From Adoptalk 2019, Issue 4; Adoptalk is a benefit of NACAC membership.
By April Dinwoodie
The National Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG) is funded through the Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Grant #90CO1122-01-00. The contents of this article do not necessarily reflect the views or policies of the funders, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Department of Health and Human Services. This information is in the public domain.
The QIC-AG was a five-year cooperative agreement, funded by the US Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, designed to promote permanence when reunification is no longer a goal and improve adoption and guardianship preservation and support. Since 2014, the QIC-AG has been working with eight partner sites to implement evidence-based interventions or develop and test promising practices which if proven effective can be replicated or adapted in other child welfare jurisdictions.
To help the entire field ensure quality implementation of services to increase pre- and post-permanency stability for families, the QIC-AG created an Annual Lessons Learned Series to encapsulate what they were discovering as the project unfolded. The recommendations below, from QIC-AG’s final Annual Lessons Learned, are designed to help others providing adoption and guardianship support services think about how to ensure the best outcomes for children and families.
Be Thoughtful About Staffing
Identifying staff that are the right fit for a particular intervention is critically important. For the New Jersey project—Tuning into Teens (TINT) an emotion-coaching program designed for parents of youth ages 10 to 18 years—the right fit meant finding and keeping staff that could successfully work with families, understand the intervention, and had availability.
The New Jersey site team invested time in developing an extensive staffing plan, including detailed recruitment procedures and a selection process tailored to the unique aspects of TINT and needs of the target population. This included the development of job descriptions that emphasized specific qualifications related to minimum standards for adoption competence to ensure that facilitators had the ability to navigate the topics around adoption, kinship care, and legal guardianship that might come up during the TINT sessions.
Potential staff participated in an interview process during which the selection team posed questions to ensure that qualifications on paper would translate to the classroom. In addition, the selection team posed scenarios to candidates to get a sense of how facilitators would mesh with each other and the families. New Jersey also thought about how to retain staff, developing plans on how to compensate staff fairly and how to increase their engagement with the project and with each other.
With this staffing plan, the New Jersey site was ultimately able to secure a team of 20 committed, well-qualified facilitators.
Consider Coaching Needs
Tennessee implemented the use of the Neurosequential Model of Therapeutics (NMT), a therapeutic model developed by Dr. Bruce Perry at the ChildTrauma Academy (CTA). With such an intervention, they found that even their existing, well-trained counselors needed extra time, attention, and experience to become adept and gain fluency in delivering a new intervention. Tennessee added more layers of support for the family counselors, including monthly one-hour conference calls led by CTA representatives or other trainers to discuss the training content. An internal learning group led by the agency’s training director also met monthly to reinforce the concepts covered during the previous weeks and staff could reach out any time to the training director or supervisors with questions or concerns. The counselors reported this combination of study group and open communication was a helpful and worthwhile part of the learning process that enabled them to discuss concepts and areas in which they needed additional support or direction.
In addition, Tennessee extended the start-up training for counselors to 14 months (the NMT certification process requires 12 to 14). The full 14 months gave the counselors an opportunity to take breaks from formal study, allowing the material to “sink in” while they integrated the practices into their work.
Plan As Far in Advance as Possible
The Texas QIC-AG site offered the Pathways to Permanence 2 (Pathways 2) training. In the course of delivering more than 20 series of Pathways 2, the best practice that emerged was to determine and publicize the schedule for each training series about four to six months in advance. This made it more likely that the site would reach its family enrollment goal.
Without a confirmed schedule, staff conducting outreach had less time to encourage families to participate and less time for promotional materials (Save-the-Date postcards and Register Now flyers) to be mailed or distributed to families. In addition, a longer lead-time allowed more opportunities for community partners to promote the intervention to the families they served.
When planning, staff also considered how to make it easy for families to participate in the free training. Texas found that providing quality childcare really helped engage families.
Market Your Services to Families
The way a service is described is key to moving families to a point where they see the program has value for them and decide to participate. Creating this awareness and motivation is particularly challenging when offering a preventive service such as TARGET, which was offered in Illinois. TARGET—Trauma Affect Regulation: Guide for Education and Therapy—is designed to serve children 10 and older who have experienced trauma and adverse childhood experiences.
TARGET is designed to engage families before they have started to experience the issues that can arise during their child’s teen years. Illinois found that their messages had to strike a tone that conveys, “Family life is fine for now, but TARGET could make it even better” or “Family life is functioning fine for now, but this program will help in case the situation changes.”
