- Email: [email protected]
Hennepin county community services department
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there was inevitable discussion as to whether Minnesota would become a state-operated social welfare system, joining the majority of states. The consensus appears to be that while this could occur with regard to public assistance and related programs, there is still interest in encouraging county variations and initiatives in the service domain. Because levels of the services currently provided are regarded as too uneven among the counties, the state department has worked on the concept that citizens have the right to a minimal floor of service from their counties, and the state should improve its capacity to define, specify, assist, and monitor that minimum. It does not anticipate a takeover. Given the state’s history and general milieu one is not surprised to note almost immediately that Hennepin (and Ramsey): share a tradition of good-quality public services; have large complements of responsible, intelligent, and competent/trained personnel on all levels; show unique (but hardly perfect) staff stability because of good salaries and strong union and civil service traditions; and have impressive county social service leadership. The response to legislative mandates and the generally heightened local expectations that there be efficient management, has been an increasingly targeted delivery system. In a national perspective, however, this is a humane system that goes well beyond the severely constricted offerings one sees in many other places. Hennepin County Community Services Department Hennepin has a Bureau of Social Services which, essentially, has four separate units (of different sizes), devoted to community services, income maintenance, veterans, training and employment assistance. The Community Services Department director reports to a deputy administrator for the Bureau of Social Services who, in turn, is responsible to the county administrator. Hennepin has, as noted, a population of over 1 million. The Community Human Services Department has a staff of over 1,000 and its budget was running over $110 million at the time of our review. The creation of the present structure may be traced to the block grant provisions of the State’s Community Services Act (1979) and the state’s subsequent partial recategorization efforts in recent years. Thus, the Hennepin department reflects impulses towards integration and coherence, as well as pressures to fulfill categorical state mandates (which are often not adequately funded), in a context of comoeting pressures for resources from other human service programs. The Community Services Department identifies some 45 to 50 program centers (each with a manager), all subsumed under 8 programs. These program centers are also cost centers and become the basis for planning and monitoring as well. They provide for attention simultaneously both to the directly delivered services and the contracted services in a
Patterns of Coping:
States and Counties
53
given area, something often lost elsewhere. Each of the categorical systems constitutes a division under a division manager: mental health, developmental disabilities, chemical health, family services (formerly called child welfare), child protection, services to seniors, disabilities. The community resources division serves the case operations by supplying or purchasing day care, emergency shelter care, foster care and a variety of other special monitored, services. The operation is planned, led, administered, evaluated, staffed and trained by two additional divisions: administration, under the county director, and support services. The director has three deputies. The political environment stresses good government, responsive and high quality services, respect for civil servants, and concern for fellow citizens in difficulty. The county board has a liberal tradition and there is willingness to employ and retain qualified professionals for public services. Thus, social work civil service salaries are outstanding and staff stability is unusual (with the exceptions to be specified). The political and civic environment, affected by the presence of many leading national companies that have been successful as innovative and well-run and also responsive to their personnel, has blended strong administration and management with high quality professional services. While the visitor from Mars, lacking a baseline, of course will identify problems and gaps, the comparative analyst will recognize here impressive accomplishments. The director has long-standing interest in strong management and comes from an M.B.O. (management by objectives) tradition. The department’s structure, executive style, and development of control devices and doctrines reflect this. There are regular meetings of the director (biweekly) with division directors and meetings with administrative officers on alternative weeks. Division directors and program managers meet in various combinations for policy development, to solve operational problems, and to monitor implementation. All management people assemble quarterly to focus on broad issues. Categorical groups come together periodically. A variety of specific interdivisional coordination devices and procedures have been implemented. The director, the generalist among a cadre of categorical specialists, is willing to stake out positions and debate them with division chiefs and other managers. Eventually, the department produces explicit mission and policy statements, guidelines (for example: purchase of service, risk assessment, case management), and specific program plans. Consistent with the general orientation is an innovative qualify assurance process (and responsible unit) as well as a rolling evaluation system in which each program is reached once in three years. With regard
