In-Home Services to Strengthen Children and Families
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ISSUE BRIEFS | APRIL 2021
In-Home Services to Strengthen
Children and Families
Most children involved with the child welfare WHAT'S INSIDE
system are not separated from their families
but instead receive services while living at What are in-home services?
home. These child welfare "in-home services"
are designed to strengthen and stabilize
families that come to the attention of child In-home services delivery
protective services (CPS).
This issue brief explores effective in-home In-home services funding
services that are being used to promote safety
and help keep children and families together,
In-home services practice elements
as well as practical considerations for their
implementation. It then presents promising
practices used by States and jurisdictions that Evidence-based programs
are working to improve their delivery of in-
home services.
Promising practices
Conclusion
References
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 1WHAT ARE IN-HOME SERVICES? routines, and manage stressful everyday
situations. The location where services are
Child welfare in-home services are a delivered will depend on the protocols of the
continuum of prevention-related supports local service providers and the availability of
and programs designed to enhance the services.
protective capacity of caregivers and improve
the conditions that may contribute to safety In defining in-home services, there
and risk concerns for children (e.g., mental is a common misconception between
health concerns, substance use, parenting those described above and home visiting
practices). They can be primary prevention programs, which match at-risk families
services geared toward the general population; with professionals or paraprofessionals
secondary prevention services for families who provide support, education, training,
with one or more risk factors for child and resources during visits to the home.
maltreatment; or tertiary prevention services Home visiting programs are often used
aimed at preventing out-of-home placement as a preventive approach with high-risk
for families in which maltreatment has already populations, such as teen parents and
occurred, provided children can remain in families with infants and young children.
their homes safely. Tertiary in-home services However, some home visiting programs
allow children to stay connected with their address the needs of families receiving in-
siblings, extended family, friends, school home services and can be used or adapted
connections, and other support systems and for a child welfare population, often through
provide resources that can help parents their inclusion as part of an in-home services
focus on addressing the issues that led to case or treatment plan (see Child Welfare
abuse or neglect or that could lead to Information Gateway's Home Visiting web
future maltreatment. section for more information.)
In-home services may be voluntary or HOW ARE IN-HOME SERVICES INITIATED?
court ordered and can encompass an array
When a report of child maltreatment is filed
of supports, interventions, and programs,
with CPS, intake workers screen the report to
ranging from transportation and housing
assess the allegations and determine whether
assistance to intensive family preservation
there are any immediate or impending safety
services. The term "in-home" refers to the
concerns. If safety concerns are identified
location where the child and family are
and thresholds are met, CPS will recommend
residing and not necessarily to the place
that the family receive either an investigation
where services are delivered. The services
or a family assessment, the latter of which
may be provided in the community or other
is typically an option in jurisdictions using
places, such as at a counseling center or child
differential response systems. In either case,
welfare agency. However, services offered
child welfare caseworkers will conduct a
in the home have several added benefits.
safety and risk assessment to determine
They give providers opportunities to identify
how safe children are in their homes and the
family strengths, offer support around family
level of risk for future harm. These safety
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 2and risk assessments, accompanied by a more WHAT TYPES OF SERVICES ARE INCLUDED?
