From the Need for Housing and Child Care to Professional Issues

Keeping Community-Based Preventive Services Effective

Lisa Caswell, LCSW, Preventive Services Program Director, Day Care Council of New York, Inc.

New York City’s first program to prevent foster care placement of children began in the Bronx Field Office of the Bureau of Child Welfare (now the Administration for Children’s Services) in the late 1960’s. In 1974, the Bureau of Child Welfare began to contract out preventive services through seven state-funded demonstration projects located in community-based organizations.

New York State’s Child Welfare Reform Act of 1979 formalized the funding stream for foster care prevention. Today there are preventive service programs covering every community district in New York City. Over the past 25 years, preventive services have grown to twice the size of foster care. As of April 2005, the Administration for Children’s Services (ACS) estimated that 76 agencies were serving 14,000 families and 34,000 children.

Least Intrusive, Client-Centered Services

Preventive services have always been the meeting ground for social workers committed to grappling with all of the economic, cultural and psychological forces that impact families. Through the use of crisis intervention, individual, couples and family counseling, advocacy and referral, home based support, and parenting skills training, preventive services are the least intrusive, and the most client-centered of the child welfare divisions. They are accessible to families identified by the ACS, as well as to those who seek these services on their own.

Preventive services, unlike other child welfare programs, allow parents and children to truly define their own needs on a voluntary basis, regardless of income or citizenship status, with the assurance of an immediate and comprehensive response.

Challenges to Effective Practice

The preventive services population has been given priority status when accessing housing and child care resources in order to ensure their stability. Unfortunately, recent federal policies have resulted in a year-long freeze on all new Section 8 housing applications, and there are increases in child care fees for working parents as a result of welfare reform.

Compliance with a federal mandate to computerize the child welfare system has also impacted this population. In 1982, advocates reached a settlement with ACS that protected the confidentiality of clients who sought out preventive services voluntarily, by restricting access to their files to on-site monitors.

Currently, advocates are challenging the full inclusion of case records in the recently launched statewide “Connections” computer system in non-indicated cases, stipulating that these cases are covered under this confidentiality agreement. At issue is the client’s willingness to comply with a referral that is not court ordered, in cases where children are at risk, but there are no grounds for placement.

Frontline staff are also under pressure with increasing numbers of challenging cases, particularly in the areas of child sexual abuse, adult depression, and teen acting-out behavior. Risk to children has increased in direct proportion to the rise in poverty, resulting in the need for greater levels of contact with families.

Increases in the level of family contact have been stymied by administrative demands. Unfortunately, the City launched its own computerized case data system at the same time “Connections” went into effect, but the two programs were not linked. This resulted in the need for double data entry at the same time as well as workers spending twice the amount of time learning each system.
Effective practice is also impacted by salary issues. On the positive side, after more than four years without any increases in the salaries of preventive workers, advocates successfully negotiated a 14% cost of living adjustment (COLA). However, a significant gap still exists between the starting salaries of ACS Field Office staff and these contracted workers, resulting in continuous challenges to the efforts that seek to stabilize this workforce.

Potential Workforce Challenge Emerges from Licensing

The New York State social work licensing law that became effective on September 1, 2004 is having unanticipated impacts within preventive services. The establishment of two licenses, the LMSW and the LCSW, has been interpreted by many as a two-tiered system, in which the LCSW clinical license is at the top, and the LMSW is perceived as a lesser license.

Applicants for the LCSW license must provide three years of supervised psychotherapy, informed by diagnosis and treatment planning, at the rate of 20 hours per week. Due to the increasing amount of time spent on documentation compounded by the ongoing need for outreach and advocacy, preventive services staff have less time for direct contact with clients, and thus have difficulty accruing the 20 hours in accordance with the new definition of clinical work required for the LCSW.

Consequently, supervisors faced challenges in the process of applying for the LCSW license because the clinical definitions that outlined eligibility were not sufficiently inclusive. This limits the number of LCSWs who will be available both to provide preventive services and to supervise the clinical work of others. If poverty has any influence on pathology, what social service sector has been more responsive and effective in addressing these kinds of clinical complexities than preventive services? Yet, the definition of clinical services in the new licensing law does not acknowledge this work as sufficiently clinical. As a result, the preventive services’ workforce is at serious risk if new MSW graduates do not seek out this sector because they cannot gain access to LCSW qualifying experience.

Resources Needed for Full Array of Services

The basic model of a preventive services program in which one worker carries a caseload of fifteen families has not changed. However, this model is most effective when utilized in conjunction with group work and paraprofessional staff that can focus on concrete service delivery. Provider agencies have consistently called for these additional program components with the support of ACS, but they are still not included as part of the current budgetary framework. This resource inequity means that not all agencies can afford to provide the full array of services that comprise the preventive services model.

We must recognize and strengthen those divisions of the child welfare system that are cost effective and comprehensive in nature by challenging policies designed to favor those who have over those who do not. In this case, we need only listen to the clients and strengthen those programs that truly meet their needs. It will require a different decision-making process in allocating resources to support programs.

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