Training DaysIllinois is facing the challenge of bringing the evidence from child welfare research into daily use.
By Ed Finkel
VOLUME 18 | ISSUE 1 | SPRING 2011
When supervisors and Managers in the Illinois Department of Children and Family Services Office of Inspector General had been shown pictures of a toddler who had belt marks across her bottom, some felt that simply meant the child had been spanked. “Welt marks on a 2-year-old’s butt? There’s something off in that picture,” says Denise Kane, A.M. ’78, Ph.D. ’01. “That’s not corporal punishment— it’s brutality.”
The Illinois Department of Children and Family Services (DCFS) is changing how it approaches child welfare, using evidence-based research to an extent previous unseen to provide training for social workers, counselors and therapists so that they are better-equipped to handle cases of child neglect and abuse. Training is important because it allows the agency to get the best current knowledge of how to work with families to its staff and the nonprofits that provide child welfare services to kids and families. Effective training must overcome obstacles such as funding shortfalls, institutional entropy and lack of resources at the grassroots level to make time for the trainings and to implement the lessons.
Kane, the inspector general of DCFS, and her colleagues realized that child protection investigators did not have sufficient knowledge of pediatrics. "You don't have a 3-month-old with a bruise. If they don't cruise, they don't bruise, so bruises on infants are highly suspicious. By providing studies from well-baby clinics, the training informs investigators on normal childhood bruising," she says. "Investigators weren't always given that information, but it's something they need to know to do their job right."
In the complex world of child welfare, with a mix of programs and providers across the state, training can literally can mean life or death for a young child. "If we want to prepare social workers to be better positioned to deliver evidence-based interventions, we need training that works on many levels: preparation of new professionals, continued training of existing professionals, continued research on what the evidence supports," says Jennifer Bellamy, an assistant professor at SSA whose fields of interest include mental health services, child welfare, evidence-based practice and fathering.
The trainings implemented by Kane's office are only one part of DCFS's determined efforts to implement guidance to bring the state-of-the-art in child welfare research to the day-to-day work: focusing workers on the needs of children and families rather than those of the system, communicating properly with all stakeholders to seamlessly address problems, providing role models to whom trainees can relate.
Tina Rzepnicki, SSA's David and Mary Winton Green Professor, has worked with Kane on how to ensure the OIG staff was sufficiently knowledgeable on topics from how children bruise to how to best interact with families. "I help them collect data, analyze it and uncover patterns of error that inform the training," Rzepnicki says. "We talk a lot about quality improvement in social work. We get at that by identifying weaknesses in organizational processes and ensuring that there is sufficient training and other supports to address those weaknesses."
The OIG training, which began in August 2008, incorporates an evidence-based curriculum based on the principles of high reliability organizations, which encourage critical thinking and self-examination. The curriculum reviews key components of investigations, including conducting a scene investigation and mock reenactment of the incident, creating a timeline of events, and identifying key informants. Staff learned the latest research on identification and interviewing of child-centered collaterals and better safety planning.
Pre-training analysis found that many investigators thought (incorrectly) that they couldn't provide information to a doctor because it could bias the doctor's opinion or violated confidentiality. To address this issue, a DCFS attorney attended each of the trainings to clarify that statute allows investigators to obtain medical information from the physician and that the investigator can share relevant information when requesting a medical opinion. A form was developed to guide workers in conducting a more systematic assessment and assist in the documentation of risks by the investigator and by the physician.
Rzepnicki has been working with Kane to evaluate the trainings, and she and the team is publishing the findings in annual reports out of the OIG, journal articles and a book chapter to be published in the fall. "We continue to collect and analyze data after the training occurs to see if there are changes in performance," Rzepnicki says. "The results are used to inform subsequent training and to determine other supports necessary for sustainable improvement."
Erwin McEwen, A.M. ’98, director of the Illinois Department of Children and Family Services, says the vast reduction in caseload that began under former Director Jess McDonald in the late 1990s—which has taken the number of cases down from 53,000 to 15,500—has opened up room in the budget and in people’s workload to train caseworkers more effectively. “We’re way out front on this,” says McEwen, who served as the department’s deputy director before becoming director a little less than five years ago. “Many states are doing child welfare reform. Illinois is doing child welfare innovation.”