comprehensive family assessment, are used to
There is no standard set of required in-home
inform the feasibility of maintaining the child
services; the goal is to find the right combination
safely in the home through the use of safety
of services and supports tomeet the specific
plans. Safety plans are written agreements
needs of each family. In-home services are
designed to help parents focus on addressing the
geared toward meeting the following goals:
issues that led to unsafe conditions or threats
to child safety, strengthen parental protective Ensuring children's safety
capacity, and enhance community connections
Strengthening parental protective capacity
so families can safely and sustainably care for
children without further agency intervention. Improving overall adult, child, and
Safety stabilization creates conditions for family functioning
working collaboratively with families to cocreate Building caregiving and coping skills
case plans with individualized in-home services. Supporting healthy and nurturing relationships
WHO RECEIVES IN-HOME SERVICES? Fostering physical, emotional, behavioral, and
educational well-being and mental health
In-home services are typically provided to
Enhancing the potential for permanency
families who have open cases with a child
welfare agency and whose children remain at Services to address family challenges could
home or have returned home from foster care. In include general prevention-related or
some cases, the allegations of child maltreatment knowledge-building information or referrals for
have been substantiated, but the child is not in tangible and intangible support, such as—but not
immediate or impending danger. In other cases, limited to—the following:
allegations have not been substantiated, but a
Age-specific parenting support, including
comprehensive assessment of family functioning
teen or adult parent training, coaching, or
prompts the provision of targeted services to
skill building to help with complex parent-
help strengthen parental protective capacities
child interactions
and address any general concerns. In-home
Individual and/or family therapy
services can also be provided to families whose
children have returned home after a stay in Referral for substance use treatment and skill
foster care; in these cases, the child welfare building to enhance coping and encourage
agency strives to ensure that parents have the behaviors that replace substance use
necessary strengths, protective capacities, and Referral for mental or behavioral health
community and relational supports to safely care treatment followed by support in applying
for their children and prevent their reentry into what was learned in treatment to improve
care. During fiscal year 2018, approximately 2 family management and child safety
million children nationwide received prevention
Information and referrals for resume-building
services and about 1.3 million received
services as well as interview and job training to
postresponse services from a child welfare
help with economic and financial stability and
agency (Children's Bureau, 2020b).
self-sufficiency
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 3 Assistance with child care and IN-HOME SERVICES DELIVERY
transportation
Child welfare agencies must deliver effective
Concrete assistance, such as food,
in-home services that can stabilize and
clothing, furniture, or housing to
strengthen families and prevent the need for
contribute to positive health and
out-of-home care whenever possible. In some
well-being outcomes
instances, caseworkers can provide in-home
VOLUNTARY VS. COURT-ORDERED IN- services directly to families, and in other
HOME SERVICES instances they may facilitate contact between
families and community-based service
In-home services can be delivered either
providers, such as family resource centers
on a voluntary basis (meaning that family
(FRCs). Having the capacity to provide an
members have agreed to participate of their
array of evidence-based or evidence-informed
own accord) or as the result of a court order
family support, family preservation, and
(meaning a judge has mandated a family's
postreunification services enables agencies
participation). Policies regarding whether
to provide individualized treatment so that
these services can be delivered on a voluntary
children can remain safely in their homes.
or court-ordered basis vary by State.
A diverse service array includes programs
Caseworkers may encounter difficulties when
that can address the physical, emotional,
attempting to engage families in voluntary
social, mental, developmental, and
services because some potential participants
educational needs of children and families,
may view the services as either intrusive or
while also considering key systemic
unlikely to provide useful benefits. (Daro
factors, such as individual, family, and
et al., 2005). In addition, parents may fear
community circumstances that may impact
that more frequent contact with the child
service delivery.
welfare system and its service providers could
put them at risk for having their children SERVICE ARRAY
removed from the home, a circumstance that
A child welfare agency's service array includes
underscores the importance of caseworkers
services funded by the agency and those
building rapport with the families on their
provided by other agencies and community
caseloads to foster trust and engagement
organizations. Families need accessible,
in services. When treatment services are
quality services to strengthen parental
mandated by a court order and conditions
protective capacity and support child safety at
in the home environment that threaten the
all points along the child welfare continuum.
safety of a child cannot be controlled despite
However, Child and Family Services Reviews
the agency's reasonable efforts, a child could
Aggregate Report: Round 3: Fiscal Years 2015–
be removed from the home and subsequently
20181 showed that State child welfare agencies
placed into out-of-home care.
did a better job of assessing the needs of
1
The Child and Family Services Reviews (CFSRs) are periodic Federal reviews of State child welfare systems to (1) ensure conformity
with Federal child welfare requirements, (2) determine what is actually happening to children and families engaged in child welfare
services, and (3) assist States in helping children and families achieve positive outcomes.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 4children and families than providing services answering the following questions about an
to meet the identified needs, suggesting that area's service needs (Capacity Building Center
States should examine the systemic issues for States, 2019a):
that create difficulties in meeting family
What are the current needs of the children
needs identified in assessments. In fact, only
and families being served?
the District of Columbia earned a strength
rating in this area (Systemic Factor #29: Array What services are currently available and
of Services). Systemic factor concerns that being provided to children and families?
were cited in the CFSRs include the following What child and family needs are currently
(Children's Bureau, 2020a): not being met by the existing service array?
