic problems. At the same time, each family is unique. Neglect may be chronic or a single occurrence, severe or mild. Personal and environmental factors vary widely and affect the types of services and supports each family needs. Strategies to address these serious challenges included the following:

• Assess needs. Conduct a thorough initial assessment of the child, parent/caregiver, family, and community/environment to determine strengths and needs. One program conducted screenings and assessments during parent support groups when children were in child care. Reassess and review often, and then revise service plans as needs change. Some programs found an interval of every 10 to 12 weeks to be effective.
• Address crises. If the need is urgent, make initial telephone contact within 24 hours of referral in order to prevent or reduce the severity of a crisis. Some programs provided a 24-hour help/advice line to afford stabilization during crises, which often occur after regular business hours.
• Customize services and be flexible. Develop individual service plans that combine prevention, intervention, and treatment as needed. Grantees suggested flexibility as to time, place (including home- and center-based services), content, length, and intensity of services, always based on each family's needs. In parenting education and support groups, be flexible with the curriculum. Address the most urgent needs first (e.g., domestic violence, postpartum depression, welfare-to-work issues), while presenting information and developing skills as opportunities arise.
• Focus on poverty issues. Some programs provided education, job training, employment, child care, and transportation to interviews to help families work their way out of poverty. Others suggested working with community members to advocate for systemic change to address financial issues that lead some families to be at greater risk for neglect.
• Offer or refer to a broad array of services. Offer multiple core components (e.g., assessment, emergency services, case management, parenting education, and support groups). Make referrals to and provide assistance accessing other resources and supports in the community (e.g., cash assistance and other concrete resources, mental health and substance abuse treatment, transportation, and child and respite care). One program effectively addressed potentially overwhelming problems by having the core (parent education) program integrated physically and programmatically in a medical center with strong links to government agencies and the foster care system. Another program used an automated and continually updated resource directory to ensure high-quality referrals. Use of case management and documentation was recommended to keep all disciplines and multiple providers working with each family aware of the same information.
• Address children's needs. One program reported good results using a center-based preschool (10 months, 5 full days per week) and psychosocial model combined with bimonthly home visits and multiple family groups. Another program found children did better when parents received professional behavior management training and the children and their families received intensive psychotherapeutic services.
• Offer services for older youth. Neglected older children and youth may carry a lot of anger and "act out" in response to feelings of abandonment, loss of control, and identity confusion. Provide youth with positive cultural exposure such as chaperoned travel; recreational, educational, and mentoring activities; workshops on life-planning; and individual counseling. Working with the whole family to improve communication and understanding was found to be especially helpful for older youth who had been neglected.
• Provide intensive, long-term services. Assign small caseloads to facilitate intense interventions. Intensive services for 6 months to 1 year (longer if necessary) were found to be more effective in engaging families and effecting change at individual and family levels.⁸ The lack of a specific time limit on services was found to reduce pressure on workers and families and allow families to pace themselves, working on issues as they arose, as time and energy permitted, with time out for crises.
• Deliver aftercare services. Follow-up services provided after the intensive service component were found to help monitor progress, maintain improved child and family well-being, and support implementation of a long-term plan to develop self-reliance.

2.2 Engaging Families

Most of the programs struggled to recruit, enroll, and retain participants. Programs reported that many families had transient living arrangements, reported frequent scheduling conflicts, and were difficult to contact (e.g., no telephones). Many families had a long history of unsuccessful involvement with service agencies, usually lasting too short a time for meaningful change to occur. Thus, it was found to be necessary to build intensive, ongoing recruitment and retention activities into the program. Strategies for engaging families included the following:

• Do not rely solely on CPS for referrals. Reports of child neglect are least likely to meet the threshold for CPS investigation or intervention, so relying solely on CPS for referrals could result in failure to meet the needs of many families.⁹ Programs sought additional referrals from the medical provider community, a help/advice line, other clients, and through positive local media coverage of the program and its participants. Voluntary participation is often a key to success, so establish a system in which there are no adverse consequences for refusing services.
• Invest in intensive, strategic outreach to new referrals. Engage families at times and in places that are most convenient for them. One program experienced a high degree of success with a strategy to initiate two home visits, two school visits, one intervention meeting, and three phone contacts during the first month.
• Develop relationships with families. Focus on developing relationships with the family during initial intake, assessment, and screening. Many families prefer to start out individually rather than as part of a group. One program had success by having home visitors connect with families prenatally. Maintain long-term partnerships with families (e.g., semi-annual family gatherings for all former and current families). Work with the whole family, including intensive efforts to engage fathers. Grantees also found certain staffing strategies had an impact on family engagement; these are described in Section 2.3 and in "Lessons Learned."
• Start with concrete services. Program design needs to provide early access to concrete services, such as financial benefits assistance, housing assistance, food banks, and transportation. Most clients are more likely to follow up on referrals for life-sustaining services than on services requiring them to engage in a change process.
• Be culturally competent. Employ service providers who "look like" the families they serve and who have knowledge of the community. In several programs where most of the families served were African American, direct service staff, mentors, and advisory board members were also African American. A program serving a largely Latino population hired two bilingual staff. A relationship-focused treatment model used by another program proved to be culturally appropriate and successful for the African American families it served.
• Meet in a safe place. In one high-risk urban area, group meetings were held in the police athletic league community center. A safe place with classroom and playgroup areas, the center also provided educational and social resources for participants.
• Offer transportation. Most programs found that providing transportation is essential for participation in group events. An alternative to providing transportation is to hold meetings in locations accessible by public transportation.
• Make child care available during group meetings. Offer child care in an adequate play space that is safe and comfortable for children and infants. Due to difficulties related to reliability of volunteer child care providers, one program recommended recruiting paid child care staff.
• Provide incentives for group meetings. Incentives are often concrete, such as meals at every session and subsidies for public transportation. Incentives also may be social. One program held Friday evening meetings that included a social component. Recruitment was never difficult, and there was almost always a waiting list. Program graduation ceremonies were found to be important opportunities to reward participants, validate their efforts, and reinforce their gains.
• Vary the content of group sessions. Utilize client leadership and input, interactive group sessions, role-playing activities, videos, games, outside speakers, rap sessions on pressing issues, and discussions.

