No Place Like Home

No Place Like Home

1st Site Visit

Larimer County, CO

Compiled Focus Group/Meeting Notes

January 24th-25th, 2012

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Data Meeting

Present: TarynDavids, Business Analyst; Joe Schreurs, Business Analyst Supervisor; Denise Suniga, Deputy Division Manager; Donna L. Parrish, NPLH Training Lead; Heather Allan, NPLH Project Coordinator; and, Lisa Merkel–Holguin.

Q1: Cost analysis- what information is currently being collected?

Tracking cost per meeting
Cost of salaries
Cost of service dollars by program areas
Can break data per family or by the life of the case. Also do general costs.
None of these costs are in TRAILS, all in Excel spreadsheets
Only services and OOH placement is in TRAILS
It would need to be a separate design but in a spreadsheet
Salaries are tracked by unit
FGDM is based on an average but there are not any time records. This is just tracked as a general cost.

Q2: Grant proposal outlines use of SDM score to select high risk cases. Do you use this?

They do not use this and are not familiar with the term SDM
NCFAS score is in TRAILS but they don’t use it as it was intended
Workers fill it out in when they get back to the office in 10 min
Was designed to be administered in home
There is a committee to get rid of this tool although it is a validated tool and available in TRAILS
ARCH-predictive model on children that received CORE services. Use the safety and risk scores for proxies. They have validated the assessment tools as a result. On PA5 (assessments at the beginning and close)

Q3. How do you track family meetings in TRAILS?

Meetings are tracked in TRAILS (FSRT, FUM, FGC) through CORE service authorizations
FSRT- one day, open and close
Entered under the oldest child and then the clients that participate are listed
TRAILS now allows you to name who the actual service was for
Can have multiple meetings listed in TRAILS
FUM and FGC are open at the begin and close at the conclusion of the meeting
If the meetings change, they will go in and change it in TRAILS
FUM’s you can have multiple meetings but will only show one start and end date
Each contact area states who actually attended
Does the child have to be at the meeting to be marked as participated?
Because it is about the child, the child may not always attend and this can be tracked
Service auths=who benefits from the meeting/service
Not linked to contacts but can get there in a round about way

Q4. Client satisfaction?

Entered into survey monkey sans the comments
Not linked to cases

Q5. Is there any other data that is being collected but not entered into TRAILS?

Q6. Collecting any poverty data?

No, but using proxies from TRAILS. Using some Q’s from the risk assessment
CBMS collects income information but the two systems don’t interact.

Q7. If as a result of an FGC, a kid is placed with kin, can this be tracked? Any links to see if a family member attended an FGC, if they are more likely to become a placement option?

Depends on the data set that’s being collected because a new report may have to be created
Already have data from federal categories for the 1451 work
The ideal is that we have a customary report to pull everything that AHA needs

Q8. Propensity score matching-want to compare cases that received fx. meetings to similar situated cases. How will the matching be done?

Most FAR meetings do not received FSRT’s
Looking at high or moderate risks and saying FAR cases have to get some sort of fx. meeting (FUM or conferencing)
A lot of cases don’t have actual conferences, except for FAR cases
The matching will be done post by using the 4 proxies
We may need to think about the sample size with JF and KC to yield the best results
Data collection in late summer

Q9. What kind of technology do staff have access to in the field?

All paired team workers have tablets- 6 months
They are ideally entering data into TRAILS in real time (they have a “mifi”)
Some connection issues
So they can alternatively enter the notes in real time and then copy them into TRAILS from word
All face-to-face meetings are required to go into TRAILS
Facilitators enter meeting notes in TRAILS also (listed as secondary workers)
demographic information on collaterals (not main family members) is not collected
% of missing data on demographics?
Safety assessment- score will indicate a need for a plan (happens first)
FSRT for developing/refining of safety plans

Q10. When the randomizer is removed, how will this impact the flow?

They are at 90/10 (90% assignment to FAR and 10% to investigations). Were at 80/20 for most of the grant so they do not anticipate any major shifts.

Focus Group Objectives:

To understand the organizational and community context for FGDM implementation.
To understand the FGDM practice framework.
To understand FGDM meeting preparation.
To understand FGDM meeting characteristics including model fidelity.
To understand the FGDM meeting follow-up process.

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Focus Group Notes

Caseworkers #1 (Intake, Ongoing, Foster/Kin)

Administrator: Heather Allan

Note taker: Donna Parrish

Please describe the evolution of FGDM use in your jurisdiction, including: (Objective 1)

Signs of Safety was a piece of literature that was influential.