SSA Associate Professor Gina Samuels, who has done extensive research on child welfare in Illinois and nationally and herself was once a child welfare worker, agrees. “Illinois has one of the better state child care systems in terms of using research, what we might broadly call evidence-based practice,” she says.
During the last two years, DCFS has put into place learning “collaboratives” across the state that front-line caseworkers and their supervisors must attend for two days every four months. The 3,000 caseworkers and supervisors taking the trainings from both the public sector and private contracted agencies are learning how DCFS is making fundamental changes to their role. “The focus of our training is to try to create a ‘new normal’ that’s not just about investigation and prevention— but an agency that strives for optimal child development,” McEwen says.
The trainings have also helped to shift the system’s traditional focus on abuse to neglect, which studies have shown comprise 70 percent of cases faced by DCFS workers, as well as giving participants greater knowledge of the impacts of trauma on people’s lives. “We’re teaching psychological first-aid,” McEwen says, “how to identify and respond to traumatic stress, because that’s the situation many of the children we see are in.”
DCFS’s trainings are also providing strategies to link families to services and to opportunities to better themselves and build a stronger family. SSA Professor Mark Courtney, former director of Chapin Hall, has found in his research that a solutions-based approach toward clients helps parents feel engaged by social workers’ services.
“If it were up to these parents, they wouldn’t have anything to do with the child welfare system,” Courtney says. “The solutions-based approach is based on the assumption that you want to start where the client is, engage them that way and offer them something they perceive to be important.”
For example, in February, DCFS caseworkers who are working with pregnant and parenting teenagers in the system began trainings at four downstate sites on how to address the population’s educational and vocational needs and to involve them in becoming more involved, supportive parents. “My focus is on helping workers and teen parents come to an agreement on an educational plan that will fit for them,” says University of Minnesota social work professor Ronald Rooney, A.M. ’75, Ph.D. ’78, who has built the trainings.
When Rooney first started working with caseworkers serving this population four years ago, the services they provided weren’t consistent and reliable. Too often, caseworkers were focusing on the teens’ deficits in education, work and parenting, which created conflict at the outset of the relationship, with little attention paid to what the teen parents were doing right and in building a constructive alliance around their issues. “While services were mandated and available, there was not a real structure to how they were delivered,” he says.
Rooney and his team found caseworkers who had a more strengths-oriented approach and developed videos of their work. For example, one video focuses specifically on how to handle teen parents who start down the road toward their educational plan and then become discouraged or depressed. “We thought that, instead of having role models of caseworkers from out of state, if you had role models from within the setting, workers might find them more credible,” Rooney says.
The Jewish Child and Family Services agency in Chicago is using ongoing Child Parent Psychotherapy model trainings that helps a therapist start a case by building their relationship with the parent, who often was not well-cared for as a child. “Usually the focus of the state is, ‘Look at this kid, look at what he needs,’” says Charlotte Mallon, A.M. ’80, the agency’s director of training. “But the parent is saying, ‘Nobody’s giving anything to me, and I have nothing to give.’” The model applies especially well to teen parents, she says.
JCFS research assistant Elisabeth Kinnel notes that the agency has worked with SSA faculty Stanley McCracken and Jennifer Bellamy in developing the training sessions around evidence-based practice. “Some of that comes from the culture of SSA and its interest in research and bringing resources to bear,” she says.
At agencies like Jewish Child and Family Services, budget cuts and high caseloads are everyday realities that must be acknowledged when planning how trainings will work. “It’s hard when you’re relying on money that you can’t predict will be there. It’s very difficult to plan. But we plan anyway because we have to,” Mallon says. “It takes time to teach people to do this. Our staff need to know what they’re doing, and we want to be sure we’re infusing their understanding with evidence-based work.”
One of SSA Professor Curtis McMillen’s research interests is how to improve the poor job that most states do in training child welfare professionals to deal with mental health issues. “Their job tends to be coordinating care for children who have been maltreated,” he says. “And yet they haven’t been well-schooled on psychiatric disorders. They haven’t been well-schooled on how to interact with psychologists or how to provide these services. Every state is having trouble getting mental-health evidence-based intervention to the people who need them. It’s especially hard with the most vulnerable populations.”
