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					                        NCCAN Kinship Care:

             Innovative Approaches to Kinship Care of
             Children in the Child Welfare System 1.03

                             90-CA-1598



The Enhanced Support Services for Kinship Caregiver Families Project

                            Final Report
                         Executive Summary




                             Submitted by:
                   Child Welfare League of America
              Mattie L. Satterfield, Kinship Care Director
                 Sharon McKinley, Project Manager
                    Research and Evaluation Unit
                  Jeff Capellini, Research Assistant
Executive Summary

       The Child Welfare League of America (CWLA) defines kinship care as the
full time care, nurturing, and protection of children by relatives, members of
their tribes or clans, or other adults who have a family relationship to a child
(CWLA Standards of Excellence for Kinship Care Services, 2000). Kinship care,
or relatives caring for children without parental support, is a tradition of child
rearing in many cultures. A relative caring for their kin’s child provides an
important option for the family to maintain family connections and stability.

      This form of child rearing is increasingly being used as a formal option in
public child welfare agencies and is one of the fastest growing segments in the
child welfare system (Child Welfare League of America, 1994; Jackson, 1999).
Approximately 20% to 23% of foster children are placed with relatives, while in
some states (including California, Illinois, and New York), this number is closer
to 40% to 50% (APHSA, Crossroads: Child Welfare Addendum, March, 2002).
Also, data indicate that relative placements make up a large proportion of
placements in the child welfare system in Maryland and Pennsylvania
(Scannapieco and Hegar, 1999).

      Despite its significant growth, there is not a clear consensus in the child
welfare field regarding the conceptual framework for formal kinship care.
While some believe it is a form of family preservation, others view it as an out-
of-home placement (Scannapieco and Hegar, 1999). As a result, there are
considerable variations among states’ kinship care policies and practices (Boots
and Geen, 1999). Kinship care placement decisions, licensing requirements,
payment levels, supervision, and service provision vary from state to state.

       These policy differences can have a significant impact on kinship
caregivers who may be in greater need of support and assistance than non-
relative foster parents (Berrick, Barth, and Needell, 1994). Studies have found
that kinship caregivers are generally lder and less educated than non-relative
foster parents (Berrick et al. 1994; CWLA 1994). They tend to have lower
incomes and poorer health than non-relative foster parents and are more likely
to be single parents. In a study of 512 child welfare workers in California,
workers reported that kinship caregivers had fewer resources than non-relative
foster parents and needed greater assistance in obtaining housing, clothing,
money, transportation, and child care (Berrick, Needell, and Barth, 1999).

      Yet, research suggests that kinship care families receive significantly
fewer services than non-relative foster care families (Berrick et al., 1994). A
California study revealed that children in kinship care were less likely to
receive mental health treatment than children in other types of foster care
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settings, despite having similar needs (Berrick, et al., 1994). The literature also
reveals that kinship caregivers are less likely to receive respite care, support
groups, and training than foster parents (Berrick et al., 1994). In a study of 60
grandmothers caring for their drug-affected grandchildren, caregivers indicated
a need for formal assistance in financial and legal matters, employment,
parenting, and dealing with the substance abuse of their children and
grandchildren (Burton, 1992). A recent survey of child welfare workers also
revealed that kinship caregivers need training on addressing the special needs
of children, using nonphysical discipline, and accommodating their roles of
protecting the children and supporting birth parents (Berrick, Needell, and
Barth, 1999).

       Studies have found that up to 91% of kinship caregivers report not
receiving any type of training (Berrick et al., 1994). As a result, kinship
caregivers may be less knowledgeable about child welfare requirements, legal
services, permanency planning, and other issues related to child safety,
permanency, and well being. For example, some practitioners have argued that
a lack of permanency planning education for kinship caregivers is one of the
primary reasons children may stay in kinship care longer than non-relative
foster care (Crumbly and Little, 1997). Supporting this premise, a recent study
of 76 kinship care cases in Illinois revealed that kinship caregivers were not
presented with all of the permanency options available to the children in their
care (Gleeson, 1999).

