August 05, 2018

How the Missouri Practice Model Transformed the State’s Child Welfare System

By Krista Ellis
Changing systems for children and families often involves starting from a different place.

Tim Decker

Director, Missouri Children’s Division

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association. 

Before 2015, Missouri lacked a unified method for assessing and engaging families who were involved in the child welfare system across the state. When Decker[1] became director of the Missouri Children’s Division in 2013, he undertook large-scale system reform. He started by getting “in the shoes” of agency staff and the children and families they served to see how they viewed the child welfare system.

Decker joined child welfare agency staff around the state as they investigated and planned with families. He spoke directly with children about their experiences and how they viewed the system. He concluded the Children’s Division needed a model that served people and families through a more holistic, collaborative approach that engaged community partners, such as parents, teachers, medical professionals, and law enforcement to create successful and meaningful change for families.

To gain insight on a larger scale, the Children’s Division and Full Frame Initiative (FFI) hosted several statewide community conversations. “The conversations provide[d] the guidance and momentum for the culture and practice changes in Missouri’s child welfare system,” said Decker.

This groundwork led to the Missouri Practice Model -- a child and family centered, evidence-based model focused on keeping families together while supporting sustainable change.[2] “The Missouri Practice Model is rethinking how we work with families,” said Decker.

Key Philosophies and Practices of the Missouri Practice Model

Key Philosophies and Practices of the Missouri Practice Model

Key Philosophies and Practices of the Missouri Practice Model

Five Domains of Well-Being

Social connectedness, stability, safety, mastery, and meaningful access to relevant resources are recognized as universal human needs to facilitate health and hope. The Missouri Children’s Division acknowledges that progress in each of these domains should be supported to break cycles of poverty, violence, and trauma, whether at the individual, family, or community level. Noah Rienks, a social worker at the Children’s Division, explained that in other systems, it was common for workers to get held up on one issue. The Five Domains approach requires workers to look at the family with a wide lens, enabling social workers to capitalize on the family’s strengths.

Trauma-Informed Care

 Like many jurisdictions around the country, Missouri emphasizes the importance of trauma-informed care. Trauma is common for many children and families involved with the Children’s Division and can affect their well-being. To assist families, practitioners must create a safe space, maximize trust, set appropriate boundaries, participate in collaboration, and prioritize youth and family empowerment and skill-building. The Model encourages child welfare practitioners to engage children and families and understand their needs. Understanding families’ needs demands viewing the full frame of a person’s life while being trauma-informed and enhancing child and family well-being. Practitioners must be active partners assisting families to develop realistic plans and achieve desired goals.

The Missouri Model addresses trauma from an individual’s past and also looks forward. Child welfare system involvement can be terrifying for a family. The goal of the child welfare system is to keep children safe, not cause further trauma for the child or family. One Missouri mother described the removal of her child in 2017 as terrifying. Yet, while she had heard horror stories about the child welfare system, she said her caseworker always encouraged her and she never felt like they wanted to keep her child away from her. Her caseworker sent her updates, encouraged her to set goals, and ensured visitation happened. During supervised visits, the foster family did not want her to hold her infant but her caseworker defended her so she could properly visit and bond with her child. While this could have happened under another model, the training under the Missouri Model reinforced this type of family-centered child welfare practice. Thanks to the engagement by her caseworker and the supports offered, the mother reunited with her son after only nine months.

Signs of Safety

Ultimately, the well-being of children is the highest priority and the Children’s Division acknowledges that that well-being of children often directly correlates to the well-being of the family. The Missouri Children’s Division further asserts that “the child welfare system must work to ensure safety is a stepping stone to well-being.”[3] To ensure child welfare practitioners properly address safety, the Children’s Division uses the Signs of Safety assessment and planning framework, which requires social workers to ask three questions of the child’s parent or caregiver:

  1. What are we worried about?

  2. What’s working well? and

  3. What needs to happen?

Alternatively, the approach accommodates a more kid-friendly tool for practitioners to complete a risk assessment with children. The ‘Three Houses’ Child Protection Risk Assessment tool allows children to describe or illustrate his or her worries, good things, and dreams to help practitioners better understand the child’s fears and needs. Rienks explained that all families have signs of safety. “I was once told: Don’t judge me by the chapter you walked in on,” said Rienks. He explained that he and other social workers in Missouri acknowledge that while a family may be having a tough time or need help, this is only part of their story. Social workers in Missouri are trained to be solution-focused to better serve families’ needs.

Team Decision Making

When cases have reached a turning point, the Model encourages child welfare practitioners to use Team Decision Making (TDM) to consider placement changes such as removal, reunification, or other permanency plans. TDM emphasizes involving families in decision making. When families have a voice in discussions about permanency plans, the likelihood of successfully meeting goals increases. TDM participants vary with each case but typically include the birth family, foster families, children, extended family, friends, support systems, service providers, social workers, and a facilitator. TDM strengthens connections to community service providers and provides child-centered interventions focused on the child’s safety, permanency, and well-being.

Rienks recounts a case in which an intensive safety plan prevented removing an infant born addicted to drugs. In the past, the situation likely would have resulted in an automatic removal. However, during TDM the Children’s Division social workers could see and facilitate a safety plan with the family and their safety network. He emphasized, “It wasn’t about taking a risk in this case, it was about giving families the chance to succeed and having the courage in what we are doing.”

Early Signs of Progress

Even though the Missouri Practice Model has only been used for a few years, the Children’s Division reports early evidence of progress due to the changes. Families are engaging more throughout their cases. Social workers report increased collaboration with other systems such as treatment providers and courts that are creating positive outcomes for children and families. The Model has safely reduced the number of children removed from the home by recognizing trauma, viewing the full frame of the individuals and family, and addressing tradeoffs.  

Decker explained that he has seen tangible evidence of the difference the Model has made for children and families in the state. Previously, the system was expanding by 6-7% per year. Now, the growth has decreased to only 1.5% with hopes of a steady decline. When asked about the Model, Decker said, “We didn’t just start something new, we changed some harmful stuff.” Before implementing the Model, many families were receiving cookie-cutter case plans despite glaring differences in circumstances that brought their children into care. Now families receive realistic case plans tailored to their needs.

Conclusion

Looking at the full frame of the family and the individual lives within it encourages social workers to plan with families rather than for them. The Model compels child welfare practitioners to see the sometimes impossible tradeoffs expected of parents and acknowledge that some old strategies simply missed the mark. By shifting the culture and perspective of the child welfare system, children and families are more likely to receive the services and supports to reach their goals, maintain a safe environment, and experience long-term stability to benefit their overall well-being.

Krista Ellis, JD candidate 2019, studies at American University’s Washington College of Law. She interns at the Center on Children and the Law where she focuses on issues such as legal representation and reunification.

Resources

Endnotes

[1] Decker is retiring in July 2018. Julie Lester will serve as the interim Director of the Children’s Division and will continue leading Missouri under the Model so prevention, reunification, and stabilization for Missouri families can be achieved.

[2] Tim Decker Reunification Hero Interview

[3] Missouri’s Children Division, slide 60.