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to the latter, program staff have opportunity to contribute to the development of criteria and the interpretation of the results, and managers are expected to respond to findings and recommendations as they plan ahead. Computer software and hardware have been built up to the point of an electronic mail system for managers and a capacity that enables some managers to draw upon a database for management, administration, and related analytic work. Staff capacity to use the latter capacities well is still limited and county and state personnel would like to improve both the client and performance data systems - and somehow to relate county and state systems. Nonetheless, this is the most sophisticated system we saw among the sites studied. About half of all services are purchased, with an emphasis on purchase of residential care and specialized programs, not infrastructure. (Massachusetts, by contrast, contracts for some of its basic child protective services.) As noted, criteria for purchase have been carefully developed and guide the activity. And, as characteristic of the respect for professional staff and their roles, each contract is monitored by a line program person along with somebody from the purchase service office, and they jointly consider renewals and new initiatives. A dual authorization procedure brings together a responsible program supervisor with a fiscal officer to authorize special expenditure around needs of a case - both to conserve resources and ensure their availability as intended. The director is nationally active, especially in the child welfare field, exposing his staff to the challenges and stimulation that come from broad experience with regard to developments throughout the country. The department faced the issue of degree of integration to be achieved within the repertoire of program missions. It began with 27 access points. It considered a fully unified intake operation. The range of responsibilities and clienteles made a completely unified access impossible. Now there are 13 access points, but intake is categorical in each. However, there is emphasis on facilitating client access and avoiding the shunting of cases from place to place. A policy of only one wrong door, as applied to adult services, sharply defines accountability for getting a client to the right place. The intake procedure for child protection and other family service cases is meant to integrate the two responsible divisions (see below). Of special interest for our overall study is the evolving relationships of and among child protection, family services, and mental health in Hennepin. Early in the history of the Community Services Department, given the state interest in and local commitment to strengthen child protective services, the child protection unit became the department’s elite corps. It constituted a well-paid and stable staff. Its case role was limited: some cases (after screening and assessment) were taken in for ongoing supervision, some children were removed from their families. After the
Patterns of Coping:
States and Counties
child protective people had had their best shot, all else went to what was then called child welfare. The latter was soon defined as a dumping ground. Gradually, this has been changed in the context of new federal legislation aimed at decreasing use of and time in foster care and ensuring permanency planning, state mandates to tighten and improve abuse/neglect investigations and assessments, and the best judgements of staff task forces and planners. Child welfare experienced a major two-year conversion into family services. Now the child protection unit has a function quite consistent with national standards and trends, concentrating on screening, investigation, assessment, appropriate disposition. However, it goes beyond this, still, in its Home-Community Treatment program, its extensive case management and referral activity for some ongoing high-risk cases, a group work service program for some families and individuals in the high risk caseload. There is an adolescent parent unit that does assessment and delivers targeted services. There also is some staff capacity for responding to self-referred clients with case assessments and services. On the other hand, the family services division (no longer merely child welfare) includes an adolescent parent service, adoption services, home team services (a local derivation out of the Homebuilder model of intensive family services), and reunification/permanency services. A fumify support unit here has a variety of mandates including court ordered case supervision and supervision for other jurisdictions, payment machinery for various special services ranging from special needs day care Another unit under to homemakers, and court-supervised placement. family services monitors AFDC protective payments and mandatory vendor programs, Thus, Hennepin has clearly resisted a national trend in which the need to develop an effective response to abuse/neglect led to a taking over of child welfare by a constricted CPS. At the intake point, it too reflects the push towards targeting and an emphasis on protection. However, its protective units have a higher general level of staff competence, a broader service mission, and access to somewhat richer service resources (yet, some would say, far from all that is needed) in a family service division which combines the new foster care program mandated by P.L. 96-272, with impressive capacity for ongoing child-family service. Nonetheless, the future is uncertain. Here, and in Ramsey County as well, the constantly increased state mandates, the pressure from new social problems, and the resource shortages keep the boundaries between child protection and family service in constant flux and do not permit fully The heavy satisfactory conceptual resolutions as to role and structure. caseload pressures in child protection and the periodic media attacks on the
56
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staff have created high turnover (and a need to be somewhat more willing than earlier to recruit non-M.S.W. social workers). Many professionals see child protective work as an entry point, not a career, and they move on. All of this requires further specification before we also introduce the role of the mandated mental health program. First, we begin with child protection. Consistent with national guidelines and standards, there is a clearly-defined and well-staffed system with the following responsibilities: to screen cases on the telephones (and handle the smaller number of walk-ins and written referrals); to ensure extended screening for complex situations; to respond in the field on an emergency basis as needed; to do timely and competent investigations of all cases; to get cases to court and/or initiate needed child placement; and The field units, with to carry cases opened for ongoing supervision. average caseloads of 20, work with cases for 4 to 6 months. A variety of categorical, special protective units (as described above) also are available. As to which cases are kept here and which sent on to family services, the general policy is that unresolved cases of abuse and neglect are to remain in the child protection division, while ongoing service and treatment belongs in family support. The dividing lines are hardly precise and some overlap, perhaps competition, is apparent. The family