Philadelphia Uses Flexible Cash to Test Storied Child Abuse Prevention Program

In March of this year, the national Commission to Eliminate Child Abuse and Neglect Fatalities released its 150-page final report. The President and party leaders from both the House and Senate appointed this 12-member group in 2012 and tasked them with bringing forth recommendations for eliminating abuse- and neglect-related child deaths in America. The group ultimately settled on a list of seven recommendations.

One of these recommendations was a “strong endorsement” for permanent finance reform, including reauthorizing a new round of Title IV-E Child Welfare Waiver Demonstration Projects. These projects are part of a federal program that allows states to spend otherwise restrictive federal dollars more flexibly.

In Philadelphia, where approximately 3,000 children will enter out-of-home care each year according to the Department of Human Services, having a waiver to Title IV-E of the Social Security Act has allowed the city and county to implement new programs. One of these is Triple P, a popular child abuse prevention program pioneered in Australia in the 1980s.

The difference between the original model and Philadelphia’s experiment is that instead of using the program to prevent abuse before it ever happens, one agency, Wordsworth Community Umbrella Agency (CUA), is using Triple P for families who have been reported for possible child abuse or have had those reports substantiated.

“For the sake of our vulnerable children and our limited budget, we need to determine whether programs like Triple P are effective in maintaining family connections rather than disrupting them,” said Antonio Garcia, a researcher at the University of Pennsylvania’s School of Social Policy and Practice. Garcia is currently studying the experimental program’s effectiveness.

“Insurmountable financial cost to the public at-large and irreversible negative developmental outcomes are likely to ensue for a significant proportion of the children who are placed in foster care and experience multiple placement moves,” he said. “Implementing Triple P is a concerted effort to disrupt this negative chain of events.”

Whether a prevention program will be effective after a report of abuse has been filed is what Dr. Garcia is trying to determine. Stories from participants and early data from the Demonstration Project suggest both promising and perplexing results so far.

Triple P, short for Positive Parenting Program, is an educational prevention program that focuses on increasing parents’ knowledge, skills, and confidence in preventing and managing behavioral problems in children and adolescents. This is accomplished through a highly individualized approach that may include individual or family counseling for one or both parents, therapeutic groups for parents and/or children and parent education. Its goals include helping parents become better equipped to handle the stress of everyday child rearing, and helping children become better able to respond positively to their individual developmental challenges.

The program is considered “evidenced-based” – meaning it is not only backed by empirical research, but also integrates client values and clinical expertise into its design – by the California Clearinghouse of Evidence-Based Interventions, an independent evaluator of practices for children and families involved with the child welfare system.

Triple-P-SidebarTriple P research spans more than 30 years, has been conducted by academic institutions in the U.S. and abroad, and is currently used in more then 25 countries, according to TripleP.net, the official corporate information website for the intervention. Until now, it has primarily been used as a prevention program, rather than an early intervention – that is, before an allegation of abuse and neglect is reported.

“This initiative provides a rare and important opportunity to evaluate what happens when this evidence-based prevention program is delivered to children and families who are reported to the child welfare system due to an allegation of maltreatment,” Garcia said.

Philadelphia is only able to do this because of the changes to federal policy allowing states and county child welfare administrations to spend money more flexibly.

Starting in 1994, in an effort to provide states the opportunity to use federal funds to test new approaches in delivering child welfare services, the Department of Health and Human Services in Washington D.C. offered states and some counties a new funding formula for foster care.

Historically, the federal government reimbursed states through Title IV-E of the Social Security Act for costs related to children who had been removed from their home and were in formal foster or kinship care. The Title IV-E Waiver Demonstration Project instead offered states a capped allocation that they could spend more flexibly, which has allowed for more money to be spent on supporting families whose children are at risk of entering foster care.

A famous example of a past successful demonstration project is the Fostering Connections to Success and Increasing Adoptions Act of 2008, which made all states eligible to receive funding for subsidized guardianship programs, a concept that had first been tested through a variety of states’ waiver demonstration projects focusing on subsidized guardianship.

Pennsylvania is currently midway through a five-year demonstration project aimed at implementing interventions like Triple P for youth in foster care. In recent years, these flexible funding waivers have been associated with both positive and negative critiques.

Significant reductions in the foster care populations in Florida, Ohio, Oregon and two counties in California, Alameda and Los Angeles, are referred to by Casey Family Programs as successful projects. The powerful charitable foundation claims that the reductions in foster care costs have allowed these states and counties to reinvest their savings into expanded child welfare services and agency improvements.

Alameda County reduced its foster care population by 21 percent in the two years following its 2007 waiver demonstration project, which focused on expanding family finding services to locate extended family members for children, as well as working with courts to expedite permanency planning.

Similarly, the foster care population in Florida was reduced by more than one-third over four years after the implementation of a waiver demonstration project, with some counties reducing their foster care populations by 50 percent. That project focused on in-home family preservation services aimed at preventing foster care at the start.

