How Connecticut moved from institutions to families
In response to a large influx of children into state care in the late 1990s resulting from tragedies that spawned fear within the agency, Connecticut developed a sprawling system of institutional settings to have enough “placements.” In January 2011, almost 30 percent of Connecticut children in care lived in an institution.
Changing that was a top priority, and so we worked to move the agency culture from one that emphasized “beds” and “placements” to one that sought the right treatment in the family home or at least in the home of a relative or foster family.
No matter what euphemisms – be it “group care” or “congregate care” – were used to describe a highly institutionalized system, this needed to be addressed. We began with a child-by-child process to drastically reduce the use of group settings for children 12 and younger.
“Team meetings” were held to find solutions for moving these younger children into family homes. This required a systematic process of cooperation and coordination among family members, their natural supports in the community, service providers and our staff.
We started by focusing on the youngest children. Gradually, we widened the team meetings to all children in an institutional setting. The result is that we have seen more than a two-thirds reduction in the number of children in care who live in a treatment facility or other congregate setting. By January 2019, less than 8 percent of children in care were living in an institution and of those who remained there, many have complex medical needs.
To ensure success, however, we had to move resources with the children to provide necessary services. While we reduced spending on group care by nearly $90 million annually, we knew re-investing in services inserted directly into the homes to support families was crucial for making this shift sustainable.
Re-investing was not easy as Connecticut was still facing serious fiscal challenges, but then-Gov. Dannel Malloy supported the department in diverting about 80 cents of every dollar saved in lower residential care costs into community-based and in-home services. Because we also knew every dollar was precious in this environment, we became more rigid about what we funded.
Supporting such “evidence-based” services that are independently evaluated was imperative to maintain confidence – internally and externally – in our new direction. We expanded services for families struggling with substance use as the opioid epidemic that is gripping the country and causing an increase in the number of children taken into care nationwide has similarly impacted Connecticut.
Substance use afflicts up to 70 percent of families involved with child welfare agencies nationwide, and the opioid crisis is taxing systems even more. We directly responded and saw success in both supporting recovery from substance use and in keeping families together. We partnered with Yale University to expand a program called “Family Based Recovery” to 500 additional families whose children are at risk for being taken into care.
Evaluations by the Yale School of Medicine showed the program reduces parental stress and depression while improving the parent-child relationship and bonding. We even found creative ways to pay for these services by working with the Harvard University Kennedy School to use private investment “social impact bonds” as seed money. Other expansions of proven substance-use treatment services were funded by grants from the federal government and other sources.
A bevy of other in-home and community-based services were put into place and/or expanded to support families – the overwhelming majority of whom face challenges involving mental health and substance use treatment needs and domestic violence. Many send clinical staff right to the family home, treat the entire family system by strengthening parent-child relationships, deliver mental health and substance use treatment, and arrange for non-clinical recreational and therapeutic activities that address family needs.
An innovative domestic violence program – Fathers For Change – takes a strength-based approach that utilizes the desire of most families to stay together as a way to engage fathers in treatment services. Individual treatment for fathers lasting up to 24 weeks includes counseling on child attachment, family dynamics, co-parenting, and the link between cognition and behavior. Program evaluations showed a high rate of father participation, less substance use, and reduced violence.
As we gained experience and confidence with the “team meeting” process, we became comfortable with expanding its use. Initially applied in the effort to find family homes for children in institutional settings, we came to understand that this tool of engagement also could be used to prevent removals from home or at least to find a relative or kin to avoid placing a child in the home of a stranger. Begun in February 2013, these “considered removal child and family team meetings” were implemented to engage families in finding solutions and alternatives to removing a child whenever possible.
Because the purpose was to prevent the trauma that comes from a removal, the design for the process was to hold the team meetings before removal unless the child’s safety required immediate removal. The team meeting gathered the family and all its supports to determine how the child could be maintained safely in the home, and, if that was not possible, then to determine if a relative or kin would be appropriate and willing to serve as a foster family.
The data showed that this engagement process worked. About 80 percent of the considered removal meetings took place prior to removal, and of those that took place prior to removal, more than 50 percent resulted in a recommendation that no removal take place. Of the rest, half went to relatives or kin.
Joette Katz is the former commissioner of the Connecticut Department of Children and Families, and a partner at the law firm Shipman & Goodwin.
This commentary was first published Oct. 30, 2019, by the Chronicle for Social Change.
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