In an early effort to recruit families, the site team first developed a communication that read, “TARGET is a unique approach to preventing disruptions and helping families prepare as teens who have experienced trauma move through what can be difficult adolescent stages.” But this message did not resonate with families who were doing fine at the time, so they did not sign up.
With insight from the stakeholder feedback on positive messaging, the site team revised the communication to read: “In any family, stressful times can come up, especially during the teen years. Even when things are smooth, big and small life stressors can take you by surprise. We want to ensure that your family has supports that can be helpful during your child’s teen years.” This seemed to help improve participation from the target population of families.
Partner with Experts
Catawba County, North Carolina, chose to implement Reach for Success, a structured early-outreach program designed to identify adoptive families who might be at higher risk for post-permanency discontinuity and might benefit from post-adoption services provided by staff success coaches. As part of this program, they needed a survey to collect reliable data to determine the challenges the families were facing.
Designing a survey is a multi-faceted process that goes far beyond creating a set of questions. While child welfare agencies understand adoption and adoptive families they might not have in-house expertise in research and evaluation. There is a science behind how questions are worded, the flow of questions, and the use of existing scales and measures. Additionally, survey results can be affected by decisions regarding survey delivery, follow up, and marketing.
Given the challenges of developing an effective, efficient survey, Catawba County Social Services sought out partners with expertise in survey design. The site team worked collaboratively with the QIC-AG site evaluator and the experts at the University of Illinois at Chicago Survey Research Lab. These collaborative partners developed the survey and the survey administration process to ensure the survey was scientifically sound and results were valid.
Think About Your Target Population’s Cultural Needs
The Winnebago Tribe of Nebraska chose to implement Family Group Decision Making. They knew that the cultural norms, values, and language of the target audience were too important to overlook during implementation. Engagement often occurs only when families feel they are understood and respected as individuals. Early in the project, the Winnebago site team realized they needed to deeply understand their tribe’s unique Ho-Chunk cultural attributes so they could ensure those attributes were reflected in the intervention.
The Winnebago team started by selecting an intervention model—Family Group Decision Making—that closely aligned with the Ho-Chunk belief system. But the site team went further to specifically adapt the model with Ho-Chunk language and culturally relevant assessment tools. In addition, the lessons the site team learned about their own tribal culture helped them to shape new tools for the intervention. Even the basic genogram was enhanced to reflect the unique Winnebago tribal structure and family preferences of the Ho-Chunk people. The site team also had to reconcile differences between the tribe’s cultural language and traditional child welfare system language to clarify concepts and policies. Even commonly used terms connote different meanings in different communities.
Engage Stakeholders Early
Providing support to families calls for a complex network of government entities, private agencies, and individual professional providers. Each component has policies, procedures, and priorities that can make system-wide coordination clumsy and wholesale change difficult. In implementing its intervention—a survey of families to assess well-being and identify strengths and signs of challenges—Vermont site leaders needed to rely on this complex network. But they were fortunate that those connections were already in place through the state’s System of Care (SOC) delivery service areas. The site team leveraged that network to engage in group conversation with adoptive and guardianship parents to gain a full view of the post-permanency landscape and make valid systemic recommendations. The team also engaged the Stakeholder Advisory Team (SAT), established prior to the QIC-AG project, to address cross-system assessment and placement challenges. Throughout the development and implementation of the survey, the SAT met quarterly to review the project progress and provide feedback.
When designing a new intervention in Wisconsin, it was crucial to get input from the people being served as well as those in and outside of the organization who would be providing the service. Each stakeholder group brought unique perspectives and insights invaluable throughout the project cycle. For this fundamental step, the Wisconsin project kicked off with a stakeholder meeting that included several adoptive and guardianship families. The meeting agenda was to explore post-permanency resources, gaps in services, and strengths and needs of the system. This early collaboration established the framework that guided the development of the intervention throughout the project. Some of the families who participated in this first stakeholder meeting became a part of the project’s Stakeholder Advisory Team, which also included agency representatives and service providers. Using the stakeholder feedback, the site team evaluated many interventions to determine if an existing program would fit the needs of Wisconsin’s adoptive and guardianship families. However, the site team determined none of the available interventions would adequately address the expressed needs and decided to create a new intervention. Under the QIC-AG the state created Adoption and Guardianship Enhanced Support (AGES) to address the complex challenges faced by families who have adopted or assumed guardianship of a child. In AGES, a worker partners with the family to identify strengths and challenges and develops a customized support plan, covering critical areas such as social supports, case management, parenting-skills development, education, and other capacity-building activities.
The site intervention profiles, lessons learned, and other reports that are part of the QIC-AG’s commitment to improve adoption and guardianship preservation and support for children and families across the US can be found at qic-ag.org.