Gaps in the availability of services or long Building a service array that meets
waiting lists for services community needs allows child welfare
Difficulty accessing services due to agencies to facilitate collaboration with
payment-related or transportation-related service providers for presently underserved
issues or more vulnerable subpopulations of
children and families. In cases where agencies
Delays in referrals and arranging services
need to increase the types of services
due to caseworker workloads
available to families, they can approach
Lack of quality providers community- and faith-based organizations
Lack of services—especially specialty and discuss the potential expansion of their
services—in rural areas services to meet client needs. For more
information on partnering with community-
The report also noted the types of services
and faith-based groups to increase service
that were most often needed but were
provision, visit Information Gateway's
insufficiently available, including substance
Engaging Communities to Support Families
use treatment, behavioral and mental health
web section. For more information on using
treatment, domestic violence services,
data to inform service array development,
trauma-informed services, housing, child
see A Data-Driven Approach to Service
care, employee assistance, transportation,
Array Guide by the Capacity Building Center
visitation, and services to support youth
for States.
transitioning into adulthood.
Agencies may need to adjust their service THE ROLE OF COMMUNITY
COLLABORATION
arrays to provide the necessary mix of
supports and programs that foster the Enhanced collaboration with community
safety, permanency, and well-being of providers can help build a service array
families in the communities they serve. that is sensitive to local needs, increase the
Decisions made around service array availability of evidence-based and evidence-
adjustments and expansions should be informed services, and strengthen community
informed by data collection geared toward collaboration with family support and
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 5preservation programs and other State and in their communities—not just vulnerable
local entities. When agencies support multiple families or those referred from the child
community providers working together to welfare system—which minimizes stigma that
deliver needed in-home services through may be associated with service reception. For
systems of care, families benefit. These more information on FRCs, see the National
providers may include the following (Capacity Family Support Network's Family Resource
Building Center for States, 2017): Centers web section.
Providers contracted for other State IN-HOME SERVICES FUNDING
interagency programs (e.g., mental health,
The primary source of funding for child
public health, workforce development)
welfare in-home services is provided through
Specialized program providers (e.g., provisions of title IV-B of the Federal Social
substance use treatment, therapeutic Security Act. Historically, that funding has
services, at-risk youth interventions, life been invested in out-of-home care services
skills services, sports and recreational (e.g., foster care). However, the 2018 Title IV-E
activities) Prevention Services Program has prompted a
Advocacy centers and volunteer resources new emphasis on prevention services,
Local churches or charitable organizations and States are increasingly investing in
evidence-based in-home services that meet
Child welfare agencies may also refer children the program's requirements. Funding for
and families to collaborative community in-home services also comes from a variety
support groups, such as FRCs, for services. of other sources, including Federal funds
FRCS are community- or school-based hubs and grants made available through legislative
that provide and connect families with a programs. Most States use more than one
variety of in-home services for every stage of the following sources to fund their
of the prevention continuum (i.e., primary, in-home services.
secondary, tertiary). They offer both formal
and informal supports and services—as well Title IV-E Prevention Services Program.
as referrals for supports and services—that In 2018, the Family First Prevention Services
are targeted to a community's specific needs Act amended the Social Security Act to allow
and interests (Russo, 2019). FRCs provide States and Tribes to use Federal title IV-E
access to a range of programs and supports funds that were previously set aside for
in a single location, thereby making in-home foster care expenses for services designed
services more accessible for families. FRCs to prevent children from entering foster
take a strengths-based, culturally informed, care. The amendment of the Act established
and family-centered approach to service the Title IV-E Prevention Services Program,
provision, allowing families to determine their which provides optional funding for certain
own goals and level of involvement. They time-limited prevention services, including
build communities that foster peer support in-home parent skill-based programs (i.e.,
for families and reduce feelings of stress and parenting skills training, parent education,
isolation. Importantly, they serve all families and individual and family counseling).