The same supervisor has run the FGDM team for 10 years; started with her. There was the Oregon model that came out. Then, took on the FGC model from NZ. Purpose was to engage families better. We saw outcomes of not engaging families.

Now there is a team of 10 or more FGDM coordinators/facilitators.

Signs of Safety came on secondly as a philosophy. Intake worker more police-like. Always have to make professional judgments, and we still have to do that.

We would see the professionals come around the table, make decisions, and then we would take these decisions to the families. We realized that as a department we weren’t seeing the outcomes for families that we wanted. Families needed to be at that table too.

Resistance from attorneys and therapists,“You cannot tell families what you are saying about them!”

Pitfall—when a family meeting turns into a staffing.

Various models of FGDM being implemented, and how the models build on each other, or not?

FSRT: Emergent basis, plug family into those slots. Come from a child protection assessment. Need to immediately plan.

FUM: Involving more people who are working with the family (coaches, foster parents, ask family to invite their support people, clergy)—do planning and updating at those meetings.

FGCs: I see the goal that we are trying to move toward FGCs, and it embodies the philosophy that families know best about themselves.

Supporters and critics?

GALs seem to struggle with families doing a lot of their own planning. Some groups are critical as they should be. GALs tend to be more resistant than other professionals.

Foster parents: When they have to engage with the family origin, it can be difficult. Can work through this.

Caseworkers: May become resistant because if families are deemed moderate or high risk based on the risk assessment, then the policy will be that you have to do a family meeting.

When a family meeting isn’t productive then it impacts the relevancy of other future family meetings. Example: foster parents need information from people in the building about court, etc.

What makes a productive meeting: preparation ahead of time, people have a shared knowledge and can move forward.

Sometimes family meetings are not needed. Especially FAR cases, when you are out in the field, you are gathering the family.

I like family meetings because they are positive. You have a facilitator. It reinforces other conversations. You can elaborate on the themes. After first 15 minutes, the anxiety decreases. Sometimes it helps engage families in the services.

Families: Scared of DHS, and fear of the unknown.

Rewarding to the family—move from an awful FSRT to an FGC. It is a moment of celebration. When you get to the end, you see the success of the family meeting.

What types of FGDM meetings are used, in what order, and for what populations? (Objective 2)
Are there case characteristics that are necessary for or encourage FGDM referral?

Family support system is the biggest predictor for success. I want “them” to outnumber “us.” Sometimes, it is difficult to get families to broaden out. Families have the expectation that their support system won’t be there for them.

FSRTs if used as a springboard to other meetings, and used to invite other family members…it can be an encourager to bring more family.

When you can recruit their support system, we have greater success. Magic happens.

Saddest ones are: undocumented families; ones that don’t have family nearby.

DV ones, with significant restraining orders, are difficult.

When school age children come and you don’t want them to hear everything, so we have child care issues.

Rely on the skill of the facilitator…we as caseworkers rely on the facilitator. We need to be purposeful in who we invite.

People talk ahead of the meeting, how can we plan for certain instances. Preparation—how can we be sensitive, etc.

What activities are involved in meeting preparation? (Objective 3)

Depends on the content and the purpose of the meeting. Placement/TPRs require more preparation. Every family is different.

Caseworkers give coordinators/facilitators the heads up about the situation.

FUMs: facilitators will do the phone calls ahead of time, and that is helpful to the caseworkers. Caseworkers do some of the prep work.

FGCs: facilitators do the preparation work. One area that the department could improve is prepping more extended family members for FGCs. Very time intensive.

FSRTs: caseworkers do the preparation. No prep work on the FSRTs. Facilitators don’t even know the purpose going into the FSRTs.

Facilitators are to keep the same families over the life of the case.

How do staff facilitate collaborative partnerships with families during meetings? (Objective 4)?

Try to keep professional people to a minimum.

Don’t have all the professionals sit next to each other. Spread out.

Leverage positive relationship with Grandma.

Try to remind the family that all of us are human—any of us could fall into their situation. Try to keep it real on a human level.

Some self-disclosure is helpful.

Chit-chat around current events. Try to find connections with each other at the start of the family meetings.

I say, “This is your meeting.” This is a team; we are all on the same team and we will work together.

Having the family start the meeting. FUMs—family can come in with an opening statement. Let them take charge. Balancing out what took place

Strength finding with family at different points (in their homes, in family meetings, etc.)

I had a lot of success with FGCs. Family expectations were a lot tougher than the department’s expectations. Then they feel like,“I agree with this, because I helped develop it.”