service division mission thus encompasses voluntary treatment (in fact, mostly technically voluntary but with potential for use of authority if needed) as well as court-ordered placements for status offenders and delinquents. Many places elsewhere in the country have separate foster care units , but very many lack any way of serving so-called voluntary cases (cases where parents come in to ask for help or are referred by agencies without coercive authority). Here, there is flexibility at both ends - there are truly voluntary cases, including some among the placed children. There also is in-home service for a range of circumstances. We have observed that in many places the new pressures on child protection have made that service the core,if not the totality, of child and family social services. Then, in a search for ways to decrease child placement, such programs have located Intensive Family services, along the lines of Homebuilders or Family Preservation models, in direct relationship to the child protective assessment process. Usually it is a relatively small-scale contracted service for a sub-segment of the eligible caseload, intended to avoid the use of foster homes, residential treatment, or institutional care, if possible. Here, in Hennepin, since the family services program is the locus of family reunification services and permanency planning in the spirit of P.L. 96-272 the decision was made to locate the intensive family services (home teams) in the division doing that work. In effect, they created an ongoing service, treatment, and placement-prevention division. Moreover, this made the intensive family
Patterns of Coping: States and Counties service an integral part of the department’s case service system, not an The family add-on or outside contract for a limited number of cases. service intake defines the placement cases as such, screens out some cases for homemakers, child care, or other single services or simple interventions, and then defines all other cases for intensive family service. This is the standard service, not the exception and the unusual. The director of the community services department interpreted it this this “was a major refocusing of our way in a 1987 communication: resources into an in-home support system designed to provide a middle alternative between placement, on the one extreme, and minimal services to families maintaining their children in their own homes, on the other extreme”. The model tested and evaluated in 1985 had been the Washington State Homebuilders program. The institutionalization of the system as part of the core service response here of course involved major changes in intensity, caseload increases, greater practice range, and revised staffing and training. Nonetheless, it clearly is a well staffed, professionally qualified clinical service, more accessible than in almost any system; it ensures that Hennepin, while now targeting its resources somewhat more than was required historically, does exemplify the enhanced child welfare or child and family service mode of coping. It should be stressed that this is not traditional child welfare. The home-team services, if they could not win Homebuilder accreditation, nonetheless represent a major departure from the tradition of open-ended supportive social services for families and children. The staff value system says that the community does not want them to remain unnecessarily in the lives of families. The average life of a case is 3 months; teens are seen for 13 weeks but court-ordered service may go on for 26. The service combines clinical and family-system sophistication with a reaching out philosophy and a readiness to get involved in practical help in the home. Half of the cases served here originally come to the court for delinquency. The number of placements which are not court-ordered have gone down since the program was inaugurated (but 20-30 percent of the 1,000 cases served per year are placed). While 20 percent return to the system some time after successful case closing (and others may perhaps appear in other systems) this is not regarded as failure, so long as the family has been stabilized after crisis and a maximum effort has been made to prevent placement “and get out of the family as soon as possible.” Among the unique features of the Hennepin intensive family service system is the fact that four home team units serve adolescents; there is one infant unit. Half of the cases are delinquency cases and almost all the adolescent cases involve parent-child conflicts. This may be explained by the program’s unique organizational history as an experiment oriented to delinquents and the fact that most of the young children in the system are
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in the protective unit which does not refer them on. Its staff, too, wants to go beyond assessment with some cases. It has developed one similar unit on its own. Also important to the home team work isjlexible money, the ability of the worker to spend up to $2,500 per family as needed for critical things that could make a difference: to install a telephone, buy children’s games, pay for car repair or a license. The mental health program which was incorporated into the new Community Services Department when it was created was a highly autonomous peer-oriented agency as contrasted with most hierarchical or semi-hierarchical public programs. Of the eight mental health units in the county program, one, with ten professionals, serves the child population. Out of two county locations the family and child mental health unit “provides a full range of outpatient mental health services to children and adolescents ... and their families . ...‘I The service is to be available to county residents in instances where the child, adolescent, and/or family system is considered to be severely disturbed. Priority is to be given to child protection and child welfare (family service) referrals. The department is unsure in fact just how or why cases are accepted or rejected, and which will, or will not, benefit from open-ended treatment. The legislature has left definitions to clinicians, and directors often decide in accord with the limits imposed by finance offices. The mental health staff had warned when taken over about being overwhelmed by a werfare mentality. In effect, for the first several years this remained a relatively privileged, almost private-practice like, clinical service, while targeting was being pushed in child protection, in one way, and in family services, in another. There also are in Hennepin relatively substantial contracted mental health services. The system thus represented for some clients a more traditional and flexible alternative. It was another possible community resource. It has not been immune from state pressures more recently: with the passage of 1987 mental health legislation, meant to respond to criticisms of the state mental health program and its deinstitutionalization efforts, the legislature has left the out-patient work with the more moderate cases without assurance of resources as emphasis is placed on case management and the more severely disturbed. The rest will be done in so far as there are resources. The department leadership has not ignored its problems of boundaries and gaps. The child protective program encounters cases it does not know what to do with, yet which do not belong to family service. These are cases that jtill between the cracks and are identified as such: truancy, serious parent-child conflicts, multiproblem families with children. If