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 6States and Tribes with an approved title Promoting Safe and Stable Families (PSSF)
IV-E prevention plan may claim title IV-E title IV-B program. PSSF is a Federal program
reimbursement for a portion of trauma-informed under title IV-B of the Social Security Act
mental health services, substance use treatment, that provides funding to States and Tribes to
and in-home parent skill-based programs for implement a coordinated program of community
up to 1 year. To qualify for reimbursement, services that includes family support, family
programs must be rated promising, supported, preservation, time-limited reunification, and
or well-supported by the Title IV-E Prevention adoption support (Capacity Building Center
Services Clearinghouse or have an approved for States, 2016). For more information on
designation through an independent systematic the program, including its funding mechanisms
review process. At least 50 percent of the and requirements, see Promoting Safe and
amount paid to the State in any fiscal year Stable Families by the Capacity Building Center
must be for prevention services that meet the for States.
"well-supported" practice criteria. For more
Temporary Assistance for Needy Families
information, see "A Complete Guide to the Family
(TANF). The Office of Family Assistance
First Prevention Services Act" in The Imprint.
administers TANF block grants to States. These
Medicaid. Medicaid, as authorized by title XIX grants have a high degree of flexibility when it
of the Social Security Act, is a program funded comes to the use of these funds. When families
jointly by Federal and State governments to receiving TANF assistance through public welfare
provide health-care coverage to low-income programs are also involved in child welfare, the
people who meet certain additional criteria. two systems can coordinate on case planning.
Most children and youth involved with the child Specifically, they can allow activities in a child
welfare system are eligible for Medicaid, and welfare case plan—including in-home services—
States can facilitate collaboration across child to count toward TANF work requirements.
protection, Medicaid, and behavioral health For more information, see the Center for
systems to fund a broad range of in-home the Study of Social Policy's 20 Years of TANF:
services that fulfill these children's needs (Center Opportunities to Better Support Families Facing
for Health Care Strategies, 2019). States can Multiple Barriers.
provide in-home services through a combination
Child Abuse Prevention and Treatment Act
of Medicaid benefits, home- and community-
(CAPTA) Community-Based Child Abuse
based waivers, and general State funds. In
Prevention (CBCAP) grant program. CBCAP
addition, select evidence-based practices
grants are provided through CAPTA to fund
included in the Title IV-E Prevention Services
child abuse prevention programs at the
Clearinghouse can be funded through Medicaid.
community level. To learn more, visit the
For more information, see How Can Medicaid-
FRIENDS National Center for Community-Based
Funded Services Support Children, Youth, and
Child Abuse Prevention website, which provides
Families Involved With Child Protection? by the
resources and capacity-building services to
Casey Family Programs' Center for Health Care
CBCAP grantees.
Strategies and Information Gateway's Health
Insurance: Medicaid, CHIP, and the Affordable
Care Act web section.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 7It is also important to note that some in-home One strategy that caseworkers can employ to
services may be reimbursable under a family's encourage family engagement with in-home
personal health insurance plan. This generally services is family group decision-making (FGDM).