       The unique dynamics of formal kinship care further suggest that kinship
caregivers may need expanded educational enrichment and support services. A
recent study of 82 kinship caregivers and 98 non-relative foster care parents
revealed that kinship caregivers rated their role as significantly greater in the
following areas as compared to non-relative foster parents: facilitating contact
with members of the birth family, helping children with their emotional and
social development, parenting, and working as a partner with the agency
(Pecora, Le Prohn, and Nasuti, 1999). This finding suggests that kinship
caregivers may need increased support and assistance to fulfill these
responsibilities and meet the demands of being both a relative caregiver for the
child and an agency foster parent.

Kinship Care in Maryland

       In 1996, CWLA provided a comprehensive report of Maryland's out-of-
home care services. CWLA identified a number of strengths and provided
recommendations for improved care. The kinship care service program in the
state of Maryland provides a comprehensive approach to providing casework
services. In fact, the state of Maryland is unique in that it has had a kinship
care program since 1983.

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     While most states were only beginning to formalize a policy specifically
related to serving families in kinship care arrangements, Maryland, through
state statute, regulations, circular letters, and through the L.J. vs Massinga
Consent Decree, has clearly articulated a sound kinship care philosophy,
mission, and goals. The procedures of assessment, monitoring, permanency
planning, and specific kinship training for workers who provided kinship care
services were in place. Using these service procedures, Maryland was effective
at assuring the safety and well being of children in kinship care.

       The State of Maryland operates two programs that provide formal kinship
care services: Kinship Care Program and Restricted Foster Care. In the Kinship
Care Program, the kinship caregivers receive Temporary Cash Assistance (TCA)
or Supplemental Security Income (SSI) funds for the children in their care. In
the Restricted Foster Care Program kinship caregivers’ homes are approved
specifically for the kin-child and they receive foster care payments, which are
substantially higher than the TCA funds which is the federal Temporary
Assistance for Needy Families (TANF) funds. Baltimore City Department of
Social Services (BCDSS) has the largest number of kinship care cases and is
the only local social service agency that has kinship care units. In December
2000, Maryland had 2,248 children in kinship care. Of that number, Baltimore
City DSS had 1,924 children in kinship care while the remainder of the state
had 324, (DHR/SSA Monthly Management Report August 2001).

Project Overview

     Despite Maryland's progress in kinship care, BCDSS administrators,
workers and kinship caregivers identified a lack of support services for kinship
families. Based on this information and previous literature reviews CWLA and
the State of Maryland’s Baltimore City Department of Social Services (BCDSS)
formed a three year research demonstration partnership funded by the
Administration for Children, Youth, and Families (Innovative Approaches to
Kinship (Relative) Care of Children in the Child Welfare System 1.03). The
project was designed to improve the safety, well being, and permanence for
children who were living with relatives and in the legal custody of BCDSS by
providing enhanced support services to kinship care families.

     The Enhanced Support Services for Kinship Caregiver Families (ESSKCF)
project was designed to provide a series of specialized support services to 100
randomly selected kinship care families (treatment group). The specialized
support services included:

         Educational enrichment services (workshops) for kinship caregivers;
         A resource book to use as a guide for planning and decision making;
         Information and referral (newsletter); and
         Social activities.
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    A second group of 100 kinship caregiver families who entered the BCDSS
kinship program at the same time were randomly selected to serve as the
control group and received the standard BCDSS case services.

Project Design and Methodology

      The project design and evaluation method used was an experimental
design to compare the outcomes of the families who received enhanced support
services (treatment group) to the families who only received standard services
(control group). The process evaluation documented the development,
implementation, and delivery of the services for the project. The outcome
evaluation analyzed whether providing enhanced support services contributed
to improvements in the child’s safety, well-being, and permanence.

Summary of Major Findings

       This project proved to be a successful in providing information and
support for kinship caregivers involved in the child welfare system. Eighty-
nine percent of the kinship caregivers who responded to the consumer
satisfaction survey rated the quality of the ESSKCF as “good or excellent.”
Additionally, 90% indicated that the services had helped them care for the
children in their home. The ESSKCF participants were also more
knowledgeable of the permanency plan options than were the non-participants.
The findings suggest that the project had somewhat greater proven success in
terms of process than outcomes. Project participants expressed more
satisfaction with services that were received from the ESSKCF project than the
standard services received from BCDSS.