Patterns of Coping:
States and Counties
truancy is an isolated problem the agency has nothing to offer. Nor are there public resources for dealing with parent-child conflict, so they attempt voluntary agency referrals. The large concern is a third group, multi-problem families whose problems are not seen as acute. Technically, there is no severe neglect or abuse found in these multiproblem families and no statutory mandate. There is often what is called mild neglect and mild acting out. Neighbors complain. One or more children may be or may have been in placement, with others at home. These tend to be marginally managing working poor who may not merit court intervention but they are chronic community cases, not provided for in a system which increasingly targets and focuses on the more extreme high risks. Hennepin may have more and broader service possibilities than most, but staff are concerned about these multiproblem families whom they are not now able to help. At the same time, for the more disturbed it is difficult to draw workable boundaries between, or to ensure coordination of, the mental health clinic offerings and the intensive family services. First, there is a concept discussed here but not fully implemented: If multi-problem, marginal, long-term neglect cases involving young children are a serious problem missed in the current targeting (as assigned to child protection and family services) why not a new target, using the methods of intensive family service? Such an approach worked very well in the setting up of a special unit for 40 mental retardation cases involving parents with limited capacities and need for long-term protection. The idea is to create within family support a home-based team for long-term neglect. Interdivisional turf problems are not yet solved: very young children are served in child protection, not family support. More service may evolve in the former. On the other hand, recognizing that many of the children in the family service program need more than the psychiatric/psychological consultation which is now available in cooperation between the family service and mental health divisions, and that more clinically guided or provided treatment is also necessary for some of the very disturbed children, the family services division director is developing new plans. A pending move to a new building will put all children’s service programs together. The intent is to locate family support home team staff on the same floor with child and adolescent mental health units. Plans are being made for a preadoption project and for various kinds of interdivisional work. The guiding philosophy is an NIMH-CASSP program, stressing interdisciplinary collaboration. No unit reorganization is planned. Our review suggests that the combination of community needs and state and local policies will preclude any move here towards a limited CPS model. Severe behavioral problems and long-term neglect do not fit the abuse/neglect pattern fully but there is no inclination to ignore them and
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hope for the best (a common response elsewhere). State mandates require provision for case management and support the development of long-term services for some cases of mental retardation, mental illness, chemical dependency, again requiring a delivery system not limited to CPS. While the philosophy is for the agency not to be intrusive where this can be avoided, and not to intervene for too long, this has not become a rationale for neglecting families. The effort to adapt is supported increasingly by measures to somehow cut across system boundaries where essential, especially between mental health and family support. The director’s philosophy is to cope with budget constraints, new problems and pressure for targeting by seeking balance. Where the pressure is for public agencies to enter cases later and later (chronically mentally ill, child abuse, etc.) they must do some early intervention and some middle intervention, while giving it lower priority. Although, in Hennepin, contracting may be cheaper, they keep their hand in ongoing service delivery, by limiting contracting to about half their service expenditures; the other half is spent for publicly delivered services. While many things are mandated, they go beyond some federal and state mandates because services are obviously needed, constantly worried whether the resources will permit this. Finally, the philosophy calls for doing well what is done, and this involves caseload size, staff quality, supervision, and the definition of professional roles. The price paid is that not everything can be done. And new added pressures arise because the serious problems of crack, homelessness, and AIDS, pose questions not encompassed by the current service delivery model. In the county director’s view, the future would seem to call for a reconceptualized new child welfare, with the current effort seen as part of a larger whole. Targeted, But Also Enhanced, Some Variations We have noted, in reporting on Florida and Texas, while mentioning Arizona, that there is range and variation at the targeted CPS end of the continuum. While at the other end, Hennepin and Ramsey counties in Minnesota represent the most fully realized current efforts both to target and to offer a range of on-going and in-home responses, they do not capture all the possibilities and variations, or fully illustrate why even this mode is not fully realized and at its best is far from responsive to all major needs of the child and family social service system. Maryland is in the process of completing its transition from county to state administration, and there are major differences in the depth of county service systems, reflecting county resources, service commitments, and the