applies to services related to reunification and FGDM uses a trained facilitator to guide parents,
crisis stabilization (before or after residential children, and other family members through a
placement) but may also be used for intensive structured case-planning process. This approach
in-home therapeutic services aimed at gives each member of the family a voice and a
preventing out-of-home placements. greater sense of ownership over the decision-
making process, which can result in more
IN-HOME SERVICES PRACTICE
engagement with their service plan and ultimately
ELEMENTS
better outcomes. While FGDM is typically used
There is no one-size-fits-all approach for in- as an engagement strategy following a child's
home services delivery; however, researchers in placement in out-of-home care, some agencies
the field have identified a set of core elements employ the practice earlier on in CPS cases
for effective practice (D'Aunno et al., 2014). The (NRCinhome, n.d.). Specifically, caseworkers
National Resource Center for In-Home Services can involve families in developing safety plans,
(NRCinhome), which was funded by the Children's identifying family strengths and anticipating
Bureau from 2009 to 2014, conducted a nationwide needs, preventing imminent placements, and
assessment of in-home service delivery practices making placement decisions. To learn more, see
in 2014. The analysis found that the following the NRCinhome research brief Family Group
in-home services elements are among those that Decision Making and In-Home Services and visit
are supported by research and consistent with the Family Group Decision-Making section of the
evidence-based practices and programs. Information Gateway website.
Family-centered practice and family Safety assessment and management. Child
engagement. Family-centered practice focuses welfare agencies have the responsibility to
on children's safety and needs within the context ensure the safety of children who remain in
of their families and communities and builds on their homes. Careful decision-making and safety
family strengths to achieve optimal outcomes. planning at the front end of a case can prevent
Rather than treating individuals within a family, future abuse and the unnecessary placement of
family-centered practice uses the power of family children in out-of-home care. However, results
relationships, interactions, and supports to help from round 3 of the CFSRs indicated that most
the entire family system. An important element States struggled when it came to providing
of family-centered practice—and in-home services to families to prevent children's entry or
services delivery—is engaging families in the reentry into foster care. Caseworkers typically
casework process. Effective family engagement use safety assessment models and tools (e.g.,
occurs when caseworkers recognize families as the Safety Assessment Family Evaluation model,
the experts in their respective situations and the structured decision-making model, the
empower them throughout the casework process. Signs of Safety approach, the Safety Organized
(To learn more, see Information Gateway's Practice approach) to help them assess and
Family Engagement: Partnering With Families to determine a child's level of safety in the home.
Improve Child Welfare Outcomes.) Risk assessments are used to assess a family's
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 8risk and protective factors and to assign a value Problem-specific interventions.
regarding the degree to which these factors Interventions should be individualized
indicate a likelihood for future maltreatment. to meet the unique needs of families.
While it is critical that caseworkers receive Caseworkers should understand that for
proper training on using safety assessment certain services to be effective, they must
tools, the tools are most effective when align with the needs of the families they
they are directly connected to assessment are working with. For example, family
practices, engagement with families, safety preservation services may not be appropriate
and service planning, service identification, for families struggling with unmanaged
and monitoring the ongoing progress of the mental health or substance use disorders.
family. Furthermore, caseworkers must develop Providing services for the purpose of fulfilling
the ability to understand and assess family practice requirements or expectations is
dynamics, caregiver protective capacities, not an effective approach to stabilizing
and family strengths and needs so they can and strengthening families. Common
critically analyze the information in its totality specialized interventions include substance
and accurately apply the tools used to guide use treatment, mental health services,
decision-making. For more information, see age-specific parenting skills training, and
the Safety and Risk Assessment and the Safety interventions for certain child behaviors.
Planning in Child Protection sections of the Culturally specific services. When referring a
Information Gateway website. family for services, child welfare caseworkers
Individualized services. Caseworkers should should seek out programs that are specifically
connect their clients with available and designed for people with that family's racial,
accessible services that target the family's ethnic, and cultural backgrounds. Having
needs. Having an array of services that are access to in-home services that employ
accessible and available allows an agency to cultural awareness and sensitivity is critical
respond in a timely manner to family needs for serving the diversity of families involved
in order to keep children at home safely. with the child welfare system. For more
Caseworkers should assess needs around the information on providing culturally specific
following factors when matching families with services to families, see the Information
appropriate in-home services: Gateway's Child Welfare Practice to Address
Racial Disproportionality and Disparity.