       Their comments also suggested greater satisfaction because of increased
knowledge of issues concerning the caregivers and the children in their care.
Through its educational enrichment services, the ESSKCF project provided
tools to facilitate caring for their kin’s children. The project’s most substantial
contribution was in increasing the knowledge of participating caregivers
concerning permanency planning in general and more specifically concurrent
permanency planning. This knowledge brought about greater concurrent
permanency planning for the treatment group. The participating caregivers’
high ratings of the project and their comments reflect an appreciation for the
ESSKCF’s support of their efforts.

Safety

      Measures of the children’s safety and well-being based on case files and
survey data were positive. From the perspective of service workers and kinship
caregivers the children in both treatment and control groups experienced safe
                                                                                  5
and stable environments. There was no documentation that any of the kinship
caregivers were incapable of caring for the child(ren) because of poor health or
because of alcohol or substance abuse.

Well-Being

       Thirty-four percent of the children in the treatment group and nearly one
half of the children in the control group were reported by their kinship
caregivers to have special medical, mental, or educational needs. Over 20% of
the caregivers (both the treatment and the control group) reported caring for
more than one child with at least one special need.

      Asthma, lead poisoning, behavior problems, and ADHD were the most
commonly identified special needs of children in both the treatment and control
groups. The caregivers in the treatment and control groups reported that they
had the necessary information needed to obtain the appropriate help for the
children in their care, and 98% of the treatment caregivers reported that they
were “usually or always” able to receive services to address the children’s
special needs.

Permanency

        BCDSS case files indicated that a majority of children in the treatment
and control groups (over 80%) did not experience a change in placement while
in kinship care. The vast majority of treatment and control group caregivers
indicated that they were “fairly sure” or “definitely sure” that the children in
their care had a permanent home with them. The caregivers expressed their
commitment in terms of “family responsibility,” and “love for the child(ren).”
Through its educational enrichment services, ESSKCF provided tools to
facilitate caring for their kin’s children. Taken as a whole, the evaluation
indicates that ESSKCF was successful in increasing the knowledge of kinship
caregivers concerning permanency options and in providing support.

      The findings suggest that Enhanced Support Services for Kinship
Caregiver Families can be valuable in assisting kin in their roles as caregivers
and child welfare providers. Information acquired through enhanced support
services can be used to broaden the caregiver knowledge base to address their
current family situations. In addition, enhanced support services can be used
to assist kin caregivers who receive Temporary Cash Assistance (TCA).

      The figures that follow present major findings and outcomes identified in
the evaluation of the Enhanced Support Service for Kinship Caregiver Families
project.


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Many children in kinship care have special needs.

Figure 1
                      Does the Child Have Documented Special
                        Medical, Mental, Educational Needs?

    60%




    50%




    40%




    30%




    20%




    10%




        0%
                Yes                           No                     Not Documented


   Just over one third (34%)of the treatment group and almost half
                            Treatment Group              Control Group



   (46%) of the control group children had documented special needs
   in their case file.


Nearly all cases that had special needs documented in their case file had
received services for those needs.
Figure 2
                          Has the Child Received Services for
                          Their Documented Special Needs?


 100%


  90%


  80%


  70%


  60%


  50%


  40%


  30%


  20%


  10%


   0%
                  Yes                                       No

                        Treatment Group            Control Group




  Nearly all of the treatment group (98%) and the control group (91%)
  children had received services for their documented special needs.
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An overwhelming majority of caregiver participants in the Enhanced Support
Service for Kinship Caregiver Families project rated the service as “good” or
“excellent,” and a majority of all caregivers were “satisfied” or “very satisfied”
with BCDSS services.

Figure 3

                             Levels of Satisfaction with
                          the ESSKCF and BCDSS Services



      90%


      80%


      70%


      60%


      50%


      40%


      30%


      20%


      10%


       0%
              Treatment Group       Treatment Group   Control Group




            Nearly nine out of ten (89%) of the treatment group rated
            ESSKCF as either “good” or “excellent.’