Kamerman
and Kahn
there was inevitable discussion as to whether Minnesota would become a state-operated social welfare system, joining the majority of states. The consensus appears to be that while this could occur with regard to public assistance and related programs, there is still interest in encouraging county variations and initiatives in the service domain. Because levels of the services currently provided are regarded as too uneven among the counties, the state department has worked on the concept that citizens have the right to a minimal floor of service from their counties, and the state should improve its capacity to define, specify, assist, and monitor that minimum. It does not anticipate a takeover. Given the state’s history and general milieu one is not surprised to note almost immediately that Hennepin (and Ramsey): share a tradition of good-quality public services; have large complements of responsible, intelligent, and competent/trained personnel on all levels; show unique (but hardly perfect) staff stability because of good salaries and strong union and civil service traditions; and have impressive county social service leadership. The response to legislative mandates and the generally heightened local expectations that there be efficient management, has been an increasingly targeted delivery system. In a national perspective, however, this is a humane system that goes well beyond the severely constricted offerings one sees in many other places. Hennepin County Community Services Department Hennepin has a Bureau of Social Services which, essentially, has four separate units (of different sizes), devoted to community services, income maintenance, veterans, training and employment assistance. The Community Services Department director reports to a deputy administrator for the Bureau of Social Services who, in turn, is responsible to the county administrator. Hennepin has, as noted, a population of over 1 million. The Community Human Services Department has a staff of over 1,000 and its budget was running over $110 million at the time of our review. The creation of the present structure may be traced to the block grant provisions of the State’s Community Services Act (1979) and the state’s subsequent partial recategorization efforts in recent years. Thus, the Hennepin department reflects impulses towards integration and coherence, as well as pressures to fulfill categorical state mandates (which are often not adequately funded), in a context of comoeting pressures for resources from other human service programs. The Community Services Department identifies some 45 to 50 program centers (each with a manager), all subsumed under 8 programs. These program centers are also cost centers and become the basis for planning and monitoring as well. They provide for attention simultaneously both to the directly delivered services and the contracted services in a
Patterns of Coping:
States and Counties
53
given area, something often lost elsewhere. Each of the categorical systems constitutes a division under a division manager: mental health, developmental disabilities, chemical health, family services (formerly called child welfare), child protection, services to seniors, disabilities. The community resources division serves the case operations by supplying or purchasing day care, emergency shelter care, foster care and a variety of other special monitored, services. The operation is planned, led, administered, evaluated, staffed and trained by two additional divisions: administration, under the county director, and support services. The director has three deputies. The political environment stresses good government, responsive and high quality services, respect for civil servants, and concern for fellow citizens in difficulty. The county board has a liberal tradition and there is willingness to employ and retain qualified professionals for public services. Thus, social work civil service salaries are outstanding and staff stability is unusual (with the exceptions to be specified). The political and civic environment, affected by the presence of many leading national companies that have been successful as innovative and well-run and also responsive to their personnel, has blended strong administration and management with high quality professional services. While the visitor from Mars, lacking a baseline, of course will identify problems and gaps, the comparative analyst will recognize here impressive accomplishments. The director has long-standing interest in strong management and comes from an M.B.O. (management by objectives) tradition. The department’s structure, executive style, and development of control devices and doctrines reflect this. There are regular meetings of the director (biweekly) with division directors and meetings with administrative officers on alternative weeks. Division directors and program managers meet in various combinations for policy development, to solve operational problems, and to monitor implementation. All management people assemble quarterly to focus on broad issues. Categorical groups come together periodically. A variety of specific interdivisional coordination devices and procedures have been implemented. The director, the generalist among a cadre of categorical specialists, is willing to stake out positions and debate them with division chiefs and other managers. Eventually, the department produces explicit mission and policy statements, guidelines (for example: purchase of service, risk assessment, case management), and specific program plans. Consistent with the general orientation is an innovative qualify assurance process (and responsible unit) as well as a rolling evaluation system in which each program is reached once in three years. With regard
54