Concrete supports. Families in crisis often
have concrete needs that are not being Strengthening protective factors. Although
met. Caseworkers should determine if there protective factors were not evaluated as
are family needs around income, housing, part of the NRCinhome assessment, they
transportation, utilities, health care, child are increasingly being emphasized by child
care, and other basic or essentials needs. welfare in-home services providers (e.g.,
FRCs), programs (e.g., home visiting programs),
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 9and agencies (Child Welfare Information Incredible Years
Gateway, 2020). A protective factors approach Interpersonal Psychotherapy
to child maltreatment prevention focuses
Motivational Interviewing
on positive ways to engage families, such
as by emphasizing their strengths and Multidimensional Family Therapy
identifying areas where they have room to Multisystemic Therapy
grow with support. Examples of protective Nurse-Family Partnership
factors include parental resilience, social
Parents as Teachers
connectedness, and social-emotional
competence in children. To learn more, Parent-Child Interaction Therapy
see Information Gateway's Protective Factors SafeCare
Approaches in Child Welfare. Trauma-Focused Cognitive-Behavioral
Therapy
EVIDENCE-BASED PROGRAMS
Triple P (Positive Parenting Practice)
Evidence-based programs are those that
have been evaluated for effectiveness and Other programs that have not yet met the
shown to produce positive outcomes. Since clearinghouse criteria but are highly regarded
the enactment of the Title IV-E Prevention in the field include the following:
Services Program, there has been an
Family Connections
increased emphasis on scaling up programs
that are rated as promising, supported, or Project Connect
well-supported by the Title IV-E Prevention Signs of Safety
Services Clearinghouse. As of March 2021, Solution Based Casework
the in-home services programs listed below
Additional evidence-based programs can
have met the rigorous evaluation standards
be found on the California Evidence-Based
prescribed in the ratings criteria and are
Clearinghouse for Child Welfare website. It is
therefore eligible for reimbursement under
important to note that Tribal IV-E agencies
the Title IV-E Prevention Services Program.
are not required to implement programs
Please note that the clearinghouse is regularly
that meet the Title IV-E Prevention Services
updated. You can find the most up-to-date list
Program's rating requirements and may
of eligible programs in the Find a Program or
instead determine their own practice criteria
Service section of the clearinghouse website.
for services that are adapted to the culture
Brief Strategic Family Therapy and context of the Tribal communities
Child-Parent Psychotherapy that they serve. For additional Federal
guidance, see the Program Instruction
Families Facing the Future
ACYF-CB-PI-18-10, Tribal Title IV-E Agency
Functional Family Therapy Requirements for Electing Title IV-E
Healthy Families America Prevention and Family Services and Programs.
Homebuilders
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 10PROMISING PRACTICES CFSA staff are seen as true members of their
collaboratives, which is critical for families'
Several States and jurisdictions are making
engagement, since they tend to feel more
efforts to improve their practice and delivery
comfortable working with caseworkers in
of in-home services to better serve children
these community-based organizations than
and families. The following are examples from
at the agency's downtown government
the field.
office building (Capacity Building Center for
DISTRICT OF COLUMBIA States, 2020).
In round 3 of the CFSRs, the District of Following the enactment of the Title IV-E
Columbia was the only jurisdiction to receive Prevention Services Program, CFSA tapped
a strength rating on Systemic Factor #29: into HFTCC's knowledge to assess the
Array of Services (Children's Bureau, 2020a). benefits and challenges of the evidence-
The robustness of their service array is due in based practices that were already being
large part to the nearly 30-year partnership offered through the system. The District of
between the Child and Family Services Agency Columbia was the first jurisdiction to have
(CFSA) and its Healthy Families/Thriving an approved plan for the Title IV-E Family
Communities Collaboratives (HFTCC)—a First Prevention Plan, and CFSA continues
network of five neighborhood collaboratives, to partner with HFTCC on implementation
each offering services targeted to the specific (Casey Family Programs, 2020). In 2020, CFSA
needs of its immediate community (Capacity also launched Families First DC, an initiative
Building Center for States, 2019b; Casey to establish 10 neighborhood-based family
Family Programs, 2020). Over a 20-year period success centers in wards 7 and 8, which are
that spans the CFSA-HFTCC partnership home to approximately 75 percent of the
(1998 to 2018), the number of children in children and families served by the agency (N.