McMillen is currently operating and studying a training intervention in Missouri on trauma-focused cognitive behavioral therapy for 150 therapists who work in the child welfare system. Since many of these professionals are low paid and compensated by the hour, it can be difficult to convince them to take the time to leave their offices for expensive training programs. McMillen’s study, a randomized trial, examines how therapists interact with self-directed training, including webinars, on-line training programs, discussion boards and working with other local therapists to improve each other’s skills.
Shaun Lane, A.M. ’91, the deputy director of the division of service support at DCFS and an adjunct professor at SSA, says the department is also interested in rethinking how participants learn through training. DCFS is working toward creating more distance learning opportunities, for instance, with a revised model launched in January that at least 10 cohorts have completed. “The initial satisfaction data from participants is overall quite positive,” he says. “We’re also finding that there is a group for whom it is more of a challenge; some prefer more traditional, classroom-based training.”
DCFS has also borrowed the concept of learning collaboratives from the health care field, where participants leave the trainings as part of an affinity-related sub-group that stays in touch to continue sharing methods and interventions.
“People may acquire knowledge and have some opportunity to practice their skills, but the effectiveness dissipates quite rapidly after leaving the training session,” Lane says. “The learning collaboratives are highly interactive, and the participants have the accountability back to their fellow subgroup member to share how it went and contribute to this ongoing learning community.”
As important as it is, the process of training staff can be seen as an extra cost, in terms of dollars, time and focus. Even in the current budget crisis, however, funding presents less of a challenge for DCFS than some might think. Federal Title IV-E funding, targeted to foster care and adoption assistance, covers 75 cents on the dollar for DCFS training and 65 cents at private agencies; plus, the Casey Family Programs foundation has provided a $400,000-plus grant for a Supervisory Training Enhancement Program. “[Funding concerns] may be a little worse now, but it’s never going to go away entirely,” says Rzepnicki. “The environment will always have constraints attached to it.”
The private side faces greater time- and money-related challenges, says SSA adjunct faculty member Victor Bernstein, who sits on the board of an agency with an annual budget of $800,000 which, in early March, was holding a $300,000 IOU from the state. “It’s difficult to talk about training in this economic environment because that’s an extra,” he says. “It’s a lot more difficult sell.” One private agency providing support to teen wards of the state had to withdraw from Bernstein’s training because their staff was cut from four to two and the remaining staff had no time for the training, since their workload was not reduced substantially. “They’re overburdened,” he says from the private agency staff ’s point of view. “If you’re going to introduce something, how are you going to reorganize the demands on their time? That is essential.”
McEwen draws a distinction between technical challenges, which simply require the necessary knowhow and procedures, and adaptive challenges, which require attitude adjustments. He says moving evidence-based principles into practice has faced greater challenges in culture change than anything else. For example, part of the “new normal” at DCFS will be using the Child Adolescent Needs Assessment (CANS), which McEwen describes as a strength assessment rather than a risk assessment.
“We’re really struggling with that,” McEwen says. “They’re so used to risk assessment. People have to change how they think, how they personally behave, how they feel about the population we serve.”
Kane says investigators are always skeptical when someone mentions training. The OIG’s office got pushback, for example, when they introduced the new form, which prompts communication between the family’s physician and the investigator about the circumstances of the injury and problems the family may be facing such as domestic violence. “By the time we finished the training, everybody knew the form was there to stay,” she says. “I don’t blame workers; it’s yet another form. All I can say is, ‘We’ve added one more set of eyes to that kid’s future.’”
Rooney’s main obstacle in training workers is also cultural rather than financial. “My evolving view of evidence-based practice is that we cannot afford to present it from an ivory tower, as if there’s a special kind of knowledge that the university has that is universally applicable in agencies,” he says. “That approach is likely to stimulate resistance among staff and agencies. The key is collaboration with agencies around their perceptions of what their problems are.”
Bellamy says that while there’s a lot of research on evidence-based practice, there’s relatively little research on how it is implemented in the real world. “The researchers usually say the social service providers have barriers to implementation. And providers are saying it’s the researchers who need to make adjustment to their research to fit practice,” she says.
In the end, training is just the first step in changing organizational culture and practices. “Training alone isn’t enough,” Rzepnicki says. “It doesn’t sustain your [changed] practices over the long run. Supervisors and their staff will function best in an environment where value is placed on learning from mistakes and good work is supported.”