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to the latter, program staff have opportunity to contribute to the development of criteria and the interpretation of the results, and managers are expected to respond to findings and recommendations as they plan ahead. Computer software and hardware have been built up to the point of an electronic mail system for managers and a capacity that enables some managers to draw upon a database for management, administration, and related analytic work. Staff capacity to use the latter capacities well is still limited and county and state personnel would like to improve both the client and performance data systems - and somehow to relate county and state systems. Nonetheless, this is the most sophisticated system we saw among the sites studied. About half of all services are purchased, with an emphasis on purchase of residential care and specialized programs, not infrastructure. (Massachusetts, by contrast, contracts for some of its basic child protective services.) As noted, criteria for purchase have been carefully developed and guide the activity. And, as characteristic of the respect for professional staff and their roles, each contract is monitored by a line program person along with somebody from the purchase service office, and they jointly consider renewals and new initiatives. A dual authorization procedure brings together a responsible program supervisor with a fiscal officer to authorize special expenditure around needs of a case - both to conserve resources and ensure their availability as intended. The director is nationally active, especially in the child welfare field, exposing his staff to the challenges and stimulation that come from broad experience with regard to developments throughout the country. The department faced the issue of degree of integration to be achieved within the repertoire of program missions. It began with 27 access points. It considered a fully unified intake operation. The range of responsibilities and clienteles made a completely unified access impossible. Now there are 13 access points, but intake is categorical in each. However, there is emphasis on facilitating client access and avoiding the shunting of cases from place to place. A policy of only one wrong door, as applied to adult services, sharply defines accountability for getting a client to the right place. The intake procedure for child protection and other family service cases is meant to integrate the two responsible divisions (see below). Of special interest for our overall study is the evolving relationships of and among child protection, family services, and mental health in Hennepin. Early in the history of the Community Services Department, given the state interest in and local commitment to strengthen child protective services, the child protection unit became the department’s elite corps. It constituted a well-paid and stable staff. Its case role was limited: some cases (after screening and assessment) were taken in for ongoing supervision, some children were removed from their families. After the
Patterns of Coping:
States and Counties
child protective people had had their best shot, all else went to what was then called child welfare. The latter was soon defined as a dumping ground. Gradually, this has been changed in the context of new federal legislation aimed at decreasing use of and time in foster care and ensuring permanency planning, state mandates to tighten and improve abuse/neglect investigations and assessments, and the best judgements of staff task forces and planners. Child welfare experienced a major two-year conversion into family services. Now the child protection unit has a function quite consistent with national standards and trends, concentrating on screening, investigation, assessment, appropriate disposition. However, it goes beyond this, still, in its Home-Community Treatment program, its extensive case management and referral activity for some ongoing high-risk cases, a group work service program for some families and individuals in the high risk caseload. There is an adolescent parent unit that does assessment and delivers targeted services. There also is some staff capacity for responding to self-referred clients with case assessments and services. On the other hand, the family services division (no longer merely child welfare) includes an adolescent parent service, adoption services, home team services (a local derivation out of the Homebuilder model of intensive family services), and reunification/permanency services. A fumify support unit here has a variety of mandates including court ordered case supervision and supervision for other jurisdictions, payment machinery for various special services ranging from special needs day care Another unit under to homemakers, and court-supervised placement. family services monitors AFDC protective payments and mandatory vendor programs, Thus, Hennepin has clearly resisted a national trend in which the need to develop an effective response to abuse/neglect led to a taking over of child welfare by a constricted CPS. At the intake point, it too reflects the push towards targeting and an emphasis on protection. However, its protective units have a higher general level of staff competence, a broader service mission, and access to somewhat richer service resources (yet, some would say, far from all that is needed) in a family service division which combines the new foster care program mandated by P.L. 96-272, with impressive capacity for ongoing child-family service. Nonetheless, the future is uncertain. Here, and in Ramsey County as well, the constantly increased state mandates, the pressure from new social problems, and the resource shortages keep the boundaries between child protection and family service in constant flux and do not permit fully The heavy satisfactory conceptual resolutions as to role and structure. caseload pressures in child protection and the periodic media attacks on the
56
Kamerman
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staff have created high turnover (and a need to be somewhat more willing than earlier to recruit non-M.S.W. social workers). Many professionals see child protective work as an entry point, not a career, and they move on. All of this requires further specification before we also introduce the role of the mandated mental health program. First, we begin with child protection. Consistent with national guidelines and standards, there is a clearly-defined and well-staffed system with the following responsibilities: to screen cases on the telephones (and handle the smaller number of walk-ins and written referrals); to ensure extended screening for complex situations; to respond in the field on an emergency basis as needed; to do timely and competent investigations of all cases; to get cases to court and/or initiate needed child placement; and The field units, with to carry cases opened for ongoing supervision. average caseloads of 20, work with cases for 4 to 6 months. A variety of categorical, special protective units (as described above) also are available. As to which cases are kept here and which sent on to family services, the general policy is that unresolved cases of abuse and neglect are to remain in the child protection division, while ongoing service and treatment belongs in family support. The dividing lines are hardly precise and some overlap, perhaps competition, is apparent. The family service division mission thus encompasses voluntary