out-of-home care in the District of Columbia Craver, personal communication, February 4,
decreased from 3,188 to just 707 children (78 2021). The family success centers will expand
percent) (Children's Bureau, 1998; Children's on the District of Columbia's long-standing
Bureau, 2018). prevention and early intervention work by
providing neighborhood-driven services
While there are innumerable community- and supports to strengthen families in
based agencies working in neighborhoods their communities.
across the country, HFTCC in the District
of Columbia is exemplary for the nature For more information on how the District of
and closeness of its partnerships with Columbia partners with HFTCC, listen to the
the local child protection agency (Casey How We Partner With the Community to
Family Programs, 2020). HFTCC provides Improve Service Options Podcast Series by the
community-based case management support, Capacity Building Center for States and read
and CFSA colocates its in-home services Transforming Child Welfare Systems: How Do
staff in each collaborative within HFTCC, Washington, D.C.’s Community Collaboratives
enabling caseworkers to be based in the Provide Neighborhood-Based Supports to
communities they are serving. As a result, Families? by Casey Family Programs.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 11ALASKA speak to providers and is offering technical
assistance for capacity building. OCS is
Alaska's Office of Child Services (OCS) partnered
specifically focused on developing programs
with the State's Division of Behavioral Health
that can be easily adapted for rural communities
in 2019, and together they worked with the
and have a strong cultural component that
Capacity Building Center for States to conduct
can meet the needs of Tribes throughout the
a statewide service provider gap analysis.
State. The agency is concurrently working on
This comprehensive needs assessment aimed to
changing its culture to ensure that staff and
identify where evidence-based practices were
partners focus on prevention over removal and
operating across the State and where critical
develop trusting relationships with families.
service gaps existed so that the State could
effectively implement its 1115 Behavioral Health MONTANA
Medicaid Waiver program in coordination with
the Title IV-E Prevention Services Program Montana worked with the Capacity Building
requirements. The effort included in-person Center for States in 2018 to improve its in-home
visits to 73 Medicaid providers across Alaska, services delivery. At that time, the State was
including 20 Tribal organizations providing also revisiting how it structured its child welfare
behavioral health services. The cross- contracts, which tended to be concentrated
organizational team also administered surveys within a few providers (A. Beattie, personal
to Medicaid providers and OCS frontline staff communication, November 24, 2020). For
working across 13 field offices. example, the 18 counties in region I were all
served by a single provider, making adequate
Results from the assessment are helping to service provision a challenge. The State took
inform how OCS will invest and partner with a two-pronged approach to addressing the
Tribes and community-based organizations to service delivery issue: expanding access to
develop its serve array and build capacity for services and creating family support teams.
Medicaid-reimbursable and evidenced-based
services. The analysis revealed key takeaways Expanding access to services. As part of its
regarding service gaps in rural areas as well service delivery evaluation efforts, Montana
as with the alignment of current services with found there were many small agencies across
community needs. OCS is in the process of the State that were trained in evidence-based
building a strategy to increase its provision practice models but would not apply for State-
of in-home prevention services, with a focus issued contracts, as the contracts typically
on programs approved by the Title IV-E allocated between $100,000 and $200,000
Prevention Services Program that can be funded and these small agencies could not provide
through Medicaid (S. Abramczyk, personal services at that level. To expand services and
communication, December 17, 2020). take advantage of these providers, Montana
worked with its procurement office to move
In order to encourage existing providers to from using bigger, single-provider contracts to
develop prevention services, OCS has brought using smaller contracts with fees for service.
