Early Family First Adopters Eye Motivational Interviewing as a Casework Improvement Strategy

The Family First Act was signed into law in February 2018, and mostly takes effect in October 2019

As we covered on Monday, you can add Motivational Interviewing (MI) as the tenth model of intervention approved by a clearinghouse for use under the Family First Prevention Services Act. It was hardly a surprise, since it’s received top ratings from other clearinghouses on child welfare services.

Most of the services that get greenlit by the Family First clearinghouse will be things that child welfare agencies make referrals for. It will be the provider community – nonprofits, clinicians, hospitals, treatment centers and more – that carries out any services added with the new backing of federal funding. But expect some systems to use Motivational Interviewing as a strategy to improve the job done by its own employees in efforts to steer cases in a productive direction.

“One thing missing from Family First is an acknowledgment of case management as a core component for prevention,” said Brenda Donald, director of the D.C. Child and Family Service Agency (CFSA). “We have argued that, based on our experience, you can have a list of all the wonderful evidence-based programs but the only way to get families to participate is engagement, and that starts with case management.”

Donald expects that the model will be one of the largest draws of federal funding for D.C. under the new law. And based on conversations she has been a part of, she said she expects several other states planning to implement Family First this year to incorporate MI as a caseworker component.

The Family First Act was passed in 2018, and its main provisions took effect in October of this year. It permits for the first time the use of  Title IV-E, a child welfare entitlement, to provide certain services aimed at preventing the need for foster care in some child welfare cases. Those services will generally fall in the areas of substance abuse, mental health and parenting, and states can also draw the funds for “kinship navigator” programs that help relatives and family friends temporarily care for kids.

The gambit is that more families could be kept together if the array of services available to help that cause was stronger. But this only really works if the client in crisis is willing and wants to get the help or support necessary to avoid the use of foster care.

This is the niche that MI was developed to address. It is a relatively brief intervention, including one to three individual sessions between a trained interviewer and a client. The goal is to explore and overcome what keeps people from cutting out negative or harmful behaviors, guiding rather than directing change. In the context of Family First, this fits most with people suffering from an addiction to or troubling use of drugs and alcohol.

Washington, D.C., the first system in the country with an approved Family First plan, is banking hard on Motivational Interviewing getting added to the clearinghouse list. CFSA used its Child Welfare Training Academy to train nearly 200 workers at the agency and community-based providers on Motivational Interviewing, according to CFSA Program Manager Natalie Carver.

“We believe having the benefit of our workforce trained in MI as part of ongoing case management and family engagement will ultimately improve outcomes related to keeping families together and preventing entry into foster care,” said Carver. “We are already hearing evidence of the modality’s positive impact on family-worker interaction.”

All of the initial training was done with the hope that going forward, federal dollars would soon pay for half of the cost, Donald said. “We are geared up, as soon as it’s up in the clearinghouse, so we can claim for frontline social workers.”

Maryland, which is also planning to implement Family First soon, has partnered with the School of Social Work at University of Maryland to train child welfare workers and supervisors on Motivational Interviewing using a “live supervision” approach. Ed Pecukonis, an associate professor at the school and a leading national expert on MI, said the work has been “quite productive and promising.”

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John Kelly
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John Kelly is editor-in-chief of The Chronicle of Social Change.