Mixed messages around FUMs/FSRTs: you cannot invite them without the mom’s permission. Discrepancy in understanding whether you can invite family who is out there without Mom’s permission. Different supervisors and different facilitators have perspectives on this issue.

What efforts are made during meetings to address family culture, world views, and values during FGDM meetings?

Native American family from Pine Ridge. I was facilitating the meeting. It was a Mom with post-partum. Mom had a psychotic break. They took custody of the child. They weren’t looking at the Native American father. Had an emergency family meeting. The elders, extended family came down from the reservation. The spirituality came through in the meeting. Mom was in the hospital on speaker phone. Mom was deferring everything to the elders. She respected her elders; supervisor was concerned. Lesson: not to make assumptions.

We start asking questions about culture…and families are offended.

We don’t always take into account culture—especially with Hispanic families (who live multi-generations in one household).

Spiritual diversity, socio-economic: assumptions are made. How we connect and if they see us as empathetic.

If we don’t have culturally competent resources in the community, it is very hard. Several children who are undocumented—very difficult to get resources for them. Have to dig deep.

Focus Group Notes

Supervisors #1 (Intake, Ongoing, Foster/Kin)

Administrator: Donna Parrish

Note taker: Lisa Merkel-Holguin

Please describe the evolution of FGDM use in your jurisdiction, including: (Objective 1)
Critics?

I don’t recall much negative feedback from anywhere about family meetings. Other professionals and community members seem to feel more involved. They may not agree with the result of a meeting, but the process they like – because they have an opportunity to have their voice heard both in the meeting and with the feedback forms.

I can think of an example where a therapist was unhappy because they didn’t like the level of transparency we were looking for from them re: risks to children based on Mom’s mental health. That’s the main one I can think of. Generally, I’ve heard mostly positive feedback – from GALs, etc.

There is a lot of flexibility in where/when we have meetings, which people like.

At the beginning there was anxiety to move from ‘staffing’ model where professionals met alone to talk about the family to bringing the family in with family meetings. But once they participated, they seemed to come around. Now that we’ve been doing it for so long, it’s hard to remember what it was like without it.

Challenge can come in when we have difficult personalities in the family and then it’s hard to facilitate and keep it productive. We’ve struggled to keep the purpose clear and focused. Criticisms I’ve heard are around those types of challenges, which might always happen.

Other criticisms or worries have been from family or other participants about having children there. So even if they can’t be there we’ll try to have them present in other ways, like letters. We’ll safety plan with kids there and teach them about non-verbal cues they can give us if they need a break.

What challenges to using FGDM exist?
Language barriers. Especially with translators or bilingual staff – we can’t always guarantee that staff can be available – we struggle with that.

We’ve been flexible about changing the process when we’ve needed to, to try to make sure there is an available facilitator to meet the family need. We’ve looked at policies to see if it needs to be changed over time.

It has been harder to get FGCs set up than other types of meetings. They are really time consuming and extra work. Probably hard for facilitators to coordinate these meetings in a timely way. I’ve only been to a handful of FGCs but tons and tons of the other meetings.

With all of the prep work that has to happen and all of the family members that have to be met with it is hard. By the time we’ve prepped everyone with the original purpose of the meeting the need of the meeting might have changed – but everyone was prepped for that original purpose. So we’ve tried to do that model, giving families private time, during FUMs – so we don’t go through whole long process to prep for an FGC.

What type of resources are available to support staff in FGDM?

When new workers come in they can be as nervous for meetings as for testifying in court. They are the front line workers who have to be at that table no matter who else is there representing the agency. It can be painful. Naturally, from doing it often and having it be successful, it gets better. Prepping before the meeting and having someone there to support them in the meeting is helpful.

Having participated in facilitation trainings, facilitators are taught to help workers prepare. They can be helpful in preparing and supporting caseworkers. Supervisors can fill that supportive role too.

I love, as a supervisor, attending FSRTs with workers, especially newer works to role model how we talk to families in meetings about our concerns and bottom lines. It also helps me get to know the families that my workers are working with. Even experienced workers can have anxiety about certain situations that may arise in a family meeting. It can also help to have conversations with facilitators before a meeting to let them know if there are issues that may come up – DV or conflict – to let them know that we are anxious about this, not to bias them.

Each RED team has a coach trainer assigned to the team to help new workers or specific situations with any worker – sometimes they will attend meetings (or other situations) to help role model and provide support – can shadow or be shadowed. This started 6 months ago. Workers and supervisors can request the coach. New workers automatically get a coach for 3-6 months.