            Nearly three quarters (71%) of the treatment group and two
            thirds (66%) of the control group were either satisfied or
            very satisfied with the services they received from BCDSS.




                                                                                     8
A majority of the control group reported that the information they received from
BCDSS had helped them to better care for their children. Almost all of the
treatment group reported that the ESSKCF services helped them to better care for
their children.

Figure 4
                Did the Information You Received from BCDSS Help You
                          Take Better Care of Your Child(ren)?

                                      Control Group


                                      5%




                          22%

                                                          Yes


                                                          No


                                                          No Response




                                                 73%




    Almost three quarters (73%) of the control group indicated that the
    information they received from BCDSS helped them take better care of
    their child(ren).
                Did the Information You Received From ESSKCF Help
                      You Take Better Care of Your Child(ren)?

                                     Treatment Group
                                     5%
                                6%




                                                                Yes


                                                                No Difference


                                                                No Response




                                               89%


    Approximately nine out ten (89%) of the treatment group indicated that
    the information they received from ESSKCF helped them take better care
    of their child(ren).                                                   9
A majority of caregivers for both the treatment and control groups reported that
the children in their care had shown signs of improvement.

Figure 5


                 Have the Child(ren) Improved While in Your Care?



    90%


    80%


    70%


    60%


    50%


    40%


    30%


    20%


    10%


     0%
                    Yes                                     No

                          Treatment Group   Control Group




     Nearly nine out of ten of the treatment group (87%) and over
     three quarters of the control group (77%) stated that the
     children in their care had shown signs of improvement.




                                                                                   10
At the conclusion of the ESSKCF project, more of the caregivers in the treatment
group had knowledge of legal plans and permanency options.

Figure 6

                           Do You Know What Legal Plans or Permanency
                                     Options Are Available?


           50%


           45%


           40%


           35%


           30%


           25%


           20%


           15%


           10%


           5%


           0%
                     Yes                      No      Does Not Understand Permanency


                            Treatment Group        Control Group




            At the conclusion of the ESSKCF project, almost half (49%) of the
            treatment group and nearly 4 out of 10 (38%) of the control group
            caregivers had knowledge of the legal plans and permanency
            options available.




                                                                                       11
A comparable number of treatment and control group children had achieved a
permanent legal status when guardianship was transferred to the caregiver.

Figure 7



                                      No Longer in Custody to BCDSS


           25%




           20%




           15%




           10%




           5%




           0%
                 Returned Home                 Adopted           Guardianship to Caregiver

                             Treatment Group             Control Group




        Almost a quarter of the treatment group (23%) and the control
        group (24%) achieved a permanent legal status when
        guardianship was transferred to the caregiver. Approximately
        one out of ten had returned home for both the treatment and
        control groups, while three percent (N=2) of the caregivers in the
        control group had adopted the children in their care.




                                                                                             12
The likelihood for concurrent planning was greater for the kinship caregiver
families participating in the project.

Figure 8

                                                                     Concurrent Permanency Plans

                                          80



                                          70



                                          60
 Number of Children w/ Concurrent Plans




                                          50



                                          40



                                          30



                                          20



                                          10



                                           0
                                                Plan 6      Plan 5            Plan 4               Plan 3             Plan 2   Plan 1 (Current)
                                                                                            Plan

                                                                          Treatment Group             Control Group




                                               The number of concurrent plans for the treatment group steadily
                                               increased from zero (for the oldest plan) to 68 (for the most recent
                                               plan) at the conclusion of the project.




                                                                                                                                                  13
Lessons Learned:

         The project timeline should be extended beyond three years to develop
          and implement a successful project.

         The collaborating agencies should be involved in the initial writing of
          the grant to encourage support of the project.

         A memorandum of understanding should be developed to identify
          each organizations’ roles and responsibilities.

         Collaboration between CWLA and BCDSS was made somewhat
          difficult because of BCDSS ongoing, multiple projects and
          assignments. This slowed the transfer of case records to the
          evaluators for data collection in a timely manner.

         BCDSS staff did not fully understand the project and how it could
          benefit kinship caregivers.