2.3 Hiring and Retaining Qualified Staff

Hiring and retaining qualified staff was an ongoing challenge for most of the projects. Reasons included low salaries, the stress of helping families who were dealing with complicated and serious problems, and safety issues. Unfortunately, programs found that high staff turnover often led to lower-quality service, families leaving the program prematurely, and burnout of remaining staff. Strategies for retaining staff included:

• Start with good people. Many programs cited personal qualities of the staff they hired (using descriptions such as highly qualified, creative, resourceful, persistent, warm, nonjudgmental, and caring) as critical to their success. Additional attributes of direct service staff found to be desirable included maturity, professionalism, commitment, the ability to connect, living in the community, having personal experience with the system, and child care experience (e.g., veteran parents).
• Offer realistic job previews. Allow prospective hires to "shadow" an experienced staff person during a home visit.
• Adjust caseloads. One program created a system to weight various levels of service. They then adjusted workers' caseloads according to service intensity, rather than assigning a set number of cases.
• Make sure staff feel supported. In one program, staff felt more supported when the program office was moved from an off-site location to the organization's headquarters. Another program supported staff by holding weekly individual supervision meetings between direct staff and the director to address complex problems. Other similar strategies included weekly clinical staff meetings, review of taped therapy sessions, and bimonthly case presentations.
• Address staff safety concerns. One program in a particularly high-risk area addressed home visitors' safety concerns by scheduling daytime visits only, contracting with a car service with a driver who waited outside, providing cell phones, and sending two staff into the home together.
• Share program evaluation results with staff. One program reported staff benefited from and felt motivated by the evaluation feedback. This may have balanced the feeling that the evaluation was sometimes getting in the way of providing services.
• Make promotions to encourage tenure. One way programs improved retention was by rewarding staff competence and success with promotions in level or title.
• Engage families with the entire program. When families feel a connection to the entire program, not just their regular contact person, staffing changes are not as disruptive.
• Conduct exit interviews. Both positive and negative responses were found to be instructive.

2.4 Sustaining Funding

Securing sustainable funding to continue those services that have been found effective after the demonstration grant ends is a perennial and critical challenge. Strategies included the following:

• Start with a larger-than-required cash match. One program found securing this initial investment from the agency and community built early commitment and made the transition to non-Federal funding less daunting.
• Demonstrate effectiveness. One program developed ongoing financial support from the Department of Social Services (DSS) when the program demonstrated it was reducing DSS intake workload. Another program worked early on to produce convincing service- and cost-effectiveness data. As a result, DSS provided a liaison worker and awarded a contract to expand the program. They also secured a 3-year contract from the State to continue the program and had applications to several local foundations pending at the time of their final report.
• Incorporate new program components into ongoing services. It may be easier to sustain a modification to an existing program than to fund a new stand-alone program. In one project, an experimental condition (12 months of aftercare) became the program standard, replacing the previous 3-month limit.
• Know your community resources and make yourself marketable. One program sustained its neglect services by approaching county agencies that administer State drug, alcohol, crime, and delinquency funds and securing purchase-of-service contracts with them.

⁷ Gaudin, J. M. (1993). Child neglect: A guide for intervention. (The User Manual Series). Washington, DC: U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect. back
⁸ For service duration reported by each program, see Appendix B. back
⁹ U.S. Department of Health and Human Services. (2001). Acts of omission: An overview of child neglect. Washington, DC: Child Welfare Information Gateway. [Online.] Available: http://www.childwelfare.gov/pubs/focus/acts/index.cfm. back

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You are in section: Table of Contents 1 - Overview of Services and … 2 - Common Challenges/Succesful … 3 - Lessons Learned 4 - Conclusion 5 - Appendix A 6 - Appendix B

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