in representatives from national programs to The State developed a rate matrix as part of
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 12this process—not only to increase service SOUTH CAROLINA
delivery but also to increase access to
The South Carolina Department of Social
evidence-based services with the Title IV-E
Services (SCDSS) is currently working on
Prevention Services Program in mind. The
multiple system reform efforts—including
rate matrix was set up so that evidence-
a new funding model for evidence-based
based service providers would earn a
services and a new casework practice
higher rate for services. The State also
model—that are designed, in part, to impact
began offering increased rates for providers
the State's provision of in-home services
willing to travel more than 50 miles or those
(S. Ferrufino, personal communication,
providing services in the evenings or on
January 5, 2021). These initiatives are part
the weekends.
of a statewide culture shift aimed at moving
Family support teams. Montana identified away from punitive child welfare practices
a need to be more efficient in offering and toward a focus on family safety, well-
services to families at the outset of a case. being, and prevention. Historically, South
Montana providers often felt they lacked Carolina's child welfare system has primarily
the information necessary for quickly utilized private providers that serve children
connecting a family to services, and there in out-of-home care (e.g., group homes).
was a general concern that available In addition, although the State had an
services were going untapped despite existing network of primary prevention
community need. In response to these providers, there were gaps in its secondary
concerns, region 2 implemented family and tertiary provider networks. With grant
support teams—a successful effort that is funding from the Family First Preventions
expanding to other regions. Family support Services Act Transition Grants and program
teams are assembled as part of a family's support from the Thriving Families, Safer
protection plan (ideally within 72 hours of Children: A National Commitment to Well-
the plan's establishment), with the primary Being initiative, South Carolina is expanding
goal of maintaining children in their homes its array of prevention programs, with the
when possible or quickly reunifying families ultimate goal of shifting service delivery to
in cases of removal. In region 2, there the front end of their system.
were roughly 18 community providers that
To kick off the process, SCDSS convened a
committed to being available on an as-
prevention services workgroup comprising
needed basis to support families in crisis.
a diverse range of State agencies and
Preliminary data from the first year of
stakeholders to assess the statewide
this initiative show a 48-percent decrease
evidence-based practice landscape and
in out-of-home placements and a
identify existing programs now eligible
76-percent increase in family receipt of
for title IV-E funding through the
in-home services.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 13Title IV-E Prevention Services Program. CONCLUSION
They also created guidelines for providers
The delivery of high-quality in-home
that were willing to shift their program
services that help keep children safely at
offerings to provide more evidence-
home with their families and prevent entry
based practices. South Carolina ultimately
into foster care is becoming increasingly
invested its Federal grant funds directly into
critical as States begin to shift their focus to
select provider pilot sites to help enhance
prevention in alignment with the Title IV-E
their capacity to deliver evidence-based in-
Prevention Services Program. It is often in
home services. As of January 2021, the State
a child's best interests to remain at home
was in the process of training the pilot sites,
when safety can be controlled and services
with the goal of launching service provision
are provided, and it is important to avoid
during the spring of 2021.
unnecessarily placing children in out-of-
In the years prior to these initiatives home care. Therefore, agencies must have
around in-home services, SCDSS designed a robust array of services and supports
a practice model that emphasized a and collaborative systems of care to target
prevention-focused approach to service the various family-specific challenges
provision, with core principles that were that are present in the communities they
subsequently reinforced by the enactment serve. In developing their optional title
of the Title IV-E Prevention Services IV-E prevention plans, States must select
Program. The model was built and implement evidence-based prevention
upon a set of core values—specifically that programs that, based on data for their
practice should be trauma informed, family agency's population and characteristics,
centered, individualized, and strengths are feasible for their systems and work with
based. Agencies across the State are the families living in their jurisdictions.
increasingly making a concerted effort to Historically, there has been limited data
listen to the perspectives of their families on in-home services implementation and
by engaging them in case planning and by related continuous quality improvement;
tapping into the experiences of families however, there are established measures
currently and formerly involved in their that States can take to evaluate the extent
system. They are also working to remove to which their current service provision is
the stigma that parents experience when meeting the needs of their families.
seeking assistance by shifting agency
mindset to one that normalizes help-
seeking behaviors.
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Administration on Children, Youth and Families
Children’s Bureau
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/inhome-services/.
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