         Key personnel changes for both CWLA and BCDSS challenged the
          continuity of the project.

         Social activities provided an outlet and a circle of kinship caregivers to
          share experiences and mutual emotional and psychological support.

         Service workers should be aware that caregivers may not want
          services and should not perceive this choice as a negative decision.
          They should also recognize that the offered services may not meet the
          needs of all participating caregivers.

         Service workers need to validate the kinship project in order to engage
          and sustain the involvement of caregivers.

         Based on case files and survey data, the safety and well-being of the
          children was positive.

         Enhanced support services to kinship caregiver families assist them
          in caring more effectively for the children in their care.

Recommendations

      CWLA’s findings from the project are consistent with previous literature
and support the need for enhanced support services for kinship caregivers and
the children in their care in order to maintain a safe, stable, and nurturing
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environment. The caregivers in this project had positive comments about the
project's enhanced support services. Eighty-nine percent of the kinship
caregivers in the treatment group reported that the enhanced support services
were either "good or "excellent." All treatment group caregivers reported that
the project should continue.

       CWLA recommends that support services be developed and maintained
to address the range of needs of kinship caregivers and their families. Kinship
caregivers need to be prepared to assure the safety and well-being, and meet
the specialized needs of the children, and to manage their relationship and
contact with the children's parents. A permanent enhanced support services
program can help kinship caregivers enhance the knowledge, skills, and
abilities necessary to meet the needs of the kin children in their care and work
collectively with the agency in permanency planning.

      CWLA recognizes that kinship caregivers provide a vital service to their
families as well as to the child welfare system and receive minimal assistance
from either. Children will continue to need help due to a variety of reasons.
CWLA hopes that relatives will continue to be considered as the first option to
provide care for them, which will promote and sustain family continuity.

       Baltimore City Department of Social Services showed leadership and
commitment in strengthening and supporting kinship families by partnering
with CWLA to develop and implement enhanced support services for kinship
caregivers and should continue with their history of innovative practices for kin
families. These services would aid caregivers in providing the best care for their
kin’s children. The following recommendations would assist BCDSS and other
agencies in the child welfare field in developing more comprehensive support
services for children in kinship care and in the custody of the child welfare
system:

   Develop and provide specialized enhanced support services for kinship
    families to improve their knowledge of their roles and responsibilities as well
    as the agency’s roles and responsibilities.

   Provide an array of support services that will address the concerns
    expressed by caregivers.

   The services that are offered should include, but are not limited to the
    following:

       Educational enrichment services (i.e. workshops on topics such as legal,
        concurrent permanency plan, substance abuse, and parenting
        techniques, etc.)

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       Social activities that provide opportunities for kinship families to bond,
        and to provide peer support and respite.

       Information and referral to community resources.

       Monthly or bi-monthly newsletters that provide information, parenting
        tips, dates of upcoming events, and community resources.

       Kinship caregiver resource book with information on decision making
        and planning for the safety, care, and permanency of the children in
        kinship care.

   Provide information regarding permanency planning options and agency
    requirements during the initial intake process at BCDSS. This will increase
    kinship caregivers’ knowledge and affect informed decision-making
    concerning the safety, permanency, and well-being of children in their care.

   Provide enhanced support services in the kinship caregivers’ community to
    establish a sense of familiarity and to encourage attendance.

Recommendations to Program Funders

      CWLA and BCDSS thank DHHS/ACYF Children's Bureau for affording
us with the opportunity to conduct this service demonstration project. The
program officers and the evaluation consultants were helpful and essential to
the success of the project. The annual Grantee Meeting/Conferences provided
us the opportunity to share with other grantees our successes and challenges
while expanding our knowledge in the child welfare field.

      A major challenge for grantees is the timeline for the project. The project
timeline should be extended beyond three years to give grantees time to develop
and implement a successful project. It took over a year to plan, develop, and
implement this project. First year funds were not spent because the project had
not yet been implemented. It is recommended that demonstration projects be
extended to 4-5 years which will allow grantees time to plan, develop,
implement and evaluate the effectiveness of the project. The funding for the
years planning and developing should be adjusted accordingly.




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