treatment (in fact, mostly technically voluntary but with potential for use of authority if needed) as well as court-ordered placements for status offenders and delinquents. Many places elsewhere in the country have separate foster care units , but very many lack any way of serving so-called voluntary cases (cases where parents come in to ask for help or are referred by agencies without coercive authority). Here, there is flexibility at both ends - there are truly voluntary cases, including some among the placed children. There also is in-home service for a range of circumstances. We have observed that in many places the new pressures on child protection have made that service the core,if not the totality, of child and family social services. Then, in a search for ways to decrease child placement, such programs have located Intensive Family services, along the lines of Homebuilders or Family Preservation models, in direct relationship to the child protective assessment process. Usually it is a relatively small-scale contracted service for a sub-segment of the eligible caseload, intended to avoid the use of foster homes, residential treatment, or institutional care, if possible. Here, in Hennepin, since the family services program is the locus of family reunification services and permanency planning in the spirit of P.L. 96-272 the decision was made to locate the intensive family services (home teams) in the division doing that work. In effect, they created an ongoing service, treatment, and placement-prevention division. Moreover, this made the intensive family
Patterns of Coping: States and Counties service an integral part of the department’s case service system, not an The family add-on or outside contract for a limited number of cases. service intake defines the placement cases as such, screens out some cases for homemakers, child care, or other single services or simple interventions, and then defines all other cases for intensive family service. This is the standard service, not the exception and the unusual. The director of the community services department interpreted it this this “was a major refocusing of our way in a 1987 communication: resources into an in-home support system designed to provide a middle alternative between placement, on the one extreme, and minimal services to families maintaining their children in their own homes, on the other extreme”. The model tested and evaluated in 1985 had been the Washington State Homebuilders program. The institutionalization of the system as part of the core service response here of course involved major changes in intensity, caseload increases, greater practice range, and revised staffing and training. Nonetheless, it clearly is a well staffed, professionally qualified clinical service, more accessible than in almost any system; it ensures that Hennepin, while now targeting its resources somewhat more than was required historically, does exemplify the enhanced child welfare or child and family service mode of coping. It should be stressed that this is not traditional child welfare. The home-team services, if they could not win Homebuilder accreditation, nonetheless represent a major departure from the tradition of open-ended supportive social services for families and children. The staff value system says that the community does not want them to remain unnecessarily in the lives of families. The average life of a case is 3 months; teens are seen for 13 weeks but court-ordered service may go on for 26. The service combines clinical and family-system sophistication with a reaching out philosophy and a readiness to get involved in practical help in the home. Half of the cases served here originally come to the court for delinquency. The number of placements which are not court-ordered have gone down since the program was inaugurated (but 20-30 percent of the 1,000 cases served per year are placed). While 20 percent return to the system some time after successful case closing (and others may perhaps appear in other systems) this is not regarded as failure, so long as the family has been stabilized after crisis and a maximum effort has been made to prevent placement “and get out of the family as soon as possible.” Among the unique features of the Hennepin intensive family service system is the fact that four home team units serve adolescents; there is one infant unit. Half of the cases are delinquency cases and almost all the adolescent cases involve parent-child conflicts. This may be explained by the program’s unique organizational history as an experiment oriented to delinquents and the fact that most of the young children in the system are
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in the protective unit which does not refer them on. Its staff, too, wants to go beyond assessment with some cases. It has developed one similar unit on its own. Also important to the home team work isjlexible money, the ability of the worker to spend up to $2,500 per family as needed for critical things that could make a difference: to install a telephone, buy children’s games, pay for car repair or a license. The mental health program which was incorporated into the new Community Services Department when it was created was a highly autonomous peer-oriented agency as contrasted with most hierarchical or semi-hierarchical public programs. Of the eight mental health units in the county program, one, with ten professionals, serves the child population. Out of two county locations the family and child mental health unit “provides a full range of outpatient mental health services to children and adolescents ... and their families . ...‘I The service is to be available to county residents in instances where the child, adolescent, and/or family system is considered to be severely disturbed. Priority is to be given to child protection and child welfare (family service) referrals. The department is unsure in fact just how or why cases are accepted or rejected, and which will, or will not, benefit from open-ended treatment. The legislature has left definitions to clinicians, and directors often decide in accord with the limits imposed by finance offices. The mental health staff had warned when taken over about being overwhelmed by a werfare mentality. In effect, for the first several years this remained a relatively privileged, almost private-practice like, clinical service, while targeting was being pushed in child protection, in one way, and in family services, in another. There also are in Hennepin relatively substantial contracted mental health services. The system thus represented for some clients a more traditional and flexible alternative. It was another possible community resource. It has not been immune from state pressures more recently: with the passage of 1987 mental health legislation, meant to respond to criticisms of the state mental health program and its deinstitutionalization efforts, the legislature has left the out-patient work with the more moderate cases without assurance of resources as emphasis is placed on case management and the more severely disturbed. The rest will be done in so far as there are resources. The department leadership has not ignored its problems of boundaries and gaps. The child protective program encounters cases it does not know what to do with, yet which do not belong to family service. These are cases that jtill between the cracks and are identified as such: truancy, serious parent-child conflicts, multiproblem families with children. If
