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Child Protective Services: A Guide for Caseworkers. 2003
Office on Child Abuse and Neglect, Children's Bureau. DePanfilis, D., Salus, M. K.|
|Year Published: 2003|
Chapter Nine: Service Provision
Once the case plan has been developed, the caseworker provides or arranges for services identified in the plan to help family members achieve tasks, desired outcomes, and case plan goals. Selecting and matching interventions is a critical step in the casework process. To the extent possible, interventions that have demonstrated success in addressing the issues that brought the family to child protective services(CPS) should be selected.
An important consideration in selecting interventions is an assessment of the readiness to change. For further information, see Chapter 3, "The Helping Relationship," Chapter 7, "Family Assessment," and Chapter 8, "Case Planning." For example, if a family member is at the precontemplation stage, it is important to select initial interventions that will increase their motivation to change, rather than selecting interventions that assume the individual is at the action stage. However, there is significant variation in readiness or eagerness to change among clients, and an individual's readiness to change may fluctuate from time to time. The role of the caseworker is to collaborate with the individual or family in developing plans and selecting services that will best facilitate change.
Richard Gelles, a leading researcher in the field of family violence, suggests that some families with maltreatment problems are treatment-resistant. He proposes making early decisions about permanence because the risk of maltreatment is high and the readiness for change is low.93 Since the principles and provisions of the Adoption and Safe Families Act (ASFA) are designed to ensure child safety and decrease the time necessary to reach permanency, it is critical to evaluate a family's readiness to change and select interventions that will help families ultimately achieve child safety and permanence.
This chapter introduces a conceptual framework for services based on levels of risk in a family and discusses case management and service coordination issues. The chapter also presents an overview of the various types of treatment and intervention services available for abused and neglected children and their families.
Service Framework Based on Levels of Risk
A conceptual framework developed by the National Association of Public Child Welfare Administrators (NAPCWA), presented in Exhibit 9-1, is helpful in thinking about the levels of services appropriate to the level of risk presented by the family. The top third of the pyramid represents reports of child abuse and neglect that pose the highest risk for children, are concerned primarily with child safety, and often involve child removal and court-ordered services. The primary role for the CPS caseworker is to help families understand and acknowledge the risk factors that contributed or could lead to serious maltreatment, and to engage them in developing safety, case, and concurrent permanency plans. Since services are often court-ordered, the likelihood of success will be dependent on both the caseworker's ability to communicate the potential benefits of specific intervention strategies effectively and the family's response. Family members served in this category are likely to be in the precontemplation stage of change.
The middle third of the pyramid represents family conditions that pose moderate risk to children, warrant services by CPS, focus on child safety and family well-being, and often involve collaboration with other service providers. The success of intervention is directly related to the CPS worker's ability to develop a partnership with the family. When referred, some families may be at the precontemplation stage of change, while others may be at the contemplation or determination stages of change. The role of the CPS worker is to help family members prepare for change and to collaborate on safety and case plans that will lead to improvements in family well-being and child safety.
The bottom third of the pyramid represents families that are identified as low risk for immediate maltreatment, but who experience high family stress. These families can often be served by early intervention, family support centers, and informal helping systems. The primary outcomes for these families are enhanced child and family well-being.
Case management emphasizes decision-making, coordination, and provision of services.95 Caseworkers collect and analyze information, arrive at decisions at all stages of the casework process, coordinate services provided by others, and directly provide supportive services. Three primary objectives for case management practice are relevant to the case management role of CPS caseworkers: (1) continuity of care, (2) accessibility and accountability of service systems, and (3) service system efficiency.96 These objectives are best achieved when caseworkers know the resources available, have expertise in a particular area of practice, use interpersonal and group skills to interact with other professionals, and lead and coordinate the service delivery process by developing case plans that are clear to all parties. It is the caseworker's responsibility to:
- Select, provide, and arrange for the most appropriate services;
- Communicate and collaborate with identified service providers;
- Measure progress toward achievement of outcomes and goals;
- Maintain records to document client progress and ensure accountability;
- Prepare and review necessary reports.
When other service providers are used as part of the CPS caseworker's overall risk-reduction strategy, it is important to establish a contract with the referral agency or individual professional. The contract should include the following:
- Results of the family assessment, including an identification of the most critical risk factors that the service provider is to address;
- Copy of the case plan with tasks, outcomes, goals, and identification of the service provider's role;
- Specification of the purpose of the referral and the expectations regarding the type, scope, and extent of services needed;
- Specification of the number, frequency, and method of reports required, as well as reasons for reports;
- Expectations for reporting on observable changes in achievement of client tasks, outcomes, and goals;
- Measures of client progress;
- Provisions for coordinating among providers and monitoring service provision.
Treatment and Intervention
Since child maltreatment is rooted in a variety of personal and environmental factors, interventions need to address as many of these contributing issues as possible. Early evaluation research on treatment effectiveness suggests that successful intervention requires a comprehensive package addressing both the interpersonal and concrete needs of all family members. This research suggests that programs relying solely on professional therapy without other supportive or remedial services to children and families offer less opportunity for maximizing client gains. In addition, the findings suggest that during the initial months of treatment agencies should invest the most intensive resources to engage the family, then begin altering behavior as close to the point of initial referral as possible.97
Clearly, each community should possess a broad range of services to meet the multidimensional needs of abused and neglected children and their families, but that is not always the case due to funding or other issues. Nevertheless, CPS maintains responsibility for identifying and obtaining the most appropriate services available. Selecting services in a particular case is based on:
- Assessment of the factors contributing to the risk of maltreatment and the family's strengths;
- Outcomes targeted for change;
- Treatment approaches best suited to a particular outcome;
- Resources available in the community.
Exhibit 9-2 reflects a broad selection of treatment and other intervention services for child abuse and neglect, although it is not a comprehensive guide. These services range from support for children and families to long-term treatment interventions. Some services require extensive training before implementation. Arranged alphabetically by title within categories, the exhibit summarizes the primary focus and target population for each type of service. Information regarding evaluation and research support, and related studies is included, along with references to selected manuals, curricula, guidelines for implementation, and other background material.
For more information on these treatment and intervention services, please visit the User Manual Series Web site at www.childwelfare.gov/pubs/usermanual.cfm, or review the related literature. Inclusion in this exhibit does not reflect an endorsement of the treatment or intervention by the U.S. Department of Health and Human Services.
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