Sean Hughes, a managing partner at the consultancy firm Social Change Partners and contributor to The Chronicle of Social Change, wonders whether those counties safely reduced foster care numbers, or if the financial construction of the waiver, which often allows states more child welfare funding than if they didn’t participate, led the counties to act haphazardly. Hughes noted in a recent article that Los Angeles County’s evaluation following its demonstration project revealed a 15 percent increase in foster care reentry rates.

“This figure calls into question whether Los Angeles County’s strategy of increasing reunifications to reduce caseloads under the waiver resulted in kids being rushed home before they or their families were prepared to ensure their safety,” he wrote.

The Child and Family Services Improvement and Innovation Act, which initially authorized these projects, will be up for reauthorization later this year, giving Congress the ability to change the way child welfare federal funds are allocated.

In Pennsylvania, the current demonstration project includes six counties – Philadelphia, Allegheny, Lackawanna, Venango, Dauphin and Crawford. Beginning in 2013, the project focused on implementing and expanding the use of strategies focused on increasing family engagement, conducting better assessments of child and family needs and strengths, and utilizing three evidence-based practices (EBPs), including Triple P, to improve foster care placement decisions and overall family functioning. The project also requires an evaluation of the entire endeavor to ensure that its implementation is cost-neutral.

This year, the waiver demonstration project entered phase two, which focuses on scaling up and monitoring the three EBPs being tested. This will continue through 2018, when the project concludes and is fully evaluated for success.

An interim evaluation report released in January highlighted the difficulties of implementing the new EBPs. Implementation has taken longer than originally anticipated, counties are still working to operationalize the interventions, and communication between the counties and the agencies has been challenging. The difficulties encountered while implementing Triple P in particular were highlighted by interviews with child welfare workers in Philadelphia.

Justin Williams, director of intervention and implementation at Wordsworth CUA 10 explained the initial difficulty in simply getting the program off the ground.

“In theory, I think the overall project has been a good practice to have, but in terms of implementation, it has been really rough,” Williams said.

While the department had anticipated signing up 75 families, it is actually working with about 50 families through 20 certified Triple P practitioners.

Further, Williams went on to say that the original guidelines for the implementation of Triple P haven’t been possible for his organization, due to a lack of certified providers. His team originally struggled to refer families to services in a timely manner because of the initial lack of providers.

Erin O’Donnell, Triple P coordinator at the same agency, echoed the sentiment that Triple P has been a positive addition to the agency’s services.

“For me, Triple P is one of the world’s most effective parenting programs,” O’Donnell said. “[It] gives parents the skills they need to raise confident, healthy children and teenagers, to build stronger family relationships. It is not one size fits all; it is a system that offers different levels of support to meet parents’ needs.”

Sarah Dilworth, case worker supervisor at Wordsworth CUA 5, a separate agency, illustrates the lack of knowledge with some staff on the intervention, and the confusion over how exactly the practice should be used.

“I don’t know if there’s enough knowledge base about the program for my case managers at this time,” Dilworth said. “Right now, we’re using it in in-home services to help stabilize families and then close out [their case]. If a court order says ‘parenting class’, to be quite honest, this will suffice – so I’m encouraging my team to look through their cases and see if it can be utilized,” she said.

The official mid-way outcomes report on the project recognizes the “ambitious agenda” of the demonstration project, stating, “to achieve this agenda, counties must change how they engage with their staff, while their staff change how they engage with families; and the state must also change how it engages with the counties in terms of management and infrastructure.”

The report affirms the sentiments of Dilworth by admitting the communication among and between counties and the Office of Children, Youth and Families “could be enhanced,” suggesting bringing in a dedicated project manager to take on the role as a designated point of communication between the county and the providers as a potential solution.

While the waiver demonstration project has been plagued by confusion over its relationship to the new CUA service approach and the above detailed challenges, Dilworth reflects on the potential impact the project has for families in the city.

“[With] those old programs, nobody was trying to tweak them because they had been around for 20 years,” she said “Any system change, you’re going to have issues. But in the greater scheme of things, these interventions provide permanency to these families. I really believe the traditional model put a Band-Aid on the problems.”


Ashleigh Martell Brunsink is a second year MSW candidate at the School of Social Policy and Practice at the University of Pennsylvania. 

This story has been published in partnership with the University of Pennsylvania’s School of Social Policy & Practice (SP2). In the run up to the 2016 Presidential Election, the school launched “SP2 Penn Top 10, a comprehensive multimedia initiative in which renowned SP2 faculty members analyze and address the most pressing social justice and policy issues.”

Part of the project is the creation of stories produced by “SP2 Penn Top 10 Fellows,” graduate students from the School who are trained in solution-based journalism using the Journalism for Social Change curriculum.  

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