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truancy is an isolated problem the agency has nothing to offer. Nor are there public resources for dealing with parent-child conflict, so they attempt voluntary agency referrals. The large concern is a third group, multi-problem families whose problems are not seen as acute. Technically, there is no severe neglect or abuse found in these multiproblem families and no statutory mandate. There is often what is called mild neglect and mild acting out. Neighbors complain. One or more children may be or may have been in placement, with others at home. These tend to be marginally managing working poor who may not merit court intervention but they are chronic community cases, not provided for in a system which increasingly targets and focuses on the more extreme high risks. Hennepin may have more and broader service possibilities than most, but staff are concerned about these multiproblem families whom they are not now able to help. At the same time, for the more disturbed it is difficult to draw workable boundaries between, or to ensure coordination of, the mental health clinic offerings and the intensive family services. First, there is a concept discussed here but not fully implemented: If multi-problem, marginal, long-term neglect cases involving young children are a serious problem missed in the current targeting (as assigned to child protection and family services) why not a new target, using the methods of intensive family service? Such an approach worked very well in the setting up of a special unit for 40 mental retardation cases involving parents with limited capacities and need for long-term protection. The idea is to create within family support a home-based team for long-term neglect. Interdivisional turf problems are not yet solved: very young children are served in child protection, not family support. More service may evolve in the former. On the other hand, recognizing that many of the children in the family service program need more than the psychiatric/psychological consultation which is now available in cooperation between the family service and mental health divisions, and that more clinically guided or provided treatment is also necessary for some of the very disturbed children, the family services division director is developing new plans. A pending move to a new building will put all children’s service programs together. The intent is to locate family support home team staff on the same floor with child and adolescent mental health units. Plans are being made for a preadoption project and for various kinds of interdivisional work. The guiding philosophy is an NIMH-CASSP program, stressing interdisciplinary collaboration. No unit reorganization is planned. Our review suggests that the combination of community needs and state and local policies will preclude any move here towards a limited CPS model. Severe behavioral problems and long-term neglect do not fit the abuse/neglect pattern fully but there is no inclination to ignore them and
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hope for the best (a common response elsewhere). State mandates require provision for case management and support the development of long-term services for some cases of mental retardation, mental illness, chemical dependency, again requiring a delivery system not limited to CPS. While the philosophy is for the agency not to be intrusive where this can be avoided, and not to intervene for too long, this has not become a rationale for neglecting families. The effort to adapt is supported increasingly by measures to somehow cut across system boundaries where essential, especially between mental health and family support. The director’s philosophy is to cope with budget constraints, new problems and pressure for targeting by seeking balance. Where the pressure is for public agencies to enter cases later and later (chronically mentally ill, child abuse, etc.) they must do some early intervention and some middle intervention, while giving it lower priority. Although, in Hennepin, contracting may be cheaper, they keep their hand in ongoing service delivery, by limiting contracting to about half their service expenditures; the other half is spent for publicly delivered services. While many things are mandated, they go beyond some federal and state mandates because services are obviously needed, constantly worried whether the resources will permit this. Finally, the philosophy calls for doing well what is done, and this involves caseload size, staff quality, supervision, and the definition of professional roles. The price paid is that not everything can be done. And new added pressures arise because the serious problems of crack, homelessness, and AIDS, pose questions not encompassed by the current service delivery model. In the county director’s view, the future would seem to call for a reconceptualized new child welfare, with the current effort seen as part of a larger whole. Targeted, But Also Enhanced, Some Variations We have noted, in reporting on Florida and Texas, while mentioning Arizona, that there is range and variation at the targeted CPS end of the continuum. While at the other end, Hennepin and Ramsey counties in Minnesota represent the most fully realized current efforts both to target and to offer a range of on-going and in-home responses, they do not capture all the possibilities and variations, or fully illustrate why even this mode is not fully realized and at its best is far from responsive to all major needs of the child and family social service system. Maryland is in the process of completing its transition from county to state administration, and there are major differences in the depth of county service systems, reflecting county resources, service commitments, and the